The most recent issue of the Journal of Health Care for the Poor and Underserved includes an article we wrote on the impact of mass incarceration on the communities we serve in the Bronx.
Shah M, Edmonds-Myles S, Anderson M, Shapiro ME, Chu C. The Impact of Mass Incarceration on Outpatients in the Bronx: A Card Study. Journal of Health Care for the Poor and Underserved, Volume 20, Number 4, November 2009, pp. 1049-1059.
Here is the abstract of the article as well as a link to the article itself here.
Objective. We examined the impact of arrest and incarceration on primary care patients in the Bronx, New York.
Methods. Patients at three clinics were asked eight questions concerning current and past involvement in criminal proceedings, arrest, and incarceration.
Results. One hundred eighteen patients were surveyed. Eleven (9%) patients were currently involved in criminal proceedings. Twenty-one (18%) currently had a family member in jail or prison. Twenty-nine (25%) reported ever being arrested; 65 (55%) reported that they or a family member had been arrested. Twenty-one (18%) had been incarcerated; 60 (51%) reported they or a family member had spent time in jail or prison. For most variables, rates were higher for men and the adults accompanying children at pediatric visits. Clinicians reported positive experiences discussing incarceration.
Conclusions. Involvement with the criminal justice system was common among our patients. Discussion of incarceration did not appear to have a negative impact on the clinical relationship.
The United States incarcerates far more people than any other country in the world. Last year, the Pew Charitable Trusts estimated that 1 out of every 100 American adults was behind bars. The impact of this policy falls primarily on men, on minorities and on the working class. The term mass incarceration was coined to describe how police targeting of specific neighborhoods (urban, minority, working class) creates communities where a large percentage of the men are in prison or jail. Taken as a whole the Bronx has high rates of arrests and incarceration, although even within the Bronx some neighborhoods are affected more than others. This is well illustrated in a series of maps produced by the Justice Mapping Center.
In our clinical work we have come to appreciate how incarceration affects not just the person imprisoned, but also their family. Ailing grandmothers end up caring for children when Dad goes to jail and Mom has to find a job. Children grow up in a single family home while their spends years in jail. Young boys who are having difficulty in school start playing hooky, get involved with petty crimes, end up incarcerated, and are then socialized by the prison gangs into more severe criminal activity. And just as families are affected by incarceration, so too are their communities.
In this study we tried to assess how common arrest and incarceration were in our patient population. Over the course of a few weeks in the fall of 2008, our clinicians asked patients a few simple questions about incarceration in the course of their clinic sessions. The data was collected in such a way as to protect the anonymity of the respondents. In all we collected data from 118 patients at three clinics. We found that 11 patients (9%) were involved in some type of criminal proceedings at the time of the visit. Twenty-nine (25%) reported that they had been arrested at some time in their life and twenty-one (18%) told us they had spent time in prison. Twelve percent of the families had someone return from jail within the past year. What was particularly concerning to us was that involvement in incarceration and arrest was more common among the adults bringing their children in for care than it was among the adults presenting for themselves.
The card study also brought to light issues that had previously been hidden. One of our residents remarked:
The card study of incarceration brought on an interesting discussion with a patient of mine whose son was imprisoned for many years. She’s a patient I’ve seen several times in clinic but with whom I had never thought to broach this topic.
This data reinforces our sense that mass incarceration has a major negative impact on the families and communities we serve. It suggested to us that knowing about an incarceration or arrest history may help doctors better care for their patients. This also seems to be an area in which doctors can advocate for system-level changes – such as reform of punitive drugs laws, expansion of drug treatment programs, improvements in the school system – that can prevent people from landing in jail.