May 30, 2018
Picture by Andrew Burton
People in prison suffer from high levels of “human frailty.” This is one of the findings at the heart of a new book by sociologist Bruce Western. Western and two other scholars designed the Boston Reentry Study, a longitudinal analysis of 122 people returning home after incarceration in state prison, and the experiences of the participants are the core of Western’s book. The study overcame difficulties inherent in research on recently incarcerated people and had an unusually high level of participant retention. In their descriptions of the challenges faced by those coming home, working papers provided “an almost literary glimpse into the life histories of incarcerated people, from childhood through prison and beyond.” [Dana Goldstein / The Marshall Project] A review in the Atlantic describes Western’s book, Homeward: Life in the Year After Prison, as “illuminating the role prisons play for the poor and highlighting the contours of infirmity that mark the lives of incarcerated people, often from birth to death.” [Vann R. Newkirk / The Atlantic]
Rather than benefiting from a safety net, treatment, or preventive care, people with serious illness, mental illness, or substance abuse disorders get steered into the prison system. Participants in the Boston Reentry Study reported disabilities and poor physical health, mental illness, and substance abuse in large numbers. The irony Western lays bare is that people with serious or chronic conditions or with substance abuse treatment needs suffer without healthcare but then are called to account by a justice system that relies almost exclusively on punishment and demands rehabilitation. According to Western, “Much of the agency—the will to change—that even our most humane rehabilitative programs ask of people in prison is compromised by precisely the physical and mental difficulties that places them at risk of incarceration in the first place. The people we ask to make the largest changes in their lives often have the least capacity to do so.” [Vann R. Newkirk / The Atlantic]
The poor health that precedes people’s incarceration follows them after it, adding to the demands of re-entry and making them harder to meet. For the participants in the study, chronic health conditions were managed in the Massachusetts prison system but there was little support on release. Meanwhile, the isolation and violence of prison only exacerbated mental health conditions. Those with histories of substance use disorders faced some of the greatest challenges on release. [Vann R. Newkirk / The Atlantic] Other studies have shown that after release people face a period when they are most vulnerable to health problems. A 2007 study in Washington State found that in the first two weeks after release people were at a risk of death 12 times higher than the state average, primarily from lethal overdoses. An expert from the Vera Institute of Justice told the New York Times, “We’ve always known incarceration is bad for health. But in an age of increasing attention to justice reform and health care reform, the two are increasingly connected.” [Patricia Leigh Brown / New York Times]
Programs that offer comprehensive support might mitigate the risks inherent in re-entry. Transitions Clinic Network, which began in San Francisco, now operates in 11 states and Puerto Rico and offers a model for how to support people transitioning home from prison. The network provides community-based care and the support of community health workers, usually for a period of six months. Research on the program’s effects so far suggests that it significantly reduces visits to emergency rooms and hospitals. Ronald Sanders, a community worker who was formerly incarcerated himself, worked with a patient who suffered from multiple vulnerabilities—“hypertension, near-crippling depression and memory loss from a traumatic brain injury”—and connected him to therapy, substance abuse treatment, and housing. Speaking of those who struggle with the transition, he said, “They get tired. These streets can tear you up worse than prison.” [Patricia Leigh Brown / New York Times]
Another notable finding from the Boston Reentry Study was “the incredible amount of social support older women were providing in communities hit by incarceration.” In the absence of formal support services, participants relied heavily on support from maternal figures. [Ashley Hackett / Pacific Standard] Six months into re-entry, “more than half of the participants remained reliant on family—typically mothers, grandmothers, or sisters—for either housing or financial support.” [Dana Goldstein / The Marshall Project]
Study participants also reported staggering levels of childhood trauma. Forty-two percent of participants reported having seen, as children, someone being killed. [Emily Badger / New York Times] Furthermore, half reported physical abuse by their parents and one-third had been witness to domestic violence. The Boston Reentry Study claims to be the first to examine the link between childhood trauma and incarceration, building on earlier research into adverse childhood experiences and health effects. [Dana Goldstein / The Marshall Project] Revealing the multilayered life experiences of people in prison, and their experiences of violence and trauma, challenges the “unstated assumption deep in the DNA of criminal justice jurisprudence that the world divides into two categories, and there are victims and offenders.” [Emily Badger / New York Times]