Survey Paints Grim Picture of Life in Incarceration

Over half of incarcerated people in the survey have mental health issues and nearly half have substance use disorders.

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The U.S. prison system has been criticized by activists and reformers who have noted the rampant abuse and neglect that incarcerated people face. Reports on homicides, sexual assaults and outbreaks of COVID-19 often dominate the news about prison conditions. But rarely is the public provided a full picture of the significant obstacles faced by incarcerated individuals on a daily basis.

The Survey of Prison Inmates (SPI) is a collection of self-reported survey data from state and federal prison populations. The last survey was conducted in 2016, and released late 2021; it collected data on incarcerated individuals’ drug use, mental health, access to firearms, and more. The results offer a sobering glimpse into the daily lives of incarcerated individuals that is often inaccessible for a public detached from the prison population and its daily struggles.

The most recent survey results paint a picture of systemic neglect within the prison system. The staggering, yet unsurprising, data on incarcerated individuals’ mental and physical health and safety shows the urgent need to address prison conditions. Or better yet: abolish them completely.

While the BJS has its own series of publications on the results, a new report from the Prison Policy Initiative (PPI) analyzes the results in detail, while considering identity, disability, and conditions prior to incarceration. PPI also compares many of the data points to the general U.S. population, building the case that the prison system has never and could never properly care for incarcerated individuals. The results highlight how people are living in agony in prisons.

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According to the SPI, over half of people in state prisons reported some indication of a mental health problem. In the 30 days before the survey was administered, 16 percent of respondents felt nervousness, hopelessness (12 percent) or depression (11 percent) “all or most of the time.” The rates were even higher for women in all cases of mental health disorders. While the act of being incarcerated can clearly generate these conditions, the numbers are so large, it’s likely that significant numbers of people in prisons had mental health problems before they arrived—ones that required treatment, not punishment.

It is not only the case that prisons cannot care for their populations, but also that they choose not to through underfunding treatment programs and simple neglect. When people are suffering so deeply and consistently in a system predicated on and maintained by slave labor, modest reforms do not rise to the occasion.

Addiction among prisoners is nearly as bad. According to the survey, 49 percent of people in state prisons, and 59 percent of women, dealt with substance use disorder within the year before entering prison. By way of comparison, only about 7 percent of U.S. adults had a substance use disorder in 2017. American prisons are simply addiction factories.

Substance abuse disorder has long been associated with incarceration. In the 1970s, drugs were pumped into low-income communities of color, often driving people to do extreme things to feed their addictions, or while under the influence of a substance. Those problems, plus war on drugs criminalizing possession or sale of drugs, landed thousands of people, particularly Black ones, in prison, where their labor was then exploited for profit. Then the gruesome conditions in prisons turned the system into a recidivist nightmare, with convicts returning again and again. (Activists and prison abolitionists, like Angela Davis, had always seen the writing on the wall.)

The main way prisons keep their inmates coming back is by not treating incarcerated people who have a substance use disorder, as well as criminalizing addiction in the first place. U.S. adults outside of prison often have easy access to “gold standard” medication-assisted treatment, such as methadone and buprenorphine, while incarcerated individuals are often forced into dangerous withdrawals upon entering prison.

One in 10 people in state prisons has contracted hepatitis C at some point, a number PPI reports as more than five times the estimated rate of U.S. adults with the viral infection.

According to the Jail & Opioid Prison Policy Project’s database, there are at least 600 medication for opioid use disorder (MOUD) treatment programs in the country, most of which began after 2016. And according to early reports on the results from a 2020 medication-assisted treatment program in California prisons that treated ”more incarcerated addicts than any such program in the country” and led to a 58 percent reduction in drug overdose deaths in the two years after the program was implemented.

Still, “MOUD is still not available in most facilities and, even where available, it may be difficult for many individuals to promptly access treatment,” according to a report from 2021 called Medications for Opioid Use Disorder in Jails and Prisons: Moving Toward Universal Access. This report, led by the Johns Hopkins Bloomberg School of Public Health, summarizes leading ideas on how to increase access to and distribution of these life-saving programs. Simple ideas such as low-threshold treatment, which lowers treatment requirements, or enrolling more individuals in Medicaid, could make a large difference.

The neglect is not limited to highly stigmatized problems like mental health and drug abuse. One in 10 people in state prisons has contracted hepatitis C at some point, a number PPI reports as more than five times the estimated rate of U.S. adults with the viral infection. Treatment for hepatitis C outside of jails can cure more than 90 percent of hepatitis C cases, but as PPI notes, 80 percent of people in state prisons that have been diagnosed with hepatitis C still have the disease.

The ailments that incarcerated people face afflict the non-incarcerated population as well. But there is a particular unwillingness to treat and help incarcerated individuals. This unwillingness is tied to archaic, racist views on who deserves life and liberty, and who doesn’t, as well as the need to exploit prison labor for profit. When that is illuminated through state-sanctioned surveys like the SPI, it is easier to remember why the only answer is abolition.

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