Leaving Prison = Walking the Plank?
As a result of our country's love affair with incarceration, our prison population has expanded mightily, as have, consequently, the number of people leaving prison each day. With more than 600,000 releases a year from prison (and another whopping 10 million people released from jail who were either serving sentences of less than one year or who had been awaiting trial), the urgency with which America must direct attention to the reentry of prisoners into society cannot be overstated.
The importance of developing extensive, multi-tiered reentry programs for ex-prisoners was brought sharply into focus earlier this month when the New England Journal of Medicine published an article called "Release from Prison – A High Risk of Death for Former Inmates", documenting the findings of a study comparing the mortality rate of over 30,000 ex-prisoners (62% white, 87% male) in Washington State upon their reentry into society to other state residents.
Specifically, the study found that the risk of death among former inmates during the first two weeks after their release was 12.7 times that of other state residents (and 3.5 times greater overall). Put another way, whereas for Washington residents of the same age, sex, and race as the ex-prisoners, the mortality rate was 223 per 100,000, in the first week the ex-prisoner mortality rate skyrocketed to 3,661 per 100,00, in the first two weeks it was 2,589 per 100,000, and overall it was 777 deaths per 100,000. The disparity between mortality rates of ex-prisoners and other state residents was noticeably higher among females, for inmates between the ages of 25-44, and for drug addicts. The leading causes of death for people upon leaving prison were drug overdose, cardiovascular disease, homicide, and suicide.
The statistic which, by itself, demonstrates the critical importance of immediate intervention for recently released inmates is that in the first two weeks, as mentioned above, the mortality rate is 2,589 per 100,000, but by weeks 3-4, it drops to 614 (which is still almost 3 times the average rate, but vastly lower than the figure in weeks 1-2). This suggests that while long-term intervention is important, the most crucial juncture for transitional care is when ex-prisoners first set foot outside the gates.
This study is not comprehensive, and it focuses on a particular geographic region. In addition, as the study itself acknowledges, factors such as education level, employment status, income level, residential neighborhood, and health insurance may account in part for the disparate mortality rates. However, the drastic difference in the rates suggests that both inmates and our society are often woefully unprepared for their release.
As the study concludes, "the sharply elevated risk immediately after release suggests that the reentry process contributes to excess mortality in this population" and "interventions…could include planning for the transition from prison to the community." The study suggests halfway houses, work-release programs, drug-treatment programs, education about the susceptibility to overdose after relative abstinence during incarceration, preventative care to lessen cardiac risks, intensive case management, and improving the access to and continuity of medical and mental health care.
Or, and here's a novel idea: put fewer people behind bars in the first place.