The Prison Policy Initiative's new "Whole Pie" report reveals what's at stake if prisons and jails do not take immediate steps to decarcerate.
March 24, 2020
As advocates urge prisons and jails to slow the spread of COVID-19 by releasing as many incarcerated people as possible, it’s more important than ever to understand how many people are locked up across the country, where, and why. The Prison Policy Initiative’s new edition of Mass Incarceration: The Whole Pie, released today, answers these essential questions with the most recent data.
The data and 24 visuals in the report contain significant implications for how the criminal justice system should respond to the pandemic:
- Local jails hold 631,000 people on any given day, including 470,000 people still awaiting trial. Jail overcrowding poses a serious public health risk in light of COVID-19, making it essential that courts, police, and prosecutors reduce jail populations to slow the spread of the virus.
- Low-level infractions like misdemeanor charges, technical violations of probation and parole, and failure to appear in court account for millions of jail and prison admissions each year – admissions that should be put on hold immediately to improve public health outcomes.
- 39,000 immigrants are currently being held by ICE for no reason other than their undocumented status. Unless they are released, their incarceration will put them at a heightened risk of contracting COVID-19.
- While the majority of people in state prisons are convicted of violent crimes, federal and state officials can still take measures such as expanding parole and compassionate release to allow these individuals – many of whom are elderly or medically vulnerable – to go home.
“Now that COVID-19 is entering prisons and jails, our failure to end mass incarceration is making itself known as a public health crisis,” said Executive Director Peter Wagner. “If policymakers want to prevent a human tragedy from taking place in prisons and jails, they need to do what they’ve been refusing to do since we published our first Whole Pie report: shrink the incarcerated population to a fraction of what it is today.”
Even under normal circumstances, the lack of available data about the criminal justice system poses a significant obstacle to policymakers and advocates seeking to reform that system. In the face of the current crisis, clear facts are essential to quickly and safely downsizing prison and jail populations. This year’s Whole Pie report answers that need, providing the comprehensive view of mass incarceration necessary to make sound decisions today and, when this crisis passes, to plot a long-term path forward.
The Prison Policy Initiative also recently published policy recommendations for criminal justice systems to slow the spread of COVID-19. Its recommendations include releasing medically vulnerable adults from jails and prisons, reducing jail admissions, and ending parole and probation revocations for technical violations. The organization is tracking jails, prisons, and other agencies that take these essential steps.
The full report and graphics are available at https://www.prisonpolicy.org/reports/pie2020.html.
Even in the best of times, jails are not good at providing health and social services.
by Alexi Jones,
March 19, 2020
With jails considering major policy changes as part of the response to the COVID-19 pandemic, we’re seeing a troubling question from allies with a little less experience on criminal justice issues: Given that jails provide valuable social services, wouldn’t it be bad to release people who need services? Aren’t the homeless, the mentally ill, or people with substance use disorders better off in jail?
In a word: No.
The longer answer is that even in the best of times, jails are not good at providing health and social services. Although local jails are filled with people who need medical care and social services, jails have repeatedly failed to provide these services. As a result, many people end up cycling in and out of jail without ever receiving the help they need. For example, even though a disproportionate number of people in jails have mental health disorders, jails have repeatedly failed to provide adequate mental healthcare. People with mental health disorders are often put in solitary confinement, have limited access to counseling, and not checked on regularly due to staffing shortages. The tragic result of these failures is that suicide is the leading cause of death in local jails.
Similarly, jails consistently fail to provide adequate medical care to incarcerated people. Notably, although two-thirds of people in local jails have a substance use disorder, most jails and prisons refuse to provide medication assisted treatment (MAT) for opioid use disorder—the gold standard for care. Moreover, substandard healthcare has had lethal consequences. For example, CNN recently published a scathing investigation into WellPath (formerly Correct Care Solutions), one of the country’s largest jail healthcare providers. They found that WellPath provides substandard healthcare that led to more than 70 preventable deaths in local jails between 2014 and 2018.
It’s absolutely true that people in the criminal justice system have a lot of ignored needs. But we shouldn’t misconstrue the “services” offered in jails as reasons to keep people confined in what are always harmful conditions. Given that many people in local jails have health conditions that make them especially vulnerable to this new coronavirus, and simple precautions like social distancing are nearly impossible behind bars, it is vital that we release anyone from jail who doesn’t need to be there. For many, it will be a matter of life or death.
