Prison Helathcare

Answer

Prison Health Services Lags Behind in terms of Quality, Access and Safety Compared to that is Provided at the Community Setting

            Primary care in prison should be available to every prisoner. The core purpose of providing health care services in prisons is the same as that which is aimed to be achieved outside the prison or at the community. Sick prisoners should be cared for just like how other patients are cared for outside prison. However, this may not be the case on multiple occasions since prison is a controlled environment. This paper provides a review of literature that may help provide credible responses to the thesis statement and the research questions below.  The guiding thesis statement of this review is that prison health services lags behind in terms of quality, access and safety compared to that provided at the community setting. One issue is that there is limited access to healthcare services in prison compared to a similar situation at the community setting. The second contributory issue is that there is limited healthcare resources in prison compared to a similar situation at the community setting. The third issue is that the prisons are associated with high proportion of mental health and substance addiction disparities compared to a similar situation at the community setting. The last, but not the least, issue is that prisoners are vulnerable since prison environment is highly controlled and restrictive in nature. Prison healthcare may lag behind community standards of health care, perhaps into the foreseeable future.

Research Questions

1. How does access to healthcare services in prison compares to that provided at the community setting?
2. How does prison healthcare resources compares with those available at the community setting?
3. What are mental health and substance addiction disparities in prison life? Does it compare with the situation at the community setting?
4. Does the controlled prison environment make prisoners vulnerable and hence susceptible to get physical injuries, psychosocial issues, infections, and other health conditions?

Access to Prison Health Care

            Access to healthcare services and resources in a prison setting is limited. This is despite the fact that prions may provide a unique opportunity for investing in health of the marginalized and disadvantaged populations and for addressing social exclusion and health inequalities that occur in community setting. Good access to healthcare services and resources in prison may help reduce the risk of re-offending (Baybutt & Khadoudja, 2016). Poor physical and mental health among prisoners perhaps due to poor access to healthcare services and/or healthcare resources may be associated with inmate misconduct. Inmate misconduct is associated with a range of negative experiences and demographic factors determined by the criminal justice system (Semenza & Grosholz, 2019). The incarcerated population has a constitutional right to healthcare. The U.S. Supreme Court in Estelle v. Gamble (1976) case ruled that a considered failure to provide adequate/sufficient medical treatment to any prisoner amounts to unusual and cruel treatment for prisoners. However, Medicaid coverage may be suspended or terminated when one is incarcerated. In addition, some prisoners may have been accessing any healthcare insurance before they were arrested (Dumont et al., 2012). Correctional institutions are required to provide minimum community standards of health care to inmates. Only 4,575 correctional institutions around the U.S. have been accredited by the National Commission on Correctional Health Care after meeting minimum community standards for healthcare (Rich, Allen, & Williams, 2015).

            Healthcare resources in a correctional setting are largely limited or unavailable. For example, about half of prisoners who were taking medications before incarceration are forced to leave their medication plan due to limited access or lack of medications in a prison environment. In addition, expansion of prisons might occur without expansion of prison staff (including medical staff), medication supply and without expansion of healthcare services. In addition, large prisons may be hit by budget cuts that will further impact prisoners’ health and wellbeing (Wallis, 2015). On the other hand, inconsistencies in screening procedures for mental health conditions in different prison facilities may be the reasons for the failure to treat mental health disorders (Wallis, 2015). The growth of prison population in the U.S. mirrors similar growth of prison population around the world. The growth of world prison population surpasses the global rate of population growth. Some of the key health issues affecting prison population include human immunodeficiency (HIV) virus and blood borne viral infections, which may be attributed to restrictive prison environment, lack of adequate health resources, and poor access to health care services (Kinner & Young, 2018).

Lack of adequate healthcare resources may contribute to disparities in health among the prison population compared with the general population. For example prisoners often lack access to condoms, thus, they are predisposed to higher risk coerced or forced sexual behaviors that may in turn increase the spread of sexually transmitted infections within the prison population. Prisoners may engage in high risk behaviors due to lack of condoms. It may help to explain the observation that the prevalence of hepatitis C and human immunodeficiency virus among the prison population is 9 to 10 times higher among the incarcerated population than the general non-incarceration population (Dumont et al., 2012). In addition, at some point, the prevalence of syphilis among women prisoners in New York City jails were 1000 times than that was experienced in the general population. This was attributed to lack of provision of safe sex devices/condoms to women in prison (Dumont et al., 2012).

Prisons have been experiencing overcrowding issues due to increased number of arrests for drug –related offenses as well as those with mental health issues. The criminal justice system has been growing tougher on drug offenses. The get-tough-on-crime stance has uniquely affected the Black populations; with less impact on the White population. This has contributed to the Black-White disparity in terms of prison rates. Unlike in community settings whereby drug addicts enjoy better access to drug-related treatments; drug addicts in prison stand at the mercies of courts to determine whether a diversification for treatment for prisoners may be considered. As such, access to treatment for drug and substance abuse issues in prison setting is determined by autocratic protocols and decisions. Despite shifting of drug sentencing policies to promote community drug treatment, the Black population remains underserved (MacDonald et al., 2014).  In addition, chronic prison overcrowding also poses other challenges such as the growth of aging prison population whose healthcare needs remain unmet. The changing healthcare needs of the aging prison population remain unmet. The aging prison population experiences higher rates of disability and chronic conditions than the similar aging population in the community due to poor access to healthcare and limited healthcare resources (Psick et al., 2018).

