An Advocate’s Voice: Dr. Henrie Treadwell
Director of Community Voices and Associate Director of health policy at the National Center for Primary Care, Morehouse School of Medicine
Transcript of an interview
Is there more focus on prisoner re-entry issues now than in the past? Why is that?
I think there is more focus now than in the past, for at least two reasons, and there probably are many more. One, from an economic standpoint, I think states are beginning to realize that the expense of incarcerating people has not really been a good investment based on the fact that there is no reduction in the numbers of people who are sent to prison. And I think there are corollary data that are showing that those going to prison are basically poor and have other mental health, or other health issues. That would mean that they probably should not have been in prison in the first place, or should receive treatment in community-based settings for both mental health and substance abuse issues and there’s a real deficit in the public health system. I think the other major reason that there is more interest is that communities and families in communities are really reeling from the impact of the extraction of potentially wage-earning men from their midst, fathers from their children, and this is an untenable situation.
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“I think states are beginning to realize that the expense of incarcerating people has not really been a good investment based on the fact that there is no reduction in the numbers of people who are sent to prison.” |
What are the consequences when prisoners exiting prison don’t have health care?
When they do not have health care they generally will, many times, come back with compromised health conditions. There is certainly the risk of infectious diseases that they may have taken to prison, bring home again. Again, the unattended to mental health or substance abuse issues. There’s also the post traumatic stress disorder that really seems to now be recognized—that when people have been incarcerated and come home, they have real stress associated with that period of incarceration, and so they need access to care. The other is oral health care, which is almost non-existent in many prisons, and results in the loss of teeth, particularly teeth in the front of the mouth, that make employment in a job that provides a living wage with benefits pretty much impossible. So they must have access to health care, and that health care linkage really must be established before they leave, so they have a health care home and some payment source, and preferably with someone to help them negotiate the system.
What does successful re-entry look like?
Successful re-entry looks like a place to go and live, some of the extreme prohibitions about living in public housing must be reviewed, particularly for non-violent felony offenders—they can’t go home to their mother, to their wife, to their children or their significant other, so they must have a place to live. Public housing rules must be re-examined. They need to have had their Medicaid benefits, if they were on Medicaid when they went into prison, they need to be already established so that they are eligible to go back to those services when they return, so that they don’t have these delays that make them homeless. They must have employment training, and in some cases when jobs aren’t available in the environment, there must be some way of helping those with the ability and interest to develop their own businesses. In other words, they have to have a place to live, they have to be able to have their health care taken care of and they need some economic opportunity.
Why is prisoner re-entry important?
Prisoner re-entry is important because they bring back to us everything that we sent them away with and more. They come back with compromised health, if we are concerned with hepatitis or tuberculosis or other things, and I really am not wanting to stigmatize this as an ill population, but the population is there, and so we really need to look at the health of the public. But it is not just the physical health; it is the emotional and financial health of families and communities. For us to be a society that values the individual, and that wants to maintain itself as a first world power, we must decide not to discard people who have been to prison.
Do you think it’s important to focus on health issues related to re-entry, or on re-entry as a whole but include health as a part of it?
Re-entry must be focused on the whole. Just to treat a mental health issue or a substance abuse issue without the person having a home and some stability—even things such as food stamps. We have to see whether or not we can make this person whole so that they can become a part of the community again.
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“Some would say that’s a reward; it’s not a reward. It’s what every human being would need. It’s as if your home was washed away by a hurricane—starting over. So how do we really give them a chance to start over.” |
What do you think state legislators should know about prisoner re-entry and health care?
State legislators may not know that while we think there is a system of health care to receive people in our communities, there really is not. Emergency rooms are almost not available, and are terribly expensive, so we need to provide direct and facilitated access to health care services, which are a part of almost one-stop shopping, which includes getting employed, training if you need it, housing, and making sure you have food. Some would say that’s a reward; it’s not a reward. It’s what every human being would need. It’s as if your home was washed away by a hurricane—starting over. So how do we really give them a chance to start over.
How do you think community health workers could play a role in prisoner re-entry?
Community health workers could be assigned to each person who is exiting a facility to make certain that they get to their health care appointments and receive the care needed, that their housing is adequate, and that they have some sort of income. A community health worker can provide not just facilitation to health services, but can make sure that all those other what we call ‘social determinants of health’ are also being addressed. It’s really the wraparound support system, much like people want to use patient navigators to help people with chronic diseases navigate the health system, well these are people with chronic dislocation, and they need to be guided back so that they can locate their place in a community and become stabilized.
Do you think community health workers are where our focus should be on this issue?
I think community health workers are probably the only solution here. Because people need a guide, a hand, a friend, a helper to get them reestablished. Someone who really takes the entire portfolio of a person’s being and gets them connected again. And if we look at even just the numbers of deaths from substance abuse after people come home, it’s not that people want to try to kill themselves, it’s really because they don’t have the options to treatment right away. So I think the community health worker is the first link and should be the most enduring link until that individual is reconnected within a social network that has value.
Is there anything else you want to add?
State legislators should find ways to blend the departments of corrections or jails with the public health services, including clinics, so that a really enduring bond is established between those agencies that will keep these efforts going as part of the way we do business in the United States of America, until we resolve some of these horrible issues around incarceration.
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