By Nathaniel P. Morris, The New England Journal of Medicine, July 29, 2021

When I became a physician, I was not expecting to learn so much about ankle monitors. Over the past few years, I have worked in clinics caring for patients with mental disorders, substance use disorders, or both, many of whom remain under criminal justice supervision in the community after arrest or incarceration. Some of these devices have Global Positioning System capabilities, allowing law enforcement officers to track patients’ locations. Other devices monitor the sweat on the patient’s ankle, alerting authorities if the wearer drinks alcohol. During appointments, patients tell me how these devices irritate their skin, or impede exercise, or require them to return home to charge the batteries every evening. We discuss how it feels to be seen wearing one — “the look” that other people give them after noticing that little black device.

Electronic monitoring devices are just one manifestation of the changing landscape of criminal justice in the United States. In 2020, the Covid-19 pandemic drew attention to the overcrowding and risks of contagion in U.S. correctional facilities, inspiring legal authorities in many places to pursue fewer arrests and keep people incarcerated for shorter periods.¹ One report estimated that the number of people held in U.S. jails and prisons at a given time fell by 14%, from 2.1 million in 2019 to 1.8 million in mid-2020.¹

Yet even before the pandemic disrupted law enforcement practices throughout the United States, policymakers at local, state, and national levels had been reexamining criminal justice policies and exploring alternatives to incarceration. Many clinicians are now working on the front lines of decarceration, supporting and treating patients who might once have been kept in jails or prisons.

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