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Health in correctional facilities is health in our communities

Authors:
Katherine E McLeod at McMaster University
Katherine E McLeod
Ruth Elwood Martin at University of British Columbia
Ruth Elwood Martin
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E274 CMAJ | MARCH 12, 2018 | VOLUME 190 | ISSUE 10 © 2018 Joule Inc. or its licensors
Globally and in Canada, incarcerated populations have a
higher prevalence of both acute and chronic health con-
ditions than the general population.1,2 People who expe-
rience incarceration have an increased risk of death across
almost all disease categories and are particularly vulnerable in
the weeks following release.3 Most people in correctional facili-
ties have a history of trauma or abuse, mental health conditions
or substance use.1,2 Many people in prisons experience homeless-
ness, have low socioeconomic status and have low educational
attainment.2,4 Incarcerated people are also more likely to have
barriers to accessing health care and to have unmet health needs
before their incarceration.5 Correctional facilities oer a unique
opportunity to address the health care needs of underserviced
populations and to connect people with services that will sup-
port them in the community. These aims may be more eectively
achieved through governance and service delivery models that
integrate prison health care with the general health care system.
On any given day in Canada, there are more than 14 000
adults in federal custody and 25 000 adults in provincial or terri-
torial custody.6 In provincial and territorial correctional facilities,
about half (51%) of those in remand (i.e., detained before sen-
tencing) are held in custody for one week or less, and more than
half (59%) of those sentenced are held for one month or less.6
With this short length of stay for most people in provincial facili-
ties, the health of prison populations is closely connected with
the health of communities. Improving health care services for
people in prison therefore has the potential to aect the general
population and the entire health care system; improving the
health of people who experience incarceration may decrease
health care costs, decrease rates of reincarceration and improve
public health.7
The correctional context poses particular challenges to the
delivery of health care services, such as overcrowding and security
requirements.8 However, incarceration may also be an opportunity
for people to focus on addressing health needs and to engage with
health care because of decreased substance use, increased access
to health services, and fewer competing priorities compared with
living in the community.4 Continuity of care aer release is a key
component of ensuring care is eective.4 However, continuity is
challenged by a disconnect between health care services in correc-
tional facilities and those in the community.
In most jurisdictions in Canada and around the world, health
care services for correctional facilities are governed by the minis-
try responsible for corrections and are delivered in parallel to,
and disconnected from, the health care system that serves the
rest of the population. In addition to challenging continuity of
care as noted, this isolation of prison health care challenges
community equivalence and the autonomy of health care provid-
ers.8 For example, if health care providers are employed by cor-
rectional authorities, providers may be in positions of conflict
and may not be able to adequately advocate for indicated care
and services.8
In October, British Columbia became the third Canadian prov-
ince — aer Nova Scotia in 2001 and Alberta in 2010 — to transfer
responsibility for health care services in provincial correctional
facilities from the ministry responsible for corrections to the min-
istry responsible for health. Worldwide, this integration has been
implemented by several jurisdictions. Though there has been
limited research evaluating governance models in this area,
there are examples of positive system-level change that have
resulted that illustrate the potential of integration. For example,
the Liaison and Diversion program led by the United Kingdom’s
National Health Services provides supports and, where required,
diverts people who come in contact with the criminal justice sys-
tem who have a mental health disorder, learning disability or
substance use issue to a more appropriate health care setting.9
In addition, jurisdictions that have implemented an integra-
tion model report improvements for providers, such as increased
autonomy8 and reduced professional isolation.8,10 Improvements
COMMENTARY
Health in correctional facilities is health
in our communities
Katherine E. McLeod MPH, Ruth Elwood Martin MD MPH
n Cite as: CMAJ 2018 March 12;190:E274-5. doi: 10.1503/cmaj.171357
KEY POINTS
• Integration of health care in correctional facilities with the public
health care system is an opportunity to promote health and
address the health care needs of underserviced populations.
