Professor: Arkansas should treat, not incarcerate, for drugs and mental illness

A University of Arkansas for Medical Sciences professor says Arkansas’ high incarceration rate has a negative outcome on public health. Instead, the state should focus on increasing treatment offerings for drug use and mental illness.

Dr. Nickolas Zaller, an associate professor at the UAMS College of Public Health, said in a speech at the Clinton School of Public Service Wednesday (Nov. 16) that Arkansas has the nation’s fourth highest incarceration rate, 599 per 100,000 residents, versus a rate of 471 per 100,000 nationally that itself is the highest in documented history. Arkansas’ prison population growth rate the past year was the highest in the nation, and it had the third highest jail population increase behind California and Texas.

The United States has 5% of the world’s population and 25% of its known prisoners, he said. Seven million Americans are under correctional supervision, more than half of them on probation. He said 2.3 million spend time in prison annually, and 12 million spend time in jail. Those numbers have grown rapidly since the 1970s, when the U.S. state and federal prison population was 200,000, he said. The primary reason: drug arrests, 80 percent of which are for possession, with more than 1 million such arrests each year.

Meanwhile, arrests for drug-related crimes are much higher for African-Americans than whites even though members of the two racial groups use drugs at the same rates. Overall, one in three African-American men born in 2001 have a lifetime likelihood of imprisonment, compared to one in 17 whites. Half of prisoners have children under 18, and the top two reasons children enter foster care are parental drug use and parental substance abuse use.

Using information provided by the Council of State Governments, which is working with Arkansas policymakers on the issue, Arkansas’ crime rate fell 15% from 2004 to 2014, while its incarceration rate increased 21%. Meanwhile, all of its neighboring states except Oklahoma reduced or maintained their incarceration rates and had greater reductions in crime rates except Mississippi, which had the same 15% drop. Texas reduced its incarceration rate by 16% and still had a 32% drop in crime.

Higher incarceration rates have an effect on public health, he said. Forty percent of inmates have a chronic medical condition, and one in seven individuals with HIV pass through a correctional facility each year, while one in five with hepatitis C does. Those diseases spread.

Meanwhile, more than half of all Arkansas prison and jail inmates have drug problems. Former prisoners are 100 times more likely to die of a drug overdose in the first two weeks post-release than the general population. Nationally, about half of inmates report a mental health problem. In Arkansas, about 20% are known to have a serious mental illness, but Zaller said that’s probably underestimated.

Zaller said all of this creates a repeating cycle of crime and incarceration. In the last 20 years, states’ correctional costs have risen by 315% to $44 billion annually, meaning it’s the fastest growing area of government spending after Medicaid. The prison population is aging. People are serving longer sentences, they’re getting older, and they’re requiring more health care. A 2013 report by the Pew Foundation showed Arkansas had a 90% increase in prison medical costs from 2001-08.

Zaller used other information provided by the Council of State Governments to explain why Arkansas has reached this point, including an increase in parole/probation revocations. Also, limited guidance to judges has resulted in low-level offenders being sentenced to prisons, meaning there are “a large number of people who are nonviolent offenders who are serving very lengthy prison sentences,” he said. Another factor is community correctional officers managing caseloads of up to 130 individuals. Also, in the 1970s, psychiatric hospitals were deinstitutionalized, but there was no corresponding investments in community programs, so patients became homeless and unstable and began committing crimes. Eventually, they were back in an institution – a jail.

Zaller said the most important step Arkansas can take is to increase its drug and mental health treatment capacity, which is extremely limited. For example, Medicaid plans do not fund drug treatment.

“Drug use is a terrible illness. It’s the only disease, by the way, for which it’s illegal to be sick,” he said.

Zaller said the system needs more options. When law enforcement officers encounter someone having a psychotic episode, their options are an emergency department or jail. Instead, those people could go to a short-term crisis stabilization unit. Mississippi, Oklahoma and Tennessee have these alternatives to higher cost hospitalizations and incarcerations. Also, officers should be trained in how to interact with mental illness and know what community resources are available. One behavioral health provider in Rhode Island had a licensed clinical social worker in police cars during patrols. Three counties in Colorado, Tennessee and in Bexar County, Texas, train law enforcement officers who encounter a person with behavioral health issues to take them not to jail but instead to a location where a comprehensive treatment plan can be developed In Seattle, drug offenders who possess up to 3 grams of crack are given the option by police of traditional prosecution or entering drug treatment, and there’s been a reduction in recidivism as a result. Also, prison-based educational resources can reduce recidivism up to 40%.

Zaller said some people need to be incarcerated. For others, there are better strategies.

“We’re not going to be able to incarcerate ourselves into a safer society. We can’t incarcerate away fear,” he said. “We can’t incarcerate away addiction, mental illness, all the kids who have a parent who is locked up in prison or jail and the one in three African-American men who are going to struggle the rest of their lives to even get a job.”