Mass incarceration and access to healthcare are both subjects in the national spotlight, but not many people are talking about the connection between the two. We know firsthand that this intersection can’t be overlooked. It’s what drove us to partner with Tulane University to open the Formerly Incarcerated Transition (FIT) Clinic, a place for formerly incarcerated people (FIP) to go get quality healthcare as they transition into life on the outside. Now we’re expanding our work on medical rights via an exciting new opportunity. Last month, our Deputy Director Bruce Reilly (BR), Andrea Armstrong (AA), Professor of Law at Loyola University New Orleans, and Ashley Wennerstrom (AW) with the Center for Healthcare, Value, and Equity at LSU Health Sciences Center won a research fellowship from the Robert Wood Johnson Foundation (RWJF). For the next three years, they’ll work together to lift up the medical needs of directly impacted people by taking a complete look at medical treatment (or lack thereof) within prison walls, reviewing the transition services currently available to people in Louisiana, and evaluating the effectiveness of Louisiana’s Medicaid expansion to include people with convictions. We sat down with this incredible research team to learn about why FIP-centered research is so crucial at this moment, what excites them about this opportunity, and more.
VOTE: How are you doing today? What’s something on your heart that you’re bringing with you here?
BR: Awesome. I’m thinking about the love of my daughter who’s in town!
VOTE: How did it feel when you found out you received the fellowship?
AA: Disbelief. We had just been dreaming about what the project could be like and worked on the application for so long, so when we got the email that we’d been selected it was unreal.
VOTE: How did you become interested in the intersection of incarceration and healthcare?
AA: The focus of all my research is on jail and prison conditions. It’s always been really clear to me that medical care is the leading cause of death in prison and jails, so to prevent these deaths is a really exciting possibility.
AW: My involvement started many years ago. I had a dear friend who was locked up for about 44 years, and he got cancer while incarcerated. It started as Hepatitis C, which went untreated and turned into liver cancer. It was awful to watch him go through that. His conviction was overturned, and he was released just a few days before he died. He came home with me, some friends and family. I saw firsthand the consequences of someone not getting care while incarcerated. His name was Herman Wallace, of The Angola 3.
BR: I saw so many people suffering from mental and physical health issues on the inside, as well as the real gaps in treatment and the dubiousness with which healthcare “professionals” treat people who are complaining of symptoms. When I learned about the legal standards of care, I saw the challenges with them, the failure to meet them, When I got out, I saw it’s not just a symptom of incarceration, but also a symptom of poverty.
VOTE: What are your goals for the fellowship?
AW: More broadly, [a goal is to shift] thinking about criminal justice as a public health issue, and help reframe the narrative about why it’s so important for us to care about people who are and were incarcerated.
BR: [We also want to] build awareness that this is an issue. It’s not until you start talking about it. Then people go, “oh yeah, I’ve never thought about that.” There are a lot of issues that people never thought of until some currently incarcerated people started shaking the tree a little bit.
AA: We’ll have a chance to document in a systematic way all of the different ways that people are not receiving constitutionally proper healthcare. I don’t think there’s very much that’s known about how healthcare is delivered in jails and prisons. So this is a small project that provides the opportunity for deeper work. What comes out the end of these years will lay stronger foundations for future study. The ultimate goal is to improve conditions with better healthcare with Louisiana prisons primarily, but hopefully also jails. We hope to develop strong policy changes and recommendations to put forward.
VOTE: What role do you think academia and research have in reforming our carceral system?
AA: It’s about creating a story. Academia builds a data-focused, broader story. Ashley and I in different ways are contributing the analytical data that supports and confirms the stories that we hear from VOTE members and provides the foundation to advocate for improvements.
AW: I think that in order for that research to be effective, though, it needs to be done in partnership with people who are directly impacted. This is why we’re so excited to work with VOTE.
BR: When we have these silos and researchers who “know better,” that’s when things run off course. I think we all really benefit from the connection and dedication with the community that good researchers have. The real heart and soul that they put into their work, and why they do it, what motivates them, are all the best qualities that we hope for all members of our community. Sometimes you get people who are really smart [and] they may fight to win, but they’re not really in it for the right reasons, and they’re not going to stick around when the fight is over. So we try to build with people who are in it to win it and in it to the limit.
