The examples and perspective in this article may not represent a worldwide view of the subject. (May 2021)
Prison healthcare is the medical specialty in which healthcare providers care for people in prisons and jails. Prison healthcare is a relatively new specialty that developed alongside the adaption of prisons into modern disciplinary institutions. Enclosed prison populations are particularly vulnerable to infectious diseases and mental health issues, which links prison healthcare to issues of public health, preventive healthcare, and hygiene. Prisoner dependency on provided healthcare raises unique problems in medical ethics.
Scope of field
Prison populations create specific medical needs, based on the communal nature of prison life and differing rates of imprisonment for different demographics. For example, general population ageing has increased the number of elderly prisoners in need of geriatric healthcare.:223 In addition, treatment for mental health, sexually transmitted infections like HIV, and substance abuse are all important elements of prison healthcare,:122 as well as knowledge of public health methods.:317
The separation of prison healthcare from other medical specialties and healthcare systems leads to its isolation and stigmatization as a field,:120 despite some countries' promise for "equivalence" in healthcare between prison and non-prison patients.:224
Before 1775, imprisonment was rarely used as a punishment for crime. Since that year, however, incarceration rates have grown exponentially, creating the need for physicians in correctional institutions. Aside from medical care, prisoners were often used by doctors to conduct medical research and conduct teaching, a practice amenable to allopathic medical practices that prefer scientific analysis of pathology rather than relying on patient accounts.:3,11:22 Prison medicine began, in its most rudimentary form, in Victorian England, under the health reforms promoted by wealthy philanthropist and devout ascetic John Howard and his collaborator, well-to-do Quaker physician John Fothergill.
Another early development in the history of prison healthcare was the work of Louis-René Villermé (1782–1863), a physician and pioneering hygienist whose study, Des Prisons, was published in 1820. Doctors often had to pass judgment on whether patients were malingering to avoid labor—a practice continued on slave plantations in the US.:12 The work of Villermé and other French hygienists was an inspiration to German, American, and British public health leaders and spurred an overhaul in the conditions in which prisoners were held.
Prison healthcare is not currently a primary component of medical education, although academic medical centers are major providers of prison healthcare.:2 In the 21st century, little has been published on curricula for prison healthcare, and few textbooks exist.:310 Prisons are a complicated, stigmatized environment to practice medicine, which makes it difficult to develop specific training programs for them.:125 In one pilot prison-healthcare rotation in the United States, students believed they benefited from exposure to a diverse patient population although the prison's remote location and lack of organized schedule made the experience difficult.:127
Ethics and rights
The secondary status of healthcare in prisons and the marginalization and dependency most prisoners experience as a "captive population" pose medical ethics dilemmas for doctors practicing in prisons.:: Feminist theorist and prison abolitionist Andrea J. Pitts argues that the punitive purpose of prisons prevents most doctors from adequately treating and caring for prisoner patients.:14,27 Doctors' and medical centers' increased reliance on prisons for providing access to patients ultimately creates a dual loyalty problem, as doctors are forced to balance the medical needs of their patients against the institutional needs of prisons and hospitals.:2 These dilemmas, like organ donation in the United States prison population, make it difficult for doctors to provide patient-centered care in prisons.:4
Like other countries, prisoners in Ghana are at high risk for HIV and Hepatitis C.:350 The relationship between prisons and the national Ghana Health Service is also weak, leading to disorganized care.
Health care in prisons has been commissioned by NHS England since 2013. Before that it was locally commissioned by primary care trusts. Guidelines produced in 2016 by the National Institute for Health and Care Excellence recommended that on admission there should be a health check with confidential testing for hepatitis B, hepatitis C and HIV. In 2016 there were more than 4,400 prisoners aged 60 or over in England and Wales, and the number was increasingly rapidly. “They are sicker and more likely to have complex health needs than people of an equivalent age who are living in the community”.
The House of Commons Health Select Committee produced a report on prison healthcare in November 2018. They found that difficulties in getting prescribed medication had led to prisoners being hospitalised. They had to make an appointment for medication which outside prison was freely available and they could only get one day's supply at a time. Possession of medication could lead to bullying. Transfers from prison to secure beds in psychiatric hospitals in London were taking up to a year in 2019.
The UK has practiced some privatization for its prison healthcare. For example, Care UK provides healthcare for people in about 30 prisons. LloydsPharmacy won a contract for pharmacy services in the 15 Scottish prisons in May 2019. The contract for £17 million runs until April 2022.
Before the 1960s, prisons determined what healthcare they would provide with little state or federal oversight, due to the US' "hands-off" doctrine.:15 Psychological treatment often included moral-uplift bibliotherapy from prison libraries. Modern US prison healthcare arose after events like the Arkansas prison scandal of 1968 revealed the corruption of the Trusty system and unethical medical research conducted on prisoners. Spates of prison uprisings and campaigns for prisoners' rights pressured the US prison system to change.:15–16 In the 1970s, widespread intervention by federal courts improved conditions of confinement, including health care services and public health conditions, and stimulated investment in medical staff, equipment, and facilities to improve the quality of prison and jail medical services. Guidelines issued by the American Public Health Association and the creation of the National Commission on Correctional Health Care also improved prisoner healthcare.:16
With increased care came increased costs.:17 Compared to the UK, the US now uses more partnerships with universities and the private sector to provide healthcare to prison populations.:125 Cutting costs from public health crises, like mental health, AIDS, tuberculosis, and other infectious diseases within American prisons is a primary motivation. These partnerships are supported for the improvements they make to public health and the training opportunities they provide for medical students, although specialized medical training in prison settings is rare.:2 The outsourcing of prison healthcare has lead to controversies with companies like Corizon or Prison Health Services providing substandard or negligent care to prisoners.
Prison is often the first place that people in the USA are able to receive medical treatment that they couldn't afford outside. Although US prisoners are entitled to medical care, the marginal nature of prison healthcare and US mass incarceration means that prisoners often go untreated.:17 Following the mass closure of mental health hospitals in the 1960s, Mental health services in US prisons often aren't available for criminals; most prisoners have an untreated mental disorder and psychiatric care or treatment is expensive for the mentally ill.:2 64 percent of jail inmates, 54 percent of state prisoners, and 45 percent of federal prisoners in the US report having mental health concerns. Health care in American women's prisons often does not met the needs of women prisoners, such as in the areas of pregnancy and prenatal care, menstrual hygiene and gynecological services, and mental health, especially associated with past trauma or sexual abuse. Furthermore, prison clinics often presume the continuation of the US prison–industrial complex.:4
The Society of Correctional Physicians is a non-profit physician organization founded in August, 1992 as national educational and scientific society for the advancement of correctional medicine, and became the American College of Correctional Physicians in 2015.
- Healthcare for LGBT prison patients
- Correctional nursing
- Forensic nursing
- Experimentation on prisoners
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