By Cristina Mendez, Jeffrey Selbin and Gus Tupper

In 2019, the Idaho Legislature’s Office of Performance Evaluations (OPE) published a report acknowledging Idaho’s reliance on fines and fees as a source of court funding. According to the report Idaho residents owed a total of more than $268 million in delinquent court debt. In this article, the authors further examine the state’s reliance on monetary sanctions, focusing on fees in the juvenile delinquency system, and recommending a pathway to ending the harmful impact of monetary sanctions.

57 Idaho L. Rev. (2021).

By Anna VanCleave, Brian Highsmith, Judith Resnik, Jeff Selbin, Lisa Foster

Money has a long history of being used as punishment, and punishment has a long history of being used discriminatorily and violently against communities of color. This volume surveys the many misuses of money as punishment and the range of efforts underway to undo the webs of fines, fees, assessments, charges, and surcharges that undergird so much of state and local funding. Whether in domains that are denominated “civil,” “criminal,” or “administrative,” and whether the needs are about law, health care, employment, housing, education, or safety services, racism intersects with the criminalization of poverty in all of life’s sectors to impose harms felt disproportionately by people of color. In the spring of 2020, the stark inequalities of the pandemic’s impact and of police killings sparked uprisings against the prevalence of state-based violence and of government failures. Those protests have underscored the urgent need for profound, sustainable transformations in government systems that have become all too familiar. This volume maps the structures that generate oppressive practices, the work underway to challenge the inequalities, and the range of proposals to seek lasting alterations of expectations and practices so as to shape a social and political order that is respectful of all individuals’ dignity, generative for communities, and provides a range of services to protect safety and well-being.

The Arthur Liman Center for Public Interest Law at Yale Law School Fines & Fees Justice Center Policy Advocacy Clinic at UC Berkeley School of Law, 2020. 337p.

By Public Safety Canada

Indigenous offenders continue to be disproportionately represented at all levels of the Canadian criminal justice system and the federal government is committed to addressing this over-representation of Indigenous people. The Indigenous Community Corrections Initiative (ICCI) was created to help close the gaps in service for Indigenous Peoples in the criminal justice system and address the government commitment to respond to the Truth and Reconciliation Commission (TRC) Calls to Action, in particular actions 30 and 32 regarding the over-representation of Indigenous offenders in custody. The objectives of the Initiative are to support the development of alternatives to custody and to provide reintegration support for Indigenous offenders. Public Safety Canada (PS) was allocated $10M over five years in Budget 2017 for the ICCI. While the target population for the Initiative was Indigenous federal offenders, the Department accepted proposals that included Indigenous adult offenders who had been convicted of an offence with a sentence of less than two years (generally classified as provincial offenders). The call for proposals closed in November 2017 and PS received 126 submissions. An initial assessment screened out 62 proposals that did not meet the objectives of the ICCI and a secondary assessment of the remaining proposals ended with 15 projects selected for funding. Due to the program being approved late in the 2017-18 fiscal year, the program was not able to fund projects until 2018-19. After a successful re-profiling of funds, the ICCI was able to add an additional project in 2018 which brought the total to 16 funded projects.

Ottawa: Public Safety Canada, 2021. 30p.

By Clarence Okoh & Isabel Coronado

Community supervision, or community corrections, refers to a court-ordered period of correctional supervision served outside of a correctional facility. Some policymakers insist that “community supervision” is a viable path to combat mass incarceration. However, mounting evidence makes clear that “mass supervision” is not a solution; instead, it is a leading driver of mass criminalization, especially in Black communities and other communities of color. Mass supervision’s broad range of economic, legal, and social disadvantages trap millions of individuals in cycles of carceral predation and second-class citizenship. To address this crisis, policymakers must envision an entirely new paradigm to support the needs of individuals returning home from correctional facilities. This paradigm must break cycles of correctional punishment while insisting on systemic redress and repair for communities that have carried the heaviest burdens of mass criminalization.

This report offers insights to help policymakers create that new paradigm. For this report, we interviewed over two dozen community advocates, practitioners, and systems-impacted individuals concentrated in three states–Arizona, Oklahoma, and Wisconsin–to understand better how state community supervision systems impede or support economic opportunity, with a particular focus on parole supervision.

