Health care needs of prisoners during and after incarceration

Men who have contact with the criminal justice system suffer from higher-than-normal rates of homelessness and unemployment, have lower levels of education, and often come from socially disadvantaged backgrounds^[1]. This combination of factors, along with a further negative effect of incarceration, means that the health status of incarcerated men is poorer than average, and that engagement with health care providers is particularly important for these men^[2].

The provision of health care within correctional facilities comes with a range of challenges. Health care workers encounter barriers from the restrictive nature of the environment. There is often difficulty gaining access to the prisoners due to security risks and correctional facility processes and procedures. Coordinating tertiary hospital emergency care requires collaboration between several service stakeholders and there are logistical challenges involved in transferring patients. The movement of prisoners from one prison to another creates challenges in keeping track of prisoners’ health care needs, as well as continuity of care.

A further potential barrier to the provision of healthcare for prisoners’ may be their unwillingness to seek and engage in health services^[3], but incarceration creates a unique opportunity to engage with health care services.

Every prisoner has contact with a health care professional upon reception into prison. This provides an opportunity to identify each prisoner’s physical and mental healthcare needs and to develop an integrated care plan that matches available management options to an individual’s desired health and wellbeing outcomes. This contact allows healthcare service providers to begin building a rapport with prisoners in a confidential, safe and non-judgemental environment. The goal of this first contact is to engage prisoners, educate them about their health, and encourage ongoing contact with health services.

In prisons, there is a strong focus on the prevention and management of conditions that significantly affect males. These conditions include cardiovascular disease, diabetes, asthma, prostate, and testicular cancer, testicular torsion, epididymitis, liver disease, kidney disease, sexually transmitted diseases, mental illness, self-harm and suicide prevention, and substance abuse. The best outcomes are achieved when these services can be followed up in the community once the prisoner is released. The World Health Organization states that good governance in institutions through health promotion and education contributes to better health outcomes^[4].

Cultivation of cultural awareness and understanding of the specific needs of vulnerable population groups, such as Aboriginal and Torres Strait Islander males (who are incarcerated at disproportionate rates to the general population)^[5], LGBTQIA+ prisoners, and culturally and linguistically diverse prisoners, is critical for creating change to address health inequity^[6].

If male prisoners engage with the health services provided in the prisons while incarcerated, they have the best opportunity to improve their overall physical and mental health and wellbeing. This can inspire men to continue optimising their health in the community when they are released.

Correct Care Australasia is Australia’s largest correctional healthcare provider and offers a patient-centred, nurse-led model, with services that include review and treatment by a medical officer, nursing, mental health support, dentistry, optometry, physiotherapy, podiatry, health promotion, audiology, radiology, sonography, immunisation, medication management, pathology, hepatitis C programs, weight loss clinics, alcohol and other drug services, telehealth, and discharge services.