Diversion for treatment is needed to help address substance use disorders in prison or after release to curb the burden of overwhelming mortality that affect individuals who have been released from prison (Chang et al., 2015). Prisons and jails provide an opportunity for treating drug addiction and substance use disorders among prisoners but this is not always the case since treatment decisions are decided by the courts (Chang et al., 2015). Apart from treating prisoners for drug use disorders, they should as well be provided with a life and health education programs to make them life healthy lifestyles in and outside the prison. The rationale of this recommendation is that individuals who cycle through prison and civilian life experience are likely to engage in high risk behaviors such as unprotected sex, injection drug use, unsterile piercing, and unsterile tattooing; hence, high risk of contracting or spreading HIV, hepatitis C, and hepatitis B (Kinner & Young, 2018).  

In general, unprecedented number of arrests tends to be concentrated in predominantly nonwhite and low-income communities where individuals are largely medically underserved (Dumont et al., 2012).  As a result, far higher rates of mental illnesses and physical illnesses tend to occur among jail and prison inmates than at the general population. Majority of those in jail or prisons may have been socioeconomically disadvantaged before their time of arrest and incarceration (Dumont et al., 2012). In the U.S. today, there are more people with mental health disorders in prison and jails that anywhere else. The U.S. correctional system is the biggest mental health services provider. However, only half of prisoners who are diagnosed with mental disorders receive treatment. These disparities contributes to mental health disparities in prisons and jails (Wallis, 2015).

            The social and the physical environment of a prison play a key role in determining the well-being and health of prisoners. Factors such as violence, overcrowding, lack of privacy, enforced solitude, insecurity about future prospects, isolation for social networks, and lack of meaningful activity predisposes prisoners to development of mental health issues. Comparatively these determinant factors are less often experienced in a community setting. These issues tend to increase the risk of suicidal ideation and suicides largely due to development of depression. On the other hand, chaotic life of prisoners with a broad span of interconnecting issues tends to increase the risk of re-offending behaviors. Prisoners may have also been exposed to or developed other mental and physical health determinants before incarceration such as unemployment, problematic attitudes, lack of housing, substance misuse, poor mental and physical health, lack of family network, and/or debt (Baybutt & Khadoudja, 2016).

            Prisoners are particularly vulnerable due to the restrictive or controlled prison environment. Prisoners experience an increased risk to contract communicable diseases such as tuberculosis (TB). In fact, TB is considered a severe cause of mortality and morbidity among the incarcerated populations. The restrictive prison environment is not the only reasons that make TB a serious threat but also lack of adequate healthcare resources. Prisons may have inadequate diagnostic tools and limited laboratory capacities as opposed to how it could have been the case outside the prison. In addition, prisons tend to experience interrupted supply of therapeutics and medications that increases the vulnerability of prison populations to infections and perhaps further deterioration due to untreated disease. On the other hand, there is a weak integration between prison and civilian TB services, low priority in policy making for prison healthcare, and insufficient infection control measures (Dara et al., 2015).

            People who are released from prison experience a high mortality rate compared with the general population due to the restrictive/controlled prison environment and vulnerability of the prisoners. Psychiatric determinants are the leading risk factors for increased mortality rate among individuals who are released from the prisons (Chang, Lichtenstein, Larsson, & Fazel, 2015). In a study by Chang et al. (2015) of the 47,326 individuals who were imprisoned, 2874 (6%) deaths were recorded within a span of 5.1 years. This represented a rate of 1205 deaths per100, 000 person-years. Substance use disorders were the major causes of mortality for the released prisoners. In addition, substance use disorders were also established to the independent determinants of external-cause mortality among former prisoners (Chang et al., 2015). According to Kaiser Family Foundation (2017), the average death rate is 731.9 per a 100,000 population in the U.S.

            In conclusion, determinant factors such as limited access to healthcare services, limited/ lack of healthcare resources, mental and substance abuse disparities, and prisoner vulnerability all contribute in combination or singly to poor health outcomes among incarcerated populations as opposed to other patients in the community setting. Government partnership, commitment, and sustained financing of prison healthcare services is required so as to facilitate improvement of prison healthcare services to match that provided in the community settings. The government should ensure that prisons is a place for promoting health and for resolving social and health issues; rather than for deterioration of social and health issues. Most of the prisoners’ origin from socioeconomically disadvantaged background since most arrests occur in low-income communities. Community treatment for drug offenders is recommended since diversion for treatment for drug offenders, especially for Blacks is not guaranteed. Drug related offences contribute to racial disparities in prison as well as health disparities. For example, limited healthcare resources and controlled prison environment both play a critical role in the spread of TB in prison and high morbidity and mortality of the disease. Prisons should be engaged in practices that will tackle mental health and physical health disparities in prison and in promotion of inclusion. Better healthcare for inmates will not only result in better mental and physical health, but also a reduced risk of reoffending or misconduct.