Our country has the highest level of incarceration in the world: 10 million people are imprisoned every year, but the health of these people is really forgotten. We must recognize that their experiences and health implications are not in a vacuum. These individuals often struggle with undiagnosed or untreated behavioral health problems and chronic illnesses before they are jailed or imprisoned, and their pre- and post-imprisonment health problems have a ripple effect that significantly affects the health and well-being of their families and communities, and ultimately our country.
We know that Americans who are incarcerated are sicker – those who have been incarcerated or imprisoned are associated with an increased risk of almost all diseases, and they affect a much larger percentage of our population than many think. In fact, 45% percent of Americans had a next of kin who was incarcerated, and for these Americans, this incarcerated connection correlates with life expectancy two years less than for those without a family member who was incarcerated. . was imprisoned. The penitentiary system robs Americans of years of life, even if they have not served time.
For these reasons, we Aspen Health Strategy Group (AHSG), which I co-chair with former U.S. Secretary of Health and Human Services Kathleen Sebelius, have identified: “Incarceration is a major source of ill health for individuals, families, communities, and our country as a whole.” This is the question that 24 AHSG multi-industry leaders decided to explore in 2021 through the Health, Medicine, and Society program at the Aspen Institute. We have been tasked with studying some of the biggest health problems in our country and coming up with actionable solutions, and we have outlined five key messages:Reducing health hazards from imprisonmentwhich we arrived at after extensive consultation with experts in the field, as well as with those who have personally experienced the health effects of imprisonment.
Our “five big ideas” focus on expanding health coverage, providing coordinated care, implementing quality standards, and rethinking some of the justice system’s approaches to prioritize health.
In dealing with health issues in the criminal justice system, we recognize that the size and scope of the problem is significant. With 3,000 prisons, 2,000 jails, 150 immigration detention centers and 2,000 juvenile detention facilities, we have a sprawling system that provides health care to millions of people every day with minimal regulation or quality control. Each year, 10.6 million people return from correctional facilities to their communities (600,000 from prisons and 10 million from local prisons). This includes those who have not been convicted of a crime, with nearly three-quarters of those in prison awaiting trial, who cannot afford to post cash bail and are disproportionately black.
The criminal justice system has become our primary response to mental and substance use disorders, serving as the largest provider of mental health services in our nation. Actually, three largest psychiatric institutions America has prisons in Los Angeles County, Cook County, Illinois (Chicago) and a prison on Rikers Island in New York. Suicide is the leading cause of death. Our prison system is struggling with severe overcrowding, budgetary constraints, low staff morale, and significant, sometimes dangerous, staffing shortages. But because health is not a priority in these settings, for those whose criminal behavior is linked to mental health or addictions, neglecting their health needs increases the likelihood of future reoffending, exacerbating our overpopulation crisis.
Research has shown that the health effects of these prison experiences have a wide impact that goes beyond the individual. Family members and romantic partners feel the impact “psychological stress associated with stigma, grief associated with loss, relationship strains, and economic, food and housing insecurity.” Their children are at greater risk of mental illness and substance use disorders. And communities with high levels of incarceration have noticeable health problems, including chronic stress associated with population turnover.
To address these health and incarceration concerns, we recommend:
one. Cancel Medicaid Exclusion. We defined this as “a simple step that is most likely to result in positive changes in the health of prisoners.” While the Supreme Court has ruled that incarcerated individuals have a legal right to health care, federal law prohibits the use of Medicare and Medicaid dollars for incarcerated Americans. As a result, individual prison systems provide health care with little oversight or standards. Authorizing Medicaid coverage will reduce some of the system’s competing budgetary constraints, provide continuity of coverage in and out of prison (especially in states that have expanded Medicaid), improve quality requirements, and expand population information with claims data.
2. Make health a priority in correctional systems. This means adjusting the diet, sleep and activity of prisoners when needed to treat illnesses, avoiding the use of solitary confinement, updating prison admissions procedures to account for and better address the high incidence of mental health crises and substance use on admission. increasing the level of health-related training of correctional staff, regular use of the prison system for the training of doctors, and incorporating health concerns into prisoner release planning.
3. Implementation of public health and quality standards in the field of prisoner health care. Our report explains that “despite providing health services to a highly vulnerable population, prisons and prisons operate entirely outside of many of the systems designed to ensure access and quality in the civilian health system. What is most striking about carceral healthcare is the lack of data, standards, quality reports and quality improvement systems.” Electronic health records, for example, are hardly used in prisons, and there is no basic quality measurement or transparent reporting of quality indicators. To begin addressing this issue, we recommend that the CDC, as well as state and local health departments, review how their work addresses the health of people incarcerated and then modify programs accordingly to help meet their needs.
four. Coordination of care inside and outside places of deprivation of liberty. Navigating health care is especially difficult for those who have served time in jail or prison, as any health coverage they were entitled to outside of incarceration they lose on admission. We recommend three steps for harm reduction: 1) The Medicare and Medicaid CMS Innovation Center should develop a range of initiatives to improve outcomes for those transitioning out of the correctional system into the community; 2) The Office of the National Health Information Technology Coordinator should set goals for the interoperability of electronic health records in prisons and prisons, as well as with public providers that most often serve this population; and 3) Quality improvement and standard setting organizations and CMS should develop care coordination indicators for those entering and leaving prisons.
5. Dramatically reduce the level and consequences of incarceration. The most effective and wide-ranging approach to reduce the harm caused by incarceration is to reduce the number of people incarcerated. This is already what our country needs to do to address dangerous prison overcrowding and staff shortages, so better health is an added benefit. Changing our approach to people with mental and substance use disorders will require policy changes at the federal, state and local levels, including increased use of remission courts and the creation of observation centers as an alternative to prison for those who is under the influence of alcohol or who is under the influence of alcohol. mental health crisis. In my hometown of Nashville, for example, we have successfully run a drug court program for many years that has been modeled across the country. And most recently, our sheriff’s office launched Behavior Therapy Center provision of prompt trauma-informed care to residents in short-stay settings as an alternative to prison.
By describing effective approaches to reduce the health burden in prisons, we at Aspen Health Strategy Group hope that leaders at the federal, state, and local levels will be motivated to take action.