Inmate Health and Public Safety: Research and Policy Implications Rebecca E. Blanton Senior Policy Analyst California Research Bureau

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

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

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. Policy Window New Policies on Prison Healthcare

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

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.

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 Johnson, 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

Physical Health, Mental Health and Substance Abuse Problems Among Returning Prisoners Substance Use >1x/wk. 66% 30 15 8 25 4 30 6 18 14 1 2 3 12 7 Physical Health Condition, 49% Mental Health Condition 15% 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 Increased condom use and abstinence among HIV+ participants Mental Health Services Continuum Program

Behavioral Health

Substance Abuse

Future Research Questions Connections between prisoner health and public health Benefits of continuity of care Risk reduction strategies Cost-Benefit analysis of programs

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.

Discussion/ Q & A