Correctional Health Care Welcome! Thanks for coming! I’m a Family Medicine doctor practicing at The Institute for Family Health I’m interested in primary care epecially interested in helping to make care more accessible for underserved populations. Today I’m going to be talking about aspects of correctional care and will mainly be focusing on aspects of the problems. I just want to start with some general statistics. InSung Min March 19, 2011

Bureau of Justice Statistics What is the problem? The US imprisons more of its citizen than any other country in the world. By some estimates, one out of every hundred adults in the US are behind bars (this is 5 times that of England and 8.8 times that of Frances) And the rates of incarceration are rising. These graphs are taken from the Bureau of Justice Statistics- Bureau of Justice Statistics

Although incarceration rates are on the rise, crime rates are decreasing. Furthermore, the rate of violent crime is going down. WHAT?** Why are incarceration rates going up and crimes going down? ***

Institutionalization of persons with serious mental illness: 1928-2000 Part of the story leading to increase in incarceration rates is the closure of mental health institution in the 1970s As these hospitals were shut down, people living within these institutions were left without proper health and social services. And now many of these folks are being incarcerated. This becomes especially clear when you take into account the high prevalence of mental illness among those incarcerated.

Increasing Drug related crimes Following the trend of increasing incarceration rates, is the increase in drug related crimes, starting from the 1970’s This surge in part results from the creation of the Rockefeller drug laws in NY and similar laws around the country

Rockefeller Drug Laws 1973 Mandatory 15 years to life sentence for anyone convicted of selling 2 oz or possessing 4 oz of a narcotic drug Discriminatory to people of color Many similar laws in other states                                         The Rockefeller Drug laws were part of the War on Drugs and criminalized drug use The laws almost immediately led to an increase in drug convictions. The surge was mostly a result of convictions for non violent drug crimes

Disproportionate Representation of People of Color (This is a slide on incarceration rates stratified by race) Rockefeller Drug Laws were discriminatory to people of color. Laws like this across the US have especially impacted working class, minority populations; this phenomenon has been described as “mass incarceration”. Here you can see that black men are imprisoned at 7 times the rate of white men. They are more likely to be arrested, prosecuted and more likely to be subject to harsh penalities once convicted.

It’s important to realize that incarceration not only affects those incarcerate but also affects families and communities- we should be aware that there are large numbers of formerly incarcerated people that we might see in our clinics since 95% of those incarcerated return home. They bring with them complex medical, psychological, and social needs which impact public health and community systems. Because they are both feared and stigmatizd, former inmates face special burdens accessing and using the health care system. Studies have shown that they suffer from hihg rates of infeactious diseases, chronic medical and mental health problems, substance abuse and violence. As a health care provider working with communities, I think we should be knowledgeable about the complex social and medical issues they’re facing.

Impact of Incarceration on Patients A card study was done by Montefiore in the Bronx. The purpose was to get a sense of the Impact of Mass Incarceration on our patients. Patients at three clinics were asked a breif set of questions concerning current and past involvement in criminal proceedings, arrest, and incarceration. =>Involvement with the criminal justice system was common among our patients. It also showed that discussion of incarceration did not appear to have a negative impact on the clinical relationship. Over half reported they or a family member had been arrested Nearly 1 in 5 had been incarcerated themselves 118 pts surveyed. 9% involved in criminal proceedings, 18% had a family member in jail or prison, 25% reported ever being arrested, 55% reported they or a family member had been arrested, 18% had been incarcerated, 51% reported they or a family member had spent time in jail or prison.

(Presentation will vary depending upon stage in cycle) Release At risk for Incarceration (esp. teens) Arrested Incarcerated In the community Recividism Family in crisis (Presentation will vary depending upon stage in cycle) So knowing that incarceration significantly impacts out communities, what are some solutions we can come up with? One way of thinking about the problem from a public health and family medicine perspective is thinking about individuals, families and commnities in crisis at various stages of impact from incarceration. Think about those at risk for incarceration – teens and those with uncontrolled mental health issues…. Those arrested… those in the jail and prison systems,and then those living and integrated in our communities. With this framework in mind, I wanted to share a couple of interventions that Health care providers at Montefiore have been working on. These have mainly been in the “immediate release phase” and out in the communtiies. Image Courtesy of Ray Chavez and CA Prison Health Care Receivership

These folks are referred to the clinic through the parole system. So recently, Montefiore develped a Transitions Clinic in the South Bronx. The purpose is to help address the complex medical and social issues and possibly legal issues surrounding “reentry” among those recently discharged from jails or prisons. These folks are referred to the clinic through the parole system. The hope is also that residents can rotate through the clinic, giving them exposure in their training to the unque needs of this population . Image Courtesy of Ray Chavez and CA Prison Health Care Receivership

Montefiore, and a number of other residency programs, are also creating more opportunities for residents to work in correctional health facilities with the hopes of: 1. improving skills for caring for this population, their families and communities but also, 2. to possibly inspire more quality physicians to take interest in correctional health field – both to help with patient care but also with advocating for standards of care.

Interventions: At risk: Prevent arrests Arrested: ensure adequate representation Incarcerated: Improve health conditions in the prison system Release: Improve liaison with outside services In the community: Prevent recidivism Family: Keep people in care; keep kids in school; provide social support.