Support Community-Based Treatment, Not a New Jail

Authors: Snehal Patel, MD and Lisa Medina, MA, LCDC

Photo by Hédi Benyounes on Unsplash

On Tuesday, June 15th, Travis County Commissioners will vote on whether to spend $4.3 million on the design contract for a new women’s jail, which will cost $80 million to build. The new jail is the first phase in the County’s Master Plan from 2016, which would require a minimum investment of $700 million with soaring construction prices. It is appalling that the County would prioritize spending that much money on a jail as we recover from a pandemic and winter storm, as overdoses surge and the lack of affordable housing has more people on the streets than ever before. Even more troubling is that Commissioners are calling their proposed jail a “Trauma Informed Women’s Facility.” “Trauma-informed” and “jail” are inherently contradictory, and it is misleading and dangerous to attempt to sell it to the public using language co-opted from public/mental health professionals. We say no…

As professionals trained in addressing the health effects of trauma, we are deeply concerned about the description of this jail as “trauma-informed.” Rather, we know that incarceration is an underlying cause of trauma, not only for incarcerated individuals, but also for their families and communities. In addition to long-term psychological and physical harm, incarceration involves financial ruin, family separation, loss of child custody, sexual violence, and the consequences of being humiliated by jail staff through authoritarian orders and full body searches.

All of this can be, and often is, a source of trauma, which The American Medical Association describes as “a harmful and costly public health problem resulting from violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences and is an almost universal experience of people with mental and substance-use disorders (SUDs). Racism and systems of oppression can also be a cause.”

Trauma-informed care, an idea developed by healthcare workers in the 1970s to take trauma into account in diagnosing and treating people, cannot be provided in trauma-inducing environments. The five pillars of trauma-informed care — safety, choice, collaboration, trustworthiness and empowerment — cannot be supported through the construction of a state-of-the-art jail because coercion, isolation and punishment are inherent in jailing. The Commissioners’ stated goal of addressing trauma through a new jail is a false promise — this proposal will in fact exacerbate harm, particularly in communities of color (Travis Co jail population is 35% Black in a county that is 6% Black), by investing resources to expand a system that is inherently traumatic.

If County leaders truly want to address trauma, we must invest these resources in community-based services. With $80–700 million, we could address root causes of trauma and prevent arrest and incarceration through:

  • Direct economic relief
  • Community health workers and street outreach teams
  • Affordable and supportive housing options
  • Peer-run drop-in centers for people who use drugs
  • On demand access to medication assisted treatment
  • Access to mental health treatment for trauma disorders
  • Transportation to access health services

Often, objections to solutions like the ones we propose emerge out of claims based on cost. It is true that such solutions are expensive. However, in this instance, since the county is already looking to spend nearly $1 billion on incarceration, objections due to cost simply do not hold. Expansive community-based services and treatment would be cost-effective and reduce harm. We need leaders with the will to do something bold and support community-based treatment strategies.

We call on the Commissioners Court to invest in trauma-informed community programs and services, and to stop trying to sell the misleading and false promise of a “trauma-informed” jail. Say no to building a new jail.

Assistant Professor of Internal Medicine and Population Health at the University of Texas at Austin Dell Medical School