Cook County Sheriff Tom Dart, long known as an advocate for treatment of the mentally ill who are involved with the justice system, has recently written a piece for the Chicago Tribune which highlights a key point: the cycle of violent crime is perpetuated in part by an inability to efficiently administer justice. Sheriff Dart notes that in Cook County (which includes Chicago, home of Avocet) “nearly 2,000 people have been in custody awaiting trial for more than a year, with 232 in custody pretrial for more than five years.”
He goes on to correctly state that the longer a man or a woman is in jail, the higher the probability of a negative event while in custody (e.g., assault), which then contributes to more time behind bars. From the view of health care delivery, this is especially troubling. Even the best correctional health care cannot and should not replace high-quality community care, especially with respect to behavioral health and the seriously mentally ill.
For those of us working in health care, especially the correctional health care space, understanding the environment from which our population derives (to use public health language) is essential to serving our patients. To that end, let’s take a few minutes to review some of the broader challenges facing our justice system, especially in large cities like Chicago.
Here are some of the key issues that result in large numbers of patients in jail and prison which then stress our ability to provide constitutional health care:
Racial and socioeconomic disparities: There is a pervasive problem of racial and socioeconomic disparities within the justice system. Communities of color, particularly African Americans and Hispanics, often experience disproportionate rates of arrests, convictions, and harsher sentencing compared to other people for similar offenses. This bias contributes to an unequal and unfair justice system.
Policing practices: Large cities may grapple with issues related to policing practices. Instances of excessive use of force, racial profiling, and biased policing have raised concerns about the fairness and legitimacy of law enforcement. These practices erode trust between communities and the police, making it more challenging to maintain public safety effectively.
Overcriminalization and mass incarceration: The American justice system has seen a trend of overcriminalization, where minor offenses are punished with incarceration rather than alternative measures. This approach has led to a significant increase in the jail and prison populations, causing overcrowding and placing a strain on resources, which include health services. Mass incarceration not only has social and economic consequences but also contributes to poor health outcomes among inmates, as discussed in previous commentary.
Cash bail system: Many large cities in the United States rely on a cash bail system, where individuals who have been arrested must pay to secure their release before trial. This system disproportionately affects low-income individuals who cannot afford bail, leading to pretrial detention and potential loss of employment, housing, family stability, and health benefits, including safety-net government health programs such as Medicaid. In addition, it perpetuates socioeconomic inequalities and undermines the presumption of innocence.
Limited access to legal representation: Access to quality legal representation is critical for a fair justice system. However, individuals in large cities or even rural areas where legal resources are scarce–particularly those from marginalized communities– may face challenges in accessing competent legal counsel. Public defenders’ offices are frequently overwhelmed with heavy caseloads, compromising their ability to provide adequate representation. This disparity in legal representation can result in unequal outcomes for defendants and contribute to a burgeoning population in jail and prison.
Backlog and delays: Many large cities (such as Chicago) have significant backlogs in their courts, leading to delays in adjudicating cases. Lengthy delays can have negative consequences for defendants, as they may spend prolonged periods in pretrial detention or have their cases prolonged unnecessarily. Moreover, delays can hinder the efficient administration of justice and diminish public trust in the system.
Addressing these issues requires comprehensive reforms that prioritize fairness, equality, and public safety. Efforts should focus on addressing systemic biases, promoting community policing models, reevaluating sentencing policies, and investing in alternatives to incarceration. Additionally, reforms that promote equitable access to legal representation, improve court efficiency, and reduce unnecessary pretrial detention can contribute to a more just and effective justice system in large cities.
In conclusion, while the connection between inefficient or otherwise troubled justice systems and the health of the population may not be obvious, it is an important one. We must keep in mind that despite the delays described by Sheriff Dart, most incarcerated people eventually return to their communities of origin. Therefore investing and operating a fair and efficient system is essential. If inmates are released in poor health, plagued by preventable illness that could have been addressed in the jail, the burden on equally stressed community health systems is all the greater.