Prison health care and the lessons of history

Additionally, many of them will lack financial resources to pay for appointments or prescriptions upon release, and will face substantial financial hardship for some time due to prolonged unemployment due to discriminatory hiring policies. There is the additional challenge, particular for those who have been incarcerated for many years, of learning how to navigate a healthcare system that has changed dramatically in the intervening years. The American heath care system is difficult enough to navigate for an educated, affluent patient, much less an individual facing all the socioeconomic barriers that people released from incarceration will encounter.

I encountered the challenges that the formerly incarcerated population faces through my time volunteering at the Formerly Incarcerated Transitions FIT clinic, a free clinic run by Tulane Internal Medicine residents that offers transitional services to people recently released from incarceration, including primary care and case management services. It is housed at the Ruth Fertel Tulane Community Health Center, a community clinic in Mid-City New Orleans that was established in the wake of Hurricane Katrina to address the dearth of primary care services in the neighborhood.

As a volunteer at the clinic, I had the opportunity to serve as a case manager for multiple patients recently released from Louisiana prisons.

Theme of The Conference

There is evidence supporting care management for the formerly incarcerated, including a randomized trial that found that care management reduced emergency department use in the formerly-incarcerated. This patient, Mr. B not his real name , was wrongfully convicted of first-degree murder at age 16, based on witness testimony that was later recanted.

After decades of incarceration in Angola, he was released home to New Orleans. VOTE helped to connect Mr. B, who otherwise had no established primary care provider, to the FIT clinic. On initial meeting, Mr. B was a friendly, pleasant man who bore no trace of the anger he would be justified in displaying after being wrongfully incarcerated for decades.

He was also in relatively good health, with hypertension as his only chronic medical condition, for which he was taking three medications. His physical examination revealed nothing unusual, except a blood pressure a little on the high side, but not dangerously so. B from achieving optimal health outcomes. B, unsurprisingly since he had been incarcerated as a teen, did not have a primary care provider, nor did not know how to fill his prescriptions. He had no health insurance, no immediate prospects for employment, and limited financial resources. He barely knew how to use his new cell phone, and had to be taught how to check his voicemail.

Despite his evident intelligence and resilience, Mr.

Managing Prison Health Care Spending | National Institute of Corrections

B was re-entering a society completely foreign to the one he left as a teenager when he was convicted and imprisoned. And this society is not particularly welcoming to the formerly incarcerated. As a case manager, my responsibility was to communicate regularly with Mr. B and all my other patients. I gave all of the patients I worked with my cell number, and encouraged them to call me if they had any questions or concerns about anything related to their medical care. The barriers Mr. B and other patients like him face highlight the need for a robust policy agenda to meet the unique needs of the formerly incarcerated.

One area of focus should be to facilitate access to Medicaid or other health insurance upon release. Louisiana recently announced one such program, which would automatically enroll incarcerated individuals from seven state-operated prisons in Medicaid upon release. This program is important because the process of applying for Medicaid can be time-consuming and complicated, particularly for someone unfamiliar with the system. Formerly incarcerated individuals frequently lack the proper identification required to apply for coverage, which poses an additional hurdle.

Prison medicine, public health policy and ethics: the Geneva experience

Maryland recently announced a similar program, and a number of states already have auto-enrollment of released prisoners into Medicaid. While facilitating access to affordable healthcare is very important, it is far from the only necessary policy response to improve the health of the formerly incarcerated. Economic insecurity is a significant contributor to poor health outcomes, and discrimination against the formerly incarcerated is prevalent in the job market. And generally speaking, policies that reduce the incarcerated population through policing and sentencing reform would make more resources available to meet other compelling societal needs.

Other policies such as granting the right to vote and reversing the privatization of prisons would help as well. Passing and implementing policies that help the formerly incarcerated may be a challenge in a new administration that campaigned on a harsher approach to law enforcement, and gave short shrift to the discussion of criminal justice reform.

Repeal of the Affordable Care Act and its Medicaid expansion, particularly in the absence of a concrete replacement plan, also threaten the progress that has been made in improving the health outcomes and general welfare of the formerly incarcerated. The recent progress that has been made in Louisiana, a state with a history of a harsh approach to criminal justice, could serve as a model for state and local innovation in a political environment that is not especially favorable to the formerly incarcerated.

For moral and economic reasons, it is imperative that we continue the hard work of improving the welfare of this vulnerable population. Bureau of Justice Statistics. Justice Expenditure and Employment Extracts, — Preliminary. McLaughlin M et al Federal Bureau of Prisons.

Prisons and Prison Reform

Inmate Statistics — Offenses. Last updated November 26, Sakala, L. Prison Policy Initiative. Accessed from:. Chang, S. Victorians thought that institutions were the key to most social problems, whereas their successors today prefer smaller scale solutions. Most of the drugs now used to manage mental problems have only been available since the midth century; Victorians had only sedatives and hypnotics.

US Healthcare System Explained

We have different ideas about the status of women and children, and the acceptability of violence in interpersonal relations. But the difference is not as crude as we might think. The Victorians knew about social issues and mental disorders, dealing with them as best they could by the standards of their times. The past really is another country, where they do things differently. We should respect their efforts, even if, ultimately, we ourselves choose to do things differently. What does all this mean? The famous British historian G. Trevelyan once wrote movingly:.

The exhibition helps us to reach out to them across time and to see ourselves and those around us in a different, more sympathetic light. It allows us to learn more about mental health through the lessons of history. Because we are all migrants through time. The exhibition showed at the National Records of Scotland during the Edinburgh Festival August and was part of the official Fringe program.

Between now and the end of it will be in various Scottish prisons, The State Hospital Carstairs, and on display at a UK forensic psychiatry conference. The project runs until the end of July Filed under Admin , Research , Staff. About standrewshistory With over forty fulltime members of staff researching and teaching on European, American and Asian history from the dawn of the Middle Ages to the present day, the School of History at the University of St Andrews has one of the finest faculty and diverse teaching programmes of any School of History in the English speaking world.

Thematic interests include religious history, urban history, transnationalism, historiography and nationalism. The School of History prides itself on small group teaching, allowing for in-depth study and supervision tailored to secure the best from each student. Cutting edge research combined with teaching excellence offer a dynamic and intellectually stimulating environment for the study of History.

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Notify me of new comments via email. Notify me of new posts via email. St Andrews School of History News from world-leading researchers and excellent students of history. Posts Comments. Professor Rab Houston.

William Porter, convicted of housebreaking and theft. Image: National Records of Scotland. Restraints like this were used in all UK prisons in the late nineteenth and early twentieth centuries. Share this: Twitter Facebook Email Print.


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