In an article scheduled for release in the June 2 issue of the New England Journal of Medicine, researchers from Brown University's Center of Prisoner Health and Human Rights state that the United States is dealing with an "epidemic of mass incarceration". According to Josiah D. Rich, M.D., M.P.H., who is co-director of the Center as well as a professor of medicine at Brown University, many of the 2.3 million Americans who are behind bars and the estimated 10 million who cycle in and out of prison each year suffer from substance abuse and mental illness. The inadequate treatment options in most communities has been exacerbated by the severe policy changes of the past 30 years which has been linked to the ongoing "War on Drugs". Dr. Rich stresses that "More than half of all inmates have a history of substance use and dependence or mental illness, yet they are often released to the community without health insurance or access to appropriate medical care and treatment. Sadly, without these linkages to transitional care in the community, the majority of these individuals will re-enter the revolving door of the criminal justice system, which already costs our county $50 billion annually."
According to Dr. Rich and his co-authors, Sarah E. Wakeman, M.D., of Massachusetts General Hospital, and Samuel L. Dickman, A.B., of Harvard Medical School, incarceration has risen by 600 per cent over the last 40 years. With an estimated 1 in 100 Americans currently incarcerated, no other country comes close to the United States in terms of incarceration rate. Given that most Americans in prison come from low-income and minority populations, racial and socioeconomic disparities in availability of health care risk being perpetuated indefinitely. Psychiatric problems in prisoners remain a special concern since major depression and psychotic disorders are four to eight times as prevalent as in the general population. Only 22 per cent of state prisoners and 7 per cent of jail inmates receive any form of mental health care while incarcerated.
With the growing number of substance abusers in prisons, the prevalence of infectious disease among inmates has also increased dramatically. An estimated 25 per cent of all HIV-positive Americans and a third of all individuals with Hepatitis C pass through the criminal justice system each year. Other chronic illnesses that are overrepresented in prison populations include hypertension and diabetes. The cost of care is expected to rise in coming decades as dementia becomes more prevalent among prisoners due to increased incidence of Alzheimer's disease, AIDS-related dementia, and similar illnesses.