October 22, 2009

A Pound of Cure: Tracy Velazquez on Prisons and National Health Care Reform

By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog

In a recent Washington Post op-ed, Tracy Velazquez of the Justice Policy Institute said national health-care reform could keep people out of jail.

“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,” she wrote. “Prisons, jails, and juvenile facilities are now some of the largest providers of mental health services in the country.”

In conversation with Newsdesk.org, Velazquez, whose Washington, D.C.-based think tank considers “tough on crime” policies to have largely failed, said the costs of incarceration greatly outweigh the price of preventive health care.

Bernice Yeung: Tell us more about the connection between health care reform and criminal justice policy.

Tracy Velazquez: What we have seen is that many people end up incarcerated because they have a mental illness or a substance abuse problem, and they aren’t able to get treatment. So what I am arguing is that if people get the treatment that they needed, they would be able to avoid becoming incarcerated.

… [P]eople who have trouble accessing mental health care may end up homeless. And although it’s not against the law to be homeless per se, people who are homeless are often arrested for things ranging from trespassing to public urination to public disorder.

Also, people with mental health issues tend to self-medicate with illegal substances, and then you can get in trouble with law because of that. So some people would be able to stay out of the system all together if there were adequate mental health and substance abuse treatment.

BY: How does this issue play out when it comes to parolees and prison reentry?

TV: People have difficulty accessing care when they get out of prison. Some states are beginning to look at this, like parole officers who have developed specialties in mental health. That’s a start, but they often struggle to find mental health or substance abuse treatment resources for parolees.

Many times, reentry services consist of $100 in gate money and people have to figure things out on their own. There’s not a lot of case management. Then there’s a tendency for [addicts] to end up back in prison when they use an illegal substance again, or they’re violating their parole agreement because they have dirty urine because they’re using drugs again. Or, if they’re mentally ill, they may go into crisis and the police are called.

As we reform health care in America, we need to create a new system that covers vulnerable populations like the ones that we see in our criminal justice system. And if we don’t, then we need to recognize that we will continue to have high rates of incarceration with significant populations in jails and prisons with mental health and substance abuse problems.

BY: Have you seen any efforts to incorporate this issue into the debate around public health reform?

TV: We have not heard of any efforts, which is why I wrote that opinion piece. With this population, the cost-benefit of providing treatment makes lot of sense from a policy perspective. If you can keep someone out of prison, you save, depending on the state, anywhere from $20,000 to $40,000 a year, as compared to the much smaller amount you would spend if you provided that person with treatment.

But no, I haven’t heard anyone discuss this population in the context of health care reform. This is the population least likely to be able to access traditional insurance, and they would be the ones most likely to get service through a public option.

The questions that need to be asked as we look at the different health care reform proposals out there is how they will impact low-income people and vulnerable populations, like formerly incarcerated people, and people with mental health and substance abuse problems.

If these individuals continue to fall through the cracks, then that’s going to be a problem for this country down the road.

BY: Have you heard the critique that law-abiding people have difficulty accessing care, and that those who are involved with the criminal justice system shouldn’t be a priority for care in the health care reform discussions?

TV: I have not heard that critique. People seem to get it, especially when it comes to drug addiction. People seem to agree that we need to help people who are drug addicted and who are now in the criminal justice system because of it – we need to help them recover and beat their addiction.

The Open Society Institute did a survey and found that three-fourths of Americans believe that substance abuse should be a part of health care reform.

Still, we hear some policy makers who believe that substance abuse is personal weakness issue. But most Americans, especially in some areas where meth has been growing problem, know at least one who has struggled with addiction. There is growing awareness that addiction is a public health issue and not a personal responsibility issue.

BY: How do you see these issues playing out in California, with the prison budget cuts and court mandates to reduce prison populations?

TV: A lot of people ended up in the California prison system because of drug convictions, particularly under the three-strikes law, because of felony convictions that probably had to do with addiction … [T]here are many people who are probably no longer a public safety risk who could be released back to the community.

On the flip side, as California looks to release people to the community, there needs to be some sort of related increase in services, because you don’t just want to give them $100 in gate money and say, “Have a nice life.”

Very likely, these people need mental health treatment and substance abuse treatment and other support services like finding a job and housing.

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Prisons & Health Care — The National Numbers:

The National Survey on Drug Use and Health found that 37.4 percent of people who sought substance abuse treatment said they didn’t receive it because they didn’t have insurance and couldn’t afford it; 42 percent of those who needed mental health care also said they didn’t get it because they couldn’t afford it.

A 2009 Open Society Institute poll found that 77 percent of Americans support including addiction treatment in health reform.

• According to the Department of Justice [PDF], 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.

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