From the House of Fear to the Home of Care: The Future of Imprisonment

The future of imprisonment in California, and likely much of the nation, was described in some detail this morning on KQED's California report. The California Report's Julie Small toured the construction site for the new California Health Care Facility near Stockton, where contractors are building a specialized prison for more 1700 prisoners in need of long term health care. These prisoners, currently tying down care beds and staff in prisons all over the state, will be centralized here to optimize the efficiency and success of providing them the continuous health care they need, and which California must pay for.

The new facility (notice it does not call itself a prison) may operate as a paradigm shifting model for prisons in a society where currently some 40 percent of state inmates suffer from one or more chronic illness (including mental illnesses). It is designed to hold all prisoners in single story structures (most prisons built over the past 2 centuries have multiple tiers or floors with typically no elevators (prisoners were supposed to be young, healthy, and capable of mayhem, they don't need an elevator). The cells are specially designed to bring natural light into rooms to make life there more sustainable for prisoners whose disability and medical needs, rather than risk and security threats, determine that they must remain most or all of the time. The walls will are wide to hold the arrays of complex medical technologies necessary to monitor and sustain them not to assure they do not assault their neighbors or correctional officers. These cells will surround a control center staffed primarily with nurses.

While the state of the art facility is estimate to cost close to a billion (and will no doubt really cost twice or thrice that), the spokesperson for California's court appointed correctional health care receiver estimates that it will ultimately save the state millions in annual health care costs (a rapidly growing sector of the correctional budget). That is because of the nature of the chronic illness burden facing the state's prisoners and prisons. Chronic illnesses, slow developing diseases that get steadily worse unless efforts are continuously made to monitor and check them, conditions like diabetes, hypertension, HIV, and importantly, mental illnesses, represent a fundamentally new kind of health care challenge, one that is facing our whole society as it ages. Incarceration as traditionally practiced with a generic healthy young inmate as its one-sized fits all model of prisoners is poorly configured to handle this threat. Mass incarceration, with its overcrowding, and long prison sentences that assure more prisoners will spend their chronic illness years incarcerated, made things far worse, leading to the correctional health care crisis and the Supreme Court's Brown v. Plata decision.

The new prison represents a remarkable departure (but a necessary consequence) of a state whose extreme sentencing laws and vast warehouse prisons have made it the Mississippi of mass incarceration. The account of its construction, the scale, technology, and sense of a new order being born, call to mind a parallel prison constructed roughly thirty years ago in the mid-1980s as California built the first wave of its massive prison boom. Pelican Bay's notorious supermax style SHU (for Secure Housing Unit) was also seen as a distinctive new style of prison whose use of architecture and technology would allow California to control the most dangerous of a vast new population of inmates the state's correctional planners were clearly told to anticipate. As Keramet Reiter shows in her brilliant dissertation on Pelican Bay, The Most Retrictive Alternative: The Origins, Functions, Control, and Ethical Implications of the Supermax Prison, 1976 - 2010 (Berkeley, JSP, 2012) these mid-level correctional bureaucrats, their vision shaped by the nightmarish but largely unrepeated incidents of violence from the early 1970s, wanted prisons where they could potentially thousands of prisoners so dangerous that they needed to be locked down permanently. Pelican Bay's huge costs and supersize were justified on the belief that it would ultimately hold down violence and permit the much expanded general population to operate more successfully and at lower cost. In the name of security, the prison was designed to encase the prisoner either in a their cell, or in a cell like exercise or shower room, with no programming and virtually no contact with staff or other prisoners (unless double-celled in the same conditions). Instead of measures to counteract the inevitable assault such an environment would make on mental and physical health, the designers chose to allow no natural light and no colors into the environment and designed routines without any consideration of the humanity of the bodies they were locking up. The atrocious and degrading results (frequent cell extractions using tasers and chemical weapons on often deranged inmates) were documented in the historic Madrid v. Gomez decison in 1995 but California continue to rely heavily on the SHU even today.

Pelican Bay was the house that fear built. Shaped in nightmares it became a monster factory turning its inmates and correctional officers into threatening simulacra of human beings. Ultimately it helped set the tone for an overall correctional regime that engaged in industrial scale torture through deliberate indifference to the health care needs of its mass incarcerated and chronically ill population. The California Health Care Facility reflects a care based model rather than a fear based model. Not completely. Despite the fact that most of its patients will be prisoners in need of longterm care it will have electrified fencing just like any other prison in California. Indeed, serious questions should be raised about why anyone who needs that much care, poses that little risk, and has served enough time in prison to meet a modicum of penitence should be in prison at all. Still, just like the ethics of fear amplified in Pelican Bay helped define the culture and character of California prisons in the torture years, an ethic of care may be pointing us to a more legitimate correctional model for the future of imprisonment.