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Incarceration has been used all too often as a solution for shortcomings in health and other social services. Medical and public health researchers are among those recommending that correctional facilities be used as a venue to improve individual and population health, since correctional facilities serve as health-care providers of last resort for the medically underserved (Freudenberg 2001; Rich et al. 2011). Reentry likewise constitutes a public health opportunity that is both often lost and problematic. Prison and jail inmates confront a range of challenges upon reentry into the community. The incarcerated carry a higher disease burden than the general population, and their health status and health care upon reentry have significant repercussions not only for their own post-incarceration lives but for public health as well. Correctional facilities can both serve as sentinels for the health of a disadvantaged population and implement care and transition services that ensure the continuity of medical care from prison into the community upon release, but they often fail to do so. There are complex challenges to the successful implementation of discharge planning and reintegration into society, but capitalizing upon such services to address mental health, substance dependence, and other medical needs has important consequences for both individual and community health.
Health Profile Of The Incarcerated
Incarceration is concentrated in low-income communities, and health is strongly correlated with socioeconomic status. In addition, risk factors for incarceration and for poor health frequently overlap. As a result, inmates tend to have far more health problems than the general public. The United Nations and other international reviewers have documented that prisons and detention facilities in many world regions are not in compliance with international standards like the Standard Minimum Rules for the Treatment of Prisoners, established by the UN High Commissioner for Human Rights (UNHCR). Facilities are often overcrowded and unsanitary and thereby may have additional adverse health effects for an already ill population (Jurgens et al. 2011).
Public health practitioners have long been concerned with correctional facilities as repositories of infectious diseases, especially tuberculosis, HIV, and hepatitis C virus (HCV) (Hammett 2006). Despite gains since the 1990s, HIV prevalence in the USA remains about five times higher in state/federal correctional facilities than in the general public: 1.6 % among male inmates and 2.4 % among female inmates, compared with 0.36 % in the total US population for 2006 (Hammett 2006). Internationally, studies have found wide estimate ranges for HIV prevalence in prisons, especially in the former Soviet republics and Southeast Asia. For instance, a 2007 review found between 0 % and 26 % HIV prevalence in Ukraine and 4–22 % in Indonesia, reflecting the difficulties of establishing an accurate health profile even within individual countries. HIV prevalence could not be identified at all for 76 of 152 low-income or transitioning countries (Dolan et al. 2007).
Chronic diseases among incarcerated populations are gaining attention, given the simultaneous emergence of chronic conditions like diabetes among younger people and the aging of the incarcerated population. In the USA, between 39 % and 43 % of inmates are diagnosed with diabetes, hypertension, asthma, or another chronic condition, rates consistently higher than among the general population (Binswanger et al. 2009; Wilper et al. 2009). Moreover, comorbidity (i.e., the coexistence of two or more medical conditions) is high in this population. The risk behaviors for HIV – especially injection drug use (IDU) – put the same individuals at high risk for HCV, which is 9–10 times more prevalent among the incarcerated than among the non-incarcerated (Freudenberg 2001). Because patients coinfected with both HIV and HCV have also been found to have more comorbidities than HIV mono-infected patients, these inmates are likely to carry a greater overall burden of coexisting chronic and/or infectious diseases.
These physical conditions are frequently complicated by the mental health profile of the incarcerated. The emergence of prisons and jails as the largest institutions in the United States housing the mentally ill reflects the de facto criminalization of mental illness. Well over half of inmates at any given time have a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) mental disorder. In US jails, 63 % of blacks and 71 % of whites in a 2002 national survey self-reported symptoms or diagnoses of mental illness, with rates slightly lower in state and federal prisons (James and Glaze 2006). Women, who constitute a small minority of inmates, generally have much higher rates of mental illness, and posttraumatic stress disorder (PTSD) is common among incarcerated women, about one-third of whom were subject to physical abuse and one-third to sexual abuse prior to incarceration (Lewis 2006; Baillargeon et al. 2010). Because of differing research methodologies, it is difficult to determine whether the significantly higher rates of mental illness among US female inmates reflect a distinct US experience or whether they merely reflect different data collection practices. A systematic review of studies in 12 western nations also found disproportionately high rates of mental illness among inmates. Rates of personality and antisocial disorders were lower among women than among male inmates but were similar for women and men for psychotic illnesses and major depression (Brooker et al. 2007). Rates for other world regions are difficult to obtain, in part because both medical exams and surveys are not consistently conducted.
