Report: Inmates Suffer High Rates of Illness, Poor Access to Care

BOSTON — Prisons and jails provide poor access to medical care and inmates exhibit high rates of serious chronic health conditions, according to a nationwide study of inmate health and medical care in correctional facilities.

Approximately 40 percent of the combined federal, state and local inmate population — more than 800,000 of the nearly 2 million inmates held in correctional facilities throughout the United States — reported at least one serious chronic medical condition, according to the study by Harvard Medical School and Cambridge Health Alliance. Conditions included diabetes, cirrhosis, asthma, prior myocardial infarction and persistent coronary or renal problems.

“A substantial percentage of inmates have serious medical needs, yet many of them don’t get even minimal medical care,” says Andrew Wilper, M.D., lead author of the study. “These prisoners are denied their constitutionally guaranteed right to care.”
The research effort, funded by the National Institutes of Health, is the first study to examine inmate health and medical care at correctional facilities across all jurisdictions and facility types, officials say.

Researchers analyzed data on inmate medical conditions, illnesses, physical injuries and medical and mental health care from a 2002 survey of local jails and a 2004 survey of state and federal facilities. The U.S. Census Bureau conducted the surveys independently for the Bureau of Justice Statistics.

The incidence of chronic illness and serious medical conditions among inmates is significantly higher than that of similarly aged individuals in the general U.S. population, according to the study.

The incidence of diabetes among federal inmates is 11.1 percent compared to 6.5 percent among similarly aged members of the public. More than 10 percent of state inmates and 8 percent of local inmates reported having diabetes.

The prevalence of prior myocardial infarction in the state (5.7 percent) and federal (4.5 percent) prison populations was higher than the 3 percent prevalence found in the general population, according to the study.

The prevalence of asthma among inmates held in state prisons and local jails, almost 10 percent and 9 percent, respectively, was also higher than the 7.5 percent found in the nonincarcerated population.

Access to healthcare and medical treatment delivery in correctional facilities is poor and many inmates with an illness or medical condition fail to receive care while incarcerated, according to the study.

More than 68 percent of jail inmates with persistent medical problems had not been examined by a medical professional since their incarceration. Researchers found more than 20 percent of state inmates and almost 14 percent of federal inmates with medical problems had not been evaluated since their incarceration.

Access to care was worst in local jails and best in federal prisons, according to the report. One-quarter of jail inmates who had suffered severe injuries had received no medical attention, versus 12 percent in state prisons and 8 percent in federal prisons.

Inmates with medical problems, such as diabetes, which requires drug treatment, often had their medications stopped after their incarceration, including one-quarter of chronically ill state prisoners and 36.5 percent of inmates in local jails.

Approximately 12 million inmates are released from prisons and jails each year and improved management of their chronic conditions during incarceration offers a substantial public health opportunity, according to the study. Minimizing inmates’ physical and mental disabilities also represents an important element for successful reintegration into family and employment roles.

“These individuals and the communities to which they return suffer as many carry with them the costs of untreated illness and preventable disability,” Wilper says.

The study, “The Health and Health Care of U.S. Prisoners: A Nationwide Survey,” was published in the American Journal of Public Health, and also analyzed mental health issues and care among inmates.

Almost 490,000 inmates — approximately 25 percent of the combined federal, state and local inmate population — reported at least one previously diagnosed mental health condition, such as schizophrenia, bipolar disorder, depression or anxiety, according to the study.

Researchers highlighted a pattern of low pre-incarceration treatment rates and high treatment rates during incarceration. A minority of inmates with a previously diagnosed mental health condition — federal (25 percent), state (29 percent), local (38 percent) — were taking psychiatric medication at the time of their arrest, according to the study.

Among prison inmates who had been treated with psychiatric medication for schizophrenia or bipolar disorder in the past, the proportion on treatment increased from approximately 1 in 3 at the time of arrest to almost 2 in 3 during incarceration, according to the study.

More than 69 percent of inmates in federal prisons and more than 68 percent of state inmates who had been treated with psychiatric medication in the past reported taking medication for their mental health condition since their incarceration, according to the study.

The increase in rates of mental health treatment and compliance post incarceration was less pronounced among the jail population, according to the study. Approximately 45 percent of inmates in local jails who had been treated with medication in the past reported taking medication for mental condition since incarceration.

The pattern of low rates of mental health treatment/compliance among inmates prior to arrest and the subsequent increase in treatment/compliance rates during incarceration could reflect limited access to mental health services and support networks in the community, according to researchers.

“The U.S. incarcerates more people per capita than any other nation,” says Steffie Woolhandler, M.D., study co-author and associate professor of medicine at Harvard University. “For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration.”