Health Consequences of Incarceration

Prisons and jails hold not only those responsible for inflicting interpersonal violence, but also those who have chronic histories of physical and/or sexual abuse. Individuals most likely to be imprisoned are often impoverished with little access to physical and/or mental health care prior to incarceration. As such, the rates of infectious communicable diseases in the penal institutions are far greater than in the general population, resulting in a vulnerability that can negatively affect individuals' physical health. Similarly, conditions of confinement may exacerbate or contribute to the high rates of mental health disorders among the incarcerated. Although accreditation standards exist for the delivery of health care services within jails and prisons, privatization of those services and movement toward managed care may affect the quality and quantity of services available.

Prisoners have a much greater prevalence of active tuberculosis, hepatitis C, and HIV/AIDS than the general population. Due to the crowded conditions, they may pass on their infection to other prisoners and staff. In addition, a higher prevalence of sexually transmitted infections (STIs) means that unprotected sex during incarceration threatens health through the transmission of STIs, including HIV/AIDS.

Recently, the Bureau of Justice Statistics reported that 55% of men and 73% of women in state prisons have a diagnosable mental health disorder. Certainly the loss of social supports and separation from family can contribute to symptom intensity. However, other conditions of confinement, such as threats to physical safety, sexual assaults and harassment by staff and other inmates, overcrowded conditions, and segregation also erode mental health, leading to decompensation. Although therapeutic services, such as medications and therapy, are available, only about one third of those who need treatment receive it.

Due to their being a relatively small proportion (8% to 10%) of the incarcerated, women often receive inadequate health care. This is particularly problematic because health care needs are complicated by the high rates of physical and sexual abuse women experience. Personnel delivering gynecological care may be insensitive to the possibility that an exam might trigger a reexperiencing of a traumatic event. In addition, pregnancy is a particularly high-risk situation, both medically and psychologically. Obstetrical visits and delivery take place in community hospitals. Women are escorted and observed by guards during delivery, and are sometimes shackled. Except in a few instances, mothers are returned to the institution without their infants.

The National Commission on Correctional Health Care requires institutions seeking accreditation to comply with standards for health services. These standards include thorough screening for infectious diseases and communicable illnesses at intake. In addition, mental health screening, assessment, and treatment are essential. Many states have retained private health care providers or correctional health maintenance organizations. Medical malpractice lawsuits brought by inmates against states and prison health care providers have been largely unsuccessful.