Prison health systems need better integration into the community

States need to re-examine the kind of healthcare they are providing their prison populations in order to avoid a public health crisis once they re-enter society, a new analysis concluded.

According to a report released by consulting firm HDR, many states are struggling to adhere to their mandate to provide an adequate level of care for prisoners. The report cited a lack of coordination between prison and community health systems as a key factor that has often led to gaps in care once inmates are released and back within the community.

Many states have been unable to cope with the changing health needs of a prison population that is getting older. From 1993 to 2013 the number of inmates over the age of 55 increased 400%, according to the U.S. Department of Justice. Currently more than 18% of prison inmates are over 50 years of age.

As such, states have seen increased cases of chronic conditions such as heart disease and cancer among their inmates, which have in turn has had an effect on healthcare costs. Between 2010 and 2014, federal prison medical increased 22% from $905 million to $1.1 billion. States with higher per-inmate spending had higher percentages of older inmates.

Despite increases in health spending, inmates on average tend to be in poorer health than the general population. One reason for the health disparity had to do with the standard of overall care inmates received, which David Redemske, principal health planner at HDR, described as often inefficient. He said the prison health system as a whole mostly lacks the kind of coordination with community health providers needed to continue care for inmates upon their release. Redmeske said prisons should adopt more of a public health model that focuses on wellness, disease treatment and management, prevention and creating a continuum of care during and after incarceration.

"If we don't take care of these issues while they are incarcerated they are going to bring these issues right back to the community," Redemske said.

Such issues can include the risk of infectious diseases being spread once prisoners re-enter communities if they have left prison with untreated or unmanaged cases of conditions such as tuberculosis, HIV and hepatitis C. Also, the growing rate of chronic conditions within the prison population such as heart disease and cancer threaten to put strain community hospitals if they are not properly managed by prison healthcare providers.

In terms of mental health, the report recommended increasing screening upon intake of prisoner and for prisons to staff more behavioral healthcare professionals and mental health training for corrections staff, noting there were three times more mentally ill people in prison than there were among the public receiving treatment. On the policy end, the report called for reducing the number of mentally ill incarcerated in favor of community mental health alternatives.

The analysis found wide variation throughout states in their healthcare models, which pointed to a lack of a uniformed standard of practices. One example can be found in the wide disparity in which states spend on corrections healthcare. A 2017 report by the Pew Charitable Trusts found that in fiscal year 2015 per-inmate spending ranged from $19,796 in California to $2,173 in Louisiana.

But Redemske said state prisons also varied greatly in terms of their amount of planning for an inmate's continued care upon their discharge. The report found most inmates received a two-week supply of medication and no plan for follow-up care.

"Because of that, care coordination, case management, and discharge planning are crucial to connect discharged inmates with community-based services to ensure continuity of care, and limit the need for emergency department visits," he wrote.

Despite such variation, there were common themes shared among most state prisons reviewed for the analysis. In addition to the insufficient community-based services for inmates, the report found there were a lack of nationally recognized standards for prisoner care, limited use of current technologies, limited and inconsistent staff training programs, cutbacks or the elimination of inmate education programs, and limited use of alternatives to incarceration were all constant factors.

The report called for prison health systems to seek more partnerships with public health and academic medical centers as means of providing support to continuity of care for inmate throughout their incarceration and beyond.

Redemske acknowledged that the political will to fund such supports may be difficult to fine among lawmakers. A common barrier lies in the lingering public sentiments regarding healthcare in prison that often leans toward underfunding such care out of notion that substandard care is in some way a part of the punishment.

"We need to change the dialogue between being tough or being soft on crime to being smart about it," Redemske said.