Treatment Industrial Complex

A terrific (and timely report for Hawai`i)  was just released by the American Friends Service Committee, Southern Center for Human Rights, and Grassroots Leadership about prison corporations getting into the “alternatives” business.

We have been railing against this for several years as the profiteers have lost a huge percentage of state business as many state’s have reduced their prison populations, thus decreasing or eliminating their ‘need’ for contract beds. (Hawai`i has reduced our prison population a little bit, but nowhere near what the population would have been if Hawai`i had truly embraced justice reinvestment.)

Anyway, we are very concerned that these profiteers will now try to sell their ‘community services’ to the state and replace our own community of effective and local service providers of substance abuse and mental health treatment and other vital services to ourpeople. These prison profiteers  are sharks with highly paid attorneys who negotiate these deals daily. Judging from the contracts with UPW (the ACO union) that allows them to not show up for work, we worry about the state negotiating in the shark tank.

We are worried that the Request For Proposals that the department of public safety is putting out includes not just prisons, but a reentry center.  YIKES! These guys must be salivating. We imagine that there is plenty excitement in the pig sties board rooms these days.

TREATMENT INDUSTRIAL COMPLEX: How For-Profit Prison Corporations are Undermining Efforts to Treat and Rehabilitate Prisoners for Corporate Gain
American Friends Service Committee; Grassroots Leadership; Southern Center for Human Rights
November 2014
FULL REPORT 21 pages

FINDINGS

  1. TIC_report_coverMost for-profit prison corporations have dismal records in terms of safety, cost, and quality of the prisons that they manage.6 Across the country, evidence has surfaced that these companies cut corners on staff pay and training and services to prisoners in order to make a profit.7 Application of the same business model to treatment, services, and alternatives to incarceration has demonstrated the same sorts of problems

 

  1. The profit motive is inherently at odds with the stated purpose of ‘corrections,’ including community corrections, which is to reduce offenses that land people in prison thereby reducing the number of incarcerated individuals. Private prison corporations are financially dependent on the growth of supervised populations, providing a perverse incentive not to rehabilitate.

 

  1. While many sentencing reform efforts are geared toward keeping people out of the system and/or returning them to their communities as quickly as possible, the financial incentive for private prison corporations is to keep people in custody or under some form of super vision for as long as possible at the highest per diem rate possible in order to maximize profits. This creates the potential for a dangerous trend of “net widening”—placing more people on stricter forms of supervision that is necessary, and longer than is warranted.

 

  1. The problem inherent in the Treatment Industrial Complex cannot be simplified into a for-profit vs. non-profit dichotomy. There are many examples of for-profit healthcare, mental health, and reentry programs that are effective and plenty of publicly-run and non-profit organizations with dismal track records. However, the fact that certain for-profit corporations are public traded does raise the question of where such companies’ primary loyalties lie. In most corporations, the first priority is to generate profits for shareholders. This creates pressure on the business to constantly grow, which encourages compromising the quality of care.

 

Despite the serious implications for sentencing policy, public safety, state budgets, and the lives of thousands of individuals in the criminal justice system and their families nationwide, the treatment industrial complex has not yet received the critical analysis or public attention that it deserves. Stakeholders (sentencing reform advocates, treatment providers, criminal justice professionals, elected officials) are largely unaware of this trend or its implications for their agencies, programs, or public policy options. This is a critical moment. There is a nationwide movement to rethink our criminal justice priorities, favoring evidence-based practices that favor treatment and prevention over prison warehousing. At the same time, the Affordable Care Act provides the greatest potential for providing needed substance abuse, medical, behavioral and mental health care at the community level in decades. This could divert a huge number of people from prisons and jails.8

Unfortunately, it also provides a potential new funding source to for-profit prison corporations moving into the “alternatives market.” This brief represents an initial effort to name and describe this phenomenon, as well as to provide some basic framework for decision-makers and other stakeholders to examine, evaluate, and make contracting decisions.

 

This brief represents an initial effort to name and describe this phenomenon, as well as to provide some basic framework for decision-makers and other stakeholders to examine, evaluate, and make contracting decisions.

 

Within the national dialogue(s) around mental health and criminal justice there must be more scrutiny and examination of these trends. Further study is needed on each of these segments (and the many others—juvenile detention, in-prison services, etc.) to determine the cost, effectiveness, and impacts of the treatment industrial complex.

CONCLUSIONS

Despite the serious implications for sentencing policy, public safety, state budgets, and the lives of thousands  of individuals in the criminal justice system and their families nationwide, the Treatment Industrial Complex has not yet received the critical analysis or public attention that it deserves. Stakeholders (sentencing reform  advocates, treatment providers, criminal justice professionals, elected officials) are largely unaware of this trend or its implications for their agencies, programs, or public policy Options.

This is a critical moment. There is a nationwide movement to rethink our criminal justice priorities, favoring evidence-based practices that favor treatment and prevention over prison warehousing. The debate over immigration reform rages, with the potential ‘path to citizenship’ posing a serious threat to essentially half of CCA and GEO Group’s profits. The role of for-profit prison corporations in these important policy discussions could mean the difference between reforms that truly address human needs and a destructive “widening of the net”that only serves to increase the level of control and surveillance at the expense of public safety.