What emerged from those conversations was a consensus about the need for a new legal and policy paradigm that we term “community repair.” Community repair offers an entirely different relationship between the state and systems-impacted individuals. Community repair is an anti-carceral policy approach that advocates for removing corrections and law enforcement from the reentry process altogether—recognizing that public investments in meeting basic needs such as employment, housing, and health care hold the most significant promise in disrupting mass supervision and incarceration. This framework goes further by insisting that the state must address present harms and redress the multigenerational harms of mass supervision on families and communities impacted by the criminal legal system.

Based on our conversations with stakeholders and an extensive scan of policy developments at the state and national levels, we offer recommendations for harm reduction and systems transformation of community supervision.

Washington, DC: Center for Law and Social Policy - CLASP, 2022. 28p.

By Beth M. Huebner, Lee Ann Slocum, Andrea Giuffre, Kimberly Kras, and Bobby Boxerman

This project focuses on the St. Louis County Jail which is managed by the Department of Justice Services and serves as the central detention facility for the region. St. Louis County, Missouri provides an ideal location to study the jail-probation nexus. St. Louis County is a large and diverse community. Sixty-eight percent of the population is white and 25% Black, with a small (less than 3%) Hispanic and Latinx population. The county poverty rate of 9.7% is slightly lower than the national average. The Missouri Department of Corrections (MoDOC) is a centralized system, and the St Louis County offices supervise 2,481 clients on probation. The data used in this report include administrative data from the years 2010-2020 that were provided by Justice Services. The process and outcome analyses are also informed by data collected from qualitative interviews with individuals on probation (n=47) and local criminal justice stakeholders (n=17).

Safety & Justice Challenge, 2023. 13p.

By M. Camello, M., R. Shute, & J.D. Ropero-Miller

Individuals on community supervision are often required to abstain from alcohol and drug use and are typically subjected to substance use monitoring to verify sobriety, as a condition of their supervision. Providing reliable, timely, and cost- effective monitoring of alcohol and drug use for persons on community supervision as a condition of their release is a serious challenge given high-volume caseloads and concerns with public safety. This technology brief highlights technologies and solutions used to monitor alcohol and drug use for persons on community supervision. This is the third document in a four-part series on technologies to support the monitoring and supervision of individuals on pretrial release, probation, and parole (i.e., community supervision).

Research Triangle Park, NC: RTI International. 2023. 22p.

By Donata Favretto, Cindi Visentin, Anna Aprile, Claudio Terranova, Alessandro Cinquetti

The most effective therapy for people with opioid use disorder (OUD) involves the use of Food and Drug Administration-approved medications—methadone, buprenorphine, and naltrexone. Despite evidence that this approach, known as medications for opioid use disorder (MOUD), reduces relapse and saves lives, the vast majority of jails and prisons do not offer this treatment. This brief examines what policymakers should consider when exploring how to best manage OUD in incarcerated populations.

It helps to first answer this question: How common is OUD in incarcerated populations? Data from 2007-2009 (the most recent available) showed that more than half of individuals in state prisons or those with jail sentences met the criteria for a non-alcohol and nicotine-related substance use disorder (SUD), meaning a problematic pattern of using a drug that results in impairment in daily life or noticeable distress, compared with only 5 percent of adults in the general population.

The gold standard of care is MOUD. In community-based settings, such as opioid treatment programs and primary care facilities, methadone and buprenorphine have been proved to reduce overdose deaths and illicit opioid use as well as the transmission of infectious diseases such as HIV and hepatitis C. A growing body of literature also exists on the benefits of naltrexone, the third Food and Drug Administration-approved medication.

Philadelphia: Pew Charitable Trusts, 2020. 22p.

By Pew Trust

The most effective therapy for people with opioid use disorder (OUD) involves the use of Food and Drug Administration-approved medications—methadone, buprenorphine, and naltrexone. Despite evidence that this approach, known as medications for opioid use disorder (MOUD), reduces relapse and saves lives, the vast majority of jails and prisons do not offer this treatment. This brief examines what policymakers should consider when exploring how to best manage OUD in incarcerated populations.