• Limited evidence suggests that transferring responsibility for
health care services in correctional facilities to the ministry of
health improves service delivery, continuity of care, patient
safety and population health outcomes.
• Health care professionals have a vital role in transforming care
for this population as health managers, leaders and advocates.
VULNERABLE POPULATIONS
COMMENTARY
CMAJ | MARCH 12, 2018 | VOLUME 190 | ISSUE 10 E275
to health care are also reported including increased links with
community health services,10 better health care quality,8,9 more
coordinated response to public health risks such as communica-
ble infections,8 improved assessment and understanding of
health needs,8,10 increased patient safety8 and greater inclusion
of incarcerated populations in public health initiatives.10 Further
research is needed to examine and describe the eect of health
care governance models on the health outcomes of people who
experience incarceration.
Integration is a complex process, and jurisdictions report
challenges such as the relationship between correctional and
health care sta, establishing data sharing,8 equitable resourc-
ing,8,10 prioritization of prison health,8,10 and resistance of
community-based health services to engage with people who
experience incarceration.8 These challenges illustrate the need
for collaboration at all levels of the health care system to address
the complex needs of this population.
Health care professionals and professional organizations
have a vital role in realizing this vision for better health care and
improved health outcomes for incarcerated populations. As
health advocates, health care providers can advocate for change
in policy and practice that will remove barriers to access and
improve continuity of care. As health leaders and scholars, they
can ensure that policy change results in meaningful improve-
ments in health services and is accompanied by robust evalua-
tion and continuous quality-improvement processes. As health
managers and collaborators, they are positioned to leverage
opportunities for population health interventions, so that incar-
cerated and formerly incarcerated populations are included in
programs and services, and receive safe, eective care.
Other jurisdictions in Canada, including Ontario, Quebec, and
Newfoundland and Labrador, are currently exploring or imple-
menting the policy change of transferring health care in prisons
to the ministry of health. This is an important opportunity for col-
laboration, evaluation and shared learning to improve the health
of populations across the country.
References
1. Fazel S, Baillargeon J. The health of prisoners. Lancet 2011;377:956-65.
2. Kouyoumdjian F, Schuler A, Matheson FI, et al. Health status of prisoners in
Canada narrative review. Can Fam Physician 2016;62:215-22.
3. Kouyoumdjian FG, Kiefer L, Wobeser W, et al. Mortality over 12 years of follow-
up in people admitted to provincial custody in Ontario: a retrospective cohort
study. CMAJ Open 2016;4:E153-61.
4. Abbott P, Magin P, Davison J, et al. Medical homelessness and candidacy: women
transiting between prison and community health care. Int J Equity Health
2017;16:130.
5. Green S, Foran J, Kouyoumdjian FG. Access to primary care in adults in a pro-
vincial correctional facility in Ontario. BMC Res Notes 2016;9:131.
6. Reitano J. Adult correctional statistics in Canada, 2015/2016 [juristat]. Ottawa: Sta-
tistics Canada; 2017. Available: www.statcan.gc.ca/pub/85-002-x/2017001/article
/14700-eng.htm (accessed 2017 Sept. 17).
7. Kinner SA, Wang EA. The case for improving the health of ex-prisoners. Am J
Public Health 2014;104:1352-5.
8. Prison health and public health: the integration of prison health services [conference
report]. London (UK): Department of Health and the International Centre for
Prison Studies; 2004 Apr. 2. Available: www.osakidetza.euskadi.eus/contenidos /
informacion /sanidad_penitenciaria/eu_espetxe/adjuntos/integration.pdf (accessed
2017 Oct. 1).
9. Leaman J, Emslie L, Richards A, et al. Rapid review of evidence of the impact on
health outcomes of NHS commissioned health services for people in secure and
detained settings to inform future health interventions and prioritisation in England.
