Treating Jails as Part of the Health System
Every year, the nation’s 3,300 local and county jails provide health care to many of society’s most vulnerable people. The approximately 11 million individuals who cycle in and out of jails each year have high levels of unmet health needs—mental health and substance use disorders, chronic and infectious diseases—that frequently contribute to their criminal behavior.
Yet, historically, jails have not been viewed as part of the health care safety net, nor have they been included in major health policy debates.
Burness worked with Community Oriented Correctional Health Services (COCHS) to persuade federal, state and local policymakers that meeting the needs of the jail-involved is essential to improving both public health and public safety. COCHS’s approach is to foster connectivity between health care provided in jails and health care provided in communities.
In particular, we worked to elevate the opportunities created by the Affordable Care Act (ACA) to extend Medicaid coverage to the jail-involved and connect that coverage with appropriate treatment in local communities. Our tactics included:
- Building connectivity: We forged strategic partnerships with groups such as the Department of Justice, the National Association of Counties and the National Minority Quality Forum, and convened national meetings that put COCHS’s issues on the map.
- Amplifying the message: We supported the first-ever cluster of articles on jail health in Health Affairs, including an essay that we helped develop for Sheriff Mike Ashe of Hampden County, MA, and a blog that we co-authored with MacArthur Fellow Jeff Brenner, MD. We also guided COCHS leaders on the handling of national media requests from the New York Times, PBS NewsHour, the Washington Post, the Atlantic and others.
- Establishing thought leadership: We crafted and refined issue messaging to reflect new developments and opportunities. We also helped develop high-level articles and policy papers on issues like Medicaid expansion and health information technology to inform policy discussions and local initiatives.
Results and Impact
When we began working with COCHS, connectivity was a new idea and COCHS was a brand-new organization. Today, COCHS is a recognized leader and convener among multiple health and criminal justice policy influencers in promoting connectivity between jails and communities.
With our support, COCHS has become a key resource to the Department of Justice, the Substance Abuse and Mental Health Services Administration, the Office of National Drug Control Policy, the Office of the National Coordinator for Health Information Technology and others—helping them understand and navigate this intersection between health and criminal justice policy.