At the same time, the Affordable Care Act provides the greatest potential for providing substance abuse, medical , behavioral and mental health care at the community level in decades.  This could divert a huge number of people  from prisons and jails. Unfortunately, it also provides a potential new funding source to for-profit prison corporations moving into the “alternatives market”.

There is no question that treatment services are desperately needed in many states. The constitution requires that incarcerated people be provided with quality medical and mental health care. Patients in state psychiatric hospitals and civil commitment centers deserve safe and effective treatment and safety. Alternatives to prison and reentry services are critical to reducing prison populations and lowering recidivism rates.

Yet, for-profit prison corporations are too often not qualified or appropriate to manage such programs. Applying a corporate culture of incarceration to treatment and alternatives to prison has consistently delivered  poor to disastrous results. These critical programs should be in the hands of community-based non-profit organizations and/or companies that bring experience in the relevant field, are transparent and accountable to taxpayers, and are grounded in evidence-based practice and high standards of care.

 

RECOMMENDATIONS

The emergence of the Treatment Industrial Complex raises important and timely questions about the driving force behind, the real decision-makers involved, and other influences at work in the national movement toward sentencing reform and efforts to privatize prison medical care and forensic mental health care.privatize prison medical care and forensic mental health care.

This is a new phenomenon that is only just being discovered and examined. Criminal  justice advocates, systems actors, good government proponents, treatment and service providers, mental health advocates, and government agencies must be aware of the TIC and critically evaluate any proposed movement in this direction. Within the national dialogue(s) around mental health and criminal justice there must be more scrutiny and examination of these trends. Finally, further study is needed on each of these segments (and the many others—juvenile detention, prison services, etc.) to determine the cost, effectiveness, and impacts of these emerging trends.

The fact that the Treatment Industrial Complex is an emerging and evolving phenomenon provides both  dangers and opportunities for states and local governments. In the best case scenarios, government and  systems actors have the opportunity to be proactive rather than reactionary. Because state and municipal agencies award contracts, they are key influencers in crafting how individual contracts are structured.

 

This also means that, collectively, they have the power to determine what the landscape will look like ten and twenty years from now. Although many of the privatization scenarios that we see today have been motivated by reactionary fiscal measures rather than real reform, a new approach emphasizing outcomes, evaluation, and accountability could promote creative local solutions to local problems.

 

When a state contracts with an organization or company to provide medical or mental health care,  treatment or rehabilitation services, it is handing over control of an essential public function to a company that may have different goals and priorities than the government and public. Privatization contracts represent a long term investment (typically 20 years) in a business relationship with a corporation. Once the state enters into a contract, it can be extremely difficult to nullify or amend the contract, even when the contractor is shown to be grossly negligent or abusive.

 

For these reasons, as well as those enumerated above, the following guidelines are important in guiding decisions regarding prisoner or detainee medical care, inpatient and forensic mental health care and civil commitment, and a variety of treatment, rehabilitation, and supervisory services. They are grouped by the various stages of the decision-making process: Assessment, contracting, and evaluation.

 

GUIDELINES

This analysis brings forward three primary questions that decision-makers can use in determining whether and when privatization is appropriate:

  1. What is the public health, safety or justice-related goal of the proposed program (treatment, prevention, reduced recidivism, etc.)? Does the contractor have the same or different goals?

 

  • Corporate Philosophy: Corporations such as CCA and GEO Group are historically grounded in a “prison-mindset” that emphasizes custody, control, and punishment. The difference between viewing individuals in a facility as “inmates” versus “patients” or “consumers” is vast. Even when rebranded as healthcare companies, their original purpose of incarcerating “inmates” remains.
  • Priorities: Large publicly held corporations should be viewed with scrutiny because they must continually produce increasing profit for their shareholders, often prioritizing their shareholder profits over quality, effectiveness and ethical and moral concerns.

 

  1. Is the contractor/program effective and how are outcomes measured?
  • Due Diligence: A critical component of potential outsourcing is conducting the “due diligence” on the background and performance of potential contractors. In the case of corporations such as CCA and GEO Group, decision-makers have the benefit of 30 years of state private prison contracts. Corizon and Wexford, too, have long histories, and a basic scan is enough to generate an overwhelming body of criticism including negative press, audits, investigation reports, lawsuits and the like. There are additional resources that will be listed in Appendix A that can provide more detailed evidence and analysis.

 

One critical aspect of researching these corporations’ track records is monitoring their mergers or acquisitions with other companies. Corporations such as GEO Group and Corizon should be evaluated as the sum of their parts, meaning that the histories of the companies they have acquired and spun off should not be overlooked.

 

  1. Is the level of custody or supervision appropriate to the individual’s level of risk or is it “widening the net”?
  • Level of Need: The latest research on evidence based practices in treatment and rehabilitation stresses using scientific risk assessment tools to place individuals on the least restrictive form of supervision appropriate. This allows states to focus resources on those who require the most supervision and need the most help. However, for-profit prison corporations work on a contract basis, which tends toward a “one-size-fits-all” approach.

 

  • Profit increases with volume: Corporations moving from the prison and detention market into treatment and alternatives bring a corporate perspective that is too focused on profit through term investment (typically 20 years) in a business relationship with a corporation. Once the state      enters into a contract, it can be extremely difficult to nullify or amend the contract, even when the contractor is shown to be grossly negligent or abusive.
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