How ICE and probation and parole detainers (or “holds”) contribute to unnecessary jailing
by Wendy Sawyer, Alexi Jones and Maddy Troilo,
March 18, 2020
By now, most people paying attention to the U.S. criminal justice system have heard about problems with the overuse and misuse of local jails. Chief among these problems are the serious, even deadly, harms caused by even brief periods of jail detention. But one problem has escaped the attention of the public and policymakers alike: the unnecessary jail detention caused by “detainers,” which account for as much as one-third of some jail populations, if not more. This briefing explains how detainers (also often called “holds”) contribute to unnecessary jailing, and offers a preliminary analysis of available national, state, and local data as evidence of a widespread policy problem that demands greater attention.
Detainers, explained
Typically, people in jails are categorized as unconvicted (65% nationally) or convicted (35%). In our Mass Incarceration: The Whole Pie report, we have been able to go one step further, breaking apart the roughly 16% who are held for other agencies that pay to keep them boarded there. But another group of people are still obscured by this breakdown of the jail population: people who are in jail for more than one reason, who have what we’ll call a “dual status.” A significant number of people are locked up because of some kind of “detainer” or “hold” for their probation or immigration status, for example, which renders them ineligible for release. These people aren’t brought into jail on a detainer, but the detainer can keep them there when they otherwise could have gone home.
For example, if someone who is on probation is charged with a new low-level offense, they can be held in jail without bail if the probation department has issued a detainer for violating their probation. In fact, this is a critical part of Kalief Browder’s story: initially held on unaffordable bail, he was later denied bail because the Probation Department filed paperwork saying the new charge meant he had violated probation. It was the “violation of probation” – or “probation hold” – that kept Browder at Riker’s so long, causing irreparable harm that led to his eventual death. Without his dual status as a probationer, he probably wouldn’t have had money bail set in the first place: his friend, who was arrested along with him but was not on probation, was allowed to go home the next day. Even with his probation status, the judge was willing to set bail. It was only when the Probation Department stepped in to make their claim on his freedom that the judge remanded him without bail.
Detainers or “holds” are an overlooked policy problem that carries significant personal, social, and fiscal costs. They often expose detained people to the harms of incarceration for longer periods of time than they would be otherwise. This includes innocent people like Browder, whose case was dismissed three years into his time at Riker’s, after tremendous damage had already been done. By delaying jail releases, detainers also contribute to avoidable public costs by filling up local jails, often with people who are accused of low-level offenses. Detainers undermine the work of local jurisdictions trying to reduce unnecessary detention through pretrial reform, keeping people locked up for essentially administrative reasons rather than public safety reasons.
Detainers that impact jail populations most: Probation & parole holds and ICE detainers
As we touched upon above, probation and parole violations account for a lot of detainers. These can be for either “technical violations” or new violations of law. Technical violations are behaviors that break probation or parole rules, such as missing curfew, failing a drug test, or missing a check-in meeting; they are not behaviors that would count as “crimes” for someone not under community supervision. However, when people who are under community supervision are charged with a new crime, that also constitutes a violation of their probation or parole, and typically must be reported.1 Individuals can be kept in jail without bail for either type of violation on a probation or parole detainer.
In a 2019 report, the Council of State Governments (CSG) found that “45% of state prison admissions nationwide are due to violations of probation or parole.” Technical violations alone account for 25% of prison admissions; even less (20%) are for new criminal offenses. There is no comparable analysis for jails, but the fact that community supervision violations contribute so significantly to prison populations is suggestive that these violations could be responsible for large numbers of people locked up in jails as well.
U.S. Immigration and Customs Enforcement (ICE) also uses detainers to keep people in local jails to give ICE time to take them into federal custody for eventual deportation. These detainers, or “immigration holds,” request that local officials to notify ICE before a specific individual is released from jail custody and then to keep them there for up to 48 hours after their release date. These detainers essentially ask local law enforcement to jail people even when there are no criminal charges pending.
These detainers are the subject of heated debate, as many local jurisdictions are reluctant to take on the risk of litigation and liability associated with the constitutional concerns they raise (and/or reluctant to support the Trump administration’s immigration policy), which is reflected in the growing number of detainer refusals. Part of their reluctance may be that these risks are often taken on unnecessarily: ICE doesn’t consistently take these individuals into its own custody, even when it issues a detainer for them. The last time ICE released data on this point, the agency was only assuming custody in 35% of all cases where they issued a detainer – meaning that most of the time, jails that kept people locked up on ICE detainers did so for no reason at all.
How many people are in jail because of probation and parole detainers?
