The Aspen Health Report seems to do an excellent job of laying out many key issues. I was pleased to see that it highlighted the importance of addressing mental health needs for incarcerated individuals. I'm also glad that AAMC is viewing these issues in the context of social justice.
It's always seemed odd to me, having watched mentally ill individuals shifted from state psychiatric hospitals to jails and prisons (as a de facto mental health system), that taxpayers and politicians were uninterested in providing mental health treatment but seem more willing to spend even more money on correctional institutions. The state mental health system certainly had many flaws -- abuses and disparities in care occurred there as well and many individuals were traumatized by those experiences. But substituting it for the correctional system is even more traumatizing and treatment options are quite limited, as was pointed out in the report.
The underlying belief systems that are being tapped into seem to go beyond just a bland lack of empathy, but focus more on a vengeful desire for punishment and suffering. With deinstitutionalization, the promise of community based residences for those with mental illness was never fully realized, in part because of lack of funding but in part because of negative community attitudes when efforts were made to buy/build residences in their neighborhoods.
The profit motive certainly seems to overlap as well. Just this week, NY has moved to further restrict packages except via the very expensive private vendors, which have limited items available (https://www.nysfocus.com/2022/05/12/prisons-ban-care-packages/). Food items are primarily high sodium, processed food snacks. Phone call charges are similarly unreasonably high, which limits people's ability to stay in touch with and maintain relationships with family. Obviously, these surcharges disproportionately affect those who are already having financial challenges.
In contrast, the approach in Norway to incarceration is quite different (https://www.bbc.com/news/stories-48885846;
https://magazine.ucsf.edu/norways-humane-approach-prisons-can-work-here-too) in terms of their attitudes about the purpose of incarceration and also in terms of their overall system of incarceration, so that it can restrict liberty without fostering inhumanity and perpetuation of social injustice.
The steps in the Aspen report seem like a good place to start, but it would be useful to have a greater understanding through research of the attitudes that drive inequities and reinforce the current pro-incarceration culture.
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Laura Fochtmann
Distinguished Service Professor
Stony Brook University
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Original Message:
Sent: 05-09-2022 08:19
From: David Skorton
Subject: Question of the Week: What do you think about the issue of health care for the incarcerated?
A new report by the Aspen Health Strategy Group-of which I am a member-lays out a strategy to reduce the toll that incarceration takes on the health of individuals, families, and communities. The report, Reducing the Health Harms of Incarceration, highlights some observations about the current state of health care for the incarcerated:
- Incarceration leads to poor health
- Prison health systems operate outside the norms of the health sector
- Incarceration is a counterproductive response to mental health needs
- Security needs trump health needs
- Incarceration typifies a structurally racist system
In our report the Aspen Group suggests 5 big ideas to reduce the health harms of incarceration:
- Eliminate the Medicaid exclusion (allow Medicaid coverage for the incarcerated)
- Make health a priority in correctional systems
- Bring population health and quality standards to the prison health system
- Coordinate care inside and outside the correctional setting
- Dramatically reduce the level and consequences of incarceration
What do you think about the issue of health care for the incarcerated?
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David Skorton
President and CEO
Association of American Medical Colleges
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