There is inherent tension when finding the middle path through the two dialectical points of view of incarceration and liberation. Carrying this weight after many years is probably the biggest challenge.
A good example of this is when COVID-19 was tearing through our western MA counties in early 2020. We were able to quickly pivot and successfully adapt programming because of its history of applying public health approaches to address the opioid epidemic – the Franklin County Sheriff’s Office (FCSO) is among the first jails nationwide to provide correctional populations with access to all three medications to treat opioid use disorder (MOUD, i.e., buprenorphine, methadone, naltrexone). FCSO’s COVID-19 mitigation measures were highly effective – FCSO had no COVID-19 outbreaks until late 2021 and the incarcerated population at FCSO had a 91% uptake of vaccination due to our vaccine education strategy – DPH was estimating that 10% of the incarcerated population would take the vaccine while incarcerated. For more information about this, please see this article published in the Journal of Substance Abuse Treatment.
In March 2020, Massachusetts Supreme Judicial Court mandated the release of non-violent pre-trial detainees, resulting in rapid de-population of the jail. From March 12, 2020 to May 10, 2020, the jail’s average daily count decreased from 205 to 131. While the rapid releases were suitable given the circumstances, the majority of the clients released had complex health and psychosocial needs:
About 41% of individuals rapidly released were on Medication for an Opioid Use Disorder (MOUD) – meaning they needed medication within 24 hours of their last dose or they could begin to experience adverse symptoms associated with withdrawal (note: methadone/buprenorphine users are advised to detox in a medical environment). We were given typical only a matter of hours notification that someone would be leaving.
For example, an individual scheduled for rapid release was unhoused (their plan was to live in a tent if released), was on methadone, insurance was inactive, didn’t have a car, needed transportation from the court to a rural town to pick up their belongings, and was on a GPS monitoring bracelet issued by the court (remember they were living in a tent – and they had no means to charge the bracelet – and if the battery runs out the court views this as a violation and a warrant for their arrest will be issued and they will be sent back to jail). So within 2 hours, if we were not able to activate their insurance, figure out a way for them to charge their GPS bracelet, connect the client with a methadone provider and figure out how they were going to get to the methadone clinic, the person would be going through severe withdrawals, living in a tent, in March 2020.
Would the client not have been safer spending a few more days at FCSO while we established proper aftercare support, rather than being rapidly released without any support established – this is the dialectic that can be challenging at times. Are there times when it is safer for a person to be in jail than out in the community? Many clients say yes; despite my emotional mind’s objection.
Of course, I want people to have their liberty but more than that, I want people to be alive.
Holding this level of complexity is required of social workers who work within the prison system – and it is complicated and easily leads to burn out. It is easy for these environments to chafe up against the social work values of social justice, dignity and worth of the person and service (who exactly am I serving in this environment). If incarceration is going to play a role in “the solution” to criminal activity, these systems must adopt modern evidence-based behavioral health trauma responsive strategies to transform what has objectively been historically ineffective “correctional” environments.
There is wisdom found in so many places, perhaps even from the great fictional character Jean-Luc Picard, “change always later than we think it should,” …. “as much as people try to provoke change, or dictate when it should arrive, it comes precisely when it needs to. It’s never too late for change to occur.” And currently, change is happening because it needs to! So I will continue to show up as we make this road by walking – lets continue to work to support the transformation of carceral systems in an effort to move toward effective modern evidence based treatment environments.