(The short answer: it varies, but in some places it’s over a third of the jail population, and we need better data to really answer this question.)
Continue reading →
Send our letter to your local jail, asking them to make video and phone calls free.
by Bernadette Rabuy and Wanda Bertram,
March 17, 2020
As jails and prisons across the country suspend in-person visits to slow the spread of COVID-19, families are being rapidly cut off from their incarcerated loved ones. Phone calls and video calls are now the only option for anxious families trying to stay in touch. It’s more important than ever that these calls be available at no cost.
We prepared a template letter for local advocates fighting to preserve family contact in jails during the COVID-19 pandemic. Advocates are encouraged to customize our letter as needed and send it to their county sheriff or jail warden or administrator. The full text of the letter is below, and a shorter version of the letter follows (for people in counties where public comments must be under 300 words).
Dear [Sheriff/Warden name],
Your office recently took the step of [suspending/restricting] in-person visitation at [jail name] to prevent the spread of COVID-19. While there is no question that in-person visitation can be risky at this time, incarcerated people and their families must be able to communicate in order to endure this trying, confusing, and constantly evolving pandemic.
We are writing to request your leadership in protecting incarcerated people and their loved ones by providing phone and video calls free of cost for at least thirty days – as sheriffs have done in the past on special occasions, such as Christmas, and as has been recommended by prosecutors nationwide. Other counties, such as Shelby County, Tennessee, have already taken this simple and critical step.
As you know, there is a general panic as cases of COVID-19 spread. Incarcerated people’s loved ones are even more likely to be concerned. Correctional facilities are filled with people with chronic illnesses and complex medical needs; these people are at a particularly high risk for serious complications from infections like COVID-19. Moreover, it can be difficult for correctional facilities to prevent unsanitary and overcrowded conditions, which also put people at risk for COVID-19.
While the decision to halt visits may be best for public health reasons, it puts loved ones in a bind. Families are forced to check in with their incarcerated loved ones by paying for phone or video calls. But incarcerated people and their loved ones are disproportionately low-income, and likely to be employed in fields most impacted financially by social distancing. Unless you make changes, families will likely have to choose between purchasing essential groceries or a phone call with Mom or Dad.
If [jail name] has a welfare fund for incarcerated people or has otherwise collected commissions from the fees charged for communication services, instituting a policy of free calls would be the best immediate use of that funding. You may even discover unexpected benefits to a temporary policy of free calls: For example, increased communication with loved ones has been shown to reduce misconduct in facilities by lowering anxiety and tension. Stability may be one reason jurisdictions like New York City have shifted to free phone calls permanently.
With tensions running high in [jail name] as well as in our communities, waiving the costs of phone and video calls is a simple step your office can take to provide comfort to families and protect public safety, both in and outside of the jail. Thank you for your attention to this matter.
Shorter version:
Dear [Sheriff/Warden name],
Your office recently took the step of [suspending/restricting] in-person visitation at [jail name] to prevent the spread of COVID-19. While in-person visitation can be risky at this time, incarcerated people and their families must be able to communicate in order to endure this constantly evolving pandemic.
We are writing to request your leadership in protecting incarcerated people and their loved ones by providing phone and video calls free of cost for at least 30 days – as other counties have done, and as has been recommended by prosecutors nationwide.
With visitation halted, families are forced to check in with their incarcerated loved ones by paying for phone or video calls. But incarcerated people and their families are disproportionately low-income, and likely to be employed in fields most impacted financially by social distancing. Unless you make changes, families will likely have to choose between purchasing essential groceries or a phone call with Mom or Dad.
If [jail name] has a welfare fund for incarcerated people or has otherwise collected commissions from communication services, a policy of free calls would be the best immediate use of that funding. You may even discover unexpected benefits, like how increased communication with loved ones has been shown to reduce misconduct in facilities by lowering anxiety and tension. Stability may be one reason jurisdictions like New York City have shifted to free phone calls permanently.
With tensions running high in [jail name] and in our communities, waiving the costs of phone and video calls is a simple step your office can take to provide comfort to families and protect public safety, both in and outside of the jail. Thank you for your attention to this matter.
We offer five examples of policies that could slow the spread of a viral pandemic in prisons and jails - and would mitigate the everyday impact of incarceration on public health.
by Peter Wagner and Emily Widra,
March 6, 2020
This briefing has been updated and expanded on March 27 with Five ways the criminal justice system could slow the pandemic. We recommend reading that one instead.
