Accessible, community-based care for men in distressed communities

The October 2005 issue on prison health shines a spotlight on a sad reality: too many men are receiving health care in the prison system because they did not receive it in a community-based setting. Why? Why, in light of clear evidence pointing to the link between incarceration and men’s health, do we continue to warehouse so many of our men in prison? Why are we not adequately investing in a system of care that could prevent them from being there? I commend the Journal for raising some of these important questions and providing potential solutions. Community Voices Miami, funded by the W.K. Kellogg Foundation in partnership with the National Center for Primary Care at the Morehouse School of Medicine, is working with colleagues at the Overtown Civic Partnership, also a program of the Collins Center for Public Policy, to uncover some of the key psychosocial issues affecting men in Overtown in Miami, one of the poorest urban centers in the United States. Of the 129 men interviewed for the Overtown Men’s Health Study, conducted between 2004 and early 2005, nearly 70% had been incarcerated at some point in their lives. The preliminary data suggest that the biggest health disparities among men in this community are attributed to their experiences in prison or with homelessness. Seen this way, the critical health issue is incarceration, and if we are waiting for men to come out of prison to care for them, we have waited too long. One area that requires work is ensuring the space and the resources in communities to help prevent devastating experiences such as prison and homelessness. We must also continue to highlight the fact that our jails have become the default system of care for too many who are living with mental illness. We know that it costs less to provide resources and care for these individuals outside the prison system, in the community. If we do not act now, we are certain to continue to see men—particularly those from distressed communities—cycle in and out of both the prison and the mental health system. Communities must have the resources to ensure that men can play a strong role in their own health and in their community.