States fail to meet ‘essential health needs’ of inmates: study

According to a new analysis of state prison data of the Prison Policy Initiative (PPI), state prisons mismanage and neglect a large population of inmates with chronic illnesses, disabilities, and illnesses.

“[This report adds to] existing research shows that state prisons fall far short of their constitutional obligation to meet the basic health needs of those in their custody,” wrote Leah Wang, research analyst at PPI and author of the report. “As a result, those incarcerated in state prisons are kept in a constant state of illness and despair.”

For many, prison is their first real access to care.

PPI’s analysis shows that half of those entering state prisons are not covered by health insurance. More than 27% of people in state or federal prisons with a pre-existing chronic condition were first diagnosed while incarcerated, but that doesn’t mean prison health care is working properly, according to the study.

Nearly one in five inmates have not seen a healthcare provider since admission, the analysis found.

People incarcerated in state prisons suffer disproportionately from diseases such as asthma, hepatitis B and C, HIV or AIDS compared to the general population. And the rates of all sorts of medical problems, especially chronic illnesses, in prison are much higher for people over 55.

Some 23 percent of state inmates have been diagnosed with diabetes; 62% suffering from hypertension; and 23 percent with heart disease.

Data on the management of inmates with hepatitis C in state prisons are particularly shocking: The Centers for Disease Control and Prevention (CDC) reports that modern treatments for the viral infection – chronic blood-borne infection the most common – can cure more than 90% of cases.

Yet, in state prisons, 80% of people who have ever had hepatitis C still have it. If left untreated, complications of hepatitis C can cause severe liver damage, liver cancer, or death.

People incarcerated are much more likely to have been diagnosed with a psychiatric disability at some point in their lives: People incarcerated in state prisons are 21% more likely to have bipolar disorder, twice as likely to have been diagnosed with post-traumatic stress disorder, and nine times more likely to have ever been diagnosed with schizophrenia or another psychotic disorder than the average American.

Overall, 43% of those incarcerated in state prisons have at some point been diagnosed with a mental disorder. Despite this prevalence, only 6% were recorded as actively receiving advice or therapy from a professional while incarcerated.

Table courtesy of the Prison Policy Initiative

Only 26% of inmates received professional help for their mental health at any time since admission.

“Despite how ill-suited these facilities are to provide these services, jails and prisons have become one of our country’s largest de facto mental health care providers since the deinstitutionalization of public mental hospitals from the years 1950,” Wang wrote.

The overall rate of disabilities of all kinds among prisoners of all ages is also exceptionally high. Forty percent of people incarcerated in state prisons have a disability, compared to 15% of American adults, and prisons often struggle to accommodate inmates with disabilities.

A 2017 analysis of the American Civil Liberties Union on the impact of solitary confinement on prisoners with physical disabilities reported that deaf prisoners were placed in solitary confinement or otherwise punished for not responding to verbal commands they could not hear, or for communicating in American Sign Language.

The report points out that the outcomes of inadequate health care in prisons can be difficult to track and that common adverse outcomes after release are not covered by survey data.

The report reiterates a conclusion of a 2007 study inmates released from the Washington State Department of Corrections: In the first two weeks after release from prison, former inmates had a 12.7 times greater risk of death than other state residents.

“Instead of asking, ‘Should cancer prevalence be higher or lower in prisons?’ a better question is, ‘why should a 70 year old man with cancer and heart disease be locked up?’ says Wang.

She added that even when a person’s health problems began before arrest, incarceration routinely exacerbates those health problems or creates new ones, leaving inmates less healthy in prison and once released.

“[These findings] only confirm what research has shown for years: that incarcerated people face enormous hurdles in achieving and maintaining good health,” Wang wrote.

At the end of the day chronic punishment blames inadequate care within the prison system on state policy, which defines the daily lives of more than a million people in state prisons and half a million more in jails local across the country.

The Prison Policy Initiative makes a number of recommendations to state legislators, including:

    • Eliminate inmate fees for medical care;
    • Hold private healthcare providers accountable for negligent practices;
    • Help inmates pre-register or re-register for Medicaid before release, reducing the number of formerly incarcerated people without health insurance;
    • Preventing the interruption or refusal of treatment for pre-existing conditions, including substance use disorders, which increases the risk of relapse or overdose;
    • Put in place mechanisms for external monitoring of prison conditions (such as corrections ombudsman in New Jersey); and,
    • Expand access and expedite the medical parole or compassionate release process for the very ill.

Prison Policy Initiative is a Western Massachusetts-based research and advocacy organization covering criminal justice reform and overcriminalization committed to documenting the impact of mass incarceration on society.

chronic punishment is the second part of an analysis of the 2016 Inmate Surveya national dataset released last year that provides the most comprehensive and up-to-date demographic picture of those behind bars in state and federal correctional facilities.

The full report and tables are accessible here.

Audrey Nielsen is a criminal justice reporting intern at the TCR.

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