The Impacts of Incarceration on Health and Wellbeing in Hawai‘i and Pathways to Decarceration

A Brief History of Incarceration in Hawai‘i

In pre-contact Hawai‘i, the legal system reflected deeply held cultural values centered on respect, aloha ‘ā ina (love of the land/nation), and kuleana (responsibility, privilege). One of the earliest and most profound examples of this is the Kānāwai Māmalahoe — the Law of the Splintered Paddle — issued by King Kamehameha I.¹ The Kānāwai Māmalahoe emerged from a personal lesson that Kamehameha learned during a military raid where his foot became trapped in a lava bed while attacking fisherman in a small village. In an effort to defend themselves and their families, one fisher-man struck Kamehameha with a paddle, splintering it. Instead of delivering a fatal blow, the fisherman chose mercy and let Kamehameha lay unconscious where his men rescued him. Moved by this act of compassion, Kamehameha decreed, “Let every elderly person, woman, and child lie by the roadside in safety.” Today, this law lives on in Article IX, Section 10 of the Hawai‘i State Constitution, making Hawai‘i unique as the only US state that embeds a traditional Indigenous law within its founding legal document.

Despite this foundation of protection and mercy, the current justice system is in dire need of revision. Presently, more than 5100 people in Hawai‘i are incarcerated or detained in some form.² Notably, Native Hawaiian and Pacific Islanders, including Micronesians, remain overrepresented at all stages in Hawai‘i’s carceral system. Resulting in 39% of the incarcerated population being Native Hawaiian, even though they only make up only 24% of the state’s population.³ While the majority of incarcerated individuals are male, women make up the fastest growing population segment of incarcerated individuals in Hawai‘i.⁴

The history of incarceration in Hawai‘i, as it is currently understood, is inextricably intertwined with colonization. Starting in the 1820s, missionaries brought with them a belief in sin and individual guilt, which was used to demonize cultural activities such as hula (dance), lua (traditional Hawaiian martial art), and religion.^5,6 This, along with the military’s influence starting in 1887 when the US gained exclusive control over Pearl Harbor, coalesced to shift behavior modification from a restorative model to a punitive model.^7,8 During this time, focus was placed on “preparing” youth by institutionalizing those that failed to assimilate in schools or youth whose parents were deemed unworthy under the Parens Patriae doctrine into Industrial schools such as Waiale’e Industrial School for Boys and Kawailoa Industrial School for Girls.⁹ These schools operated as boarding schools seeking to disconnect Native Hawaiians from their culture and lands.¹⁰

After the bombing of Pearl Harbor during World War II, Hawai‘i expanded its carceral model to focus on other ethnicities such as the Japanese who were imprisoned at Honouliuli Internment Camp under suspicion of disloyalty to the US.¹¹ Mirroring trends in the continental US, in the 1970s Hawai‘i’s incarcerated population grew dramatically from 398 to more than 4000 people over a 50 year period.³ Patterns of separation and displacement continue in the present day where the State of Hawai‘i transfers incarcerated individuals to private prisons on the US Continent due to lack of space, further disrupting connection to land, culture, and ‘ohana (family). This disconnection serves to further distance these individuals from the supports they need in order to appropriately heal and re-integrate into society upon release. The history and contemporary state of incarceration in Hawai‘i have, thus, negatively impacted the people of Hawai‘i, particularly Native Hawaiians.

Impacts of Incarceration on Health and Wellbeing in Hawai‘i

There is now overwhelming evidence making clear that incarceration has negative consequences for health and wellbeing, and is a driver of health inequity.^12–16 From physical and mental health, to social and economic wellbeing, incarceration has consistently been shown to negatively impact individuals, families and communities. Research has shown that incarceration worsens mental illness, increases risk of substance use disorders, increases the likelihood of suicide, and of infectious and noncommunicable diseases.¹² Moreover, health and mental health care in prison is often inadequate, particularly when it comes to transgender care, elder care, and transitional health care for people reentering society.^12,14 Incarceration is associated with worse health outcomes for all people who are formerly incarcerated compared to those who have never been incarcerated.¹⁵

The negative correlation between health and incarceration is, in part, tied to the health inequalities present in communities most targeted by incarceration, which are then exacerbated by the conditions of incarceration and poor and inadequate care before, during, and after incarceration. In fact, nearly 40% of incarcerated individuals with chronic conditions did not seek medical care even when they needed it due to the high cost of prison health care relative to prison labor rates.^17,18 Both incarceration itself, and its negative health consequences, are disproportionately experienced by Black and Indigenous communities specifically, and by communities of color and poor communities.^14,16