VOTE: Why is access to Medicaid is important for people who are just getting out?
AA: Overwhelmingly nationwide, we tend to incarcerate people who are marginalized through their income, their race, gender, disability and/or mental health status. So the people who are being released are those who were treated as second-class members of the country before they even went to prison. When they’re released, they’re likely leaving more traumatized than they came in with. [We’ll analyze] Medicaid data [for] the types of services [FIP] access when they get out and ask if the use is different from the general population. If it is, the question is why? Our hypothesis is that the use would be different because they may not have received constitutionally adequate healthcare on the inside.
AW: Medicaid [access] is absolutely critical. We know that people are at an increased risk of death right when they get out. For two weeks after being released from prison, people are 12 times more likely to die than others in society.
VOTE: Can you describe what the community engagement aspect of this research will look like?
AW: Our partnership is rooted not just in collaboration, but in friendship. Bruce and I have been doing this kind of work together for about five years already. My highest desire is whatever the directly impacted community wants. Right now, we intend to do focus groups with formerly incarcerated people about their needs that weren’t met [while they were on the inside]. Though it will be difficult, we’re also going to try to do interviews and/or focus groups with people who are currently incarcerated. [Throughout the research], we’ll keep directly impacted communities and transition services updated on what we’re finding, and check in with VOTE staff and members to be sure we’re asking the right questions and doing the research the right way. If the community says there’s something we’ve missed, by all means, we can make adjustments as we go.
VOTE: What do you hope the long-term impact of your study will be?
BR: This fellowship is another brick in the wall, another step in the journey towards giving people the healthcare they deserve. If you’re going to take over someone’s body, and not give them the option to take care of their own body, then you have to take care of that body until you no longer have control over them. No one should live in a world where their family members go to prison and aren’t able to get preventative medications or to treat things that are treatable, and suddenly have them dumped back on your door.
AA: In many ways, jails and prisons are seen as isolated “behind the walls” spaces where society and family members don’t have access, and [therefore can’t be] involved. Instead, I want us to think about them as public health spaces. Jails and prisons are part of our social fabric. What happens in these facilities doesn’t stay contained in these walls, but spills out in lots of different ways--in incarcerated people’s relationships with their families, their ability to get a job. When we think about these spaces as public health spaces our practices radically change.
AW: We have this idea that people who are in prison are “bad people”, so while they’re there whatever happens to them is not really our concern. We hope to bring some compassion to this issue. Regardless of whether someone is incarcerated, they still have the right to respect and dignity. Poor health should not be part of the punishment.
VOTE: Beyond this fellowship, what do you hope to see for the future of healthy communities?
AA: First, I’d like to see people leave no worse off than when they entered [jail or prison]. Confinement and separation are punishment enough. We have people who are being held captive to a healthcare system that doesn’t keep them healthy. Health takes lots of forms. In healthy communities, mental health is addressed, people can get acute and preventative care when they need it--not just when it’s an emergency--and when people come home they don’t have lots of obstacles.
AW: When we think about reentry, [sometimes it] sounds like we’re trying to check boxes of getting someone housing or a job. We forget to talk about people’s wellness and mental health. We don’t think about restoring and establishing relationships that have been damaged [or prevented] while people were incarcerated. How do we help this person become a full member of society in the same way that we do for those of us who haven’t been incarcerated?
BR: Part of this is about access, part of it is about availability. Those are two different things. It’s kind of like having voting rights and not having them. Just because you have them doesn’t mean you can use them. If you’re going to have a program that’s providing, let’s say, medication treatment for addiction, but at the same time isn’t going to test people for diabetes, it’s a little bit half-hearted and may defeat the whole purpose. Why am I going to keep you alive if I’m going to let you die of something else? I want to see a world where the medical professionals are as engaged with our community of currently and formerly incarcerated people as they are with other communities. There’s no reason for that division. If you’re in jail in New Orleans, you’re within half a mile of three hospitals. There’s no reason to build a barrier and say “we don’t do healthcare across the wall.”