Since publishing this article, we have been tracking which prisons, jails and other criminal justice agencies are making meaningful policy changes to slow the spread of COVID-19. See our tracker, which we update daily, at https://www.prisonpolicy.org/virusresponse.html.
The United States incarcerates a greater share of its population than any other nation in the world, so it is urgent that policymakers think about how a viral pandemic would impact people in prisons, in jails, on probation, and on parole, and to take seriously the public health case for criminal justice reform.
Below, we offer five examples of common sense policies that could slow the spread of the virus. This is not an exhaustive list, but a first step for governors and other state-level leaders to engage today, to be followed by further much-needed changes tomorrow.
Quick action is necessary for two reasons: the justice-involved population disproportionately has health conditions that make them more vulnerable, and making policy changes requires staffing resources that will be unavailable if a pandemic hits.
The incarcerated and justice-involved populations contain a number of groups that may be particularly vulnerable to COVID-19, the novel coronavirus. Protecting vulnerable people would improve outcomes for them, reduce the burden on the health care system, protect essential correctional staff from illness, and slow the spread of the disease.
The other reason to move quickly is that, on a good day, establishing and implementing new policies and practices is something that the government finds challenging to do on top of its other duties. If a pandemic hits and up to 40% of government lawyers are either sick or taking care of sick relatives and most of the rest are working from home, making policy change is going to be much harder and take far longer. If the government wants to protect both justice-involved people and their already overstretched justice system staff from getting the virus and spreading it further, they need to act now.
Here are five places to start:
- Release medically fragile and older adults. Jails and prisons house large numbers of people with chronic illnesses and complex medical needs, who are more vulnerable to becoming seriously ill and requiring more medical care with COVID-19. And the growing number of older adults in prisons are at higher risk for serious complications from a viral infection like COVID-19. Releasing these vulnerable groups from prison and jail will reduce the need to provide complex medical care or transfers to hospitals when staff will be stretched thin. (In Iran, where the virus has been spreading for several weeks longer than in the U.S., the government just gave temporary release to almost a quarter of their total prison population.)1
- Stop charging medical co-pays in prison. Most prison systems have a short-sighted policy that discourages sick people from seeking care: charging the free-world equivalent of hundreds of dollars in copays to see a doctor. In the context of COVID-19, not receiving immediate, appropriate medical care means allowing the virus to spread across a large number of people in a very confined space. These policies should all be repealed, but at a minimum should be immediately suspended until the threat of pandemic is over. (This will also reduce the administrative burden of processing and collecting these fees.)
- Lower jail admissions to reduce “jail churn.” About one-third of the people behind bars are in local jails, but because of the shorter length of stay in jails, more people churn through jails in a day than are admitted or released from state and federal prisons in 2 weeks. In Florida alone, more than 2,000 people are admitted and nearly as many are released from county jails each day.2 As we explained in a 2017 report, there are many ways for state leaders to reduce churn in local jails; for example, by: reclassifying misdemeanor offenses that do not threaten public safety into non-jailable offenses; using citations instead of arrests for all low-level crimes; and diverting as many people as possible people to community-based mental health and substance abuse treatment.3 State leaders should never forget that local jails are even less equipped to handle pandemics than state prisons, so it is even more important reduce the burden of a potential pandemic on jails.
- Reduce unnecessary parole and probation meetings. People deemed “low risk” should not be required to spend hours traveling to, traveling from, and waiting in administrative buildings for brief meetings with their parole or probation officers. Consider discharging people who no longer need supervision from the supervision rolls and allow as many people as possible to check in by telephone.
- Eliminate parole and probation revocations for technical violations. In 2016, approximately 60,000 people were returned to state prison (and a larger number were arrested), not because they were convicted of a new criminal offense, but because of a technical violation of probation and parole rules, such as breaking curfew or failing a drug test. States should cease locking people up for behaviors that, for people not on parole or probation, would not warrant incarceration. Reducing these unnecessary incarcerations would reduce the risk of transmitting a virus between the facilities and the community, and vice versa.
There is one more thing that every pandemic plan needs to include: a commitment to continue finding ways — once this potential pandemic ends — to minimize the number of confined people and to improve conditions for those who are incarcerated, both in anticipation of the next pandemic and in recognition of the every day public health impact of incarceration.