London (UK): Public Health England; 2016. Available: www.gov.uk/government /
publications/health-outcomes-in-prisons-in-england-a-rapid-review (accessed
2017 Sept 12).
10. Hayton P, Boyington J. Prisons and health reforms in England and Wales. Am J
Public Health 2006;96:1730-3.
Competing interests: None declared.
This article has been peer reviewed.
Affiliation: Faculty of Medicine, School of Population and Public
Health, University of British Columbia, Vancouver, BC
Contributors: Katherine McLeod and Ruth Elwood Martin
co authored the manuscript. Both approved the final version to be
published and agreed to be accountable for all aspects of the work.
Correspondence to: Ruth Elwood Martin, ruth.martin@ubc.ca
... However, a "disconnect between health care services in correctional facilities and those in the community" further compounds the health risks faced by justiceinvolved women in Canada (McLeod & Martin, 2018, pg.274) An integrated model of healthcare delivery, one that is governed by the provincial health ministry, and that has coordinated and accountable links to community organizations, has greater capacity to facilitate the transition from incarceration to community (McLeod & Martin, 2018;Smith et al., 2019), potentially reducing the harms of this mobility. Use of enhanced or integrated primary health care has been linked to reduced recidivism and reduced re-incarceration time (Wang et al., 2019), and may further mitigate the negative effects of incarceration. ...
... A supportive, evidence-based approach to STBBI identification and treatment for incarcerated women that removes stigma, maintains privacy and improves access, combined with structural policies to prevent incarceration, could decrease STBBI incidence and interrupt the cycle of incarceration and poor health outcomes. A coordinated and accountable program of reintegration that facilitates continuity of public health interventions for STBBI, safe housing, harm reduction, and addresses barriers to successful community transition -in particular ensuring basic subsistence needs are met -can improve outcomes as well (McLeod & Martin, 2018;Pederson et al., 2015;Smith et al., 2019). Following the principles of gender transformative health promotion, these interventions should be woman-centered, trauma-informed, and strength-based. ...
Slipping through: mobility’s influence on infectious disease risks for justice-involved women in Canada
Article
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  • Nov 2021
Background The relationship between incarceration and women’s vulnerability to sexually transmitted and blood-borne infections (STBBI) is understudied in Canada, despite numerous studies showing that justice-involved women experience very high rates of infection. Justice-involved women in Canada are highly mobile, as a result of high rates of incarceration and extremely short sentences. From a public health perspective, it is productive to understand how the mobility of justice-involved women shapes their vulnerability to STBBI. Results This narrative review demonstrates that mobility between incarceration facilities and communities drives sexually transmitted and blood-borne disease risk for justice-involved women in Canada. Associations and interactions between epidemics of gender-based and intimate partner violence, substance use, and STBBIs shape the experiences of justice-involved women in Canada. In correctional facilities, the pre-existing vulnerability of justice-involved women is compounded by a lack of comprehensive STBBI care and limited harm reduction services. On release, unstable housing, disruptions to social support networks, interruptions in medical care, and relapse to or continuation of substance use, significantly increase individual disease risk and the likelihood of community transmission. High rates of incarceration for short periods perpetuate this cycle and complicate the delivery of healthcare. Conclusions The review provides evidence of the need for stronger gender-transformative public health planning and responses for incarcerated women, in both federal and provincial corrections settings in Canada. A supportive, evidence-based approach to STBBI identification and treatment for incarcerated women - one that that removes stigma, maintains privacy and improves access, combined with structural policies to prevent incarceration - could decrease STBBI incidence and interrupt the cycle of incarceration and poor health outcomes. A coordinated and accountable program of reintegration that facilitates continuity of public health interventions for STBBI, as well as safe housing, harm reduction and other supports, can improve outcomes as well. Lastly, metrics to measure performance of STBBI management during incarceration and upon release would help to identify gaps and improve outcomes for justice-involved women in the Canadian context.