An important component of prisoners’ mental health profile is substance dependence and addiction. Estimates of the number of the incarcerated meeting DSM-IV criteria for drug dependence or addiction vary widely but are well above 50 % and again substantially higher among female inmates (Freudenberg 2001; James and Glaze 2006; Binswanger et al. 2009). Comorbidity of substance abuse and mental illness is common among inmates. Addictions and other mental illnesses both increase the probability of engaging in behaviors associated with infectious disease transmission and complicate treatment for conditions such as HIV and HCV, which require a sustained adherence regime and careful monitoring for adverse drug interactions.
While incarceration may improve health conditions for some (e.g., by providing access to health care, stable shelter, and regular meals), it can worsen health outcomes in other respects. This may be the case especially with mental illness and addiction. Those with mental health issues are more vulnerable to placement in isolation, an environment particularly hazardous to mental health. Most facilities adopt a “cold turkey” approach to substance addiction, leaving the addicted subject to withdrawal during incarceration and more vulnerable to overdose upon release. Although drug use is technically forbidden in nearly all facilities, it remains common and the shared use of needles also contributes to the transmission of infectious diseases, especially HCV. Needle and syringe exchange programs exist in several European and Asian countries, but few facilities to date participate (Jurgens et al. 2011).
A number of national and international mandates exist regarding the provision of health care to inmates. In the United States, two key Supreme Court decisions have upheld the finding that correctional facilities must provide health care comparable to what might be reasonably attained in society. In 1976, the Estelle v. Gamble decision declared that the deliberate failure to provide health care constituted unconstitutional cruel and unusual punishment. Since Estelle v. Gamble, litigation or the threat thereof has greatly improved correctional health care, and in 2011, Brown v. Plata ordered the state of California to reduce overcrowding on the grounds of its interference with the due provision of health care. Despite these legal advances, a lack of standardized reporting and quality measures has made it difficult to know the quantity or quality of health care actually provided on a national basis. However, studies have indicated that many inmates in need of health care do not receive it or receive suboptimal care, whether for HIV, HCV, chronic conditions such as diabetes, mental illness, or substance abuse. There are some correctional facilities that are recognized as public health models of successful diagnosis and treatment of inmate health conditions. For the most part, though, there is still room for improvement in prison health services. Jails and pretrial detention centers diagnose and treat even smaller percentages of inmates, in part because of higher turnover and shorter stays. Since 95 % of inmates are eventually released, the inmate health profile follows them to reentry, with considerable implications for both their own reentry experience and community health.
Transitioning To The Community
Incarceration is a temporary situation for most inmates, and as recidivism rates are high, many people cycle repeatedly between the community and detention. In the USA, over seven million people leave jail and an additional 600,000 exit state and federal prisons annually (US Bureau of
Justice Statistics 2003). They are largely a high need, low-resource demographic: in addition to more than usual health needs that may interfere with daily functioning, as a group they have less education and fewer economic and social resources than the general population. Releasees also frequently return to the community in highly unstable circumstances, struggling to reestablish housing, employment, and relationships. In this context, attention to health needs often falls by the wayside, and high-risk behaviors such as unsafe sex and relapse to drug use are common. The overwhelming challenges of reentry are evident in mortality trends. Data in the USA and other nations have documented a spike in mortality in the first 2 weeks after release: in the USA, releasees were 12.7 times more likely to die in that period than the general public and 129 times more likely to die of an overdose (Binswanger et al. 2007). Similar post-release mortality rates have been identified in other countries.
Correctional authorities are increasingly addressing this problem with discharge planning, a term that broadly refers to the process of helping prisoners to prepare to make the transition from incarceration back into the community, but the resources allocated to transition services have been steadily reduced in the last 20 years even as the correctional population has increased fourfold (Re-entry Policy Council, 2005). As a result, only about 10 % of releasees from US state prisons in need of discharge planning actually receive it, far less than was the case in earlier decades (Mellow and Greifinger 2005). In general, the high turnover rates and short stays of jail inmates prevent discharge planning in jails altogether.