None of the ideas in this briefing are new. All five are well established criminal justice reforms that some jurisdictions are already partially implementing and many more are considering. These ideas are not even new to the world of pandemic planning, as we found some of them buried in brief mentions in the resources listed below — albeit after many pages about the distribution of face masks and other technical matters. Correctional systems need to be able to distribute face masks to the people who need them, of course, but making urgent policy decisions about changing how and where you confine people is not something that should be relegated to a sentence about how agencies may want to “consider implementing alternative strategies.”
The real question is whether the criminal justice system and the political system to which it is accountable are willing to make hard decisions in the face of this potential pandemic, in the face of the one that will eventually follow, and in the context of the many public health costs of our current system of extreme punishment and over-incarceration.
Appendix: Other resources for practitioners
While preparing this briefing, the Prison Policy Initiative identified some resources that may be helpful for facilities and systems that may be starting from scratch on a COVID-19 response plan, which we share below. This list is not intended to be comprehensive, and will hopefully soon be out of date as other agencies update and share their own plans:
- Correctional facilities pandemic influenza planning checklist, CDC, September 2007 (This checklist is very helpful, but many of the links in the document are broken as of this publication. Presumably the CDC will update this soon.)
- Pandemic influenza and jail facilities and populations, Laura Maruschak, et. al., American Journal of Public Health, September 2009
- Pandemic influenza preparedness and response planning: guidelines for community corrections, Patricia Bancroft, American Probation and Parole Association, August 2009
- How public health and prisons can partner for pandemic influenza preparedness: A report from Georgia, Anne C. Spaulding, et al., April 2009
The new resource uses data generated by New York’s law ending prison gerrymandering.
February 19, 2020
A new project from the Prison Policy Initiative maps where people in New York state prisons come from, down to the neighborhood level — providing a groundbreaking tool for studying how incarceration relates to community well-being.
The project, Mapping Disadvantage: The Geography of Incarceration in New York, provides anonymized residence data for everyone in New York state prisons at the time of the 2010 Census. Readers can download the data at several geographic levels, including counties, cities, and legislative districts.
“If you want to study how mass incarceration has impacted specific communities in New York, or how incarceration tracks with other indicators of community health, we’ve just published the geographic data you need to do that,” said Prison Policy Initiative Research Director Wendy Sawyer.
In a short report, produced in collaboration with VOCAL-NY, the Prison Policy Initiative provides examples of what can be done with the new dataset. The report shows that:
- In New York City neighborhoods with high rates of asthma among children, incarceration rates are also significantly higher.
- In city school districts, 5th grade math scores are very strongly correlated with neighborhood incarceration rates.
- Across the state of New York, every 1% increase in a particular Census tract’s unemployment rate is correlated with an uptick in the incarceration rate.
A landmark 2010 law made this mapping project possible. In 2010, New York passed a bill ensuring that people in prison would be counted as residents of their hometowns at redistricting time. This reform ended the electoral distortion known as “prison gerrymandering,” which had given extra political influence to the legislative districts that contained large prisons. The law required the state prison system to share its own records of where incarcerated people actually resided with redistricting officials. Using these records, redistricting officials produced a corrected dataset that they used to draw new district lines, and the Prison Policy Initiative repurposed this dataset for its report.
For the 2020 round of redistricting a total of seven states — California, Delaware, Maryland, Nevada, New Jersey, New York, and Washington — have passed legislation to end prison gerrymandering and nine additional states — Colorado, Florida, Illinois, Michigan, Nebraska, Pennsylvania, Rhode Island, Virginia, and Wisconsin — have legislation pending.
“These states are passing laws to end prison gerrymandering because they believe that everyone should have the same access to political power, regardless of whether they live next to a large prison. But these laws also have a secondary positive impact: they can make a deeper understanding of our criminal justice system possible,” said Executive Director Peter Wagner.
Prison systems have shown they are unprepared and unwilling to care for an aging prison population - whether by improving healthcare or expanding compassionate release.
by Emily Widra,
February 13, 2020
A newer article about state prison deaths with data from 2018 is now available. We suggest using that article instead of this one.
A new Bureau of Justice Statistics report released yesterday shows that from 2015 to 2016, the number of deaths in U.S. state prisons increased from 296 to 303 per 100,000 people. What accounts for these deaths?
Chronic illnesses continue to be the leading cause of death in state prisons, according to the report — far outpacing drug- and alcohol-related deaths, accidents, suicides, and homicides combined. The number of deaths from chronic illness — including a growing number of deaths from cancer in prison, at a time when overall deaths from cancer are going down — is a testament to the extremely poor healthcare incarcerated people receive. It also highlights the ways that prisons are unable and unwilling to care for their elderly residents, who comprise a growing share of the prison population.
