What Can New York City Learn from Abroad?

Despite their ubiquity, American carceral facilities often undermine safety, worsen health and actively inflict harm to the people who live in them, the staff who work in them and the communities, families and neighborhoods affected by them. In the U.S., litigation and — to a lesser extent — legislation have been the primary drivers of prison policy changes. Unfortunately, litigation and legislation frequently produce compromised outcomes that maintain the status quo or require prison staff to implement mandated change without explanation or training. Litigation is also extremely costly and time-consuming for state agencies. While each is a critical tool for motivating change and for holding agencies accountable for failing to live up to essential human rights standards, litigative and legislative efforts have so far failed to bring the solutions and implementation strategies needed to realize the transformational change that is so desperately needed in these institutions.

It is in this context that a growing number of experts, community-based organizations, advocates, legal professionals and legislators — and even jail and prison leaders — have begun looking at approaches and practices from around the world for inspiration. We run one such effort, Amend, a physician-led program based at the University of California, San Francisco, a leading medical school and health research university. In our view, carceral facilities in the U.S. are characterized primarily by a command-and-control, compliance-oriented approach that affects nearly every interaction, function and outcome. That organizational culture is deeply at odds with efforts to prioritize health, healing and rehabilitation over punishment and retribution.

Not long ago, the health care profession was at a similar crossroads. In the 1990s, U.S. health care was in crisis. Deaths due to medical errors were unsettlingly common, and the culture of care in many health care systems was driven by rigid hierarchy and characterized by an overly simplistic understanding of risk and risk mitigation. Out of that crisis came parallel revolutions in quality improvement and patient safety that ultimately transformed our health care systems from doctor-centered to patient-centered, imbuing them with values, norms and organizational structures that prized and reinforced transparency, learning and constant quality improvement. 

U.S. health care leaders and patient advocacy groups looked to other health care systems and other fields to reshape their system from within. Here are just two examples: The approach to risk that informs most patient safety programs in U.S. hospitals today was adapted from a model first used in aviation, while the hospice and palliative care movement in U.S. health care was adapted from a London hospital. The term “palliative care” was coined by a Canadian physician before it became a movement in U.S. health care.

Underlying these examples of transformative change are two questions that shape our work at Amend: How does transformative change happen? And can it happen in our carceral facilities?

The Norwegian Prison Service was experiencing a similar crisis in the 1990s — and asking similar questions. Having followed the U.S. down the path of mass incarceration and increasingly punitive policies and practices, prisons in Norway were overcrowded and characterized by violence, drug use and little meaningful positive interaction between prison staff and incarcerated persons. In response, Norwegian prison and political leadership embarked on a search for solutions that explored alternative approaches in other countries and other fields. They drew inspiration from team-based psychiatric care models. To motivate and guide profound changes to the role of officers in their system, they borrowed and adapted the “dynamic security” concept from the U.K. and the “contact officer” model from Sweden. To improve their rehabilitative programming, they established their own cognitive behavioral programs closely modeled on interventions they observed in Canada. They adapted nonviolent security practices from Scotland, the drug court model from the U.S. and their approach to continuing education for staff from Finland and Denmark. The list goes on. 

Norway is not alone in having taken — and benefited from — this approach to system transformation. In fact, one critical insight from our work with Norway and others is just how unique U.S. jails and prisons are for their insularity, lack of transparency and what can only be described as a bunker mentality that leaves little room or reward for self-reflection, open inquiry and change. 

Most U.S. jails and prisons are not intrinsically motivated to change; or practiced in self-assessment and self-reflection; or engaged in open inquiry, learning and innovation; or genuinely committed to continuous quality improvement. Yet these are values and norms that can be instilled and reinforced by novel interventions that demonstrate the potential for transformative change. 