It helps to first answer this question: How common is OUD in incarcerated populations? Data from 2007-2009 (the most recent available) showed that more than half of individuals in state prisons or those with jail sentences met the criteria for a non-alcohol and nicotine-related substance use disorder (SUD), meaning a problematic pattern of using a drug that results in impairment in daily life or noticeable distress, compared with only 5 percent of adults in the general population.

The gold standard of care is MOUD. In community-based settings, such as opioid treatment programs and primary care facilities, methadone and buprenorphine have been proved to reduce overdose deaths and illicit opioid use as well as the transmission of infectious diseases such as HIV and hepatitis C. A growing body of literature also exists on the benefits of naltrexone, the third Food and Drug Administration-approved medication.

By Miranda Davies, Rachel Hutchings and Eilís Keeble

There were 11,494 people under 25 years of age in young offender institutions and prisons in England and Wales as of 31 December 2022, representing 14% of the total population in custody. While the number of children (under 18) in secure settings has fallen sharply over the past 15 years, very serious challenges remain over the use of force in the children’s secure estate, with ongoing concern over children being held in solitary confinement, some for extended periods. From a legal perspective, young people are treated as adults from the age of 18 within the criminal justice system, but there is recognition of the needs of 18- to 25-year-olds as ‘young adults’ (see the work of t2a.org.uk), distinct from the needs of children or other adults. This analysis uses routinely collected hospital data to look at the service-use patterns of children and young adults aged 25 and under in young offender institutions and prisons in England. We engaged with experts and looked at the literature to consider this in the context of the key health care needs of young people. Looking across the children’s secure estate as well as the adult estate provides a novel perspective on the key health care issues for young people, allowing us to compare experiences in the so-called ‘children and young people secure estate’, which caters for those aged 18 and under and is run as a distinct part of the custodial estate, with those in the adult estate, which manages young adults alongside prisoners in older age groups. Understanding how health care access and needs differ is important, because the distinction between the two parts of the system is becoming increasingly blurred. Recently, population pressures in the adult estate have led to an increase in the number of young people aged 18 or over in the children’s secure estate, which will drastically alter the age profile of the children’s secure estate population.

A summary of the key findings and some considerations for policy-makers are provided below. We found that some of the biggest problems affecting the adult prison estate – violence and self-harm – have a disproportionate impact on young adults. We consider how the prison service can meet the needs of young people in custodial settings, and the benefits of providing tailored support for young adults in particular.

London: Nuffield Trust, 2023. 55p.

By Jennifer Peirce, Tara Dhanraj Roden, Sandhya Kajeepeta, Elizabeth Swavola, and Jesmeen Grewal

This report presents an analysis of women’s experiences with the local criminal legal system in Buncombe County, North Carolina: their pathways into and out of the jail, their living conditions and concerns during detention, and their perspectives on how services and systems in the county can improve. The underlying research project was part of the broader jail reduction work of the Safety and Justice Challenge (SJC) network. In 2018, the Vera Institute of Justice (Vera) selected Buncombe County as a Safety and Justice Challenge site with which to partner in identifying drivers of growth within the women’s jail population and opportunities to reduce the number of women in jail. Buncombe County has a population of 269,452 (as of April 2020) and covers 656 square miles, including the City of Asheville.1 The findings in this report are based on administrative data from the jail (January 2017– April 2021); surveys with 40 women, representing nearly all the women who were held in the jail in September 2021; and interviews with 21 women conducted by Vera staff via video calls. Although the findings are responsive and specific to the needs of women in Buncombe County, many of the recommendations, if implemented, can benefit all people who are involved in the local criminal legal system.+ Broadly, this report finds that women’s pathways into jail in Buncombe County—in line with national patterns—are shaped by economic instability and laws and policies that criminalize acts of survival and acts related to substance dependency.2 In general, there is an excessive use of police, jail detention, and community supervision for low-level charges that do not pose a public safety risk. There is a clear opportunity to reduce the use of criminal legal system resources to respond to these situations and invest instead in supportive community-based services, especially for women. The key findings and recommendations from this work are grouped into six themes: 1. the criminalization of poverty, 2. bail, 3. community supervision, 4. substance use, 5. jail conditions and costs, and 6. interagency coordination and communication.

