The Growth of Incarceration in the United States Exploring Causes and Consequences (2014) / Chapter Skim
Currently Skimming:
7 Consequences for Health and Mental Health
7 Consequences for Health and Mental Health
Pages 202-232
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From page 202... ...
. In addition to the causes of incarceration described elsewhere, the inadequate community treatment of drug addiction and, to a lesser extent, mental illness can be viewed as underlying contributors to behaviors leading to incarceration (and reincarceration)
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Next, we look at the impact of incarceration on both physical and mental health, and then at health following release. We conclude the chapter with a review of knowledge gaps in these areas and concluding remarks.
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In this section, we address in turn the following aspects of the health profile of the incarcerated population: mental health, substance abuse, infectious diseases, chronic conditions, aging prisoners, and the health of female inmates. Mental Health A recent survey by the Bureau of Justice Statistics (James and Glaze, 2006)
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From page 205... ...
Although nationwide studies are not available, small-scale studies show the high rate of criminal justice involvement among those with mental illness who are receiving mental health services. In San Diego, for example, 12 percent of mental health service recipients were incarcerated during a 1-year period; in Los Angeles, 24 percent of Medicaid clients receiving mental health services were arrested over a 10-year period (Cuellar et al., 2007; Hawthorne et al., 2012)
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In contrast, the Bureau of Justice Statistics reports that 68 percent of jail inmates have symptoms consistent with DSM-IV definitions of dependence or abuse. About 47 percent of jail inmates have alcohol dependence or abuse, compared with 54 percent of jail inmates with drug dependence or abuse, indicating a substantial population dealing with both substances simultaneously (Karberg and James, 2005)
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5. Tailoring services to fit the needs of the individual is an important part of effective drug abuse treatment for criminal justice populations.
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. However, reported rates may understate the true prevalence in facilities that do not perform universal screening or among sex workers, who often are released from jail before testing is conducted (National Commission on Correctional Health Care, 2002)
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. National surveys of prisons in 2004 and jails in 2002 revealed that 77 percent of federal prisoners, 69 percent of state prisoners, and 18.5 percent of jail inmates reported being tested for HIV since their incarceration (Maruschak, 2004, 2006)
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Even in the youngest age group (18-33) , 10 percent of jail inmates and 11 percent of prison inmates had hypertension, compared with 7 percent of nonincarcerated individuals in the same age group, and patterns were similar for other common chronic conditions (e.g., asthma)
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In that same period, the U.S. incarcerated population aged 55 or older in the state and federal prison systems increased by some 550 percent as the prison population doubled (Williams et al., 2012)
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Nonetheless, 18-30 percent of male prison inmates exhibited alcohol dependence/ abuse, only slightly in excess of figures for the U.S. general public, while at 10-29 percent prevalence, female prisoners were two to four times as likely as nonincarcerated women to have alcohol dependence/abuse (Fazel et al., 2006)
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We discuss the difficulty of assessing the quality of care across correctional facilities because of the lack of uniform standards, the disconnect between correctional health care and that provided within the community, and the variations in correctional health providers and availability of treatments. We close with a reflection on the role of correctional health care in offsetting health disparities.
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The Bureau of Justice Statistics reports that in 2001, state prisons spent 12 percent of their operating expenditures, or $3.3 billion, on health care for prisoners. There was wide variation by state, ranging from $5,601 (Maine)
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. Hamden County jail in Massachusetts, which partners with community health centers, facilitates continuous care delivery by assigning new inmates, based on their zip code, to care from staff of community health centers while inside the facility and developing individualized discharge plans linking inmates to their local health centers upon release (Conklin et al., 2002)
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Correctional Health Care Providers The structures, quantity, and quality of correctional care vary widely both among the states and within state and local systems. The picture of who provides care in correctional facilities overall is incomplete.