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... Despite the challenges, effective mental health care is delivered in prisons both internationally [61,62] and in Ireland [10,11]. While it is widely accepted that prison is not an appropriate place to deliver healthcare, it may present an opportunity to engage marginalised groups who are otherwise excluded from care in the community [63][64][65]. Indeed, while incarceration is associated with increased suicide risk, some argue it may be an appropriate place to offer stable mental healthcare, especially for young men with psychotic illness [66]. ...
People experiencing homelessness requiring psychiatric review in prison, a study of a male and female remand prison over 1 year period
Article
Full-text available
  • Apr 2025
  • IRISH J MED SCI
Background There are high numbers of people experiencing homelessness (PEH) in Ireland. PEH experience barriers to accessing mental health care and are overrepresented in prison populations, particularly in remand prisons. To date, there has been limited research conducted on this population, and their specific needs. Aims In this study, we explored homelessness in those referred to prison psychiatry teams in Dublin’s remand prisons, and profiled the clinical characteristics of the population. Methods Participants included all persons referred to prison inreach psychiatry teams in one male and one female remand prison over one year between 01/07/22 and 30/06/2023. We examined key aspects of psychiatric service provision including population characteristics, psychiatric and medical history, referral outcomes, alternative pathways and complex health needs. Results A total of 89 PEH were referred to prison mental health services during the study period. High rates of active psychotic illness were found in the cohort, with 68% psychotic at the time of the assessment, and 56% having a diagnosis of serious mental illness. More than half the cohort reported current use of substances and 42% current use of alcohol. Over one-third of referrals were made for those with a history of mental illness, with no current symptoms. Only one-fifth of the cohort were discharged to the prison GP following their initial assessment, the remainder requiring ongoing input from prison inreach or community psychiatric services. Significant vulnerabilities were found within 25% including intellectual disability, and membership of ethnic minorities. Conclusions There are high rates of mental illness and co-morbid vulnerabilities found in the population. Appropriately addressing the needs of this population will require an integrated, multisystem approach.
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... Provincial and territorial custody is for individuals with sentences of less than two years, while those in federal custody are serving sentences over two years (Lee, Ross, & Saad, 2021). Healthcare provision in federal prisons is managed by the Correctional Service of Canada, which is the ministry responsible for corrections and is separate from the healthcare system that serves the general population (McLeod & Martin, 2018). In Ontario, healthcare in provincial prisons is managed by the respective Ministry of Justice (Lee, Ross, & Saad, 2021). ...
The State of Mental Health Services for Incarcerated Adults in Ontario: A Scoping Review
Article
Full-text available
  • Feb 2024
  • INT J OFFENDER THER
Individuals with mental illness are significantly overrepresented in the Canadian justice system. Given the high rate of mental illness among individuals who are incarcerated, correctional facilities must implement accessible and effective mental health resources. This not only improves their health and well-being but also contributes to their rehabilitation efforts. However, evidence suggests that the care provided in prisons is inadequate. This scoping review asks, “What is known about the access and quality of mental health care services for adults who are incarcerated in Ontario?” Mental health care services included non-acute interventions and care that is provided in the institution. This scoping review followed the PRISMA Extension for Scoping Reviews methodology. Databases searched include MedLINE, EMBASE, CINAHL, PsycINFO, Criminal Justice Abstracts, JSTOR, Google Scholar, and the grey literature. The search yielded 354 titles and abstracts of which 16 met the inclusion criteria. Conducted from 2010-2022, the 16 studies included qualitative, quantitative, and mixed methods. Common themes that were identified related to segregation, mental health assessments, medication prescribing and access, opioid agonist therapy, psychiatric service access, systemic and institutional barriers, mental health perception, and the need for collaboration. Despite the significant demand for mental health care in Ontario correctional facilities, limitations to quality care are evident. Such limitations intersect and are then exacerbated, resulting in poor mental health care provision among the incarcerated population. More research is warranted regarding the access, quality, and efficiency of mental health care in Ontario prisons, and how factors including ethnicity, gender, and prison classification (provincial vs. federal) may influence mental health care and its outcomes.