Sources: Bureau of Justice Statistics, Mortality in State and Federal Prisons, 2001-2016 and Mortality in Local Jails and State Prisons, 2000-2013
Prison accelerates aging and increases the risk of early death from illness
As we’ve written about previously, each year of time served in prison takes two years off an individual’s life expectancy. Evidence suggests that the reason for this is that incarcerated people experience “accelerated physiological aging.” Prison ages incarcerated people by 10 to 15 years on average, which in turn makes them more vulnerable to chronic health conditions earlier in life than would be expected. As we see in the new prison mortality data, these chronic conditions – cancer, heart disease, liver disease, and respiratory diseases – are among the most frequent causes of death in state prisons.
Researchers have identified a number of reasons why prisons increase the risk of illness and early death (for a concise review, see Novisky 2018). These include, but are not limited to: varying degrees of health literacy and capital among incarcerated people; constraints on transportation to necessary appointments outside the prison; and inadequate healthcare in prisons due to insufficient resources, limited medical providers, restrictions on medication administration, and treatment bias because of stigmas attached to incarcerated patients. And – particularly for older or otherwise more vulnerable people – punitive practices like solitary confinement compound existing physical and mental health concerns and risks.
Prisons are not prepared for the health problems and mortality of their aging populations
Nationally, the imprisonment rate for people over 45 years old has more than doubled over the past three decades while the rate for those under 45 has actually dropped slightly. Mortality has become an urgent issue in places like the Louisiana State Penitentiary (“Angola”), where the average age is over 40 and the average sentence is longer than 90 years. With thousands of aging adults facing the prospect of dying in prison in the coming years, how are prison systems preparing to handle the increased physical and psychological needs of the graying prison population? In short, they’re not preparing at all.
While the country incarcerates more older adults for longer sentences, prison systems have not adapted to the changing needs of the prison population. Despite examples of increased spending on prison healthcare, access to necessary healthcare remains inadequate. There are frequently lapses between prescription refills, as well as unmet dietary needs and unaffordable medical copays. We know that copays jeopardize the health of incarcerated populations, staff, and the public because when healthcare is unaffordable, sick people avoid the doctor, and diseases are likely to worsen and require more aggressive care. Yet most states still require copays to see medical staff behind bars. And even when incarcerated people do see medical staff, they face long waits: older adults in federal prisons wait an average of 114 days to see needed medical specialists in cardiology and pulmonology, which also puts them at risk for late diagnoses or no treatment at all.
Recent research from Prof. Meghan Novisky reveals how older incarcerated adults cope with the difficulties of accessing healthcare in prison. In her extensive qualitative study, Novisky finds that older incarcerated adults must rely on their networks – both in and outside of prison – and strategically use the limited resources available to them. Specifically, these older adults try to access health information from outside, from the prison library, and from other incarcerated people with medical backgrounds; they use the commissary and access to the kitchen to supplement the insufficient diet provided them; and they doggedly advocate for themselves with providers and through the grievance process, all in an effort to get their basic health needs met.
Beyond individual health outcomes, the financial burdens of the aging prison population can’t be overlooked: care for this population costs 2-3 times more than for their younger counterparts. The federal prison system reports spending 5 times more on medical care and 14 times more on medications per inmate in facilities with higher percentages of older inmates.
Bringing a measure of dignity to death in prison: Hospice programs
As the recent BJS report reminds us, mortality rates in prison are unlikely to slow, given the aging population and systemic healthcare problems. This reality begs the question: what does mortality behind bars actually look like for the people who are dying?
Currently, less than 4% of prisons have hospice programs. Most prisons and jails were not built with any consideration for the fact that they would house people dying of cancer, pulmonary diseases, liver failure, and dementia. But hospice has become one of the few humane attempts to address mortality in prison.
Hospice care involves a team of providers who care for people with life-limiting illnesses and their families with medical care, pain management, and emotional and spiritual support. The hospice model of care, based on a belief that every person has the right to die pain-free and with dignity, has made strides to fit into what Fleury-Steiner (2008) calls “the prison’s ‘natural environment’ of aggressive discipline and custody.”
“When speaking on end-of-life care, no one should be excluded. Dying with dignity is an essential component of our humanity and needs to be extended even into the shadows of our society.”
– Marvin Mutch, Human Prison Hospice Project
About half of these prison hospice programs use incarcerated people as volunteers or as employed (and underpaid) caregivers. They become a crucial part of the care team, given that medical staff are often spread thin and correctional officers don’t have the necessary training to provide end-of-life care. (Incarcerated volunteers who work in hospice do receive appropriate training.)
