Closing

As the discussion continued, several participants reflected on the relationship between incarceration policies and various aspects of public safety. Several challenged the use of the term as a cover for a moral or political agenda—or confusion. Josiah Rich puzzled that “we as a nation haven’t really resolved why we’re locking people up. We’re not clear about that. Are we rehabilitating, or are we punishing them, or are we doing both?” Jamie Fellner argued, “there is a role for retribution and punishment in a criminal justice system,” but that the current rates of incarceration and lengths of sentences go “far beyond legitimate penological goals either of retribution or of incapacitation or of deterrence.” Marc Mauer (The Sentencing Project) concurred, “There’s something fundamentally off when the wealthiest society in the world maintains the world’s largest prison population.” Mauer stated that many now believe the United States incarcerates far too many people and keeps them incarcerated for far too long—beyond the point of providing public safety, and at significant opportunity cost to other methods of promoting both public safety and public health.

In practical terms, Faye Taxman pointed out that incarceration has lost its deterrent effect exactly because it has become so widespread. The criminological and sociological literature confirms that, because of current rates, incarceration has “become more normalized in the general population,” thus diminishing its value for public safety. Rich also suggested that regardless of moral perspective, a practical assessment of the current system reveals its ineffectiveness in serving public safety. Referring to



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Closing A s the discussion continued, several participants reflected on the relationship between incarceration policies and various aspects of public safety. Several challenged the use of the term as a cover for a moral or political agenda—or confusion. Josiah Rich puzzled that “we as a nation haven’t really resolved why we’re locking people up. We’re not clear about that. Are we rehabilitating, or are we punishing them, or are we doing both?” Jamie Fellner argued, “there is a role for retribution and punishment in a criminal justice system,” but that the current rates of incarceration and lengths of sentences go “far beyond legitimate penological goals either of retribution or of incapacitation or of deterrence.” Marc Mauer (The Sentencing Project) concurred, “There’s something fundamentally off when the wealthiest society in the world maintains the world’s largest prison population.” Mauer stated that many now believe the United States incarcerates far too many people and keeps them incarcerated for far too long—beyond the point of providing public safety, and at significant opportunity cost to other methods of promoting both public safety and public health. In practical terms, Faye Taxman pointed out that incarceration has lost its deterrent effect exactly because it has become so widespread. The criminological and sociological literature confirms that, because of current rates, incarceration has “become more normalized in the general popula- tion,” thus diminishing its value for public safety. Rich also suggested that regardless of moral perspective, a practical assessment of the current system reveals its ineffectiveness in serving public safety. Referring to 37

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38 HEALTH AND INCARCERATION the mentally ill who are so disproportionately represented in the inmate population, Rich observed a pattern of “somebody incarcerated, and then come[s] back, and then incarcerated again, and then come[s] back, and then incarcerated again. Something’s wrong.” Rich proposed an outlook “instead of trying to punish people for punishment’s sake, let’s try and look at it as what are the outcomes we want” because the current system “doesn’t make sense if you want public safety.” Mauer also affirmed, “In terms of public safety, we’re well past the point of diminishing returns in terms of what we get out of high rates of incarceration.” He further emphasized that the choice “is not building prisons or doing nothing” but rather using resources in a variety of other ways to promote public safety. This would involve a “fundamental shift in approach,” beginning with a substantial reduction in the prison popula- tion overall. Mauer referred to “credible scenarios and policy analysis that suggest a reduction of 50 percent or so in the prison population would not have adverse effects on public safety and would be eminently doable if we have the political will.” Mauer cited ongoing efforts in California, New Jersey, and New York, through either policy initiatives or court orders, to produce substantial reductions in prison populations. Learning from these experiences will help guide subsequent efforts. Ceasing the current overinvestment in incarceration, making a 50 percent reduction in the prison population, will permit resources to be redirected toward disad- vantaged communities, allowing “justice reinvestments” to redress health and socioeconomic disparities. Mauer acknowledged this is a “challenging shift both politically and practically to make. It seems like the time is ripe to start thinking about how we go about making that shift and what that would look like, and what outcomes we might expect to see.” Bruce Western brought the workshop to a close, articulating sev- eral insights that had emerged over the course of discussion. He began by acknowledging that the growth of the incarcerated population in recent decades is partly “in response to a very substantial public health problem.” Essentially, he observed, “we wound up to an important degree punishing illness and poverty.” Thus, the issues of public health and public safety are deeply intertwined. Western went on to describe prisons and jails as “Janus-faced insti- tutions.” They perpetuate social damage even as they simultaneously deliver much-needed treatment. Thus, “there’s a deep paradox in the character of these institutions that we have to come to grips with.” To do so, Western proposed a “virtuous circle” in which correctional facilities are actively involved in improving public health and the resulting gains in public health reduce prison populations. How could such a virtuous circle be generated and sustained? Western identified three ideas emerging from the workshop discussion.

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CLOSING 39 First, he noted, the logic of treatment is fundamentally different from the logic of custody, especially as “there is a significant suspension of moral judgment about the status of the patient compared to moral judg- ment about the status of the prison inmate.” Promoting the logic of treat- ment could help foster the virtuous circle. Second, Western commented on the depth of the discussion regarding the ethical and political responsibilities of the healthcare community itself (see the section titled “Healthcare Providers” earlier in this report). Acknowledging that he had become far more cognizant of this issue because of the workshop, Western suggested that deeper civic and political engagement on the part of healthcare providers could have tremendous impact on establishing and maximizing the virtuous circle he described. Finally, Western emphasized the value of making transparent the impact of public health on public safety, broadly conceived. If the link between the two were more widely perceived, this would help sustain the virtuous circle, improving both health and safety.

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