Care for mental, physical health severely lacking among incarcerated

Key takeaways:

• Overall, 13.8% of prisoners who had one or more chronic physical conditions did not receive care.
• Co-payments, especially higher ones, were also tied to lower odds of care.

Approximately one-third of imprisoned individuals with a mental health condition received no treatment, according to a study results published in JAMA Internal Medicine.

A sizable proportion of those incarcerated in the U.S. failed to receive any treatment of chronic physical conditions. Co-payments charged by many prisons decreased odds of receiving treatment among the incarcerated, researchers reported..

Major health organizations like the ACP have previously called for better health care in jails and prisons. Yet, “data on health and access to care in correctional settings are collected infrequently,” Emily Lupton Lupez, MD, MPH, from Harvard Medical School, and colleagues wrote.

Study investigators conducted a cross-sectional analysis, where they examined data — taken from the U.S. Bureau of Justice Statistics’ 2016 Survey of Prison Inmates — on 1,421,700 prisoners (mean age, 35 years; 93.2% men).

The researchers assessed the self-reported prevalence of 13 chronic physical conditions, six mental health conditions and severe psychological distress, as well as the proportion of prisoners who reported no treatment.

They also compared the 2016 survey data to 2004 survey findings.

The prevalence of most chronic physical and mental health conditions increased in 2016 compared with 2004.

Lupez and colleagues found that 61.7% of prisoners reported one or more chronic physical conditions. Among those, 13.8% had received no medical visit since their incarceration.

Meanwhile, 40.1% of prisoners reported ever having a mental health condition, among whom 33% had received no mental health treatment.

The researchers also pointed out that 13.3% of respondents met the criteria for severe psychological distress, among whom 41.7% had not received mental health treatment in prison.

Overall, 90.4% of state prisoners resided in facilities requiring co-payments, including 63.3% in facilities with co-payments exceeding 1 week of prison wages.

Researchers reported an association between co-payments and worse access to care, a finding that “is novel, troubling, and unsurprising,” Lupez and colleagues wrote.

Specifically, prisoners with chronic conditions in prisons with co-payments greater than or equal to 1 weeks’ prison wage had higher odds of having no clinician visits in unadjusted (OR = 1.84; 95% CI, 1.37-2.48) and adjusted analyses (aOR = 2.17; 95% CI, 1.61-2.93).

The researchers explained there are several possible reasons for the rising prevalence of health conditions and illness among prisoners.

For example, “many come from communities with high rates of poverty and poor health,” they wrote. “A worsening supply of community psychiatric resources may funnel people with mental illness into carceral settings.”

Ultimately, “limited and fragmented oversight and regulation, a lack of commonly accepted standards of care, underfunding, and medical staffing shortages impede provision of adequate care in carceral settings,” Lupez and colleagues concluded. “Timely and comprehensive data collection and better oversight to ensure care access are needed.”

In an accompanying editorial, Benjamin A. Howell, MD, MPH, MHS, an assistant professor of medicine at Yale School of Medicine, and colleagues highlighted multiple strategies to improve health care in correctional facilities.

“To meet the ethical obligation to provide needed health care access, the imposition of co-payments should be eliminated across all correctional systems,” they suggested.

They added that the provision and financing of health care in jails and prisons “should be held to the same standards and oversight as the provision of care outside of correctional settings.”

References:

• Howell B, et al. JAMA Intern Med. 2024;doi:10.1001/jamainternmed.2024.3572.
• Lupez E, et al. JAMA Intern Med. 2024;doi:10.1001/jamainternmed.2024.3567.