A mental and physical health crisis is building in correctional facilities in this country and continues after release and reentry into society.
In Hawaii, a surge in inmate deaths amidst a mass exit of mental health practitioners from the state’s correctional system spark concerns of injustice and inadequate practices, bringing about the development of new approaches to justice.
In Washington, D.C., a 2023 lawsuit filed by formerly incarcerated people alleges that fundamental health care was denied to them while in Department of Corrections custody. One inmate was denied access to lubricants needed for the insertion of a catheter, leading to chronic pain and bleeding.
Additionally, self-harm incidents and instances of solitary confinement are regular occurrences. According to a former case manager at a Washington, D.C. jail, safe cells, or solitary confinement cells, are regularly used in facilities when inmates report suicidal ideation or experience mental health crises. These deprive inmates from necessary care and isolate them during traumatic instances of severe mental instability or duress.
With high rates of suicide and medical emergencies leading to deaths—five inmates have died in Washington, D.C. facilities in 2024 alone (with a total of eight deaths from 10/23 through 9/24), advocates and family members of the deceased have called for changes.
Across the country similar incidents and alarmingly high rates of mental illness in inmate populations further emphasize the need for change in the country’s carceral systems. According to the Prison Policy Initiative, as many as 66% of inmates incarcerated at federal facilities report never receiving mental healthcare. Thirty-three percent of incarcerated people in state-run prisons with diagnosed mental health disorders report they never received adequate mental health care during incarceration.
Beyond instances of neglect for mental health issues, Dr. Evelyn Wang, Director of Yale University’s SEICHE Center for Health and Justice, finds that incarceration impacts an individual’s access to physical and mental health services even beyond the confines of prison and jail facilities. Wang contends that losing access to health insurance, social stigma and socio-economic instability, plus years of perpetual medical neglect while behind bars, render returning citizens into a state of medical despair.
The perpetual destabilizing treatment of incarcerated people makes reentry and return to society even harder.
I started The National Reentry Network for Returning Citizens in 2010 because there were no alternatives to prison for young Black boys being held in jail in the Washington, D.C. area before there was proof of innocence or guilt for non-violent offenses.
In 2023, the network served 189 clients, got jobs for 59 clients and three-year transitional housing for 27 clients. When doing a Strengths, Weakness, Opportunities and Threats analysis on clients, it became apparent that most clients struggle with primary health issues, mental health, trauma, homelessness, addiction, aging, and being alone.
According to statistics from the Washington, D.C. Department of Corrections approximately 1,784 inmates have been in department custody on any given day during fiscal year 2024.
According to a 2006 report by the JFA Institute, the average length of stay for individuals in DOC Custody was 3.3 months. The average length of stay for inmates in BOP Custody was 3.3 months, or 105 days.
This means a large proportion of the inmates incarcerated in DOC Facilities will be released each year, with new inmates filling their space. As transient facilities with various purposes, ranging from pre-trial detention all the way to long-term sentencing, DOC facilities release and transfer thousands of inmates each year.
Looking to mental and physical health services provided in carceral facilities for DC Residents, the facilities offer disparate services. The Department of Corrections website shows all inmates receive comprehensive mental and physical health evaluations upon entering the facility.
After leaving facilities, access to mental and physical health healthcare becomes more uncertain. Difficulties navigating services can lead returning citizens into positions of social, health-based, and economic instability. Court-mandated separations and relationship terminations when involving other justice-impacted people can make returning citizens feel isolated, compounding difficulties of reentry.
Despite record expungement efforts and moves to ban questions about a criminal record during job interviews, a lack of recent professional experiences on resumes can make finding gainful employment a challenge. Homelessness, food instability, and economic precarity are capped off by the continuous exposure to stigma and judgement from others.
With this, negative health outcomes can follow when they go untreated due to inaccessibility of care and diminished sense of agency and worth among returning citizens. Addiction, mental illness, and untreated physical conditions can take hold during this time.
As this transition is ripe for challenges and destabilization, some policymakers have made efforts to decrease the frequency of negative outcomes for reentry.
New Jersey Rep. Rebecca Michelle “Mikie” Sherill (D-NJ) recently introduced legislation to increase funding for reentry services. The Improving Mental Healthcare in the Re-Entry System Act of 2024 would provide federal, state, and local services with $100 million a year in grant funding to improve economic, social, and health-based services for returning citizens.
If passed, the bill would expand its funding for reentry services to $140 million a year by 2029, representing a robust step by the federal government to empower returning citizens for optimal reentry outcomes.
Looking to D.C.-based efforts, transitional services have emerged to improve reentry experiences. According to the Department of Correction Programs and Case Management Website, when inmates make the transition from incarceration to reentry, DOC facilities offer a transitional assistance program, allowing inmates who anticipate release to live with others in a similar position, developing reentry plans with special emphasis on maintaining wellness and health.
Upon release, returning citizens in Washington, D.C. have access to resources from the Mayor’s Office on Returning Citizen Affairs. The READY Center offers returning citizens programming and services for up to six months after release. They provide these services along with the D.C. Department of Behavioral Health; but it is insufficient to provide regular care for returning citizens even when they are not in crisis.
CORE DC, a government contract organization that supervises returning citizens through reentry, provides them medical and clinical services. Public health insurance and nonprofits in the D.C. area can provide acute care and fulfil needs, but gaps in services and access exist.
Better implementation and improvement in all communities is urgently needed. Around the country, a consistent lack of accessible services for people in crisis traversing the challenging landscape of reentry means isolation and atomization can take hold.
Policymakers, funders, non-profit leaders, justice and health advocates, communities and citizens need to work to increase funding and expand public awareness to bolster the capabilities of reentry services. Help for returning citizens’ healthcare must expand in order to better serve everyone.