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Inmate Health and Public Safety: Researchand Policy Implications

Rebecca E. BlantonSenior Policy Analyst

California Research Bureau

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CA-based Releasee Health, 2009

134,564 inmates paroled/discharged in CA

32,300 people with mental illnesses 17,870 with active or inactive

tuberculosis 9,900 people with Hepatitis C 2,400 people with diagnosed HIV or

AIDS

Debates About Prisoner Health Care

Current Arguments– Morally obligated– Constitutionally obligated – Tax payers should get a good ROI– Prisoners are being punished and

deserve only the most basic health care New Arguments

– Inmate health is a public safety and public health issue

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Overview

Introduction Opening the policy window Prisoner/parolee health and public safety Prisoner/parolee health and public health Future research Conclusions Question and Answer session

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Opening the Policy Window

Problem: (1) Large number of ill inmates released each year, (2) Illness impacts public health and public safety, (3) Costs for not treating illnesses rising.

Policy: Non-prison programs demonstrated to work at reducing crime and benefiting public health.

Political: (1) Public wants criminal justice reform, (2) Public okay with non-prison solutions, (3) New Administration championing evidence-based government, (4) Need to solve CA’s budget crisis.

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New Policies on Prison Healthcare

Policy Window

New Public Position on Prisons

Prison System Needs Reform

NR, 6%Disagree,

14%

Minor Reform, 31%

Major Reform, 49%

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20

40

60

80

100

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enta

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ePrevention

WorksNo prison fornon-violentoffenders

Californian's Accept Prevention Premise

Totally Agree

Strongly Agree

Excerpted from Tulchin, Ben. “Public Safety by the Numbers.” Presented at the American Association of Political Consultants Annual Meeting. March 10, 2011. Washington, DC.

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Key Sources of Inmate Health Information

NCCHC. 2002. The Health Status of Soon-To-Be-Released Inmates: A Report to Congress. Volumes 1 and 2.

BJS. 2004. Survey of State and Federal Prisoners.

Rand. 2009. Understanding the Public Health Implications of Prisoner Reentry in California.

Inmate Health

50% of men and 67% of women have chronic health conditions

TB: 4x higher than public Hepatitis C: 10x higher than public HIV: 8-9x higher than public Schizophrenia: 5x higher than public Bipolar Disorder: 3x higher than

public

Disease Transmission to Public

1989: Multi-drug resistant TB spreads from prisons to NYC

1993: Meningitis outbreak spreads from LAC to Los Angeles

1996: 22 percent of all new syphilis cases in Chicago traced back to Cook County Prison.

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HIV/AIDS, Incarceration and the African-American Community

Lifetime HIV infection rates in the African-American Community: 1 in 16 men; 1 in 32 women

28.5% of Black men will enter the criminal justice system sometime in the life

Between 0.9 and 2.4 percent of inmates infected with HIV

Impact on HIV Rates Due to Imprisonment of Black Men

11Johnson, Rucker C. and Steven Raphael. (2006). “The Effects of Male Incarceration Dynamics on AIDS Infection Rates among African-American Women and Men.” National Poverty Center Working Paper Series, #06-022.

Tuberculosis

CA prevalence rate: 13.28 percent 500 inmates with active TB released

each year Evidence TB is transmitted from

inmates to the general public

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Physical Health, Mental Health and Substance Abuse Problems

Among Returning Prisoners

15

30

12

18

72

8

30

1

46

25

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Mental Health Condition15%

Substance Use >1x/wk.66%

Physical Health Condition, 49%

WOMEN MEN

Urban Institute Study (Malik-Kane and Visher, 2008)

Conclusion: Any type of health condition amongst parolees was associated with engaging in criminal activity or a higher likelihood of being reincarcerated.

Ill Releasees Experience…

Less stable housing More difficulty holding a job Women are more likely to live with a

“negative influence” Low income: Men: $900/mo.

Women: $650/mo.

Programs that Help Ill Releasees

Transitional Case Management Program– Reduced Recidivism

Prevention Case Management Program– Reduced Recidivism– Increased condom use and abstinence

among HIV+ participants Mental Health Services Continuum

Program– Reduced Recidivism

Behavioral Health

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Substance Abuse

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Future Research Questions

Connections between prisoner health and public health

Benefits of continuity of care Risk reduction strategies Cost-Benefit analysis of programs

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Conclusions

Clear public health and public safety implications of prisoner reentry established.

Changing the frame of the debate will get policy people on the same page.

Researchers and policy workers necessary to shift the debate.

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Discussion/ Q & A