Are Correctional Facilities Adequately Caring for the Health of Their Inmates?
According to the American Academy of Family Physicians (AAFP), incarcerated individuals are “disproportionately affected by chronic health conditions, mental illness, and substance abuse. However, they tend to receive inadequate healthcare before, during, and after incarceration or detention, further exacerbating their disadvantage.”
As of 2016, the United States had the highest incarceration rate in the world with approximately 6.6 million people, including those on parole or on probation. The AAFP feels that there were two main factors that contributed to this rate.
Mental Health
First, court cases removed mental health patients from inpatient facilities to outpatient care due to the new and better drugs on the market that could facilitate this transition. However, as this transition occurred, additional funding was not allocated for this outpatient treatment and patients were released without adequate care, becoming homeless and more prone to arrest. A 2009 study found that 14.5% of men and 31% of women who were incarcerated suffered from some sort of mental illness compared to 3-4% of the general population.
Drug Addiction
The second factor is the war on drugs that was started in the 1980’s resulting in lengthy sentences for even small amounts of illegal drugs causing a 10-fold increase in the number of people incarcerated for this offense. There is a lack of treatment for drug abuse during and after incarceration as well, which leads to repeat offenses and an increase in deaths due to overdose. In fact, only 11% of the individuals who have substance use disorders receive treatment while incarcerated leading to a higher risk of withdrawal while in custody; then overdosing when returning to the community. It has been proven that treatment reduces mortality and recidivism.
Infectious Disease
The incarcerated population has significantly higher rates of disease than the general population suffering from infectious disease, mental illness, and/or substance abuse and addiction. The common infectious diseases are TB, hepatitis C, HIV/AIDS and other sexually transmitted diseases. And outbreaks of the flu and COVID are more likely in the prison population than the general public.
Reproductive Health
Due to the fact that 17% of adults in jails and 7% in prisons were women with the majority under the age of 45, 6-10% of those being pregnant, there is a definite need for reproductive healthcare. Women get pregnant in jail as well. Despite the AAP recommendation of prenatal visits occurring at least monthly, only half of the women in the prison system get pregnancy care thus leading to pregnancy complications and low birth weight babies.
Chronic Conditions
As our incarcerated population ages, their healthcare requirements increase. When inmates are young, they need dental care, reproductive healthcare, and mental healthcare, as well as first aid due to violence and injuries while in the facilities. Older adults have chronic conditions such as high blood pressure, diabetes, and heart disease, among others, that require regular checkups and regular medications. They also may start becoming physically disabled or have cognitive impairments such as dementia or Alzheimer’s disease.
According to PBS/NPR, 40% of incarcerated people have chronic healthcare issues. They lack the ability to control their circumstances and therefore cannot advocate for themselves. They may not feel comfortable asking for the care they need. And ultimately, the correctional staff decides who gets treatment. Dr. Nicolas Scharff was a corrections physician and noted the disconnect between care and incarceration. Inmates have had a lot of physical trauma leading to orthopedic problems and chronic pain. They also have had psychological trauma requiring mental health treatment. Most chronic diseases in this population are first diagnosed upon intake as they have also not taken care of themselves prior to being incarcerated possibly due to the social determinants of the healthcare system. Surprisingly hearing deficits are common and lead to more difficulty with socialization.
Epidemiology
There have been no comparative studies on health outcomes in private versus state-run prisons but there have been anecdotal reports showing that there is poor quality care across the board.
Compared to the general population, incarcerated individuals have higher rates of mortality and morbidity. Approximately 40% of men and 60% of women who are incarcerated have multiple health conditions. Once released, they have difficulty finding health insurance, healthcare providers, making appointments and refilling prescriptions.
In the past dozen years or so, a majority of the states have contracted out prison healthcare to private companies often paying them on a per-inmate, per-day basis, which of course, creates an incentive to cut costs. There are three major healthcare providers within this field—Corizon Health, Centurion Managed Care, and Wexford Health Sources. Even when a facility changes providers the staff doesn’t necessarily change thus ultimately leaving the patients with the same standard of care they had before the change. States don’t provide any better care when they attempt to provide it themselves. California has been under receivership since 2006 after not meeting constitutional standards.
Right to Care
By law, this population has the right to receive the healthcare they need. A US Supreme Court decision in the 1970’s, Estelle vs. Gamble, set the standard ruling that they should be granted the same standard of care that is available to the general population. However, this standard ends up being decided by the physicians, contractors, and medical directors at the facilities in question. There are barriers to care such as overcrowding, troubling scheduling appointments due to the fact every inmate has to be accounted for every second of the day, possibly needing secure transport to an outside facility thus requiring extra personnel to go with them, and urgent care requiring red tape and paperwork through so many people that the patient does not get seen by the specialist in time to help.
The Eighth Amendment of the US Constitution guarantees individuals who have been convicted of a crime a fundamental right to be free from cruel and unusual punishment. Indifference to their injuries or illness constitutes cruel and unusual punishment. The Fourteenth Amendment provides all citizens due process and equal protection under the law.
Of course, it can be argued that, for some people, incarceration can provide healthcare they may not otherwise have gotten, especially for people living chaotic lives who need respite and stabilization: Thus, in addition to healthcare, providing “healthier” meals, a structured day, and reduced access to addictive substances. However, on the other hand, the nutritional value of prison meals is far from ideal, there is overcrowding, poor ventilation, and stress that may further exacerbate pre-existing medical conditions.
There is no easy solution and certainly no swift one.
Bibliography:
Ahébée , S. (2021, April 9). 40% of Incarcerated people have chronic conditions – how good is the health care they get behind bars? . Retrieved from WHYY.org: https://whyy.org/segments/why-good-health-care-in-u-s-prisons-may-be-hard-to-come-by/
American Academy of Family Physicians. (2021, July). Incarceration and Health: A Family Medicine Perspective (Position Paper). Retrieved from www.aafp.org: https://www.aafp.org/about/policies/all/incarceration.html
American Academy ofpediatrics & The American College of Obstetricians and Gynecologists. (2007). Guidelines for Perinatal Care. Elk Grove Village, IL; Washington, DC.
Committee on Causes and Consequences of High Rates of Incarceration; Committee on Law and Justice; Division of Behavioral and Social Sciences and Education; National Research Council; Board on the Health of Select Populations; Institute of Medicine. Healt. (2013). Impact of Incarceration on Health. In Health and Incarceration. Washington, DC: National Academies Press (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK201966/
Greenblatt, A. (2019, July 29). America Has a Health-Care Crisis — In Prisons. Retrieved from governing.com: https://www.governing.com/archive/gov-prison-health-care.html
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