Physicians need to be advocates for prisoners' health

January 10, 2007

Providence, RI -- Physicians are an essential component of correctional institutions and have a responsibility to advocate for effective and humane treatment for inmates. This is the view expressed in a commentary published in the January 11 issue of the New England Journal of Medicine by Scott A. Allen, MD, and Josiah D. Rich, MD, MPH, physicians at the Center for Prisoner Health and Human Rights at The Miriam Hospital and Brown Medical School.

Citing the steady increase of incarcerated individuals in the United States that has resulted in record high inmate numbers, the authors point to the inadequate treatment of mental illness and addiction in the community as a source of the increase - especially among women.

"The natural history of untreated addiction and mental illness often results in illegal activity, and persistently inadequate treatment perpetuates a cycle of crime and incarceration," says Rich. "The correctional system should view incarceration as an opportunity to link inmates with effective therapy such as mental health services, high-quality drug treatment, and support services for reentry into society upon release, if we ever expect to decrease recidivism rates."

The authors note that punishment is often favored over rehabilitation in many prisons, which may cause harm to a prisoner's physical and mental health. In addition, in situations where effective therapeutic services are available, they are often underused.

Statistics show that although 57 percent of inmates in state prisons reported using drugs during the month before committing their offense, only 20 percent participated in substance abuse programs while in prison. Federal prisons echo this trend with reports stating that of the 63 percent of inmates being held for drug offenses, only 15 percent participated in prison-based drug treatment programs.

The authors also support programs for non-violent offenders that would place them in residential treatment programs and group homes instead of in prison. California took initiative with this concept when it passed The Substance Abuse and Crime Prevention Act, known as Proposition 36, in 2000. Proposition 36 changed California state law to allow first- and second-time nonviolent, simple drug possession offenders the opportunity to receive substance abuse treatment instead of incarceration.

"We feel strongly that alternatives to mass incarceration for non-violent offenders, such as residential treatment programs, need to be explored," says Allen. "Here, the basic requirements such as nutrition, shelter, and medical care would be provided, but in a more efficient, nonpunitive therapeutic setting. In addition, community-based alternatives would save taxpayers millions of dollars in incarceration costs annually."

Initial reports analyzing the effectiveness of California's Proposition 36 estimate that over 150,000 people benefited from the treatment and that it saved taxpayers about $1.3 billion. Given that the annual cost of housing an inmate is approximately $36,000, while the average cost of a 50-day residential treatment program is $3840 - the savings is evident.

Rich and Allen encourage physicians to campaign for sentencing laws, policies and procedures that directly affect the health and well-being of their patients and to encourage more humane and effective treatment alternatives for addiction and mental illness.
The Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center ( was established in 2005.

The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital ( offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care. One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, attracting $17 million of the world's HIV/AIDS research dollars. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services three times and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system.


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