It’s no secret that both our criminal justice system and our health care system are failing.
Yet there is a growing awareness among social policy experts and scholars that something surprising happens when you look at these two systems together: Opportunities for meaningful solutions emerge because the majority of individuals cycling through the criminal justice system are also frequent users of the health care system.
Consider the story of Abe. (We’ve kept his real name private.)
In 2010, he arrived at the emergency room covered with cuts and bruises. Abe had been living in the streets in Camden, New Jersey, and got into a fight with a friend. At the hospital, the doctors noted that he was suffering from chronic illnesses, including severe depression, alcoholism, and drug addiction.
The treatment? The doctors gave him antibiotics to prevent infection of his cuts and discharged him that day.
He returned to the emergency room two weeks later. Because he was homeless, Abe had difficulty taking the antibiotics, and his cuts became infected. A few months after that, Abe was hit by a car, and treated at the hospital for three days. This was only the beginning of a long pattern. Over the next five years, Abe visited Camden emergency rooms 24 times, spending roughly forty-five days in the hospital. In short, ambulances became all-too familiar for Abe.
So did police cars.
From 2010 to 2014, Abe was arrested more than 15 times, mostly for low-level offenses. He was picked up several times by police for shoplifting from a store outside the hospital, just moments after he had walked out of the emergency room.
In between, Abe was also commonly booked for being intoxicated in front of the same handful of liquor stores. Each time, he was booked by police, given a summons to appear in court, and then released. After failing to show up in court and pay fees, a warrant was put out for his arrest, and the next time Abe was picked up, he spent a month in the Camden County Jail. Over that five-year period, Camden police officers spent over 120 hours handling Abe’s criminal violations.
Three years ago, we set up a meeting with Camden County Chief of Police J. Scott Thomson. We had an idea. One of us (Anne Milgram) had been the New Jersey Attorney General, where she was in charge of overseeing the Camden Police Department. The other (Dr. Brenner) was running the Camden Coalition of Healthcare Providers.
The Coalition had already discovered that frequent users took up an extremely high amount of medical professionals’ time and accounted for the majority of the costs in the Camden health care system. We wondered: was this the same population that interacted so frequently with the police?
By integrating existing healthcare, police, and jail data sets, the Coalition broke down the traditional information silos that isolate the health care and criminal justice systems. What they found surprised all of us.
Sixty-seven percent of the frequent users of the criminal justice system were also frequent users of the health care system. Two-thirds of the people who cycled in and out of jails also cycled in and out of hospitals. The data also showed that a small percentage of the population accounted for a disproportionate amount of interactions with police and hospitals.
Normally, health care and criminal justice professionals do not compare notes or combine data, but when we did, a clear pattern emerged. We found Abe, and others just like him who are caught in a revolving door in which their immediate, acute symptoms are treated while their underlying struggles, such as mental illness, substance abuse and homelessness, remain untouched.
As a result, they return time and time again.
The Camden study taught us a simple lesson: people do not experience the health care and criminal justice systems in isolation. It should not be surprising, then, that when we work in, study and reform these systems in isolation, we miss a lot.
In short, Abe teaches us that we must move upstream and focus on individuals, not institutions. We draw from this and other lessons in a new report we have co-authored on the integration of health and criminal justice data, published by the Program in Criminal Justice Policy at Harvard Kennedy School.
Integrating health care and criminal justice data has enormous potential for tracking underlying issues and addressing them head on. By viewing individuals’ data holistically, we are able to shift the focus of analysis from system providers to system users. Doing so provides more opportunities to develop programs that will prevent medical and criminal problems before they occur.
We have only begun to scratch the surface of how to prevent crime and unnecessary hospitalizations by integrating data. There is much more to be learned about when and how we should intervene to detect underlying issues causing individuals to end up in jail or an emergency room.
These areas of research could have a transformative impact on the many Americans revolving in and out of jails and hospitals and, ultimately, could save countless lives.
It may be that the criminal justice and health care systems pose overwhelming challenges on their own, but when you put these two challenging problems together, a new set of solutions emerges.
Anne Milgram is a former New Jersey Attorney General and Distinguished Scholar in Residence at NYU School of Law. Dr. Jeffrey Brenner is the Senior VP of Integrated Health and Social Services at UnitedHealth Group and the former Executive Director of the Camden Coalition of Healthcare Providers. Together, they are co-authors of a new report on the intersection of health and criminal justice published by the Program in Criminal Justice Policy at Harvard Kennedy School.