To date, there has not been any large-scale research examining the patterns of implementation or results of discharge planning, either across the USA or internationally. However, collaborative work focusing on HIV provides one basis for such research. A multicenter, Health Resources and Services Administration (HRSA)-sponsored Special Project of National Significance (“Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative”) was established in 2007 to test and evaluate models for linkage to care for people with HIV leaving jail. One linkage project under way makes use of new federal reporting requirements to link correctional and clinical data, thereby constructing an empirical basis for evaluating why some linkage succeeds and some fails. This HIV-specific work may be creating paradigms that can be used to evaluate the transition from correctional health care to community-based health care for other health conditions as well. It is clear that to achieve successful linkage to community-based health care, discharge planning must extend beyond the provision of information and even initial free services. A widely noted study in Texas found that only 5 % of HIV-positive releasees filled free prescriptions in time to prevent an interruption of treatment, suggesting the critical role of factors beyond the ability to pay (Baillargeon et al. 2009).
Discharge planners increasingly understand the need to view health within a broader spectrum of reentry needs. Because inmates are so often undereducated and lacking both financial and social resources, discharge planning is often unsuccessful unless it provides sustained, holistic assistance. On the one hand, untreated medical conditions will reduce the probability of successful reintegration into the community; on the other, the failure to address other reentry needs (especially employment and stable housing) significantly undercuts the probability of resolving health needs. Thus, medical discharge planning must occur in coordination with other transitional services targeting complex social needs.
Numerous guidelines recommend that discharge planning requires an ongoing, two-stage approach in order to be effective. Ideally, the process should begin shortly after admission into the correctional facility, though in general it is set in motion only a few weeks or months before the inmate’s anticipated release. There is broad consensus among guidelines that the second stage should proceed to ongoing case management in the community upon reentry (Re-entry Policy Council, 2005). Randomized controlled trials have not yet confirmed the benefit of case management service; however, studies found an association between case management and positive health or behavioral outcomes (Springer et al. 2011). As a result, discharge planning requires the kind of sustained cross-agency collaboration that is frequently difficult for state and community agencies to coordinate and maintain. Only in rare cases do state health departments have any jurisdiction over correctional health care, so discharge planning requires Departments of Correction (or their non-US counterparts such as Ministries of Justice) to reach out to partners they are not ordinarily organized to work with.
Despite these organizational challenges, there are programs that provide more successful discharge planning results for health care and health behaviors, and there are examples of discharge planning being addressed by collaborations between corrections officials, cross-agency coalitions, and local community agencies. Many of the existing programs aim to build multi-sectorial collaboration with community-based organizations in order to prepare individuals for release and provide them with health care within a spectrum of other resources such as housing, employment, and social benefits. One such program is the Hampden County Jail in Massachusetts, which adopted a public health paradigm for its inmate health-care services (Conklin et al. 2002). The county sheriff’s office partnered with the public health department, regional medical centers, and community health centers to provide continuous health-care delivery by assigning new inmates to care based on their zip code, in order to facilitate continuous care delivery by linking inmates to community providers prior to their release. Staff from community health centers provide health services inside the facility during incarceration and develop individualized discharge plans before release. Program evaluations are incomplete but indicate improved inmate and community health, reduced recidivism, and cost savings. Even in this closely coordinated system incorporating community providers into prerelease correctional care, however, releasees are frequently lost to follow-up care.
In light of generally insufficient resources, even where correctional authorities are concerned to support discharge planning, such services are often only provided for inmates with dedicated resources such as those with HIV or severe mental illness. HIV-centered reentry programs have been implemented in a number of states. Transitional services may be facilitated by two mediators: a small geographic range to work within and a close-knit, locally respected health professional community that works effectively with corrections authorities. (Thus, guidelines and best practices for discharge planners often warn not to “lift” programs from other communities, since what works in one setting may not work in another without adequately taking account of local circumstances.) In the Community Partnerships and Support Services for HIV-Infected People Leaving Jail (COMPASS) program, for instance, the Rhode Island Department of Corrections agreed to have jail staff notify community outreach workers when inmates with HIV were admitted or when inmates were newly diagnosed. Outreach workers then met with inmates in the jail to assess their postrelease needs and provided sustained case management upon reentry (Nunn et al. 2010).