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... Prisoners have an increased prevalence of bloodborne pathogens, such as HIV and HCV (Akiyami J.M., et al., 2020), and are also disproportionally aff ected by various forms of mental illnesses, including substance use disorder (SUD). From a human rights and public health perspective, prisoners need to have equitable access to healthcare (McLeod and Martin, 2018). From a legal perspective, this is also essential, as it has also been mandated under the Mandela Rules and the Canadian Corrections and Conditional Release Act that prisoners must have the same access to health care to what is available in the community (Canada, 1992). ...
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... Developing a national or multi-jurisdictional inventory of active community-based services is an inherently complicated endeavor when there is wide geographic dispersion of and decentralized public information about the services of interest. This scenario is the case in Canada which has a federal correctional system (overseeing sentences of two years or more), plus 13 provincial/territorial jurisdictions each with its own correctional system (for sentences less than two years in length) and approach to health service provision and community reentry (e.g., McLeod & Martin, 2018). Additionally, when a project team is primarily based in one jurisdiction (which was also the case in our work), constructing an inclusive inventory of services with a national or multi-jurisdictional scope readily turns into a time-and resource-intensive effort, especially with finding smaller and/or community-led local programs. ...
Community-Based Mental Health and Substance Use Services for People Leaving Prison: Equity and Inclusion Strengths and Limitations in Specialized Service Inventory Development
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  • Nov 2022
Community reentry from prison is a challenging process, especially for persons with lived and living experience of mental health concerns. Access to appropriate community-based care for those leaving prison is a key part of improving health equity for this population. Our work to develop a cross-Canada inventory of active community mental health and substance use services for criminal justice-involved persons represents a valuable example for others hoping to conduct projects that are similar in nature and scope. We describe the strengths and limitations of our health equity-informed, multi-pronged approach to service inventory development, highlighting the importance of considering and addressing search- and stakeholder-related biases. Investment of time and resources is critical to ensuring comprehensive and inclusive identification of community-based mental health services and meaningful resource development.
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... The majority of federally incarcerated individuals in Canada are eventually released into the community, usually under a conditional release (e.g., day/full parole, statutory release [after serving 2/3 of sentence], long-term supervision orders, etc.). During this time they are required to abide by specific release conditions (e.g., refrain from substance use, reside within a community-based residential facility [i.e., a "halfway house"], etc.), with the ultimate goal of rehabilitation and reintegration into society (Correctional Service Canada, 2007;Macmadu & Rich, 2015;McLeod & Martin, 2018). Continual engagement in OAT throughout this supervised community reentry period is crucial, however, a myriad of factors may influence OAT commitment and retention. ...
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  • Jul 2022
Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.
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... The federal system, overseen by the Correctional Service of Canada, is responsible for administering sentences of two years or longer, while the provincial/territorial systems manage sentences under two years in length. These correctional systems have adopted their own approaches to health-related programming and community re-entry, representing many jurisdictional differences and nuances that are beyond the scope of this commentary (e.g., McLeod & Martin, 2018 ). For the national inventory we developed, we had a multi-jurisdictional focus and broadly searched for active community-based substance use and mental health services that were designed or appeared promising for criminal justice-involved persons, including those leaving federal and/or provincial/territorial correctional settings. ...