New York: Vera Institute of Justice, 2022. 55p.

By Hilde T. Werminka, A. A. J. Bloklanda,b, J. Beenc, P. M. Schuyt, . N. Tollenaare and R. Apel;

Noncustodial sanctions may present an attractive way to reduce the prison population rate, but only when noncustodial sanc-tions meet custodial ones in terms of deterring recidivism. Using administrative criminal records data of all individuals convicted in the Netherlands in 2012, this study examines the effects of short-term imprisonment versus noncustodial sanctions on crime. We employ an instrumental variables approach to account for selection processes and to produce consistent estimates of the effects of imprisonment. Findings indicate that being sentenced to prison rather than a noncustodial sanction increases the prevalence of recidivism by 10 percentage points and increases recidivism rates by 1.07 registered crimes during a follow-up period of three years. Treatment effect heterogeneity analyses show that the detri-mental impact of imprisonment is most pronounced for first-time prisoners, and adult offenders, compared to repeat prisoners and young adult offenders.IntroductionReducing the prison population is one of the biggest challenges faced in the criminal justice system across countries worldwide. There are many good reasons to exercise restraint when it comes to imprisonment. For one, imprisoning people is an expensive enterprise, and the costs of imprisonment typically weigh heavy on the criminal justice budget (e.g. Phelps & Pager, 2016). To the extent that imprisonment maintains or even increases marginalization of the imprisoned population following their release, these direct costs may be dwarfed by imprisonment’s indirect societal costs

Justice Quarterly, April 2023.

By Jacob Harris, et al.

While there is a growing literature investigating the causes and consequences of the US prison boom—the tripling of prison facilities between 1970 and 2000—much less is known about current patterns of prison closures. We use novel data capturing the universe of prison closures (N=188) from 2000 to 2022 to identify and characterize what we term “the prison bust”—the period since 2000 when prison closures began to climb and eventually eclipse new prison building. We show that the prison bust is, in part, a consequence of development-oriented prison-building policies that aggressively used prisons to stimulate struggling local economies. The bust is primarily concentrated in the counties that pursued prison building most aggressively, reflecting a highly cyclical and reactionary pattern of prison placement and closure. We also show that, relative to counties with at least one prison but no closures, closures are concentrated in metro counties with stronger local economies and multiple prisons. Overall, we highlight the prison bust as an important new era in the history of US punishment and provide a new dataset for investigating its causes and consequences. We conclude by discussing the theoretical and policy implications of these findings.

Unpublished Paper, 2023. 36p.

By Miranda Davies, Lucina Rolewicz, Laura Schlepper and Femi Fagunwa

There were, on average, 83,000 people in prison in England and Wales at any one time last year, yet relatively little is known about prisoners’ physical health care needs; how and why they access hospital services; and whether their physical health needs are being adequately met. Drawing on over 110,000 patient hospital records for prisoners at 112 prisons in 2017–18, this study provides the most in-depth look to date at how prisoners’ health needs are being met in hospital. Prisoners use hospital services far less and miss more hospital appointments than the general population • Prisoners had 24% fewer inpatient admissions and outpatient attendances than the equivalent age and sex demographic in the wider population, and 45% fewer attendances at accident and emergency departments. • 40% of outpatient appointments for prisoners were not attended (32,987 appointments) – double the proportion of non-attended appointments in the general population. Our research found that the value of non-attended appointments by prisoners in 2017/18 where no advanced warning was given equated to around £2 million for the NHS. Prisoners have particular health needs related to violence, drug use and self-harm • Injury and poisoning were the most common reason for prisoners being admitted to hospital, accounting for 18% of cases (2,169 admissions) compared to 6% of all admissions in the general population (aged 15+). • Psychoactive substance use was recorded in more than 25% of all inpatient admissions by prisoners in 2017/18. Hospital data reveals potential lapses of care within prisons for certain groups of prisoners • Six prisoners gave birth either in prison or on their way to hospital, representing more than one in 10 of all women who gave birth during their prison stay. • There were 51 hospital admissions by 39 prisoners with diabetes as a result of diabetic ketoacidosis (DKA), an avoidable and potentially life-threatening complication of diabetes caused by lack of insulin. This analysis points to two key areas where more focused policy attention could result in improvements to prisoner health: improving prisoners’ access to hospital care and making better use of hospital data. We therefore make the following recommendations for the five public authorities involved in the National Partnership Agreement for Prison Healthcare – the Ministry of Justice, Her Majesty’s Prison and Probation Service, Public Health England, the Department of Health and Social Care, and NHS England – as well as prisons, health care providers, commissioners, and the research community .