Hawai‘i is no exception when it comes to the negative health consequences of incarceration and the role it plays in furthering health inequality. Jails and prisons in Hawai‘i are far from the mythical paradise so many imagine when they think of Hawai‘i, especially when it comes to health and wellbeing. Native Hawaiians are incarcerated at disproportionately high levels, and the preexisting health disparities prior to incarceration are generally worsened during and after incarceration.^19,20 While more research is needed, existing studies have shown that incarceration in Hawai‘i has negatively impacted mental health and suicide in particular,^21,22 has provided especially inadequate health care for incarcerated elders,^22,23 is detrimental to the relationships between incarcerated people and their families,²⁴ and has negative implications for education and employment post incarceration which have implications for health outcomes.²⁵

Current Context and Challenges in Hawai‘i

Hawai‘i, like many other places, faces various social, political, economic, and geographic challenges as it relates to issues of incarceration, health, wellbeing, and safety. Two current challenges are particularly relevant to discussions of decarceration and health. The first is the proposed construction of a new 1300 bed jail on the island of O‘ahu, to replace the aging O‘ahu Community Correctional Center (OCCC). The second is that because of overcrowding in the state prisons, Hawai‘i houses about 1000 people to be incarcerated off island in the Saguaro Correctional Facility in Arizona, a private prison run by Core Civic.²¹ Together these challenges present openings for important discussions and choices about how to create lasting and equitable safety, health, and wellbeing for all people in Hawai‘i, and Native Hawaiians in particular.

The OCCC is the largest jail in Hawai‘i with 950 beds, largely for people who are detained pre-trial. The two most pressing issues with the OCCC are the jail’s deteriorating conditions and overcrowding with more than 1000 currently detained or incarcerated at the facility. The State’s proposed solution for these problems is the construction of a new jail, estimated to cost nearly one billion dollars. The majority of state elected officials including the Governor have offered support for this plan and some planning steps are already underway.²¹ Still, critics of the proposed jail argue that building a new and bigger jail won’t address the root causes leading people to jail like poverty, houselessness, mental illness, and addiction, nor is it a good use of public investments towards the larger goal of public safety. Those opposed to the new jail assert that tax dollars should instead be invested into a continuum of care including mental health and substance abuse treatment, employment training for living wage jobs, youth programs and supportive housing.²⁶

Since 1995, Hawai‘i has been sending people incarcerated in the state prison system to the continental US to serve their sentences, largely in private prisons. What was meant to be a temporary measure is now a common practice in place for nearly 30 years. Proponents of this practice argue it is more cost effective than building a new prison on island.²⁷ However, critics argue that those incarcerated at Saguaro Correctional Center are 3000 miles from their families, making visits costly and challenging, and that the prison itself has received various complaints about the health and safety of the people incarcerated there.^28–30 Critics of both the new jail and of sending people off island agree that decarceration coupled with investments in housing, health care, treatment and employment will bring more safety and better health for the people of Hawai‘i.^26,27,31

Decarcerating Hawai‘i: Pathways to Safety, Health and Justice Beyond Incarceration

The current state of incarceration in Hawai‘i—marked by overcrowding, aging facilities, and the ongoing practice of sending incarcerated individuals away from their ‘āina, homes, and families—presents an urgent and distressing reality. Within this crisis lies opportunities to improve the safety, health, and wellbeing of people in Hawai‘i, with particular attention to ending the disparate treatment of Native Hawaiians and Pacific Islanders. Grounded in decades of research and advocacy efforts in Hawai‘i, the authors offer a just and effective approach that legislators, practitioners, and advocates can take up to create a safer, healthier and more equitable Hawai‘i.

At the heart of the debate is the issue of overcrowding. An alternative to construction of a new facility is investing in decarceration policies and practices, including diversion and restorative justice programs that could provide critical relief. Robust investments in diversion programs, restorative justice and violence interrupter programs, as well as policy reforms relating to sentencing, parole, probation and bail reform, would go a long way in reducing the number of people entering the system and the length of time they remain entangled in it.

Prevention and early intervention efforts should also be prioritized and integrated to prevent incarceration in the first place. Every year more than 15 000 people are booked into Hawai‘i’s jails, many of them due to issues related to houselessness, mental illness, and substance use disorders.^2,32 Investments in supportive housing, community-based mental health and substance use treatment, and youth development would go farther in creating more safety and health and preventing incarceration.

Finally, creating a just paradigm requires the state to confront the ongoing legacy of colonialism and punitive approaches to safety. Hawai‘i has a long history of encouraging cultural practices that support restoration over retribution. Supporting community-led solutions such as ho’opono(pono) (form of conflict resolution; general and familial) and training a healer in every ‘ohana offers a framework for transforming this vision into a reality. At this pivotal moment, we have the opportunity to invest in people over prisons. These recommendations offer a pathway for decarceration, community-based care, and investments in self-determination and sovereignty to support the wellbeing of all Hawai‘i residents.