Addressing the complex substance use and mental health needs of people leaving prison: Insights from developing a national inventory of services in Canada
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Internationally, transitions from prison to the community are often precarious experiences for people who are living with substance use and mental health concerns. In Canada, a continuing opioid overdose crisis and overlapping challenges related to the COVID-19 pandemic have generated urgency for scaling up community-based services that can meet the complex substance use and mental health needs of people leaving prison. In this commentary, we reflect on our experience with and knowledge gained by developing a national inventory of substance use and mental health services for criminal justice-involved persons who are re-entering the community. We learned that there is a scarcity of such community-based services specific to criminal justice-involved populations and a glaring lack of information about culturally safe and appropriate supports. Stakeholders from organisations across Canada identified that communities need a comprehensive array of low-barrier services, inclusive of harm reduction and substance use treatment services, to meet the diverse needs of people leaving prison. We recommend building greater investment in and awareness of community-driven, local programs, as well as enhancing efforts to engage people with lived and living experience in service design and provision. We also briefly describe a few programs to highlight examples of how to operationalise the themes that we observed to emerge while developing a national inventory of community-based substance use and mental health services for criminal justice-involved persons.
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Implementation of good documentation practices and good storage and distribution practices for medical products in female penitentiary in Costa Rica
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  • Jan 2025
Purpose This paper aimed to the enhancement of health-care services at a female penitentiary center in Costa Rica by implementing good documentation practices (GDocP) and good storage and distribution practices (GSDP) among the staff responsible for medications (SRM). Design/methodology/approach The methodology used in this project was qualitative, as it sought to deepen and reinforce the knowledge of the SRM about GDocP and GSDP in the Vilma Curling CAI to achieve its implementation. Additionally, different questionnaires were applied to measure the initial level of knowledge of GDocP and GSDP and the new skills acquired by the SRM at the end of the project. Findings Some improvement opportunities were identified in pharmaceutical service, management of the documentary system and knowledge of GDocP and GSDP among SRM. It is important to highlight the essential role of pharmacists, as experts in medical products, in health-care teams. Their participation significantly contributes to improving health outcomes for vulnerable populations, such as incarcerated women. Research limitations/implications Limitations included a small sample size, the security regulations to entry to the penitentiary center and limited information related to the implementation of GDocP and GSDP in such environment. Originality/value This project explores a poorly researched field such as the implementation of GDocP and GSDP and the impact that this could have on the pharmaceutical service of a penitentiary center.
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Prisoners' experience of health self-management: A qualitative study
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Purpose: Among the noninstitutionalized population, health care is increasingly shifting from a paternalistic model toward promoting patients' involvement in decision-making and in managing their condition. This paradigm shift toward health self-management is less applicable to individuals in prison whose health management choices are limited. The aim of this study was to explore prisoners' health self-management needs and the strategies used to maintain health self-management in a highly restrictive prison environment. Design: A qualitative phenomenological study design was selected for this research. Methods: An interpretive phenomenological analysis was chosen to present the narratives of prisoners regarding their health self-management. Semi-structured interviews were conducted with 15 male prisoners followed by content analysis. Results: The analysis of the participants' narratives revealed four major themes: (1) "I thrive on the anger so I can turn it into some more sit-ups:" Initiating sporting activities (2) "Food shouldn't be that white…:" Prisoners' quest for healthier eating (3) "I felt I want more out of life…:" Avoiding an unhealthy lifestyle (4) "I want to be taken care of:" The struggle for better health care. Conclusions: The findings suggest that prisoners can overcome the challenges of maintaining health in prison and become committed to better health management. Prisoners who serve as health resources may help reduce the load on correctional facilities' health care systems and the public.
