Stop the treatment industrial complex

The United States is the world’s leader in incarceration. For nearly 40 years, the prison-industrial complex expanded without interruption and nearly every social problem in America was met with a hammer. Homelessness, mental illness, drug addiction and violent crime all carried criminal penalties and lengthy sentences. Both political parties supported it, companies profited from it, and entire towns built their economies on the back of it.

Recently, however, the political and economic coalition that created mass incarceration has come under pressure. In 2014, 30 states passed laws aimed to reduce their prison populations. These are welcome developments. Mass incarceration is a moral abomination that must be acknowledged, repudiated and unraveled.

But a new system has emerged that bears many of the same features. You could call it the “treatment-industrial complex” — the growing network of facilities and companies built to handle court-ordered community corrections, correctional medical care, and mental health and civil commitment facilities.

As more individuals are being treated and rehabilitated both inside and outside prison walls, for-profit companies are stepping in and profiting. Community corrections is particularly expansive, and includes an array of out-of-jail programs like probation and parole services, halfway houses, day reporting centers, drug and alcohol treatment programs, home confinement, electronic monitoring, and various supportive services such as educational classes and job training. Although many of these services are provided by public-sector and nonprofit entities, the expansive reach of treatment and rehabilitation is increasingly attracting for-profit companies. Their success depends not on being effective, but in keeping as many people as possible under supervision for as long as possible. The lengthier, deeper and more expansive the treatment, the greater the profit.

Community correction programs that occur outside of prison walls are the most lucrative opportunity for the treatment-industrial complex. The majority of individuals involved in the criminal justice system, roughly two-thirds, are in community programs, not behind bars. Programs like home confinement, day reporting, drug and alcohol treatment, probation, parole, and remote electronic monitoring are expanding and proliferating as alternatives to incarceration continue to gain momentum.

Prison-like treatment facilities such as forensic psychiatric hospitals and civil commitment centers are also growing in both number and enrollment. Government statistics suggest that employment in these areas will increase by 22.8 percent by 2022.

There’s also the provision of more narrowly tailored medical and mental health care within existing prisons and jails or in new facilities. Currently, about 25 states contract some or all of their correctional health care to private companies, and countless local jails do the same. Numerous counties in California, including Alameda, Santa Clara, Contra Costa, San Mateo and San Francisco, have authorized new jail construction projects to house individuals whose primary crime is having an untreated mental health or substance use disorder.

Rehabilitation and treatment is a more humane and effective response to mental health illnesses and drug use than retribution and punishment. Mental health and substance use are public health issues that do not require a criminal justice response. Nevertheless, if policymakers decide to use a treatment based approach within the criminal justice system, it will succeed only if the incentives of the providers align with the patients.

It is most important to get these incentives right when states contract out work to private companies, whose bottom line depends on the growth of supervised populations, rather than their rehabilitation and treatment. For more than 30 years, private companies like Corrections Corporation of America (CCA) and GEO Group have profited from mass incarceration. They operate more than 158 correctional and detention facilities in the U.S. and three other countries, and their annual revenue exceeded $1.79 billion and $1.84 billion, respectively, in 2015.

These companies, along with others, are now profiting from the new revenue streams created by treatment and rehabilitation programs.

GEO Group, for example, created GEO Care in 2012 to provide correctional mental health care services and operate state psychiatric hospitals. Merging with Correct Care in 2014 and spinning off to form Correct Care Solutions, they now run psychiatric treatment hospitals and civil commitment centers in Florida, South Carolina and Texas and provide subcontracted mental health and medical care inside prisons and jails as well. In 2010, GEO acquired Behavioral Interventions Inc., a company specializing in community correctional monitoring using technologies like GPS ankle bracelets, voice verification and remote substance-abuse detection. GEO clearly sees the monetary potential in these services, noting in an earnings call in November that “the emphasis on offender rehabilitation and community reentry programs as part of criminal justice reform will create growth opportunities for our company.” The GEO Group has begun to capitalize on alternatives to immigrant detention as well. In 2015, U.S. Immigration and Customs Enforcement awarded GEO Care $11 million to provide case management services to migrants who have been released from detention centers and $56 million for their ankle monitoring services.

CCA has followed suit, acquiring Correctional Alternatives Inc. in 2013 and Avalon Correctional Services in 2015, leading operators of halfway houses and other reentry services.

These for-profit companies argue that they have developed the expertise to best treat these patients, but their foray into treatment, rehabilitation and case management should be met with great suspicion. Their record of managing prisons is ripe with abuse, and complaints alleging inadequate safety, care and arbitrary cost-cutting abound. These same complaints are now proliferating regarding their treatment and rehabilitation programs.

In Florida, a man died in a scalding bathtub at the GEO-run South Florida State Hospital after being left unattended in 118-degree water. His cause of death was listed as “undetermined,” though his skin had peeled off his body. In Westchester County, New York, where Correct Care Solutions has provided medical care to the jail since 2010, more than 40 inmates have sued the company over inadequate care. In one case, Correct Care Solutions staff returned a man to his jail cell after he complained of chest pains because they believed he was faking. He was dead less than four hours later.

These are just a few examples of how the treatment-industrial complex is inflicting harm on some of the most marginalized Americans. However, there are ways to stop it before it garners the size and power of the prison-industrial complex.

The government must invest in public health strategies that improve access to quality treatment options for mental health and substance use disorders. Obamacare is a major step in that direction because it expands access to substance use and mental health treatment, offering coverage to many Americans for the first time. Individuals who receive proper care are less likely to be ensnared by the criminal justice system. Moreover, the federal government should incentivize states to use this funding to expand treatment options for mental health and substance use disorders, preferably by awarding contracts to community-based organizations rather than for-profit corporations.

If the criminal justice system must provide specialized health care to a large number of people, companies should not be able to profit from it. Instead, states should run these health care facilities themselves with strong independent oversight. If states choose to privatize these services, they should impose strict contract management procedures to mitigate abuse. Bed quotas and occupancy guarantees are failed contracting practices that should be replaced with incentives for rehabilitation and release. In addition, contract oversight must be taken seriously and regular audits should be used to ensure accountability.

In order to limit prison profiteering, Congress should pass the Justice Is Not For Sale Act. The bill prohibits the federal government, states and localities from contracting with private corporations to run prisons and immigrant detention facilities, but could be expanded to include treatment centers, mental health facilities and other components of the treatment-industrial complex. With those additions, the bill would make great strides in curbing for-profit abuse in the prison-industrial complex and ending the treatment-industrial complex before it causes further harm.

Not until the prison-industrial complex had decimated both communities of color and state budgets did it begin to show signs of cracking. The treatment-industrial complex is in its infancy. We should heed the warnings of history and scrutinize the incentives and priorities of those who stand to profit from it now rather than later.