Incarcerated Populations and Healthcare: Myths and Facts

I think you can answer this from both a legal and ethical perspective. 

Legally, incarcerated populations are one of very few populations that have a fundamental right to healthcare. Given these populations have a fundamental right to healthcare, we should take that seriously. It's something our government is in charge of, and tax dollars are used on. 

I think it’s important to try and think through what we criminalize from a legal perspective as well in this country; a lot of that has to do also with medical conditions and health concerns. When we deinstitutionalized mental illness starting in the 1970s, a lot of folks with mental illness went into our legal system. And with the ‘war on drugs,’ those with substance use end up in our legal system as well. Often the case is – especially in talking with our rural areas and jails – there’s no other place in the area that has any sort of substance-use treatment. This has created a knot. It is hard to disentangle behavioral health and substance use from the legal system because the legal system is  the only place many of these issues get treated. 

When it comes to an ethical perspective, we have to consider that people’s health generally deteriorates in these spaces, and then most are going back to their communities. They are expected to immediately return and be neighbors and community members, but are often struggling with complex  mental and physical health situations. 

And personally, they're people – so their health inherently matters. They're people I love. That's why I do this, and all people are worthy of good health.

There's a lot of issues with data, and these issues depend on the type of system we’re talking about. There are two main carceral systems in our country: jails and prisons.

Jails are county-run institutions where people generally go while they're awaiting trial or if they're sentenced to less than a year. Most people in the legal system are there and they're cycling through, with the average stay of less than a month. There are jail standards in Colorado, but there’s very little set at the state or national level stating what health or general population data must be made publicly available. 

This creates two problems. First, there are a lot of discrepancies – what authorities are willing to share really depends on the county. We get data from some counties that we don't get from others. And second, when data is available, it’s not updated in a way that public health or healthcare folks can respond to because it is often significantly delayed. Such a delay is not going to help you respond to an overdose crisis that is happening right now.

AB Nexus grant will investigate the intersection of heat in Colorado prisons:

Most carceral facilities lack air conditioning, creating new health challenges as summers get warmer. As part of the AB Nexus collaboration, LeMasters is working alongside David Ciplet, PhD, from CU Boulder to investigate the impacts of climate change on incarceration and societal re-entry. Their research will investigate the health effects and experiences of incarcerated populations exposed to extreme heat in Colorado prisons. “Some of our carceral facilities were built 10 years ago; some were built 100 years ago,” said LeMasters. “Trying to understand the impact of that amount of heat on incarcerated populations, day to day, over the course of our warmer months is really what we’re looking at.”

Then second, when people go through our state and federal prison systems – when sentenced for a year or more – there are more regulations dictating what has to be reported. The baseline is reporting death through the Federal Death and Custody Reporting Act, which mandated these institutions produce information about who is dying, when and why. Even with this legislation, we don't know in real time what is going on inside these facilities. 

When I send requests for data, it's often turned down, because it looks bad for these institutions when there are, for example, really preventable cancers that are killing people. Or, when people are dying of heat stroke in facilities because they're on psychotropic medication that prevents them from sweating and are in a facility that lacks air conditioning. Or, when people are having mental health crises and dying by suicide and overdose, which is a type of death that these facilities play an outsized role in preventing. These deaths are either not reported or severely unreported. There's very little that we know, at least that's shared openly.

Broadly, no. 

Now there are two systems to think of here. Probation is usually a sentence in lieu of incarceration. Someone's probably been in jail for a short amount of time, but their primary sentence is in the community. The other is parole – conditional release from prison – where people are also supervised in the community. I think we think of community supervision as a lesser punishment – you’re able to remain in your community. So that makes sense in a way that we think it would be better for you. 

The work that has been done in this space though finds that community supervision is really invisible. People are trying to live their lives, and they're often subjected to a lot of mandatory meetings, fees, urinary drug tests, restrictions on where they can work, but also requirements to work. Or, in the case of parole, they’ve often lost health insurance, might not have stable housing or social support, including employment. Taken together, these stressful situations coalesce into really difficult situations for folks with their health. 

We find that in some studies done on mortality within this population, it's worse for folks on probation compared to incarceration. We also know that it takes a severe toll on mental health. However, I think it's really important, when we do this work, to not think a solution is then, "Well, why not just incarcerate people, it’s simpler?”  There are other ways prison is certainly more harmful than community supervision. We need to really think about how those systems can be detrimental and work towards more fundamental change to decrease our use of them altogether.

They generally don't. 

The interviews we’ve done have seen that those incarcerated with behavioral health issues – that we often don’t have low-cost, accessible community treatment for – get worse in a carceral facility. A quote that sticks with me from someone I talked to is, "If you don't have PTSD going into prison, you're sure going to have it coming out."

These are very traumatic, harmful institutions for folks. And when people come out, they’re not set up to be healthy. We have some instances where people have amazing social support or connections to different community agencies, but generally folks are in a worse situation. Because even though they have a fundamental right to healthcare, healthcare inside is generally abysmal and is neither sufficient nor timely with chronic health issues often going unaddressed entirely. 

Another challenge is due to policy decisions like the ‘war on drugs’ and crime bills in the 1980s and 1990s that had things like mandatory minimums and three-strike laws. We have an aging prison population that were given these longer sentences and are being released when they are 60, 70 years old. And at that age, it's really hard to get someone into a nursing home if they're coming out of prison. It's hard to set folks up for success.

No, it has a big impact on partners, families and social circles. 

For non-incarcerated partners, it creates an immediate and stressful financial burden with a family member losing a primary source of income. From there, we see the adverse health effects of poverty and not being able to meet basic needs. It's incredibly stressful to have a family member or a loved one incarcerated. And over 113 million people in the country have an immediate family member who has been to prison or jail. 

This ripples outward into the larger community when such a proportion of our overall population becomes incarcerated. It takes a large toll on kids missing a parent – especially for their mental health.