January 11, 2007

As Number of Prison Inmates Soar, Experts Stress Effective Treatment for Mental illness

Physicians are an essential component of correctional institutions and have a responsibility to advocate for effective and humane treatment for inmates. This is the view expressed in a commentary published in the January 11 issue of the New England Journal of Medicine by Scott A. Allen, MD, and Josiah D. Rich, MD, MPH, physicians at the Center for Prisoner Health and Human Rights at The Miriam Hospital and Brown University Medical School.

Citing the steady increase of incarcerated individuals in the United States that has resulted in record high inmate numbers, the authors point to the inadequate treatment of mental illness and addiction in the community as a source of the increase – especially among women.

"The natural history of untreated addiction and mental illness often results in illegal activity, and persistently inadequate treatment perpetuates a cycle of crime and incarceration," says Rich. "The correctional system should view incarceration as an opportunity to link inmates with effective therapy such as mental health services, high-quality drug treatment, and support services for reentry into society upon release, if we ever expect to decrease recidivism rates."

The authors note that punishment is often favored over rehabilitation in many prisons, which may cause harm to a prisoner's physical and mental health. In addition, in situations where effective therapeutic services are available, they are often underused.

Statistics show that although 57 percent of inmates in state prisons reported using drugs during the month before committing their offense, only 20 percent participated in substance abuse programs while in prison. Federal prisons echo this trend with reports stating that of the 63 percent of inmates being held for drug offenses, only 15 percent participated in prison-based drug treatment programs.

The authors also support programs for non-violent offenders that would place them in residential treatment programs and group homes instead of in prison. California took initiative with this concept when it passed The Substance Abuse and Crime Prevention Act, known as Proposition 36, in 2000. Proposition 36 changed California state law to allow first- and second-time nonviolent, simple drug possession offenders the opportunity to receive substance abuse treatment instead of incarceration.

"We feel strongly that alternatives to mass incarceration for non-violent offenders, such as residential treatment programs, need to be explored," says Allen. "Here, the basic requirements such as nutrition, shelter, and medical care would be provided, but in a more efficient, nonpunitive therapeutic setting. In addition, community-based alternatives would save taxpayers millions of dollars in incarceration costs annually."

Initial reports analyzing the effectiveness of California's Proposition 36 estimate that over 150,000 people benefited from the treatment and that it saved taxpayers about $1.3 billion. Given that the annual cost of housing an inmate is approximately $36,000, while the average cost of a 50-day residential treatment program is $3840 - the savings is evident.

Rich and Allen encourage physicians to campaign for sentencing laws, policies and procedures that directly affect the health and well-being of their patients and to encourage more humane and effective treatment alternatives for addiction and mental illness.

Source: The Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center (www.prisonerhealth.org).

The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School

In another related article in the New England Journal of Medicine, it was noted (as reported in New Scientist Magazine):

Being released from prison may be far riskier than anyone thought. Former inmates of Washington state prisons were 3.5 times more likely to die during their first two years after release than people of the same age, sex and race who had never been incarcerated.

The danger was greatest during the first two weeks, when former inmates were 13 times more likely to die than their not-jailed peers.

The study tracked 30,237 former inmates released between July 1999 and December 2003. Leading causes of death included drug overdose and suicide, which the team believe may be due to prior addictions, underlying mental illness and the stress of re-entry into society.

Source: New Scientist
New England Journal of Medicine: Release from Prison — A High Risk of Death for Former Inmates


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