Introduction

For the past two decades, I've had a deep interest in wound care, but my son's wound care experience in 2020 shifted my attention to a largely overlooked population. As a mother, as I prepare to face his third incarceration, I am an even stronger advocate for transforming families and the lives of those who have been incarcerated. I have recently become a Prison Fellowship Justice Ambassador. In my opinion, we must never lose sight of the fact that the prison population is a subset of the general population. You can read my previous blog of my son’s wound care experience here.

Mass Incarceration

Nearly 2.3 million people are imprisoned in the U.S.’ criminal justice system, which includes 1,833 state prisons, 110 federal prisons, 1,772 juvenile correctional facilities, 3,134 local jails, 218 immigration detention facilities, and 80 Indian Country jails, as well as military prisons, civil commitment centers, state psychiatric hospitals, and prisons in U.S. territories. Prisons and jails are important for society’s protection.^1,2 However, the Eighth Amendment to the Constitution gives those convicted the right to adequate medical care. The Americans with Disabilities Act (ADA) is a federal law that requires equal access to services, programs, and activities for inmates with disabilities, such as diabetes. Over 95% of incarcerated persons eventually reintegrate into the general population, bringing their health conditions with them, and 80% lack health insurance following reintegration. Proper care enables those incarcerated reintegration into society to partake in productive activities and avoid becoming a burden to others.^3,4,5

Monitoring Chronic Conditions

There is a deficit of standardized chronic condition screening for the incarcerated. Correctional facilities have experienced a rise in chronic disease instances, including wound chronicity, heart disease, diabetes, cancer, hypertension, and asthma, as well as increasing health care costs and higher rates of COVID-19. Around 44% of incarcerated people have had a chronic illness, compared with 31% of the general population. Many chronic conditions are linked to the reasons those incarcerated end up in prison in the first place. According to the Centers for Disease Control and Prevention (CDC), incarcerated people with drug and alcohol addictions, mental health issues, and homelessness are overrepresented in the population.⁶

Diabetes Management

It is projected that roughly 80,000 incarcerated people have diabetes, resulting in a 4.8% diabetes prevalence rate, with a higher number of amputations. Many of these people with diabetes are diagnosed for the first time during prison intake. Routine screening for diabetes-related complications should be performed on all incarcerated persons with a diabetes diagnosis, as described in the ADA Standards of Care. Interval chronic illness clinics for people with diabetes are an efficient way to monitor patients for diabetes-related problems. This allows for appropriate referrals to consultant specialists on an as-needed basis, as well as for interval laboratory testing. Routine screening and management of diabetes include medication management, nutritional management, glycemic monitoring, foot care, optometrist or ophthalmologist care, and education.^7,8

Aging Population

Many prisons lack a design that allows for effective geriatric care, and there are barriers to those who need palliative care for this growing population. Older people incarcerated in the United States are the fastest-growing population in the prison system. Unhealthy lifestyles and insufficient health care among imprisoned individuals contribute to the earlier development and rapid progression of a number of illnesses prevalent among older adults. This topic also has a deficit of peer-reviewed epidemiologic data.⁹

Safer Care For Everyone

Scheduling medical appointments is one of the most significant obstacles to receiving care. In correctional facilities, all movement must be monitored and controlled for security. According to a survey conducted by the CDC, 30 of the 45 states surveyed used telemedicine for at least one sort of specialty or diagnostic treatment. Patient in prison who receive treatment through telemedicine also report a higher level of perceived satisfaction with the treatment.¹⁰ Traditionally, people who are incarcerated who require serious medical attention are transported outside of the correctional facility to hospitals or other care facilities. This puts many individuals at risk, including security guards, hospital employees, and visitors to the facility. Numerous correctional facilities are located in remote areas, necessitating the transportation of detainees to obtain care. Correctional institutions utilize telemedicine to save transportation costs and expand services within the facility.