Qualitative research with COMPASS care recipients revealed another complicating feature of transition services: their success relies to a great extent upon sustained personal relations. Successful initiation of community-based care upon reentry and ongoing treatment adherence was strongly associated with intensive case management, including home calls to remind participants to keep doctor’s appointments, providing transportation to medical and other services, and assisting with processes like registering for Social Security or disability benefits. As the smallest state in the USA, RI has a highly centralized and compact service area and close ties among professional communities, advantages that may be difficult to replicate elsewhere. Participants also highlighted the importance of having an engaged and perceptibly caring doctor, the absence of which was identified as a barrier to treatment adherence in other studies (Nunn et al. 2010).
Because patients with HIV are six times more likely than those with other chronic conditions to identify a regular source of care after discharge, non-HIV postrelease continuity of care may be even worse. This is particularly relevant for those with addictions and mental illnesses who received insufficient treatment during incarceration, many of whom are incarcerated in the first place because community-based treatment was not available to them. Although more likely to receive discharge planning (66 % of state prisons provided some form of postrelease support to access community-based mental health services in 2000 (Baillargeon et al. 2010)), the proportion of releasees receiving needed mental health services is further reduced by incomplete identification of mental health needs among inmates prior to release. A 2008 study in Texas and Ohio found that self-reported mental illness was about one-third more common postrelease than during incarceration, which the authors hypothesized was due to inmates withholding information about mental health diagnoses from correctional staff (Mallik-Kane and Visher 2008). It is also possible that mental health deteriorates for some inmates as a result of incarceration itself.
For those inmates with mental health needs who are identified in time to arrange transition services, several sets of guidelines and best practices have been set out by the American Psychological Association, the Council of State Governments, and other entities. Even with such resources available to discharge planners, releasees with mental health needs often fail to link to community-based care and, even when they do, experience frequent treatment relapses, especially when there is an addiction or substance-dependence comorbidity. Mentally ill releasees are more likely to be homeless and usually exhibit patterns of health-care utilization for acute episodes (e.g., emergency department use or psychiatric hospitalizations) rather than ongoing mental health and medical treatment. Even though inmates with mental illnesses are generally given a supply of medications upon release, medication maintenance has been found to decline 8–10 months postrelease (Mallik-Kane and Visher 2008). The successful transition to community-based care upon reentry may be especially difficult when mentally ill inmates complete their sentences and are released without community-based supervision by a parole officer. Parolees may be subject to oversight and sanctions for failing to complete treatment (though this gives rise to possible ethical concerns about enforcing undesired medical treatment, which has more generally been found unconstitutional in the USA and elsewhere). Releasees who have completed their sentence, on the other hand, are not required to follow the recommendations of discharge planners; this scenario also eliminates the parole officer as a potential resource, albeit a coercive one, for releasees.
The specific mental health needs of people with substance dependence or addiction are subject to similar difficulties in effective discharge planning. Releasees with addictions are particularly prone to relapse and recidivism; many are returning to families or social groups with similar substance abuse habits, increasing the risks of relapse (Mallik-Kane and Visher 2008). In addition, enforced abstinence during incarceration contributes to both relapse and overdose upon release. Medication-assisted treatment (MAT) for opiate addiction has been found effective in reducing heroin use, criminal behavior, HIV-risk behaviors, and overdose deaths. For example, methadone, a synthetic opioid, has been used for several decades to treat opiate addiction, as it reduces the craving for shorter-acting opioids and with proper dosing blocks their euphoric effects. However, correctional authorities are generally reluctant to employ it. As a result, inmates with substance dependence or addiction are less likely to have methadone or other MAT as part of their discharge planning (Nunn et al. 2009). Interventions that follow in-prison drug treatment programs with postrelease treatment have been shown to reduce post-reentry drug use and its associated recidivism. Since the most recent developments in behavioral science emphasize the role of environmental triggers over individual motivation, though, such treatment is often undermined by a return to the original environment upon reentry.
