DOJ Initiatives Focus on Correctional Health Care

Article excerpt

Jan. 22-27, 2010

Ninety-five percent of all inmates will eventually be released, so the health of incarcerated offenders has a direct impact on public health. The Department of Justice and its Office of Justice Programs (OJP) are involved in three critical areas of correctional health care--substance abuse treatment, treatment of mentally ill offenders, and reduction of sexual violence in prisons.


Substance Abuse Treatment

Data from the Bureau of Justice Statistics tell us that more than half of all state inmates were abusing or dependent on drugs in the year before their admission to prison. By way of comparison, the last published National Survey on Drug Abuse and Health from the Substance Abuse and Mental Health Services Administration found that 9 percent of the general population was classified with substance dependence or abuse in the past year.

There is no question that substance abuse and crime are strongly connected, and we are working to address this link on both the front and back ends. On the front end, we are supporting alternatives to incarceration, in particular, drug courts. Drug courts use the monitoring and coercive power of the judicial system to provide treatment to drug-involved offenders. I'm encouraged by the bipartisan support for this approach, and that both President Obama and the attorney general are strong backers of drug courts. Studies have found them to be very effective, not only in reducing recidivism, but in saving taxpayer dollars.

There are other models that recognize the importance of treatment. The Hawaii State Judiciary operates a program called Hawaii's Opportunity Probation with Enforcement (HOPE). HOPE focuses on probationers, and it relies on swift, certain and proportionate sanctions for probation violators. If someone violates a term of his probation--say, by failing a drug test--he goes to jail within 48 hours. The first time, the sentence is short--a weekend or maybe a week--but it lengthens for each successive sentence. It also uses a triage approach. Sanctions alone work in keeping some offenders off drugs, and HOPE accounts for that. But offenders who cannot stay off drugs and who keep coming back will get referred to intensive treatment. Our National Institute of Justice funded an evaluation of HOPE and found that it has been very effective in reducing positive drug tests. For 685 probationers who were in the program for at least three months, the missed appointment rate fell from 13.3 percent to 2.6 percent, and "dirty" drug tests fell from 49.3 percent to 6.5 percent. HOPE and drug courts are models that should always be kept in front of us. They can, and should, be part of the solution to some of the problems we are facing in institutional corrections.

In terms of institution-based treatment, OJP supports the Residential Substance Abuse Treatment (RSAT) program. RSAT provides intensive drug treatment in prison, and it has been effective in treating offenders with substance abuse disorders and preparing them for reentry. Follow-up studies on RSAT programs have shown that graduates relapse and recidivate at lower rates. I am pleased that this year we were able to triple our funding of RSAT from last year, to $30 million.


From the RSAT evaluations, we have found that programs are most effective when they are used both inside the walls and outside in the community. Community matters. We also know they are most effective when they address other, nonsubstance abuse issues, like mental health disorders.

The Mentally Ill Offender

People with mental illness are overrepresented in jails and prisons. A recent report from the Council of State Governments and Policy Research Associates suggests that almost 17 percent of jail inmates have a serious mental illness. That is three to six times higher than the general population, and it means that as many as two million bookings of people with serious mental illness may occur every year. …