London: Nuffield Trust, 2020. 83p.

By Miranda Davies, Rachel Hutchings, Eilís Keeble and Laura Schlepper

The number of older people in prison in England and Wales is increasing, but prisons are not well set up to meet health care needs associated with ageing. Between 2010 and 2022, the number of prisoners aged 50 or older increased by 67% (from 8,263 to 13,835),2 and is predicted to increase to 14,800 by July 2025.3* Prisoners tend to be in poorer health than the general population, and this is particularly the case for older prisoners, who are considered to be ‘older’ from the age of 50 in recognition of their additional health care needs. Tough conditions in prison – regime constraints, poor living conditions and the threat of violence – disproportionately affect older prisoners, but these are not new problems. The extent to which the needs of older people in poor health can be met effectively in a prison setting is questionable, given the multiple competing priorities. For this work we used routinely collected hospital data to look at the health care needs of older people in prison in England. A summary of the key findings and considerations for policy-makers are provided below. We found significant health care needs associated with frailty among our older prisoner population. We consider the implications for the prison service of managing increasing numbers of older prisoners as the population continues to age.

London: Nuffield Trust, 2023. 51p.

By Chad M. Topaz, Shaoyang Ning, Maria-Veronica Ciocanel & Shawn Bushway

Race-based inequity in federal criminal sentencing is widely acknowledged, and yet our understanding of it is far from complete. Inequity may arise from several sources, including direct bias of courtroom actors and structural bias that produces racially disparate impacts. Irrespective of these sources, inequity may also originate from different loci within the federal system. We bring together the questions of the sources and loci of inequity. The purpose of our study is to quantify race-based disparate impact and differential treatment at the national level and at the level of individual federal judicial districts. We analyze over one-half million sentencing records publicly available from the United States Sentencing Commission database, spanning the years 2006 to 2020. At the system-wide level, Black and Hispanic defendants receive average sentences that are approximately 19 months longer and 5 months longer, respectively. Demographic factors and sentencing guideline elements account for nearly 17 of the 19 months for Black defendants and all five of the months for Hispanic defendants, demonstrating the disparate impact of the system at the national level. At the individual district level, even after controlling for each district’s unique demographics and implementation of sentencing factors, 14 districts show significant differences for minoritized defendants as compared to white ones. These unexplained differences are evidence of possible differential treatment by judges, prosecutors, and defense attorneys.

Humanities and Social Sciences Communications volume 10, Article number: 366 (2023)

By The Robina Institute of Criminal Law and Criminal Justice

KEY POINTS • Despite the common practice of drug testing as a condition of supervision, there is no research that focuses on the effectiveness of drug testing on its own in reducing recidivism and drug use. • Increased drug testing as part of an Intensive Supervision Program (ISP) approach does not reduce re-offending but does increase the detection of technical violations and revocations. • Random drug testing alongside swift, certain, and fair sanctions shows evidence for reducing recidivism and drug use in the short-term but shows no benefit once the individual goes back to supervision as usual. • Drug testing works well as a way to monitor compliance with supervision conditions, but there is no evidence that it reduces re-offending or drug use when used apart from other supervision practices.

St.:Paul, MN: Robina Institute of Criminal Law and Criminal Justice , 2020. 4p.

By Nazgol Ghandnoosh

One in five Black men born in 2001 is likely to experience imprisonment within their lifetime, a decline from one in three for those born in 1981. Pushback from policymakers threatens further progress in reducing racial inequity in incarceration

Following a massive, four-decade-long buildup of incarceration disproportionately impacting people of color, a growing reform movement has made important inroads. The 21st century has witnessed progress both in reducing the U.S. prison population and its racial and ethnic disparities. The total prison population has declined by 25% after reaching its peak level in 2009.1 While all major racial and ethnic groups experienced decarceration, the Black prison population has downsized the most. The number of imprisoned Black Americans decreased 39% since its peak in 2002.2 Despite this progress, imprisonment levels remain too high nationwide, particularly for Black Americans.