Reviews of existing transition services suggest that discharge planning can provide critical assistance in linking releasees to continued health care upon reentry, with improved outcomes for both health and recidivism. However, discharge planning remains available to only a fraction of reentering prisoners with health needs. In many facilities, concerned staff receive little institutional support from administrators who may view continuity of care as extraneous to the facility’s function of punishment and/or public security. Even in facilities with supportive administrators, budgetary constraints frequently limit the amount of services available. It is also clear that even well-planned and well-funded transition services are undermined by other structural barriers that releasees encounter upon reentry.
Foremost among these is the problem of access to care. Unlike most other developed nations, the uninsured constitute a substantial percentage of the US public. Almost 80 % of former prisoners in a 2008 survey were without private or public insurance upon reentry (MallikKane and Visher 2008). Because unemployment is high among releasees, Medicaid (state/federal coverage for those under 65 with income, family, or health qualifications) is particularly important. Although federal regulations require only that states suspend Medicaid during incarceration, most states terminate it altogether. As a result, releasees lack financial coverage and thus access to most health care during the critical reentry period. Since the reapplication process is cumbersome and often overwhelming for a lowresource population (e.g., low literacy hampers successfully completing paperwork, and the lack of stable housing interferes with the reception of notices from the Social Security Administration), resuming coverage can take months or occur not at all. This problem was exacerbated after 1996, when the Social Security Administration implemented a system of financial incentives to encourage correctional facilities to notify them upon incarceration of a Medicaid recipient, resulting in prompt termination of benefits including medical coverage.
Starting in 2014, the 2010 Patient Protection and Affordable Care Act (ACA) will expand eligibility for Medicaid for most reentering offenders, especially by targeting the low-income adult males that constitute the majority of inmates. Even the expansion of coverage under the ACA, however, will leave about one-third of the currently uninsured without coverage; thus, insurance can be expected to remain a critical factor in postrelease access to health care.
In addition to low rates of coverage, releasees are hampered by poor access to health care and often rely on emergency rooms for care. The successful transition to community-based care upon reentry is further hindered by poor communication among the various health-care providers involved. It is seldom possible for patients even among the general population to conduct their own medical histories from provider to provider, making inter-provider communication all the more critical for patients with complex health needs and low medical literacy. While discharge planning is far more frequent in prisons than in jails, state and federal prisons are also much more likely to be geographically distant from inmates’ home communities and thus from the health-care providers to whom releasees must transition. Since a minority of US providers have transitioned to electronic health records (EHR), the successful communication of medical histories and treatment plans from correctional facilities to community-based providers is even more difficult to coordinate. As a result, information regarding health needs and service history can be fragmented and care correspondingly poorly coordinated.
Finally, releasees with health needs frequently reenter a social context that is poorly equipped to support their health needs and can undermine even the best discharge planning. Regardless of intent, releasees often have little choice but to return to networks and associations that support criminal activity and risky health behaviors. Family dynamics are especially critical upon reentry. Inmates with physical health needs are as likely to receive material support from their families as inmates without physical health problems, but they also appear to be more likely to be involved in domestic violence. In a 2008 survey, men with health problems were more likely to be victims of domestic violence than other men upon reentry, though their female counterparts were more likely to perpetrate domestic violence than women without physical health problems (Mallik-Kane and Visher 2008). Releasees with substance dependence or addiction are especially likely to return to families engaged in substance use and criminality; here too, men were more likely to suffer domestic violence than male inmates without substance dependence.
Reentry And Community Health
Correctional facilities do not often live up to their potential to link the medically underserved to health care. In a widely cited 2008 study of releasees in two US states, most of the prisoners returning to the community had received some health care for their physical conditions but one-third of men and a quarter of women had not (Mallik-Kane and Visher 2008); moreover, no studies are available that measure the sufficiency of care that is provided. As a result, most inmates return to their communities with unresolved health problems. This has repercussions not only for the postrelease health of prisoners themselves but for the community as well.