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. The principles of drug abuse treatment of the National Institute on Drug Abuse presented earlier in Box 7-1 suggest that drug treatment, in parallel with sanctions for individuals involved with the criminal justice system, can be effective in leading toward recovery from drug addiction as well as reducing criminal behavior (see also Matejkowski et al., 2011; Nordstrom and Williams, 2012)
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. Drug treatment administered by the criminal justice system has taken several approaches: assignment to interventions within the community, referral to drug courts where treatment is merged with judicial oversight, treatment while incarcerated within prisons and jails, and/or participation in reentry programs when prisoners transition from prison back to the community.
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From page 219... ...
and the general lack of understanding of drug addiction and evidence-based treatments, but these problems are exacerbated in the correctional setting. Correctional health care staffs generally do not include physicians familiar with addiction medicine who can educate correctional authorities about addiction as a medical condition; as a result, addiction frequently is omitted from the list of medical conditions for which treatment must be provided (Chandler et al., 2009)
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The latter theory is discounted on its face because the health profiles of prison and jail inmates in general are worse than those of the general population. However, the theory may play a role in the reduced disparities among inmates compared with the general population because incarceration casts a broad net into the black population, capturing a large number of relatively healthy 8 The healthy worker effect, initially observed in studies of occupational diseases, explains that workers usually exhibit lower overall death rates than the general population because the severely ill and chronically disabled are ordinarily excluded from employment (Last, 1995)
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Unfortunately, the available evidence is limited, and we can only conclude that, overall, health probably improves during incarceration in some ways but deteriorates in others. Conditions of Incarceration and Health For people living especially chaotic lives, incarceration can offer respite and stabilization.
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foods are common, although prison meals may be better than those normally consumed by people living especially chaotic lives. One of the few studies to measure inmates more than once found that 71 percent of women gained weight over a 2-week period after admission to jail, on average 1.1 pounds per week (Clarke and Waring, 2012)
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. A survey of female inmates in Rhode Island also found a strong inverse correlation between the number of incarcerations and willingness to remain abstinent from smoking after release (Nijhawan et al., 2010)
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. In a study of one jurisdiction, 32 percent of male prison inmates reported a physical assault in a 6-month period (Wolff and Jing, 2009)
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. In a survey of current inmates, more than 4 percent of prison inmates and 3 percent of jail inmates reported sexual assault (Beck et al., 2013)
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. While the Prison Rape Elimination Act required all states to collect and report all allegations of such incidents and to note whether they had been "substantiated" through investigation, serious questions continue to be raised about the completeness and reliability of the data acquired.
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The elevated risk of overdose in the days following release reflects the insufficient nature of drug treatment during (and after) incarceration.
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In general, those diagnosed with mental illness are more likely than others to receive discharge planning (Baillargeon et al., 2010b) , but they also are more likely to be homeless and to rely extensively on emergency department health care after release.
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Public Health Opportunities There is need for systematic study of ways to capitalize on public health opportunities associated with incarceration, particularly for infectious diseases such as HIV, HCV, and STDs, and also for mental illness and substance abuse. Understanding which components of the criminal justice system are or
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Furthermore, it is important to understand what is necessary to implement such interventions and what short- and long-term health, public health, and criminal justice outcomes can be expected. Research is needed to understand the extent to which underlying health issues, especially substance abuse and mental illness, contribute to incarceration and recidivism.
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When asked about reducing correctional medical costs, a correctional administrator replied, "No problem, just stop sending me sick prisoners."11 Correctional institutions have essentially no control over who enters and leaves. To reduce the burden of disease in correctional facilities, diversion strategies in the court system could potentially connect individuals to more appropriate treatment, particularly those with histories of mental illness and substance abuse given their high prevalence in incarcerated populations.
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232 THE GROWTH OF INCARCERATION individual barriers, such as insufficient discharge planning, community care providers, and ancillary services, likely exist. Finally, monitoring the broader, population-level outcomes of reduced incarceration and improved screening, health care, and postrelease linkages to health insurance and care will be important to determine their societal benefits.
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