Reforms to drug law enforcement and to sentencing for drug and property offenses, particularly those impacting urban areas which are disproportionately home to communities of color, have fueled decarceration and narrowed racial disparities.3 These trends have led scholars to declare a “generational shift” in the lifetime likelihood of imprisonment for Black men.4This risk has fallen from a staggering one in three for those born in 1981 to a still troubling one in five for Black men born in 2001.5 Black women have experienced the sharpest decline in their imprisonment rate, falling by 70% between 2000 and 2021.6

But nine years after national protests catapulted the Black Lives Matter movement following the police killing of Michael Brown in Ferguson, Missouri and three years after a national racial reckoning triggered by Minneapolis police officers killing George Floyd, progress in reducing racial disparity in the criminal legal system is incomplete and at risk of stalling or being reversed.

The United States remains fully in the era of mass incarceration. The 25% decline in the total prison population since 2009 follows a nearly 700% buildup in imprisonment since 1972.7 The prison population in 2021 was nearly six times as large as 50 years ago, before the era of mass incarceration, and in 2022 the prison population expanded.8 The prison and jail incarceration rate in the United States remains between five and eight times that of France, Canada, and Germany and imprisonment rates in Arkansas, Louisiana, Mississippi, and Oklahoma are nearly 50% above the national average.9 The reluctance to fully correct sentencing excesses, particularly for violent crimes as supported by criminological evidence, prolongs the harm and futility of mass incarceration.10

Racial equity in incarceration remains elusive. The lifetime likelihood of imprisonment among Black men born in 2001, although decreased, remains four times that of their white counterparts.5 Black women’s rate of imprisonment in 2021 was 1.6 times the rate of white women.12 These disparities are even more pronounced in certain states, and among those serving the longest sentences.13 In 2021, American Indian and Latinx people were imprisoned at 4.2 times and 2.4 times the rate of whites, respectively.14 Fully uprooting these racial and ethnic disparities requires both curbing disparities produced by the criminal legal system and addressing the conditions of socioeconomic inequality that contribute to higher rates of certain violent and property crimes among people of color.

Washington, DC: The Sentencing Project, 2023. 16p.

By Selma Djokovic and Ryan Shanahan

Findings from a randomized controlled trial (RCT) conducted in prisons in South Carolina show that Restoring Promise’s approach to culture change significantly reduces prison violence and the use of restrictive housing (commonly referred to as solitary confinement).1 Restoring Promise Restoring Promise, an initiative of the MILPA Collective and the Vera Institute of Justice (Vera), works with departments of corrections to transform housing units so that they are grounded in dignity for young adults (ages 18 to 25) in prison. Launched in 2017, Restoring Promise is now operating in six prisons and one jail across five states. The housing units are led by trained corrections professionals and mentors— incarcerated people over the age of 25 who are serving long, often life, sentences who live on the unit with and guide the young adults. Participation for young adults includes living in a designated housing unit, having a structured and meaningful daily schedule, being connected to mentors, developing leadership skills, enhancing connections to family and community, and designing and participating in specialized programs and activities. The program strives to transform the prison culture into one of accountability, healing, and learning.2 The findings Restoring Promise housing units had less violence and fewer restrictive housing unit stays. Findings from an RCT conducted in South Carolina show that Restoring Promise’s approach to culture change in prisons significantly reduces violence. Young adults living in a Restoring Promise unit experienced a 73 percent reduction in the odds of a conviction for a violent infraction and an 83 percent reduction in the odds of a restrictive housing stay during their first year of participation, compared to the control group in general population. These numbers account for a range of factors that may have implications for the outcomes (including custody level, education level, pre-treatment outcomes, length of time in the study, race, and age). Researchers looked at other outcomes and did not find significant treatment effects (disciplinary misconduct, grievances, injuries, staff use of force, and medical/mental health interventions).

New York: Vera Institute of Justice, 2023. 8p.

