Tracy Velazquez: An Underconsidered Benefit of Health Reform: Fewer Prisoners
As Congress debates the costs of reforming our health-care system, it should consider one significant collateral cost of not acting: maintaining the world's highest rate of incarceration. Every year, thousands of people are locked up in U.S. prisons and jails because they do not have access to health care to treat mental illness and drug addiction.
People with mental illnesses often end up in prisons, jails and juvenile facilities when they are unable to access treatment in their communities. According to the Department of Justice, one in four people in state prisons experienced mental health issues in the year preceding incarceration, and nearly two-thirds of people in local jails live with mental illness. Untreated mental illness often leads to public order offenses, crises that cause law enforcement to intervene, and "self-medicating" with alcohol and illegal drugs. Parents of children with serious emotional disturbances who are uninsured or under-insured sometimes turn their own children in to the police, because their kids will get at least a minimum of treatment in the juvenile justice system. Prisons, jails, and juvenile facilities are now some of the largest providers of mental health services in the country.
People with no access to health care are also likely to return to prison after being released. In a visit I made to a state prison, an individual with a serious mental illness told me that earlier that year he had been released from prison with 10 days worth of medicine and $100 in cash. He was left on his own to figure out how to manage his illness. He relied on a local clinic for pharmaceutical "samples" for a time, but ended up homeless and self-medicating with alcohol and other drugs, which led to his being sent back to prison.
And regardless of the billions of dollars spent annually on the "war on drugs," people do use illicit substances. When they become addicted, many do not have access to effective treatment services. As a result, addicted people end up in prison or in jail for things that can include possession, distribution or other offenses that support addiction. Over half of people in state prisons meet criteria for drug dependence or abuse.
While some mental health and substance addiction treatment services are available for people in prison or jail, the Washington State Institute for Public Policy found that, for every dollar spent on treatment in prison, the community receives $5.88 in public safety benefits, but if treatment is provided in the community, the return is nearly $19.
If through improved access to health care we were to reduce our nation's incarceration rate by just 10 percent, the country could save roughly $5.5 billion annually. And this doesn't include the savings in courts, police, parole, and other related costs of incarceration.
Tracy Velazquez is the executive director of the Justice Policy Institute.