While having access to hospice care in prison is certainly better than dying there without such care, dying in prison is a bleak scenario no matter what. One hospice patient at the California Medical Facility expressed this succinctly to a New York Times journalist entering the hospice unit, greeting her with, “Welcome to death row.”
The alternative: Compassionate release
For terminally ill incarcerated people, the other option is compassionate release: the early release of individuals who are facing imminent death and do not pose a threat to the public. Compassionate release was created by Congress to release incarcerated people “when it becomes ‘inequitable’ to keep them in prison any longer.” This option allows incarcerated people to seek hospice care outside of prison, a chance for dignified death, and time with family. Moreover, it has the practical benefit of reducing medical costs to the state and federal government.
However, this more humane release mechanism is extraordinarily underutilized, for a number of bad reasons: narrow eligibility requirements, a burdensome application process, protracted hearings, third party veto power, a lack of formal timelines, reluctance of providers to provide a prognosis, lack of medial knowledge of parole board members, and no systematic procedures for tracking applications and decisions. According to The New York Times, between 2013 and 2017, the federal Bureau of Prisons approved only 6% of the 5,400 compassionate release applications received; meanwhile, 266 other applicants died in prison. Their analysis of federal prison data shows that it takes over six months, on average, for an incarcerated person to receive an answer on their compassionate release application from the BOP. In one tragic example, prison officials denied an application for someone because the BOP determined he had more than 18 months to live, despite prison doctors’ prognosis of less than six months. Two days after receiving the denial, he died. With a timeline like that, it is no wonder that the number of older adults dying behind bars continues to grow.
In 2016, over 1,000 people died in local jails - many the tragic result of healthcare and jail systems that fail to address serious health problems among the jail population, and of the trauma of incarceration itself.
by Alexi Jones,
February 13, 2020
A newer article about jail deaths with data from 2018 is now available. We suggest using that article instead of this one.
A new Bureau of Justice Statistics report reveals that over 1,000 people died in local jails in 2016, underscoring the dangers of jail incarceration. Most troublingly, the report finds at least half of these deaths are preventable, with suicide remaining the leading cause of death. These preventable deaths are the tragic result of healthcare and jail systems that fail to address serious health problems among the jail population – both inside and out of the jail setting – and of the trauma of incarceration itself.
The new report reveals that half of all deaths in jails are due to suicide, accident, homicide, and drug or alcohol intoxication, all of which are largely preventable. Once again, suicide was the leading cause of death in jails. The jail suicide rate is far higher than that of state prisons or among the American population in general.
The other half of deaths in jails are due to illness, such as heart disease or liver disease, many of which likely could have be prevented if not for the abysmal healthcare in jails.
People in jail often have serious physical and mental health needs. They are five times more likely than the general population to have a serious mental illness, and two-thirds have a substance use disorder. They also are more likely to have had chronic health conditions and infectious diseases. Moreover, many people experience serious medical and mental health crises after they are booked into jail, including withdrawal, psychological distress, and the “shock of confinement.”
Yet despite their serious needs, people in jail rarely have access to adequate healthcare. History has shown that jails are unable to provide effective mental health and medical care to incarcerated people.
For example, CNN recently published a scathing investigation into WellPath (formerly Correct Care Solutions), one of the country’s largest jail healthcare providers. The investigation found that WellPath provides substandard healthcare that has led to more than 70 preventable deaths in local jails between 2014 and 2018. WellPath, like other correctional healthcare companies, has been accused of prioritizing cost-cutting over patient health, with little governmental oversight. CNN found that WellPath doctors and nurses often denied specialized testing, medication, and treatments. They have also failed to diagnose and treat psychiatric disorders, denied emergency room transfers for urgent cases, and allowed common infections and conditions to progress to the point of fatality.
Previous research also shows that the jail environment itself can lead to serious health crises. As a report from the Department of Justice explains, “certain features of the jail environment enhance suicidal behavior: fear of the unknown, distrust of an authoritarian environment, perceived lack of control over the future, isolation from family and significant others, shame of incarceration, and perceived dehumanizing aspects of incarceration.” People in jails are regularly denied contact with family and friends through the elimination of in-person visits and the high cost of phone calls, denied access to adequate medical care and nutritious food, exposed to unbearable heat and cold, and often subjected to the torturous conditions of solitary confinement.
