In 1987, my dad was sentenced to over 40 years in federal prison on drug trafficking charges.
It’s not something my family talks about. Only once, as a teenager, do I remember my dad mentioning his incarceration. In this conversation, defining the truth is difficult. His words were his truth and I do think that matters because it was his lived experience. I didn’t know what to say, so I listened. And I believed him. Most vividly, I remember seeing my dad as both a victim and a hero in his story.
My dad’s sentencing was harsher due to the Anti-Drug Abuse Act of 1986 that passed after President Ronald Reagan declared a war on drugs. Under the Reagan administration, legislation was introduced to increase penalties for drug possession and to create minimum sentences for drug-related offenses. This legislation has a legacy of controversy, including disproportionately and unfairly targeting minority groups.
With the war of drugs came harsher sentences that were longer and painful. Strategies were implemented to punish convicts and make the experience as difficult as possible. Moving facilities more frequently and at longer distances from family, friends, and the comfort of familiarity became more common. Outrageous telephone rate charges that my mother had to ration minutes or work extra shifts to afford, the list of uncomfortable and, at times, malicious practices goes on. This war was to prove that inmates deserve punishment, not rehabilitation.
My dad only served seven years of his 40-year sentence. While his early release is something to feel fortunate about, it is my belief that he never mentally recovered. The mental health effects of his prison experience that fueled his anger and conspiracy theories still negatively impact my family. The result of my father’s prior incarceration is why, even as a third-generation son of Cuban immigrants, I’m still fighting the war on drugs.
The criminal justice system in the United States is in dire need of reform – for many reasons – but mental health remains among the top. Understanding the relationship between mental health and the criminal justice system is key to driving equitable policy practices that can improve health outcomes and reduce inequities faced by so many. Prisons and jails in the United States incarcerate a disproportionate number of people with a current or past mental health problem. Many facilities are not equipped to treat these conditions.
After release from incarceration, many individuals face social challenges related to stigma and discrimination and are at high risk for poor mental health outcomes including substance misuse, recidivism, and suicide.
However, less attention is paid to how the incarceration experience and prison living conditions are fundamental instigators of mental and behavioral health issues that can linger for years (or for a lifetime). This is a root cause in limited opportunities in accessing social, educational, and economic resources that are central to wellbeing and health.
Denying mental health care services to participants in the justice system can be felt far after their sentence is carried out. It stretches beyond individuals and makes it difficult to maintain relationships with family, hold a job, and establish a productive worldview.
Improving and expanding access to mental health and health services inside prisons and upon release can be supported through policy. Removing barriers to mental health resources would have helped my dad and at least 43% of current and former inmates, who report not receiving mental health related services. This lack of healthcare disproportionately affects Black and Latino populations. In one study in Los Angeles County jails, 41% of incarcerated people of color were found to have a mental illness.
Surprisingly, many prisoners are charged copays for medical care, a practice temporarily paused during the pandemic. Cost is a well-documented barrier to accessing health care services, and especially burdensome within the prison system as many inmates do not earn an income, and those that do max out at 52 cents an hour. Furthermore, the Medicaid Inmate Exclusion Policy – Social Security Act (Sec. 1905) prohibits use of federal funds and services for medical care provided to “inmates of a public institution” which disproportionately impacts detained individuals prior to conviction.
California’s amendment to Advancing and Innovating Medi-Cal (CalAIM) Section 1115 can serve as a model on how to ensure physical and mental health conditions are treated for inmates. The amendment is also a guide to strengthening pathways to community-based care prior to release.
Additionally, insurance companies should expand coverage for mental health providers and leverage telehealth options to include counselors and clinicians that can broaden access and availability of providers nationally. By supporting adherence and availability of medications or treatment regimens ensures that no therapy disruptions occur during confinement and ongoing treatment (and prescription orders) after release.
State prisons drive mass incarceration by the sheer number of people incarcerated at the state level. Over 770,000 people in these facilities are serving excessively long sentences – over ten years or longer, according to data from 2019. Policy reform should be supported by state and local led initiatives that support long term mental health awareness and support services. If the goal is to rehabilitate prisoners to lower the rearrest rate overall, then the justice system is failing miserably – but failing more so with people of color as it is well documented that Black and Latino individuals are disproportionately imprisoned, and many end up back in prison once they have completed their sentence. According to a 2018 study, 47% of Latino prisoners were rearrested within the first year of their release.
In continuing the fight on the war on drugs, I know there is more than one villain. The prison system is well-documented as being overly punitive, under-resourced, can be predatory, and have outsized health impacts that puts certain groups more at risk than others. For-profit prisons remain a shameful practice. At the same time, there are people who deserve their time facing justice, my dad being one of them.
Through meaningful advocacy, the multi-generational impacts of incarceration on families can improve. Crafting equitable policy is a start, but not a replacement for community-led programs and initiatives. Advocating for mental health services, expansion of care, and rehabilitation and reintegration, can be pillars for values that generate a new era for equitable policy. Rethinking the war on drugs means thinking beyond punishment as the only solution. Without a focus on mental and behavioral health for justice-involved individuals, every sentence is potentially a life sentence.
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