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OPINION

Any solution to Mass. and Cass must be informed by experiences of formerly incarcerated

Without their wisdom, we may all continue to be trapped in a run-around game.

Mike Andrick (center, crouching), director of Outreach Services with the Pine Street Inn, makes a wellness check of people experiencing homelessness in Newmarket Square, with Corey Grier, (right), director of strategic planning at the Boston Public Health Commission, Jan. 6.Craig F. Walker/Globe Staff/The Boston Globe

My first patient of the morning was new to me. Though he was in his late 50s, his medical records were sparse. After welcoming him, I asked him where he had previously received his medical care. He said that he was just released from a long sentence in prison. Still early in my career, I distinctly remember my heart quickening — worried I would not connect, that he would not trust me, and that his story would overwhelm me.

As my mind was still churning, he looked at me directly and began to tell his story. My worries quieted as I listened. That day, we addressed untreated hypertension and diabetes. As I continued to treat his medical conditions over the course of the next several years, he continued to tell me his story. A story in which he was left without a home or a job post-incarceration. A story of endless probation. A story of being shut out of everyone’s lives and, as the result of the no-association rule in his parole, being unable to connect to anybody with any history of a criminal record. He was alone, struggling with depression, insomnia, housing insecurity, and joblessness. His story would, over the years, be joined by many other similar stories from my patients. But he was my first real teacher on the failings of our society in caring for the men and women who are leaving prison to rejoin the larger community. There are no easy on-ramps provided, and they are left to navigate so much with so little.

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Today, my clinical practice is steps away from the intersection of Massachusetts Avenue and Melnea Cass Boulevard, the area known as “Mass. and Cass” that Boston Mayor Michelle Wu is addressing (and that was addressed before her by Acting Mayor Kim Janey) in regular press conferences. The issues seemingly have been well parsed — this is a place where our city’s growing rates of substance use disorders, untreated mental health conditions, and inadequate housing options have created a perfect storm, leaving in its wake the wreckage of people’s lives, lives shaped by living in tents and too often by untreated intergenerational and personal trauma.

There are positive solutions that have begun to take place for individuals living on Mass. and Cass — pop-up living quarters, full-spectrum treatment facilities in transitional housing, improved access to mental health and substance use disorder treatment. However, in looking for solutions to Mass. and Cass and similarly complex areas around the country, few are addressing the role that incarceration has played in some of these individuals’ lives. People who have served time in prison are left with limited work history, criminal backgrounds, low incomes, and limited housing options. Their lives have been shattered by the structural racism and inequities of our carceral system, and then they continue to be trapped by the rules of parole. They served their time but have limited options upon release.

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A local colleague who knows this world all too well told me that he often sees people he shared jail time with down on Mass. and Cass, and it breaks his heart.

Increasing affordable and transitional housing stock in Boston is a critical next step. Indeed, a recent Boston Reentry study indicates that six months out of prison, 35 percent of individuals were staying in transitional or marginal housing and this number ballooned up to 43 percent 12 months after release from prison. Rates of recidivism in this population are directly tied to lack of adequate housing. Two-fifths of those who do find housing find it in neighborhoods where there are higher rates of incarceration and recidivism.

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However, increasing housing stock is not sufficient for those who have suffered at the hands of our carceral systems. Recognizing and treating their unique mental health is also critical. While there has long been an understanding that our prison system disproportionately incarcerates people with mental health disorders, there is increasingly strong evidence that the conditions of prison — witnessing violence, being removed from loved ones, losing one’s sense of autonomy or agency, being placed in solitary confinement — accelerate mental health disorders and create new traumas. This means that even when people leave prison, many suffer from long-term mental health consequences; a set of syndromes similar to PTSD but specific to the conditions of prison, this is known as Post Incarceration Syndrome. These mental health needs are unique and will require increased and specialized services.

Beyond addressing the housing and mental health needs of individuals post-incarceration, politicians, policy makers, and public health advocates must recognize the punishing aspects of our parole system. The Massachusetts system was established in 1837 — the first of its kind in the country — as a way for people to rehabilitate their lives. Today, the state’s parole system is filled with barriers to reintegration, often making people feel trapped and further isolated.

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One key tenet of parole is the “no-association condition,” which demands that someone on parole be prohibited from associating with (or even being caught in the vicinity of) anyone who has a history of a criminal record. Up to 25 percent of people in Massachusetts have some sort of criminal record, and these rates disproportionately affect Black and Latinx communities. Reconnecting to loved ones or even seeing neighborhood friends often can mean a violation of parole and a high chance of being reincarcerated. This vicious cycle of incarceration and parole is beautifully illustrated in a board game called “The Run Around,” a SEED Institute game shaped by the expertise of youth of color who have experienced firsthand the cradle-to-prison pipeline and the never-ending “run around” of prison and parole.

Creating feasible solutions to complex public health, social, and medical issues such as Mass. and Cass requires multidisciplinary teams — ones that incorporate the important voices and lived wisdom of those who have experienced firsthand our carceral system. Their stories, mental health, and housing needs are unique and must be directly addressed. Further, if leaders from all sectors want to truly heal our communities, they must recognize the wounds inflicted by our carceral system — a system that not only upholds a structurally racist society by disproportionately imprisoning Black and Latinx communities, but also perpetuates these inequities by offering very few social, economic, and health opportunities to those who leave prison. If we cannot face and begin to heal these gaping wounds, we will all continue to be trapped in a run-around game.

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Dr. Katherine Gergen Barnett is vice chair of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center, clinical associate professor at the Boston University School of Medicine, and a fellow at the Boston University Institute for Health Systems Innovation and Policy.