Most of us probably have a basic familiarity with what the criminal justice system is, how it works (hint: nothing like Law and Order, sort of like The Wire), and why it's relevant to public health. We know that people involved with the justice system are subject to entrenched racial disparities, poverty, under-education, bleak job and housing prospects, and health issues like HIV, hep C, substance use, and mental illness. Maybe fewer public health folks realize that while we now incarcerate a higher percentage and raw number (~2.3 million) of individuals than China, most people under correctional supervision are actually living in the community on probation or parole (~4.9 million). And despite the fact that corrections spending (now at $68 billion per year) increased 300% over the past 20 years, outpacing education, transportation, and public assistance, recidivism rates have remained stable, with most people reoffending within three years of release from jail or prison.
Since most people sent to prison are eventually released, and most "corrections" actually happens in the community, it's crucial that public health professionals and researchers think about the criminal justice system not as a silo but as a series of public health intervention opportunities and in some cases, intercept points. The health of people in jails and prisons and on probation and parole is public health, and the health, social, political, and economic impact of justice system involvement on families and communities is difficult to overstate.
As the flowchart below illustrates, the criminal justice system is a complex "system of systems," comprising numerous institutions and processes through which individuals move. The chart, taken from a report on criminal justice and mental health systems collaboration, is necessarily generic, as these processes differ from jurisdiction to jurisdiction. But the myriad opportunities for public health interventions (e.g. screening) and cross-system collaborations should be readily apparent, to say nothing of advocacy and social action.
Finally, a quick note on the difference between jails and prisons and probation and parole, which should allude to different public health challenges and opportunities that each institution/system raises (e.g., continuity of care from incarceration to the community):
- Prisons are "long-term confinement facilities run by a state or the federal government that typically hold felons and offenders with sentences of more than 1 year. However, sentence length may vary by state. Connecticut, Rhode Island, Vermont, Delaware, Alaska, and Hawaii operate integrated systems, which combine prisons and jails." [source]
- Jails are "confinement [facilities] usually administered by a local law enforcement agency; intended for adults, but sometimes holding juveniles; for confinement before and after adjudication. Such facilities include jails and city/county correctional centers, special jail facilities such as medical treatment or release centers, halfway houses, work farms, and temporary holding or lockup facilities that are part of the jail’s combined function. Inmates sentenced to jail facilities usually have a sentence of 1 year or less. Connecticut, Rhode Island, Vermont, Delaware, Alaska, and Hawaii operate integrated systems, which combine prisons and jails." [source]
(All slide data from BJS)
The community corrections system includes
- "Probation, where more than 4 million people may be at risk of penetrating further into the criminal justice system. Probation is a period of sentenced correctional supervision in the community, generally in lieu of incarceration, during which courts maintain jurisdiction over cases.
- Parole, where nearly 800,000 people have become more deeply entrenched in the criminal justice system and may require significant intervention to successfully reenter the community. Parole is a period of conditional release to correctional supervision in the community following a prison term, during which conditions are set and compliance is monitored by a state releasing authority. "
Stay tuned for more resources on some of the key policy and programming challenges that the criminal justice system presents to public health.
Resources referenced in this post:
Alexander, Michelle. (2010). The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York: The New Press.
Western, B. & Pettit, B. (2010). Incarceration and social inequality. Daedelus, 139(3), p. 8-19. As cited in Abramsky, S. (2010, October 8). Toxic persons: New research shows precisely how the prison-to-poverty cycle does its damage. Slate.
Griffin, P. A. & Muetz, M. R. (2006). Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness. Psychiatric Services, 57(4).
Fruedenberg, N. (2001). Jails, Prisons, and the Health of Urban Populations: A Review of the Impact of the Correctional System on Community Health. Journal of Urban Health, 78(2).
Seth, thanks for providing a succinct tour of the skeleton of the criminal justice system. It is important for people to understand these key distinctions which they often used interchangeably.... My anecdotal experience has been that a striking proportion of people cannot articulate an accurate differentiation between basics like jails and prisons. It is critical to understand the different points of contact with the system for a variety of public health reasons, like from a programmatic view, which phase through the cycle an intervention should be implemented to yield the intended effect; and through a policy lens how social benefits like SSI and Medicaid may be terminated based on the length and type of involvement in the system. From a legal view, the fortitude of fundamental rights and liberties, against state infringement, rights that underpin autonomy in medical decision-making and bodily integrity vary based on where in the criminal procedural stream an individual is treading. All a long way of saying that each procedural branch represents a unique vantage point necessary to consider analytically.
ReplyDeleteAlso, you touched on the sheer size of how the CJ system has swelled. The magnitude of the numbers of people under the eye of the system in some shape or form never ceases to shock me. See Ernie Drucker’s “Plague of Prisons” for compelling descriptions expressed in public health terminology (i.e. epidemiology) that analogizes of the impact of deliberate policies fueling mass incarceration (e.g War on Drugs) to infectious disease epidemics and natural disasters by looking at their comparable magnitudes in years of life lost. I really recommend reading this book as it is an excellent opportunity to exercise our cognitive capacities to reason the sheer scale of the population impact of retributive criminal justice.
http://www.plagueofprisons.com/excerpts.html
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