Balanced Nutrition Food Programs

Healthy dietary options impact mental and physical health, chronic conditions, and wound healing. Therefore, food in prison is a crucial aspect of an incarcerated person's effective rehabilitation and reintegration into society after release. Prison food is mostly processed and loaded with cholesterol, sodium, and sugar. Fruits are not normally available because they can be turned into prison wine.¹¹ In the United States, a rising number of prisons and organizations are attempting to develop and implement sustainable food programs that will help incarcerated people receive better nutrition. Among the recognized benefits of the move are the alleviation of chronic diseases such as diabetes and heart disease, the savings on medications and health care costs, and the improvement of inmate morale.

Dual Diagnosis: Mental Illness and Addiction

Incarcerated people frequently receive dual diagnoses of addiction and mental illness. While incarcerated, addressing substance addiction and mental health issues helps reduce relapse and decreases the likelihood of future incarceration. Prisons across the country have made a concerted effort to expand and improve access to mental health specialists. However, there is a substantial gap in follow-up with a psychiatrist after prison release. Correctional facilities have increasingly begun screening inmates on entrance and training all staff on how to interact appropriately with the mentally ill. In some jurisdictions, treatment centers for convicts with mental health disorders have been established, employing hundreds of health care professionals such as doctors, nurses, dieticians, occupational and physical therapists, and psychiatrists.⁶

Conclusion

Understanding your patients is the first step toward closing care gaps. There is also concern among clinicians and correctional nurses that they will be assaulted, and those who have been incarcerated may be hesitant to speak out to their nurse or provider if a correctional officer is present. Significant progress has been made over the last decade, but there is still potential for improvement, and it is critical to maintain services that are equivalent to those given in the community, particularly in terms of wound care.

References

1. United States Bureau of Justice Statistics. Census of state and federal adult correctional facilities, 2012. Inter-university Consortium for Political and Social Research [distributor], 2020-09-15. Accessed December 29, 2021. https://doi.org/10.3886/ICPSR37294.v2
2. Wagner, Wendy Sawyer and Peter. “Mass Incarceration: The Whole Pie 2020” Mass Incarceration: The Whole Pie 2020 | Prison Policy Initiative, www..prisonpolicy.org/reports/pie/2020.html.
3. Cook L.. Changes in the provision of effective wound care within the prison services. Wounds UK. 2011;7:66-70.
4. Corrections1. 4 trends in correctional healthcare. Accessed December 19, 2021. https://www.corrections1.com/correctional-healthcare/articles/4-trends-…
5. Edge C, Black G, King E, George J, Patel S, Hayward A. Improving care quality with prison telemedicine: the effects of context and multiplicity on successful implementation and use. J Telemed Telecare. 2021;27(6):325-342. doi:10.1177/1357633X19869131
6. Hornung CA, Greifinger RB, Gadre S. A projection model of the prevalence of selected chronic diseases in the inmate population. In: The Health Status of Soon-to-Be-Released Inmates: A Report to Congress. Vol 2. Chicago: National Commission on Correctional Health Care; 2002:39-56.
7. American Diabetes Association. Diabetes management in correctional institutions. Diabetes Care. 2008;31(suppl 1):S87-S93. doi:10.2337/dc08-S087
8. American Diabetes Association. Standards of medical care in diabetes—2008 (position statement). Diabetes Care. 2008;31(suppl 1):S12-–S54.
9. Widra E. Incarceration shortens life expectancy. Prison Policy Initiative. 2017. Accessed December 11, 2021. https://www.prisonpolicy.org/blog/2017/06/26/life_expectancy/
10. Mateo M, Álvarez R, Cobo C, Pallas JR, López AM, Gaite L. Telemedicine: contributions, difficulties and key factors for implementation in the prison setting. Rev Esp Sanid Penit. 2019;21(2):95-105.
11. Sostre SR. Prison food: a hidden public crisis. Womanly. 2020;6. Accessed December 29, 2021. https://www.womanlymag.com/issue-no-6/prison-food-a-hidden-public-healt…