Moreover, jails are often understaffed and/or have inadequately trained staff, and the vast majority of people working in jails are trained as correctional officers, not health providers or social workers. Despite years of evidence that suicide is the leading cause of jail deaths, many jail staff are not even trained in suicide prevention. Worse, some jail staff display indifference toward incarcerated people’s lives, often refusing to take their health concerns seriously and cutting off access to healthcare – with fatal consequences. For example, Clackamas County Jail workers were caught on camera laughing and joking about a military veteran overdosing in his cell. Even a nurse on duty reportedly spent less than five minutes with the man, who died after authorities finally took him to a hospital.
The Bureau of Justice Statistics data released yesterday emphasizes, yet again, the dangers of even short jail stays: 40% of jail deaths occur within the first week of a person’s incarceration. Given how just a few hours or days in jail can turn deadly, the report underscores the need to divert people away from jail – especially those with mental health and substance use disorders who are at increased risk – as well as the urgency of reducing the use of pretrial detention.
Most "consumers" of telecom services in jails are families in poverty. Counties can and should negotiate contracts that treat them more fairly.
by Prison Policy Initiative,
February 7, 2020
The average cost of a phone call from a Texas county jail is 44 cents per minute1 — which can add up to hundreds of dollars a month for families trying to stay in touch — but Dallas County may soon lower its rates to 1 cent per minute. How? The county is aggressively renegotiating its contract with jail phone provider Securus, prioritizing getting the lowest rate possible for the families making the calls.
For other counties wondering how to negotiate contracts that treat consumers more fairly, we’ve just published three “best practices” guides. Our three guides cover the three most common types of telecommunications contracts in jails: contracts for phone services, contracts for video calling technology, and contracts for electronic tablets.
The simplest and best policy for a county is to pay for these services out of its general fund, thus making communication free. (Otherwise, personal wealth determines which families can stay in touch and which families can’t.)
For counties that won’t go that far, though, it’s still possible to write a jail contract that holds the vendor accountable, and allows families to stay in touch without paying dearly. Our best practices guides show how smart agencies can:
- Get the lowest rates possible for families by refusing commissions
- Protect customers from predatory fees, such as unnecessary “account maintenance” fees or high deposit fees.
- Make sure that vendors return customers’ unspent funds
- Ensure that expensive technology is never used to “replace” vital (and free) existing services
- Avoid excluding good providers from the bidding process by accident
During the contract award process, county procurement officials are often outmatched by their counterparts in the jail telecom industry — highly experienced businesspeople intent on maximizing their returns. Because of this imbalance, far too many poor families end up paying hundreds or thousands of dollars a month to stay in touch. But county governments that do their homework can get families a fairer deal.
To learn more, see our new best practices guides about:
And if you are new to these issues, see our research and advocacy about phone services in prisons and jails, protecting in-person visits from the video calling industry, and exploitation on prison tablets.
Footnotes
Nearly one out of every 100 people in the United States is in a prison or jail.
by Peter Wagner and Wanda Bertram,
January 16, 2020
We’re often asked what percent of the U.S. population is behind bars. The answer: About 0.7% of the United States is currently in a federal or state prison or local jail. If this number seems unworthy of the term “mass incarceration,” consider that 0.7% is just shy of 1%, or one out of a hundred. And a little more context shows that this fraction is actually incredibly high.
Because talking about portions of a percentage can be confusing, this concept is more often expressed as a rate: The United States currently incarcerates 698 per 100,000 people. (The rate is out of 100,000, rather than 1,000 or 10,000, because back when incarceration was much rarer you needed a larger denominator to express the rate in whole numbers. But either way, these are all different ways of expressing the same percentage.)
In some ways, though, looking at the portion of a country that is incarcerated understates the sheer size of mass incarceration, because the denominator includes many groups that are infrequently incarcerated. For example, no toddlers, few adolescents, and not very many teenagers are incarcerated.
Rather than calculating how many people in the U.S. are incarcerated, you could calculate how many adults are incarcerated (0.88%), or how many working-age adults are incarcerated (1.07%). These statistics are rhetorically useful, but are often difficult to pair with compatible data from other countries, states or topics, so they’re not used very often.
There is another way to look at the scale and uniqueness of the U.S mass incarceration experiment: Less than 5% of the world’s population is in the United States, but 20% of the world’s incarcerated people are right here:
For more perspectives on the scale of mass incarceration, see:
As of August 2021, the newest available data on incarceration in both the U.S. and globally does not change any of the statistics or percentages referenced in this article.
