Public Safety and Public Health

This morning I saw an announcement about a new initiative called “Law Enforcement Leaders to Reduce Crime and Incarceration” and thought it was an important thing to share on this blog. This alliance consists of 120 top current/former police commissioners and prosecutors, including both district attorneys and state attorneys general. These law enforcement leaders have come together to influence legislation and public opinion around mass incarceration. Their first project: supporting the Sentencing Reform and Corrections Act of 2015, a bipartisan bill currently moving through the Senate. This issue matters because there are currently over 2.2 million people in American prisons and jails.

The United States incarcerates more of its citizens than any other nation on earth, and by a disturbing margin: we have just 5 percent of the world’s population, but 20 percent of the world’s prisoners. What’s more, our prison population has grown by over 500 percent since 1978. At any given moment, one in 35 Americans is in prison, on parole, or on probation.

Why is criminal justice a health policy issue? Well, there are many reasons, but let’s start with the fact that the largest mental health provider in the United States is the Cook County Jail. This does not reflect well on our criminal justice policy or our health policy.

One of the main drivers of mass incarceration has been the “war on drugs”, which led to aggressive sentencing laws that caused an explosion in the number of people imprisoned for non-violent drug offenses. At the moment, about 20 percent of the prison population is serving time for a drug offense. Chicago Police Department Superintendent Garry McCarthy, co-chair of the Law Enforcement Leaders group, explained, “[T]here is a difference between putting a gun in somebody’s face and saying ‘give me your money’ and getting caught with ten bags of heroin because you have a problem. They are two totally different crimes. And the priorities have to be reflected in the laws.”

About 30 to 60 percent of inmates have a substance abuse condition, and about 20 percent have a serious mental illness. Inmates with a serious mental illness are more likely to be incarcerated multiple times than those without. At great human cost, harsh mandatory sentencing laws have tied the hands of judges, and precluded them from considering important context (such as a mental illness) when issuing sentences. The Senate bill seeks to mitigate several of the more devastating aspects of mass incarceration, such as reforming mandatory minimum sentencing for drug offenders, improving post-release support systems for ex-offenders, and limiting solitary confinement for juveniles.

Mass incarceration sits at the intersection of law and health policy; as legislators and law enforcement leaders come together to tackle this problem, health care experts should join the conversation.

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