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Medical homelessness and candidacy: Women transiting between prison and community health care
Article
Full-text available
  • Jul 2017
Background Women in contact with the prison system have high health needs. Short periods in prison and serial incarcerations are common. Examination of their experiences of health care both in prison and in the community may assist in better supporting their wellbeing and, ultimately, decrease their risk of returning to prison. Methods We interviewed women in prisons in Sydney, Australia, using pre-release and post-release interviews. We undertook thematic analysis of the combined interviews, considering them as continuing narratives of their healthcare experiences. We further reviewed the findings using the theoretical lens of candidacy to generate additional insights on healthcare access. Results Sixty-nine interviews were conducted with 40 women pre-release and 29 of these post-release. Most had histories of substance misuse. Women saw prison as an opportunity to address neglected health problems, but long waiting lists impeded healthcare delivery. Both in prison and in the community, the dual stigmas of substance misuse and being a prisoner could lead to provider judgements that their claims to care were not legitimate. They feared they would be blocked from care even if seriously ill. Family support, self-efficacy, assertiveness, overcoming substance misuse, compliance with health system rules and transitional care programs increased their personal capacity to access health care. Conclusions For women in transition between prison and community, healthcare access could be experienced as ‘medical homelessness’ in which women felt caught in a perpetual state of waiting and exclusion during cycles of prison- and community-based care. Their healthcare experiences were characterized by ineffectual attempts to access care, transient relationships with healthcare providers, disrupted medical management and a fear that stigma would prevent candidacy to health care even in the event of serious illness. Consideration of the vulnerabilities and likely points of exclusion for women in contact with the criminal justice system will assist in increasing healthcare access for this marginalised population.
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Health status of prisoners in Canada
Article
Full-text available
  • Mar 2016
  • CAN FAM PHYSICIAN
Objective: To review the literature for quantitative research on the health status of persons in custody in provincial, territorial, and federal correctional facilities in Canada, and summarize recent evidence. Quality of evidence: A search was performed in research databases and the websites of relevant Canadian governmental and non-governmental organizations for quantitative studies of health conducted between 1993 and 2014. Studies were included that provided quantitative data on health status for youth or adults who had been detained or incarcerated in a jail or prison in Canada. Main message: The health status of this population is poor compared with the general Canadian population, as indicated by data on social determinants of health, mortality in custody, mental health, substance use, communicable diseases, and sexual and reproductive health. Little is known about mortality after release, chronic diseases, injury, reproductive health, and health care access and quality. Conclusion: Health status data should be used to improve health care and to intervene to improve health for persons while in custody and after release, with potential benefits for all Canadians.
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Mortality over 12 years of follow-up in people admitted to provincial custody in Ontario: a retrospective cohort study
Article
Full-text available
  • Apr 2016
Background: We aimed to define rates and causes of death in custody and after release in people admitted to provincial custody in Ontario, and to compare these data with data for the general population. Methods: We linked data on adults admitted to provincial custody in Ontario in 2000 with data on deaths between 2000 and 2012. We examined rates and causes of death by age, sex, custodial status and period after release, and compared them with data for the general population, using indirect adjustment for age. Results: Between 2000 and 2012, 8.6% (95% confidence interval [CI] 8.3%-8.8%) of those incarcerated died in provincial custody or after release. The crude death rate was 7.1 (95% CI 6.9-7.3) per 1000 person-years. The standardized mortality ratio for those incarcerated in 2000 was 4.0 (95% CI 3.9-4.1) overall and 1.9 (95% CI 1.5-2.4) while in provincial custody. The most common causes of death were injury and poisoning (38.2% of all deaths), including overdose (13.6%) and suicide (8.2%), diseases of the circulatory system (15.8%) and neoplasms (14.5%). In the 2 weeks after release, the standardized mortality ratio was 5.7 overall and 56.0 for overdose. Life expectancy was 72.3 years for women and 73.4 for men who experienced incarceration in 2000. Interpretation: Mortality was high for people who experienced incarceration, and life expectancy was 4.2 years less for men and 10.6 years less for women compared with the general population. Efforts should be made to reduce the gap in mortality between people who experience incarceration and those who do not. Time in custody could serve as an opportunity to intervene to decrease risk.
