Alternatives to Incarceration: Be Careful What You Wish For

As awareness is growing of the financial and human costs associated with mass incarceration, we’re hearing talk from politicians on both sides of the aisle (and, believe it or not, even from the Koch Brothers) about the need for “alternatives to incarceration” (ATIs).

The term “alternatives to incarceration” takes for granted that we are talking about ways to handle criminals who otherwise would need to be incarcerated — that incarceration is a reasonable baseline against which to measure “alternatives.” In light of the over-representation of Americans of color and low-income Americans in jails and prisons, however, it’s necessary to be careful about any sort of presumption of correlation between criminality and incarceration. In fact, about a third of people locked up in the US are awaiting trial; that is, they have not been convicted of a crime. Another third are locked up because they violated the terms of probation or parole; that is; the “criminal” act was not sufficiently egregious to require imprisonment but a subsequent action – often simply not showing up for a meeting with a parole or probation officer, or failing to keep up restitution payments or money owed in court fees – was the reason for incarceration. And 97% of federal and state criminal prosecutions are resolved by plea bargain – often accepted by defendants out of fear that if they don’t accept the deal they will be locked up even longer — rather than by trial.

Given these numbers, it’s easier to make a case for abolition than for “alternatives to incarceration.” But that is not the direction in which public discourse seems to be moving. To the contrary, the increasingly popular sentiment goes something like this: A whole lot of people sitting in jails and prisons are mentally ill; they are drug users who need treatment more than they need punishment. Echoing this sentiment, Los Angeles County – the US county with the largest number of incarcerated people – recently approved a $1.9 billion proposal to tear down Men’s Central Jail and construct a 4,885-bed “Consolidated Correctional Treatment Facility”. And while “treatment” certainly sounds beneficial, the content of that treatment has yet to be spelled out.


Over the past five years I followed a cohort of Massachusetts women who cycle in and out of prison as well as a variety of treatment programs. All of the women, at some point in their lives, have been diagnosed with a psychiatric disorder (most commonly substance abuse, bipolar disorder, PTSD). Overall, these twenty-six women spent far more time in treatment than in correctional settings. Yet, at the end of five years only three women had settled into reasonably secure housing, stable employment and long-term desistance from substance abuse.

Typically, treatment programs include some combination of pharmaceutical, twelve-step and psychotherapeutic components. Most of the women I have come to know are prescribed mind-boggling assortments of psychotropic medication, some of which make them, as Elizabeth (a white woman in her early forties, Elizabeth was homeless for a decade) used to say, into “a space shot” who shuffles around in a daze that puts her at elevated risk for being robbed or assaulted. Whether anti-anxiety, anti-depression or anti-psychotic drugs, these medications are not intended to cure the underlying problems such as sexual assault and homelessness that lead to anxiety, depression and substance abuse. Rather, psychotropic medications are prescribed in order to manage the individual’s response those problems.

While not all treatment programs prescribe psychotropic medication, virtually all incorporate – explicitly or implicitly — twelve step ideology and practices. Treatment facilities tend to be plastered with twelve step slogans such as “Let Go and Let God” and “Cultivate an attitude of gratitude,” and formal AA/NA meetings typically are part of the treatment regime. With emphasis on admitting one’s powerlessness (Step 1) and making moral inventories of one’s faults (Step 4), these programs do not seem to offer the women I have come to know a meaningful script for re-organizing their lives. When I visited Joy, who has been homeless for nearly fifteen years and nearly died as a consequence of a brutal sexual assault, several weeks into her stay in a treatment facility she enthusiastically explained to me that, “I’m learning that my problems are in my head.” Unfortunately, her problems also were in the real world: Less than a year later she was back on the streets where she was sexually accosted by a police officer who then arrested her for solicitation.

Most treatment programs in Massachusetts also include some sort of psychotherapy, and nearly all of the women I know have been treated by multiple therapists over the years, sometimes beginning in adolescence or even childhood. With its focus on the individual psyche, psychotherapy addresses personal flaws such as poor impulse control, allowing oneself to be a victim, and struggles to “get over” past traumas. But as Elizabeth explains, “I don’t need to talk about my problems. I need a place to live so that I won’t be scared all of the time.” This does not mean that therapy is useless; it does mean that “talk is cheap” without the material conditions that permit women like Elizabeth and Joy to build a secure life.


