The confluence of the opioid epidemic and the relocation of low-level offenders to Indiana county jails, among other factors, have left jails dramatically overcrowded, understaffed, and lacking adequate resources to appropriately house and care for the individuals incarcerated there.

Jails, of course, have a constitutional obligation to meet the medical needs of the individuals in their care. Many Hoosier jails, however, struggle tremendously to meet that minimum standard—due at least in part to the unique nature of jail medical care and the unrelenting flow of people into an already burdened system. 

The care gap is perhaps most acutely felt in the provision of mental healthcare. As Steve Coll highlighted in his recent (and excellent) New Yorker article, the healthcare problems facing our nation’s jails are severe, and unfortunately, Indiana is no exception. According to 2017 Bureau of Justice statistics, nearly half of individuals incarcerated in jail have some form of mental health disorder, and more than a quarter have a severe condition. It is estimated that more than two-thirds of those who are incarcerated suffer from drug or alcohol addiction or dependency—mental health issues in their own right. Many individuals suffer from acute mental health needs at the time of booking--their contact with law enforcement may have occurred during a time of crisis or they are beginning to withdraw from drugs or alcohol.  

These individuals need specific, acute care monitoring and treatment during their initial hours in custody, and continuing care during their time in jail. Even these basic measures are beyond the capacity of many of our jails, and the results are grim—including all too frequent reports of suicides in facilities around the state.   

Few people would dispute that under-resourcing is a significant causal factor in the current healthcare crisis. Nationwide, jails have attempted to balance the influx of individuals entering the system with lowering costs by contracting the provision of medical care to private, often for-profit correctional health care companies. (For more on that, I recommend both Michelle Alexander’s masterful work The New Jim Crow: Mass Incarceration in the Age of Colorblindness and Ava DuVernay’s heart-wrenching documentary Thirteenth.) Indiana is no exception to the general trend, and many jails here have privatized their medical care in an attempt to achieve cost savings. Indiana has also attempted to stem rising costs by allowing jails to charge up to $15 per visit with the jail’s medical staff, and another $15 for the processing of medication. This practice, however, leads many individuals to forego “sick calls” in order to avoid accumulating bills that they cannot pay for treatment that they commonly view as inadequate.    

These efforts, quite simply, are not working. The ACLU of Indiana is constantly fighting litigative battles, with several active cases claiming Indiana jails have failed to provide treatment to individuals who are incarcerated.

But ultimately, we must cut our incarceration rate, and as a society, we must take seriously our obligation to provide the physical and mental health care that incarcerated individuals deserve and require.