At Amend, we have seen that an approach that identifies and adapts the best international practices is working, even with incarcerated individuals who have committed serious acts of violence while in prison, the people who prison officials have historically held up as evidence that change is not just dangerous but impossible. Here are a few examples or areas where we have drawn value from our partnerships with a growing community of international experts and prisons:

1. Mass incarceration. A critical component of what makes prison systems outside the U.S. more humane is their lower incarceration rates, shorter sentences and wider use of alternatives to incarceration including electronic monitoring, restorative justice or treatment-based community programming. In Washington, the Department of Corrections has rolled out a Graduated Reentry program in part informed by Norway’s approach to early release. In California, community advocates and legislators have passed model legislation defining the purpose of prison as a fundamentally rehabilitative one. Such legislation opens the door to a broader conversation about whether many currently incarcerated Californians would be better served in the community, and supports a resetting of values inside California’s carceral settings. 

2. Institutionalization. The physical environment, security-focused routines and norms, and dehumanizing approaches to communication and community that typify most U.S. jails and prisons are deeply harmful. Engagement with systems outside the U.S. reveals an accelerating and truly global effort to rethink not just what prison is for but what it looks and feels like. In Northern Ireland and Scotland, that has meant transforming their women’s prisons into what the Northern Irish call a “Secure College.” Here in the U.S., in Washington State, it has meant rethinking what “visitation” means to provide incarcerated people and their families as normal an experience of togetherness as possible, and even a pilot project that allows incarcerated individuals to journey with staff into their local communities to visit coffee shops and try running errands in preparation for their return to the community. In many countries, this evolving understanding of what incarceration can and should be has led to deep and focused work retraining prison officers to value human rights and practice skills as mentors in behavior change alongside their responsibilities to maintain safety and security.

3. Solitary confinement. Much of our work in the U.S. has focused on improving conditions for incarcerated people including addressing widespread practices like solitary confinement, five-point restraints and the frequent use of chemical spray. In Norway, we found a public health approach to working with these populations grounded in team-based care and patient-centeredness (fundamental modern health care concepts) and have since adapted it for use throughout the West Coast. An early study of that effort shows that, in the U.S., as elsewhere, a safe and effective prison does not require such punitive and inhumane practices, even in the most challenging of cases, charting a clear path toward the abolition of this long-held practice. 

4. Professionalism and training of the workforce. Many people who are incarcerated have been failed by our community safety net systems — from education to social services to health care. It is often said that U.S. prisons and jails are the nation’s largest mental health providers. Yet on arrival in a U.S. jail or prison, an incarcerated person’s experience is determined primarily by their interactions with correctional line staff who have had just a few weeks of training — most of it focused on control and the application of physical force. Our international partners have an enormous amount to teach us about retraining and reconstituting the prison workforce to dismantle harmful (for all) “us vs. them” mindsets, policies and practices. That knowledge is now being eagerly absorbed and integrated into correction officer trainings in each of the states we work with. 

Skeptics and critics of the appeal to international models to guide transformative change in U.S. jails and prisons often call such work a distraction from the “real” task at hand or point out meaningful differences between these other countries and ours to suggest that any dialogue is bound to be fruitless. These objections miss the intended goals and actual outcomes of international inquiry and engagement and at the same time deploy some of the same simplistic, incurious and exceptional thinking that is at the root of opposition to change within our jail and prison systems. 

At the same time, not all U.S. jail and prison systems are primed to benefit from programs like ours. Over the past decade, we have found this work benefits greatly from leadership teams that are genuinely committed to leading the way in transforming U.S. jails and prisons for prison staff and people who are incarcerated alike, and from political, labor and community leaders similarly inclined to provide critical support and resources. Amend worked briefly with the New York City Department of Correction (DOC) and Mayor’s Office of Criminal Justice under the DeBlasio administration in 2019, an effort primarily focused on informing the design of borough-based jails set to replace the City’s Rikers Island facilities. That partnership was upended by the COVID-19 pandemic and made difficult to restart by persistent DOC staffing challenges and frequent changes in leadership.

Our work at Amend is far from the only critical effort needed to radically transform our prisons and jails. Litigation, legislation and fierce advocacy — including calls for abolition of the carceral system as we know it — remain as timely and essential as ever. But we believe — and see — that guiding departments of correction (and the staff who interact with people who are incarcerated every day) to adopt a values-based approach to their work and create their own initiatives inspired by public health and human rights-focused examples from Norway and elsewhere can light a practical path toward transforming these deeply broken systems.