The Threat of Prison

As harm reduction facilities expand into behavioral health services, prisons remain an obstacle to progress.

By Maximilian Eyle

            As harm reduction agencies expand toward addressing the psychological health of participants, prisons continue to entrap the most vulnerable members of our communities. Once incarcerated, the person often finds themselves in a destructive and repetitive cycle that can be damaging to their physical and mental wellbeing. Our prison system has become a destination for people with behavioral health issues, especially those with substance use disorders. This is in large part a result of a lack of mental health resources, as well as the continued criminalization of drugs and drug users.

            Many people use drugs as a means of treating the pain that comes from prior trauma. Tragically, this greatly increases their risk of entering the prison system, which only exacerbates the strain on their mental health. Prison environments can be damaging and dehumanizing, and have a poor record of adequately caring for prisoners with behavioral health issues. Consider that roughly 56% of state prisoners have been diagnosed with a mental health disorder, and yet only about one-third of those diagnosed ever receive treatment after being incarcerated, according to a PBS investigation.

            “Jails and prisons are among the least therapeutic environments in the world,” says Alisa Roth, a journalist who spent years investigating the relationship between mental health and our criminal justice system. “You’re not bringing out the best in their behavior; you’re bringing out the worst in their behavior.” It is not surprising to learn that a person’s psychological health might be seriously damaged within this environment.

            Tactics like solitary confinement are widely known to have disastrous effects. “You have patients with mental health problems who are decompensating [– functionally deteriorating under the stress –] or simply doing extreme things to try and get out of there,” wrote Dr. Homer Venters –  the former head of New York City’s correctional health services. He also went on to state that solitary confinement leads to prisoners being up to seven times more likely to harm themselves. The watchdog group Solitary Watch reports that more than 80,000 inmates across the United States are held in isolation at any given time.

More than 80,000 inmates across the United States are held in isolation [solitary] at any given time.

            As a harm reduction center that works primarily with people who inject drugs, we have come to witness firsthand the counterproductive effect that our criminal justice system has on the people it is supposed to be helping. “If you’re an injecting drug user,” says SACHR Clinical Director Bart Majoor, “you lead a high-stress lifestyle in every way you can imagine.” Because drug use is criminalized in our society, avoiding the prison system is yet another challenge that many participants must face.

            By recognizing the many anxieties inherent to the lifestyles of many people who inject drugs, we have been able to tailor our services to better support this population. When someone doesn’t know where their next meal is coming from, how can we expect them to concentrate on improving their mental health? Providing access to basic services like showers, clothes, and hot meals allows us to better address the physical and mental wellness of our participants. We actively employ masseuses, acupuncturists, behavioral health specialists, and yoga instructors. We also offer a sanctuary space for participants to relax and disconnect from the stressors in their lives.

            These strategies are also important for people living with HIV – another community that is susceptible to high levels of stress. The stigma surrounding HIV, as well as the challenges of maintaining your health, can take an emotional toll, which is why behavioral health resources are an essential care component for that population. SACHR also offers numerous group sessions led by trained professionals that support a range of populations, including the LGBTQ+ community, the HIV-positive community, young people who inject drugs, women, and more. The social integration that comes from these sessions is also highly therapeutic. “When you don’t need to relax through drugs anymore, and you know what to do when you wake up in the middle of the night with anxiety,” says Majoor,” it’s tremendously helpful.”

“When you don’t need to relax through drugs anymore, and you know what to do when you wake up in the middle of the night with anxiety,” says Majoor,” it’s tremendously helpful.”

            Unfortunately, it only takes a small drug possession arrest or a failed urine test while on probation to send a participant back into the prison system. Once behind bars, it is very easy for the progress that has been made through therapy to dissipate. This presents a huge barrier to progress. Van Asher, a program manager at SACHR, can attest to this: “A large percentage of participants are constantly going in and out of the revolving door of the system. Often for short-term things because they’re criminalized. But each time this happens – progress is lost and the risk of overdose and infection increases.”

            Another systemic barrier can be found in the lack of bilingual and bicultural behavioral therapy resources, another barrier to accessing care. Even someone with a strong command of English as a second language may feel much more comfortable conducting their therapy in their native tongue, or at least with a therapist who has an understanding of their culture, traditions, and background. The Hispanic population in the United States is rapidly growing and makes up nearly 20% of the total population, and yet the American Psychiatric Association reported in 2016 that “only 5.5% of U.S. psychologists say they’re able to administer mental health care services in Spanish.” In the Bronx, there is a large Hispanic population so we are careful to hire bilingual employees who are better able to serve this community.

            SACHR is certainly not the only harm reduction agency that is expanding its behavioral health services. There are renewed efforts nationwide to expand mental health services and push back against the stigma that has prevented many people from seeking care. Yet the potential impact of these resources is greatly limited by our prison system. The most vulnerable members of our communities are regularly detained in environments that are almost perfectly engineered to destructively impact their mental health. Until we disrupt that cycle, it will be difficult to achieve meaningful progress.