Research into incarceration’s effects on community health has focused particularly on the transmission of infectious disease upon release. In the USA, the majority of HIV infections are acquired prior to incarceration, not while in prison or jail (Beckwith et al. 2010). However, incarceration makes a significant contribution to the spread of infectious diseases by means of the behavior it fosters upon reentry (Lichtenstein 2009). Because incarceration in the USA is concentrated in specific communities rather than being randomly distributed, it removes large numbers of young males from impacted neighborhoods and contributes to high-risk sex by leading to increased sexual relationship concurrency. Other studies have found that incarceration is associated with sexually transmitted diseases and teenage pregnancy by similarly affecting neighborhood social characteristics such as the ratio of males to females (Thomas et al. 2008). In addition, because HIV treatment is interrupted upon release in over 90 % of cases, releasees’ heightened viral loads carry with them a greater infectiousness and likelihood of developing drug resistance, creating in turn the potential for reservoirs of drug-resistant HIV in communities most affected by incarceration (Baillargeon et al. 2009).
A second field of research has emerged regarding incarceration and family health, examining both the direct effects on the mental health of inmates’ families and mediated effects on their physical health. For some, the imprisonment of a family member may represent a reprieve from a family member prone to substance abuse or domestic violence (Comfort 2007), and reentry can combine relief at the return of a family member with new stressors. Since the prison environment may foster psychological orientations like suspicion and aggression, release may have adverse effects on already-existing marriages, in addition to reducing marriage prospects in some communities by affecting the supply of marriageable men (London and Myers 2006; Massoglia 2008). These patterns are of public health concern because marital status is recognized as a key marker of health status, particularly for poor men. Moreover, committed relationships protect against sexual risk taking, so that the incarceration-based disruption of relationships contributes further to the spread of infectious disease.
There is increasing attention among US researchers to the effects of incarceration and reentry upon the children of inmates as well. Although some children’s well-being has been found to benefit from the incarceration of a parent (i.e., where there is a history of domestic violence or violent crime), these cases are outnumbered by the adverse effects on mental health when the parent was incarcerated for a nonviolent offense, as is the case in the substantial majority of the increase in incarceration since the 1970s (Wakefield and Wildeman 2011). Parental incarceration is associated with both internalizing mental health problems (e.g., anxiety or depression) and externalizing problems (e.g., aggression or delinquency) (Wildeman and Western 2010). The magnitudes of these associations are small, but on a population level, they contribute 25–45 % of the disparities in behavioral problems between black and white children (Wakefield and Wildeman 2011).
Finally, it is important to recognize the health consequences of the economics of reentry. In addition to decreasing employment opportunities, in most states, a prison record eliminates eligibility for public assistance such as food stamps, public housing, and student loans. These restrictions have repercussions on life trajectories, health behaviors, and health outcomes. State and national policy also contributes to the community health effects of incarceration and reentry. The US Census counts prisoners as residents of the largely white, nonurban communities where prisons and jails are increasingly relocated. As a result, the public funding and political redistricting that utilize census data for distribution favor the latter over the communities from which prisoners come, and both political weight and funding for public health initiatives are diminished in the low-resource communities most releasees return to.
Both incarceration and reentry offer opportunities to improve the treatment and health of high-needs individuals who often lack financial and social resources to address their health needs independently. At the same time, incarceration has been associated with poor long-term health outcomes, and because people of color are incarcerated far more frequently than whites in the USA, the experience may ultimately exacerbate rather than mitigate health disparities (Massoglia 2008; Wildeman 2011). Similar trends are visible elsewhere, for example, in the disproportionate incarceration of Australian aboriginals. Correctional authorities work regularly with the public health, medical, and social services professions to establish transitional services for releasees with health needs, but the highly complex individual and social challenges of reentry coupled with scant resources have made effective discharge planning rare. Although Estelle v. Gamble and similar international mandates do not extend to reentry, significant improvements in postrelease individual and community health are possible with substantial intervention and advocacy by the public health and medical communities.
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