Incarceration and Health in the US

Posted on by BUJPH

By Izzy Fish 

 

“Guilty.” 

For many, this word is a death sentence, no matter how short the prison time is. A sentencing, no matter the length, is not just a matter of physical confinement to most defendants in the United States. It’s a matter of physical health, mental health, access to health care, future employment, and many more factors.1 

Today, over 2 million people are incarcerated, nearly 33 percent of whom are Black with immigrant detentions quickly on the rise.1 Every year a person spends in prison corresponds to a two year decrease in life expectancy which brings the entire United States’ life expectancy down by five years.2 Of the prison population, 80 percent have a chronic condition, commonly asthma or a form of hepatitis.3 Despite the overwhelming evidence supporting the need for expanded health services in prisons, many prisons face barriers to care. Most states enforce a copay of $3 dollars to see a clinician–a steep price considering most prison jobs only pay $0.75 a day.1 Other prisons require a correctional officer to agree to refer the patient to a nurse and the nurse must refer the patient to a clinician before they are able to receive care.1 When patients are released, there is often no way for them to continue receiving care. This is either because states have put barriers to accessing healthcare or they did not have access to care in the first place.1

There are two institutions in conflict here–the United States justice system and the healthcare system. The justice system has a history of corruption, with officers abusing their power and private corporations making profit from jails.1 One of the most violent cases of this is in Alabama, where prisoners are stabbed, killed, and even tied up for days without guards noticing.4 The healthcare system isn’t much better. Although the system does not blatantly abuse patients, it isn’t providing access to the services that it should. A disproportionate number of people entering prison are either on Medicaid or are uninsured.3 For some individuals, their time in prison is their first encounter with a healthcare provider–and these services tend to be reactionary, not preventative.3 Once released, they struggle to get back on their insurance plans, as many states have restrictions for people with criminal records–along with barriers to accessing jobs, housing, and food stamps.1

Yet there’s another issue rising in prisons: mental health. Almost 50 percent of the incarcerated population in the US reports having one or more mental health disorders, and this number could be underreported, as many go undiagnosed.3 Only a quarter of those in prisons report having received treatment for a mental health disorder.3 Forty-nine percent of people in prisons report having problems with substance use in the year before admission, compared to 7.5 percent of the general US population.4 And it doesn’t just stop at the individual who is incarcerated–family members experience higher levels of stress, stigma, and heart disease as a result of their loved one’s incarceration.1 

How do other similar profile countries compare? There are a total of 10.7 million people incarcerated worldwide, most of whom also suffer from higher rates of mental health disorders (especially substance use disorder), infectious diseases, and chronic conditions.5 In European countries, 32.8 percent of prisoners report having a mental illness.6 Although still an alarming statistic, the lower percentage when compared to the US could be due to European countries having rehabilitative justice systems or even stronger healthcare systems. In both the US and internationally, the most common cause of death for prisoners is suicide. In the US, this occurs at a disproportionately high rate in prisoners who have spent time in solitary confinement.4 

In most European countries, there is a central belief that prisons are not an acceptable place to treat mental illness, causing governments to put resources into creating services specifically for prisoners struggling with their mental health.7 The US could model this system. For example, Belgium diverts its prisoners to psychiatric wards, prioritizing treatment instead of jail time.7  Portugal has been decriminalizing drug use, allowing those arrested for using drugs to seek free treatment.8 In Serbia, prisoners must seek legally enforced treatment, which has also been found to decrease rates of re-entry.5 These are some possible solutions to the problem. Not everything will be fixed in a day, and not everything will be fixed by only looking at healthcare in prison systems. The US has a long and complicated history with our healthcare system, yet that should not cause us to continue treating our incarcerated population as second-class citizens.

 

References

  1. Levins, H. (2023, March 6). Reviewing the Flaws of US Prisons and Jails’ Health Care System. Penn Leonard Davis Institute of Health Economics. https://ldi.upenn.edu/our-work/research-updates/the-flaws-of-u-s-prisons-and-jails-health-care-system/#:~:text=American%20prisons%20and%20jails%20holding,Health%20Economics%202023%20Samuel%20P.
  2. Widro, E. (2017, June 26). Incarceration Shortens Life Expectancy. Prison Policy Initiative. https://www.prisonpolicy.org/blog/2017/06/26/life_expectancy/
  3. Repouliou, A. (2016, March 27). Mental Health in Prisons Around the World: Europe and Africa. Princeton Public Health Review. https://pphr.princeton.edu/2016/03/27/mental-health-in-prisons-around-the-world-europe-and-africa/.
  4. Equal Justice Initiative. (2023). Prison Conditions. https://eji.org/issues/prison-conditions/.
  5. McLeod, Katherine et al. (2020, March). Global Prison Health Care Governance and Health Equity: A Critical Lack of Evidence. Am J Public Health. 10.2105/AJPH.2019.305465.
  6. World Health Organization. (2021). Health in Prisons European Database. https://www.who.int/data/region/europe/health-in-prisons-european-database-(hiped).
  7. Repouliou, A. (2016, March 27). Mental Health in Prisons Around the World: Europe and Africa. Princeton Public Health Review. https://pphr.princeton.edu/2016/03/27/mental-health-in-prisons-around-the-world-europe-and-africa/.
  8. Kryuchkov, I. (2023, February 15). One-Third of People in Prison in Europe Suffer From Mental Health Disorders. World Health Organization. https://www.who.int/europe/news/item/15-02-2023-one-third-of-people-in-prison-in-europe-suffer-from-mental-health-disorders.
Izzy Fish