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Miriam doctor calls for rethinking the “epidemic” of incarceration

June 3, 2011

On the same week that two medical marijuana card holders were raided for growing 31 plants (the legal maximum is 12 mature plants per person, so they had 7 more than they should have) a local doctor and professor at Brown’s medical school is speaking out against policies he says are responsible for putting too many Americans in jail for the wrong reasons.

Dr. Jody Rich co-authored the New England Journal of Medicine editorial with Dr. Sarah Wakeman of Mass General Hospital and Samuel Dickman of Harvard Medical School.  The article sites some startling statistics-

The largest facilities housing psychiatric patients in the United States are not hospitals but jails. More than half of inmates have symptoms of a psychiatric disorder…and major depression and psychotic disorders are four to eight times as prevalent among inmates as in the general population.

Dr. Rich and his colleagues say this is the “…result of the ‘War on Drugs’ and our country’s failure to treat addiction and mental illness as medical conditions.”  They argue prisons aren’t doing enough to provide the health care these people need.

only 22% of state prisoners and 7% of jail inmates receive mental health treatment while incarcerated.

The editorial calls not just for the end of these policies, but for rethinking how we transition prisoners back into the community.

Although discharge-planning practices vary considerably, inmates are typically released with no more than a 2-week supply of even crucial medications such as insulin and with no primary care follow-up, so the burden of care falls predominantly on emergency rooms and is financed primarily by the public sector.

The authors say doctors need to play a role in fixing this problem- both through challenging federal and state laws, and thinking of new ways to treat prisoners now.

The medical profession has the chance both to advocate for changes in the criminal justice system to reduce the number of people behind bars who would be better served in community-based treatment and to capitalize on the tremendous public health opportunities for diagnosing and treating disease and for linking patients to care after release.

Here in Rhode Island, the medical director of our prison system is also the temporary director of the Department of Health. I know Dr. Michael Fine has thought a lot about these issues.

In the past, he’s described plans to create a “medical home” for prisoners.  I’ve reached out to him for some updates on how the state helps prisoners transition into the community.  I’ll post his response when I hear back.

In the meantime, what are your thoughts on this article?

3 Comments leave one →
  1. S. Bock permalink
    June 3, 2011 8:05 pm

    Hi Megan,
    Just want to clarify something. The legal limits vary depending on a few factors. First, each caregiver can have at a minimum, 12 immature plants and 12 mature plants. If each caregiver is a caregiver for more than registered patient they can then have 12 immature and TWENTY FOUR mature plants. If these caregivers are also patients they can have an additional 12 & 12 each. In some instances a single caregiver who is also a patient could have as many as 36 immature plants and 24 mature, for a whopping total of 60 plants. It may be that there was lack of clarity on these specifics during the arrests, or it could be that the people in question did infact go over their totals. There’s also the possibility that there is confusion over the difference between mature and immature plants…
    Sbock

    • June 3, 2011 8:27 pm

      Thanks for the clarification Seth! You’re right- it’s completely possible these guys were within the legal limits depending on their caregiver status and the maturity of their plants. My intention was to point out how puny their grow was- seemed like so close to legal if not totally legal. Not exactly a HUGE operation.

  2. Craig permalink
    June 7, 2011 3:15 am

    The failure of our nation to make sure everyone has adequate mental health care is one of our great failings. So much substance abuse, domestic violence and crime is a result of untreated mental health issues. None of these scourges would go away, but all would be lessened by funding true mental health services for everyone. The Providence Center, Gateway and even the prisons deserve credit for doing what they can – but its not enough. From police officers to teachers to primary care doctors, we need to get better at dealing with this.

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