I am not sure which group is more marginalized and more expendable in our society, the mentally ill and substance abusers or the incarcerated, but I do know that if someone is mentally and physically ill, abusing substances and incarcerated, they are doubly cursed. And if they happen to be mentally ill and incarcerated and of color, well, forget about it.

To address this problem, we need to rely on groups like the readers of the Amsterdam News to supply the advocacy to stop what I, as a medical professional, view as inhumane treatment. Prisoners are suffering and occasionally dying because they are not receiving adequate health care. Prison officials are expected to provide a level of health care comparable to that received in the community, but they are not adequately staffed, nor is that staff systematically trained to provide such a service, nor has the community outside prioritized its health care systems in order to care for these individuals.

Dr. Andrew Wilper of the Cambridge Health Alliance reported in the American Journal of Public Health that in 301 state prisons and local jails, his study found exceedingly high rates of chronic medical conditions and significant mental health conditions that had not been professionally addressed.

For inmates reporting a prior diagnosis of mental disorder, 38.5 percent of federal inmates were found to have at least one chronic medical condition, the same fraction of local jail inmates. In total, 42.8 percent of state prison inmates were chronically ill with rates of diabetes, hypertension, prior myocardial infarction and persistent asthma that exceeded comparable rates in the general population.

Furthermore, the incidence of HIV is twice that of the outside population. Yet, 20 percent of state prisoners and a startling 68.4 percent of local jail inmates in surveyed jurisdictions had received no medical examination since incarceration. Some injured in prison-12 percent of state prisoners and 24.7 percent of jail inmates-saw no medical provider after serious injuries such as fractures, sexual assault and traumatic unconsciousness.

I have seen the quality and availability of prisoner health psychiatric and substance abuse care over the past four decades. While I can tell you today that the systems for the delivery of care have improved, nearly everywhere such care remains a subordinate, rudimentary discipline, and it has not taken its correct place in our national public health infrastructure, where access and quality are the key and preeminent values. The essential tension between care and custody has been, and remains, a barrier to correctional health care comparable to that in the community.

Nationally, there are 2.26 million persons incarcerated in jails and prisons, the highest rate on the planet-about 751 of every 100,000. In addition, 48 percent of those in our prisons are African-American. In New York State, there are now roughly 57,000. It is clear that incarceration remains the criminal sanction of choice and that minority incarceration remains disproportionate.

Mental health problems, with their co-occurring health and substance use disorders such as depression, bipolar disorder, post-traumatic stress disorder, anxiety disorder and personality disorder, are pervasive. Among federal inmates, 14.8 percent had a mental health diagnosis, while at least one psychiatric disorder had been diagnosed in 25 percent of both state prison and jail inmates. So we ask, why are some of these ill individuals incarcerated in the first place?

One big reason is the mass psychiatric hospital deinstitutionalization that began in the 1960s. It was an action that did not include developing adequate community resources to serve an ill population and allow them independent living, especially those who do things that are against the law.

Instead, we have trans-institutionalized them, shifting many from psychiatric hospitals to prisons. In addition, prisons and jails are holding many ill people who were not under appropriate treatment at the time they were arrested.

Here’s what must be done:

* Public health officials, physicians, psychiatrists and addiction and other treatment providers need to discuss their differences with judges, prosecutors, public defenders, correctional officials and probation and parole officers. They need to realign their relationships and build a new consensus on protocols that support a medical recovery-public health approach.

* Elected officials and legislators who are on committees that have justice system oversight, along with those on public health and substance abuse committees, must monitor this relationship-building and require medical professionals and their criminal justice partners to reach a consensus.

* Elected officials must be informed of the progress of these efforts.

* Health care professionals must learn how to collaborate with inmates’ employment, housing, education and vocational training as well as spiritual and family relations.

* Adequate resources must be allocated to health care professionals to enable them to take this comprehensive and holistic approach to service provision.

Dr. Phyllis Harrison-Ross is commissioner of the New York State Commission of Correction. She has more than 35 years as a mental health professional, and is emeritus professor of psychiatry and behavioral health services at the New York Medical College.