In Canada, there are approximately 250 000 adult and 1500
youth admissions to correctional facilities each year, and an average of about
40 000 people are in correctional facilities on any given day.1–3 The
length of stay in correctional facilities for most adults and youth is days to
weeks,3,4 and
many people have multiple incarcerations each year. International data reveal
that the health of the incarcerated population is poor compared with that of
the nonincarcerated population, with a disproportionate burden of mental
illness, infectious diseases, chronic diseases, and premature mortality.5 In
this context of a large population with poor health transitioning in and out of
correctional facilities, there are many opportunities to improve health and
health care.
The World Health Organization (WHO) has identified
the need for coordinated health care and service delivery for incarcerated
people. Recognizing the overrepresentation of marginalized populations in
prisons, the risks of communicable diseases transmission at the time of
release, and the unhealthy living conditions in most correctional facilities,
the WHO has called for “close links or integration between public health
services and prison health.”6 The
WHO has also noted the need for “partnerships between corrections-based and
external service providers”7 in
order to provide “effective and continuous services for prisoners.”7
The period of transition between the community and
correctional facilities might be associated in particular with health risks,8 including
alcohol withdrawal on admission9;
disruptions in essential treatment during admission or release, such as
methadone therapy,10 antiretroviral
therapy,11 and
psychotropic medications12; and
death13 or
hospitalization14 on
release. However, these transitions also present opportunities to improve
health and health care, such as the initiation of contraception before release15,16 and
providing linkages with primary care services at the time of release.17,18
There are multiple barriers to achieving continuity
of health care during incarceration and at the time of release. Inmates are
frequently transferred between facilities, which complicates ongoing medical
management. The length of stay is often short and there might be uncertainty
regarding the date of release, which might preclude effective discharge
planning.19 Planning
for release might not be a priority within institutions, which might reflect a
lack of executive-level champions, limited financial resources, and poor data
resources such as electronic medical records.20 Recently
released persons might face multiple competing priorities, including the
demands of parole and the need to arrange for reinstatement of income supports.14,17,19 Finally,
high rates of mental illness, including addictions, and poverty in this
population might contribute to low rates of follow-up for care.5,21
These substantial challenges notwithstanding,
primary care physicians and other health care providers can take basic steps to
improve health and health care during incarceration and at the time of release.
As an example, the following case illustrates efforts to optimize care for a
woman through 2 incarcerations.
Full article at: http://goo.gl/Z7cYwZ
By:
- 1Postdoctoral fellow at the Centre for Research on Inner City Health at St Michael's Hospital in Toronto, Ont, and a family physician at the Hamilton-Wentworth Detention Centre. kouyoumdjiaf@smh.ca.
- 2Family physician with the Shelter Health Network in Hamilton, the Maternity Centre of Hamilton, and the Brantford General Emergency Department in Ontario.
- 3Family physician at St Michael's Hospital and Primary Care Lead at Inner City Health Associates in Toronto.
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