As a response to COVID-19, the release of low-risk people, or people with high-risk health conditions, from jails, prisons and youth facilities is appropriate and urgent.
Numerous state and local jurisdictions have released people held pre-trial, those convicted and scheduled for release in the near future, and the elderly or those with certain health issues.
While these releases are critical, they highlight an urgent need for proper discharge planning to meet the immediate and long-term needs of people returning to their communities.
Some populations are affected more than others. The racial disparities endemic to the criminal justice system are well-known, and we are learning how COVID-19 disproportionately impacts communities of color.
The stakes are high and the consequences are not limited to those directly affected. We cannot cloister away their suffering.
It is axiomatic that prison and jail health is public health. Every day, correctional staff go in and out of facilities, and then home; and the same principle applies to those released. Their fates are inexorably tied to those of the larger community.
Imagine you’re a “vulnerable” person, released to keep you from infection. Other than the clothes that you came in with, you don’t have much. Maybe ten days of HIV medication that has kept you alive for the past dozen years. A mostly-empty asthma inhaler. And a dwindling supply of medication that keeps your terrifying hallucinations at bay and allows you to function.
You were given a list of health providers to contact, but you have no computer for telehealth sessions.
In accordance with the CDC’s guidelines, before leaving, a nurse took your temperature and asked if you had symptoms of COVID-19. You did not, but you had heard that many people were sick and several had died. You’re scared because you know you could have been exposed to the virus and are especially at risk given your asthma.
The local homeless shelters, where social distancing is an uphill battle, are full of people in your situation, and food is hard to come by.
Want a job? Now? Forget it. Society locked you up but was unprepared to help you stay out and stay healthy and stable once released. You are largely unprepared for life in the community that you left temporarily.
And you know you are not the only one.
Even in the best of times, too many jurisdictions fail to provide adequate resources to give formerly incarcerated people the help they need to secure health care, housing, nutritious food, employment, education, a safe and healthy physical environment, and other factors the public health community call social determinants of health.
In the context of a pandemic, access to assistance is even more scarce, if available at all.
Lack of Action
The lack of action by most jurisdictions to protect returning citizens during this pandemic is potentially lethal.
In a seminal 2007 study in Washington state, researchers found that during their first two weeks following release from prison, formerly incarcerated persons were 12.7 times more likely to die than other state residents —and that was not during a pandemic.
Overdose was the primary cause—a cause preventable with proper transition services or an intervention as simple as releasing individuals with appropriate medication effective in saving people in overdose from death.
Many people recently released are over the age of 55 and have chronic health conditions which require monitoring and medication. Without these supplies and services, they face death from known killers such as cardiovascular disease. And helping released persons obtain food, housing, and, as circumstances change, employment and community support must be integral components of any successful reentry program.
Unfortunately, the recently passed federal CARES Act does not provide any reentry related support for persons being released from jails and prisons.
While some states, including California, Connecticut and New York, have worked to include returning citizens in their response plans to provide shelter to the homeless population, this is a drop in the bucket of what must be done nationwide.
Ultimately, what is critical for successful transition, now more than ever, is a wrap-around public health approach: one-stop service facilitators who can assist with necessities such as linking released persons to health care, to obtaining safe and stable housing, and everything in between.
Comprehensive, all-in-one service providers remain a sorely unmet need. We cannot afford for it to remain so any longer.
Gabriel B. Eber is Senior Associate, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health. Marc Schindler is Executive Director of the Justice Policy Institute and former interim director of the DC Department of Youth Rehabilitation Services.