Abare: No new jail—rising COVID cases call for decarceration

Last month, amid the largest outbreak in the jail since the start of the pandemic, a man being held in our county jail died from COVID-19. Now, as omicron surges, people in custody are more vulnerable than ever.

The COVID pandemic has highlighted what epidemiologists have known for decades—correctional facilities concentrate disease and spread it to communities. Yet despite public health officials’ calls to release individuals, the Board of Supervisors is considering a dangerously misguided approach—construction of a new jail.

For decades, policymakers have erroneously associated incarceration with increased public safety. As a physician who works with justice-involved individuals, I can attest that policing and confinement make my patients and our community less safe. By design, incarceration promotes premature mortality and exacerbates mental illness and addiction. My patients need high-quality mental health and substance use treatment—not a new jail.

Although jails are the largest provider of mental health care and housing for people with severe mental illness, jail exacerbates mental illness. Even in a high-priced facility with shiny new bars and updated technology, the essence of detention is to strip individuals of their humanity. Jail promotes decompensation of psychiatric disorders and the development of coping techniques poorly suited for living in the community.

With the exception of those who die in custody, all others will eventually be released. Due to their experience in jail, these individuals are often sicker, more isolated, less able to acquire resources to sustain their well-being and more likely to fall through the cracks of a fractured safety net.

The prevalence of substance use disorders among those in jail is estimated between 50-70%. Yet jail does not promote sobriety or protect from overdose death. There is no existing facility in our county for patients requiring medically supervised withdrawal management. When denied access to treatment, many patients suffering from addiction find themselves vulnerable to arrest.

After five decades of historically unprecedented expansion of incarceration in the United States, there are now political and cultural shifts acknowledging that locking human beings in cages isn’t working.

In a statement formally endorsed at its annual convention on Oct. 26, 2021, the American Public Health Association recommended “moving towards the abolition of carceral systems and building in their stead just and equitable structures that advance the public’s health by: (1) urgently reducing the incarcerated population; (2) divesting from carceral systems and investing in the societal determinants of health; (3) committing to non-carceral measures for accountability, safety and well-being.”

We can reduce incarceration in this county. In spring 2020, while other California jails became the center of outbreaks, Santa Clara County acted decisively in the interest of the public, releasing approximately 1,000 individuals. Criminal activity at that time, including violent offenses, did not increase. Patients of mine who were released from jail to community supervision in the setting of COVID-19 were able to address their health and social issues.

Instead of creating space for more detainees within a new jail facility, the board should focus county resources on avenues to release more individuals from pretrial detention. These interventions would reduce the jail population—without impacting public safety—and improve space, sanitation and staff-to-patient ratios.

This is a critical juncture in our county’s handling of public safety and health-related social ills that are currently treated with incarceration. Responding with a new jail would be a grave disservice to the people of this county and a lost opportunity to meaningfully address the root causes of crime and disability in our community. When what’s desperately needed is community-based, high quality and accessible mental health and drug treatment services, using precious public dollars to build a new jail facility is backwards public policy.

Marce Abare, MD MPH, provides primary medical care for patients recently released from custody at the Reentry Resource Center and for jail-detained individuals with substance use disorders at Elmwood and Main Jail. She’s cared for hundreds of men and women who cycle through Santa Clara County jails, and is intimately familiar with the landscape of service provision for county residents living with medical complexity, severe mental illness and addiction. She speaks only for herself as an individual, not on behalf of her employer.