Health and Incarceration A Workshop Summary (2013) / Chapter Skim
Currently Skimming:
2 Vulnerable Populations and Opportunities for Reducing Health Risks
2 Vulnerable Populations and Opportunities for Reducing Health Risks
Pages 15-30
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 15... ...
Many of these proposals involved changes to the workforce, such as retraining parole officers, educating judges, raising the skill of screeners, and hiring former inmates as community health workers. Throughout the discussion, workshop participants expressed awareness of the potential of many measures to perform a threefold function: prevent incarceration in the first place; treat the health needs of the currently incarcerated, their families, and the released; and prevent recidivism.
|
From page 16... ...
The co-occurrence of mental disorder and substance abuse can complicate the detection of either, particularly when staff or diagnostic instruments are insufficiently sensitive, or where overcrowding and/or understaffing reduces the time spent on medical screening. Osher termed such co-occurrence a "critical issue" that needs to be addressed at points of both entry and exit from the correctional system.
|
From page 17... ...
Reflecting on the disproportionate numbers of people with untreated or undertreated mental health problems and addiction in the prison population, Allen noted that, given the lack of adequate care, "what we're left with is a very large number of people with compelling health needs who are ultimately incarcerated in institutions whose mission is security and where [medical] treatment is an afterthought if it even occurs at all." This theme of an inherent tension of attempting to provide therapeutic care within institutions organized for security recurred throughout the workshop (see further discussion below)
|
From page 18... ...
Osher identified these as the "central eight dynamic risk factors" that account for much of the variance in people becoming incarcerated: antisocial attitudes, antisocial friends and peers, antisocial personality patterns, substance abuse, family and marital factors, lack of education, poor employment history, and lack of pro-social leisure activities. Each of these risk factors, Osher emphasized, can be addressed through interventions.
|
From page 19... ...
. that focus just on monitoring conditions of release, then we're not going to make progress toward a system so that people can take care of their own needs outside of the criminal justice system." If this could be accomplished, Taxman argued, inmates could "find a way to become more contributing members of society and find value in their own lives." Currently, however, "that's not something the criminal justice system is invested in doing." Addressing substance abuse effectively was another priority
|
From page 20... ...
Workforce issues also figured in the discussion of substance abuse treatment. "It's really important," Chandler affirmed, "to make sure that criminal justice actors, and especially leaders, understand the underlying and important health problems of this population." Unfortunately, addiction is widely misunderstood.
|
From page 21... ...
"This increasing number of older adults," Williams declared, "really changes the entire health landscape of the correctional system." Williams explored several characteristics of the disease burden of older adult inmates. First, as in the general population, older inmates have the highest rates of typical chronic health conditions (congestive heart failure, diabetes, chronic obstructive pulmonary disease, etc.)
|
From page 22... ...
Because of the unique challenges of a prison environment and the resulting disabilities, Williams explained, "In older adults, simply cataloguing chronic disease is insufficient." Given aging trends of the incarcerated population and their associated health conditions, Williams observed that "correctional institutions are increasingly becoming a critical delivery site for long-term care or nursing homelevel care, as well as palliative care or care for people with serious chronic illnesses." In confronting and meeting the needs of the rapidly increasing older adult inmate population, Williams underscored the importance of examining both health and nonhealth policies of the criminal justice system. Beginning with health-related policies, Williams advocated four immediate changes.
|
From page 23... ...
have fewer healthcare resources, especially for chronic disease management." In concluding, Williams affirmed the responsibility of the medical profession to "help with criminal justice policy, and be at the table to anticipate potential health consequences [of] both health policies [and]
|
From page 24... ...
The stress of an unplanned pregnancy could add to their difficulty of getting re-established in the community, and some are soon re-incarcerated. Clarke shared research that indicated that about 70 percent of women in the criminal justice system who are at risk for an unplanned pregnancy indicated they want to start a contraceptive method.
|
From page 25... ...
According to Chandler, "This is the only population that we can name where we can safely say that all of the individuals in this population merit [screening for addiction and identifying] a drug abuse intervention." She advocated "comprehensive screening for all adolescents in juvenile justice to determine the severity of their substance abuse problem," to be followed by "either an indicated prevention intervention or a drug use treatment intervention." Chandler estimated that half of youth in the juvenile justice system have a substance abuse problem severe enough to warrant a diagnosis; thus, "you're going to be providing treatment to a large number of adolescents." FAMILIES The public health impacts of soaring incarceration rates are manifold.
|
From page 26... ...
This reflects both the challenges faced upon return to communities and the insufficient nature of substance abuse treatment during incarceration, during which prisoners may not realize their tolerance to opiates has declined. Despite efforts to improve the outcomes of prisoner re-entry through assistance with employment, housing, and other transitional needs that ultimately affect health, only about 10 percent of prisoners from state prisons in need of discharge planning actually receive it (Mellow and Greifinger, 2007)
|
From page 27... ...
Her first proposal was that individuals with a past history of incarceration be involved in improving the healthcare of returning prisoners. This is an issue of workforce training and cultural competence, as well as providing former prisoners with a role in decision making or "having a seat at the table." Addressing all these issues would entail "people with experience of incarceration coupled with proper training as a community health worker to help patients navigate the healthcare system following release, and really deal with all the social issues that might emerge in those days, weeks, months post-release." Wang's second suggestion was to improve transitions from prison to community healthcare systems.
|
From page 28... ...
Wang suggested that both criminal justice professionals and healthcare providers need to develop cultural competence when dealing with this population. Steven Rosenberg (Community Oriented Correctional Health Services)
|
From page 29... ...
Such conflicts cannot be navigated past: "They're baked into the pie. There are two functions and they come into conflict." Yet Allen agreed on the imperative of mutual respect between corrections officers and healthcare providers: "It's really important while we demand respect from custody [staff]
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.