There is little evidence pointing to long-term success for any particular drug treatment modality. Studies showing positive outcomes typically fail to track program participants for long enough time to establish meaningful rates of success, look only at participants who completed the program, fail to control for confounding variables, or look at very small numbers of participants from the start. The absence of evidence for the success of treatment programs is especially glaring when the treatment is coerced or carried out in a coercive situation. It may be tempting to believe that even if treatment doesn’t help everyone, at least it doesn’t hurt. Yet, as we’ve learned from the past — from efforts to “cure” homosexuality to the tranquilizers (“mother’s little helper“) of the 1960s,  when a patient’s ideas or behaviors challenge social hierarchies of race, gender, sexual orientation or class, treatment that is ostensibly for the patient’s own good may be used to bring the “deviant” individual back into line. As those of us old enough to remember Jack Nicholson’s performance in One Flew Over the Cuckoo’s Nest can attest, therapeutic interventions aimed at “getting inside” the patient’s head can carry heavy costs indeed.

The murky line between punishment and treatment has not been lost on some of the corporations involved in the prison industry. Correctional Healthcare Companies, for example, has expanded beyond providing medical services to prisons and now offers services for the “full spectrum” of “offenders” lives: “pre-custody, in custody, and post-custody,” a timeline that perhaps says more than the company intended about American understandings of criminality.

Read more: Incarceration by Any Other Name: A Return to the Cuckoo’s Nest?

8 thoughts on “Alternatives to Incarceration: Be Careful What You Wish For

  1. Thank you for this well-referenced summary of the harmful and traumatizing ways the mentally ill and others are handled by the criminal justice system. Indeed, be careful what you wish for — and take a careful look at what is being offered.

    An example of what needs a careful look is the Los Angeles County plan referenced in the posting: The plan is for a jail which will be called a “County Consolidated Treatment Facility.” When a Supervisor asked the planners and advocates for the jail (all advocates were either county officials or the contracted construction management people) whether building spaces for 3200 seriously mentally ill made sense when it was expected that 1000 would be diverted to non-jail settings in a diversion program being devised currently, the answer was that the plan was flexible, and that if diversion were successful, the spaces could be used for high-security inmates.
    In 2012 a similar sized plan (but without the mental illness component) failed to win approval. The County is appropriately under pressure from the U.S. Dept. of Justice concerning the handling of the mentally ill, so the facility is planned and presented to deal with that — while proven jail-population reduction reforms have been recommended to the Board for years but minimally adopted.
    The report of the construction management company which recommended the plan quoted the County’s Department of Mental Health to the effect that one reason for the need for space for more mentally ill in the jail was “Decreases in available treatment resources in the community including several acute psychiatric hospital closures.” Huh? Community facilities are being closed so build more facilities in jail? If you find that hard to believe, see page 8 of the report:

    Here are two Los Angeles Times editorials expressing serious doubt about the jail plan as the best way to serve the mentally ill or the county as a whole. (This story may be of interest to people in jurisdictions in which the decision-making is itself jailed in past policies. Fortunately the L.A. Board of Supervisors has two new members — out of a total five — and we have some reason to hope for major revisions in the plan).
    The first, July 7, 2014:
    One choice comment from that editorial:
    “Nor does it include the opportunity cost of accommodating thousands of mentally ill inmates who could be treated as patients in the community, at less expense to the county, instead of as convicts or pretrial detainees in jail. Figures from across the country give encouraging evidence that people treated and supervised outside of jail are less prone to commit new crimes and cycle back through the jail system.”
    The second, January 4, 2015:
    A quote from that one, describing the policy statement implied in the project:
    “In pushing forward with a new jail that could keep as many people locked up as were, say, two years ago, the Board of Supervisors is in effect making an astounding policy statement: The current jail population is the correct one, despite the theoretical embrace of mental health diversion, the ability to authorize some no-bail, pretrial releases, and the recent reduction of sentences for some crimes. And the $2 billion — or perhaps twice that, when including bond interest — should all be spent on incarceration rather than more effective, and cost-effective, alternatives.”

    And let’s add, more humane ones.

  2. Hello. The article “Alternatives to Incarceration: Be careful what you ask for” points to a few of the problems with current mental & addiction treatment programs available to women in the prison system. Traditional psychiatric medications (drugging) is a method used for institutional environment control, while the ever famous & long standing 12 step addiction program fails to address underlying causes and changes to thought and behaviors. Many women who would benefit from alternative therapies are “raped” of the chance to learn how they can live a productive life in the community. More recent studies have indicated very promising success in Cognitive Behavioral Therapy & Behavioral Modification Treatment of PTSD, Depression, Mood Disorders, OCD, Anxiety, & Drug Addiction. This and other educational options must be offered especially with regard to mothers of young children and women unable to gain employment that meets living expense requirements. Alternative programs are desperately needed through-out the U.S. as a means to prevent further harm, maintain family preservation, & parent-child relationships.
    Hope this helps bring attention and action!
    Laura Shepherd

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