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Health status of prisoners in Canada Narrative review
Article
Full-text available
  • Mar 2016
Objective To review the literature for quantitative research on the health status of persons in custody in provincial, territorial, and federal correctional facilities in Canada, and summarize recent evidence. Quality of evidence A search was performed in research databases and the websites of relevant Canadian governmental and non-governmental organizations for quantitative studies of health conducted between 1993 and 2014. Studies were included that provided quantitative data on health status for youth or adults who had been detained or incarcerated in a jail or prison in Canada. Main message The health status of this population is poor compared with the general Canadian population, as indicated by data on social determinants of health, mortality in custody, mental health, substance use, communicable diseases, and sexual and reproductive health. Little is known about mortality after release, chronic diseases, injury, reproductive health, and health care access and quality. Conclusion Health status data should be used to improve health care and to intervene to improve health for persons while in custody and after release, with potential benefits for all Canadians.
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Access to primary care in adults in a provincial correctional facility in Ontario
Article
Full-text available
  • Feb 2016
  • BMC Res Notes
Background: Little is known about access to primary care either prior to or following incarceration in Canada. International data demonstrate that the health of people in prisons and jails is poor, and access to primary care in the community may be inadequate for incarcerated persons. We aimed to describe the primary care experience of adults in custody in a provincial correctional facility in Ontario in the 12 months prior to admission. Methods: We conducted a written survey, and invited all persons in the institution to participate, excluding those in segregation. Results: One hundred and twenty-five persons participated, 16.8 % of whom were women. The median age was 33. In the 12 months prior to admission to custody, 32.2 % (95 % CI 23.5-40.8 %) of respondents did not have a family doctor or other primary care provider and 48.2 % (95 % CI 38.8-57.6 %) had unmet health needs. Participants reported a mean of 2.1 (SD = 2.8) emergency department visits in the 12 months prior to admission. Conclusions: Study participants report a lack of access to primary care, a high mean number of emergency department visits, and high unmet health care needs in the 12 months prior to incarceration. Time in custody may present an opportunity for connecting this population with primary care and improving health.
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The Case for Improving the Health of Ex-Prisoners
Article
Full-text available
  • Jun 2014
The global prison population exceeds 10 million and continues to grow; more than 30 million people are released from custody annually. These individuals are disproportionately poor, disenfranchised, and chronically ill. There are compelling, evidence-based arguments for improving health outcomes for ex-prisoners on human rights, public health, criminal justice, and economic grounds. These arguments stand in stark contrast to current policy and practice in most settings. There is also a dearth of evidence to guide clinicians and policymakers on how best to care for this large and growing population during and after their transition from custody to community. Well-designed longitudinal studies, clinical trials, and burden of disease studies are pivotal to closing this evidence gap.
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The health of prisoners
Article
  • Nov 2010
  • LANCET
More than 10 million people are incarcerated worldwide; this number has increased by about a million in the past decade. Mental disorders and infectious diseases are more common in prisoners than in the general population. High rates of suicide within prison and increased mortality from all causes on release have been documented in many countries. The contribution of prisons to illness is unknown, although shortcomings in treatment and aftercare provision contribute to adverse outcomes. Research has highlighted that women, prisoners aged 55 years and older, and juveniles present with higher rates of many disorders than do other prisoners. The contribution of initiatives to improve the health of prisoners by reducing the burden of infectious and chronic diseases, suicide, other causes of premature mortality and violence, and counteracting the cycle of reoffending should be further examined.
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Prisons and Health Reforms in England and Wales
Article
  • Nov 2006
  • AM J PUBLIC HEALTH
Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by over-medicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty’s Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system.
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Adult correctional statistics in Canada
  • Jan 2015
  • J Reitano
Reitano J. Adult correctional statistics in Canada, 2015/2016 [juristat]. Ottawa: Statistics Canada; 2017. Available: www.statcan.gc.ca/pub/85-002-x/2017001/article /14700-eng.htm (accessed 2017 Sept. 17).
Department of Health and the International Centre for Prison Studies
  • Jan 2001
  • London
London (UK): Department of Health and the International Centre for Prison Studies; 2004 Apr. 2. Available: www.osakidetza.euskadi.eus/contenidos / informacion /sanidad_penitenciaria/eu_espetxe/adjuntos/integration.pdf (accessed 2017 Oct. 1).