Quashed report warned of prison health crisis

WASHINGTON — A government report, blocked from publication a decade ago, presciently warned of an advancing, double-barreled health crisis of mental illness and substance abuse that has currently swamped the nation’s vast prison systems.

The 2006 document,  prepared by then-Surgeon General Richard Carmona, urged government and community leaders to formulate a treatment strategy for thousands of sick and addicted inmates that also would assist them after release or risk worsening public health care burdens.

“This (report) has demonstrated that, far from being geographically and metaphorically separated from the community as was the case with Alcatraz Island, correctional facilities and those who pass through them are an integral part of the larger community,’’ Carmona wrote in the document titled, “The Surgeon General’s Call to Action on Corrections and Community Health.’’

The 49-page report, Carmona said, was quashed at the time by George W. Bush administration officials who feared that such an acknowledgement would require a financial commitment that the administration was not willing to make.

Both Carmona and Roberto Potter, who served as an editor of the document while then-detailed to the surgeon general's staff from the Centers for Disease Control and Prevention, said the decision to quash the report was relayed to them through Department of Health and Human Services officials they did not identify.

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"It was what they call a top-drawer veto,'' said Potter, now a criminal justice professor at the University of Central Florida. "We missed one of those teaching moments. When something like this goes out under the surgeon general's seal, it really carries a lot of weight.''

Former Utah Gov. Mike Leavitt, who served as HHS secretary at the time, said that he had "no memory of such a report.''

"It's possible that it was not a matter I dealt with,'' Leavitt said.

The administration’s handling of the report and other surgeon general reviews, including the “Call to Action on Global Health,’’ were called into question in 2007 by the House Oversight and Government Reform Committee, where Carmona contended that the surgeon general’s mission as the nation’s doctor had become increasingly and dangerously marginalized by political considerations.

More than a decade after the prison report was completed, local, state and federal officials are struggling to address the same health emergency — now in full bloom — that was outlined in the pages of the surgeon general's warning.

"We deny the American public essential information that they need when this information is suppressed,'' Carmona said. "We missed an opportunity to take appropriate action to protect the public health.''

In addition to mental illness and substance abuse, the report also highlighted concerns about the prevalence of infectious and chronic diseases, urging government officials to invest in a strategy that "could build on the positive outcomes of correctional health care in ways that would benefit the larger community'' when inmates are released back into society.

While substance abuse was identified as "the most prevalent ailment'' among inmates, the report found that mental illness was up to three times higher within U.S. jails and prisons that in the general public.

"The nation's largest mental health facilities are in large urban jails,'' the report stated.

As part of a series of articles highlighting the costs of mental illness, USA TODAY reported in 2014 that an estimated 1.2 million people in state, local and federal custody reported some kind of mental health problem.

The number, based on data gathered by the Justice Department, represented 64% of those in local jails, 56% of state prison inmates and 45% in the federal prison system.

Among the largest concentrations of prisoners with mental illness has long resided in Chicago's Cook County Jail, where Sheriff Tom Dart has kept a running tally on the agency's website. As of Wednesday, 34% of prisoners identified themselves as mentally ill.

Dart said he was not aware of the surgeon general's document that warned of advancing mental illness in prisons and jails, but he said such a report could have been "a potential game changer.''

"If this study had seen the light of day, there is no telling how much money would have been saved,'' Dart said, referring to waves of repeat arrests involving mentally ill suspects for often minor offenses. Because there are few public treatment facilities, the suspects more often end up in jail with no means to post bail or seek private treatment.

"This is why people have a complete disgust with the way government operates,'' the sheriff said.

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Ron Honberg, national policy and legal affairs director at the National Alliance on Mental Illness, said the "criminalization of the seriously mentally ill'' was being tracked well in advance of the surgeon general's 2006 unpublished report. Yet he said the bully pulpit of the surgeon general's office would have likely brought new, needed attention.

"Anything that comes out of the surgeon general's office, people pay attention,'' Honberg said. "It would have been a call to action.''

Ronal Serpas, a former police chief in New Orleans and Nashville who now leads a law enforcement coalition supporting criminal justice reform, attributed the prevalence of mental illness and substance abuse as central factors in many police encounters with the public that result in some use of force, justified or not.

"The (surgeon general's) report was prophetic, to say the least,'' Serpas said.