By Jamie Jenkins

The largest book ban in the United States takes place in this country’s prison system. Prison officials can ban any book that threatens the security or operations of the facility. Books about Black people in America and books about the history and politics of prisons are often targeted for their potential to be divisive or incite unrest. The result is that Black people, who are already disproportionately victimized by the criminal punishment system, are prevented from reading their own history and the history of the institution imprisoning them. This Note examines the legal backdrop enabling these draconian book bans to persist today. As an example, it highlights the recent ban of Heather Ann Thompson’s “Blood in the Water: The Attica Prison Uprising of 1971 and its Legacy” in Attica Correctional Facility. It situates book bans in prisons alongside the anti-CRT mania plaguing our school systems, and labels both practices as forms of “memory law” meant to stifle the democratic engagement of marginalized groups. Finally, this Note argues for a rebalancing of interests that centers the rights and needs of incarcerated people.

(January 16, 2023). Columbia Law Review, Forthcoming, Available at

By David H. Cloud; Brie Williams; Regine Haardörfer, et al

Question What is the association between exposures to extreme heat and suicide-watch incidents in a state prison system without air-conditioned living units?

Findings This case series of 6576 facility-incarceration days found that extreme heat was significantly associated with a 30% increase in the incident rate of daily suicide-watch incidents.

Meaning These findings suggest that extreme heat may increase vulnerabilities to situations that lead to suicide-watch placements for incarcerated people, bolstering calls for heat mitigation and decarceral interventions to assuage heat-induced harms among incarcerated populations.

Importance Extreme heat poses a distinct risk to the 2.1 million incarcerated people in the United States, who have disparately high rates of behavioral health conditions. Suicide is a leading cause of death among people in prisons.

Objective To examine associations of extreme heat, solitary confinement, and an indicator of suicidal behaviors among incarcerated men in a Deep South US prison system.

Design, Setting, and Participants This longitudinal case series panel study included adult men in prisons in Louisiana, a state with one of the largest prison systems in the United States that has been engaged in litigation due to lack of air conditioning and extreme heat. The unit of analysis was prison facility-days. A facility-level data set was created by merging administrative data files, which included demographic characteristics, health classification, housing location and movement, disciplinary records, and involvement in suicide-watch incidents for all incarcerated men in Louisiana during the observation period. Individual-level variables were aggregated to facility-days to merge in daily maximum heat index data from the US Local Climatological Data, which were linked to the zip codes of prisons. The observation period was January 1, 2015, to December 31, 2017. Data set construction occurred from August 2020 to September 2022, and analysis was conducted from December 2022 to February 2023.

Exposure The focal exposure was extreme heat days. Daily maximum heat index data were categorized into 6 bins (<30 °F, 30-39 °F, 40-49 °F, 50-59 °F, 70-79 °F, and ≥80 °F) and as an indicator for any facility-day where the maximum heat index exceeded the 90th percentile of heat indices for total days in observation period. Conditional fixed-effects negative binomial regression models were used to calculate incident rate ratios to test associations between extreme heat and suicide watch incidents, while controlling for covariates.

Main Outcomes and Measures The focal outcome was daily count of suicide watch incidents that were recorded in a carceral system database. Covariates included daily percentages of incarcerated persons at each prison with serious mental illness diagnosis, daily rate of solitary confinement, and total facility population.

Results The sample of 6 state-operated prisons provided 6576 facility-days for the analysis. Results suggest a dose-responsive association between extreme heat and daily counts of suicide-watch incidents; compared with days with temperatures between 60 and 69 °F, the rate of daily suicide incidents increased by 29% when the heat index reached the level of caution (ie, 80-89 °F) and by 36% when reaching extreme caution (90-103 °F) (80-89 °F: incidence rate ratio [IRR], 1.29; 95% CI, 1.17-1.43; P < .001; 90-103 °F: IRR, 1.36; 95% CI, 1.15-1.61; P  95% CI, 1.18-1.45; P < .001).

Conclusions and Relevance Findings suggest an association between extreme heat and an indicator of suicidality among an incarcerated sample, contribute to an emerging literature exploring linkages between climatological events and health outcomes in prisons, and may have implications for legal interventions and advocacy seeking to abate heat-induced morbidity and mortality in carceral contexts.

JAMA Netw Open. 2023 Aug; 6(8): e2328380.