By Barton, Keith
Corrections Today , Vol. 71, No. 6
Providers of health care in local correctional facilities are well-positioned to improve public health and safety while reducing recidivism and public expenditures. As a population, jail inmates tend to be high-risk and difficult to reach, with limited access to health care outside of jail. By linking offenders with a local health care provider whom they can continue to see after release, jails can stabilize detainees' health and help improve the health of the community. In addition, providing appropriate mental health medication and treatment can reduce violence inside the jail and also in the community after inmates are released.
Community Oriented Correctional Health Services (COCHS) is a nonprofit organization funded in part by the Robert Wood Johnson Foundation to foster partnerships between local jails and community health centers. COCHS promotes the establishment of medical homes where offenders in the community can get regular, timely and well-organized care, including management of chronic conditions. This approach has been shown to reduce utilization in already crowded public hospitals and emergency departments.
Because jail detainees generally return to their home communities and because many are in jail for short stays, jails are excellent places to detect, treat and interrupt the spread of communicable diseases in a high-risk, risk-taking population with limited access to health care. COCHS views jails as one of several places in the community where people receive medical and mental health care. As part of the community, jails can work in partnership with neighborhood health centers, public health officials, mental health providers, social service agencies, and local housing authorities to improve public health, reduce crime and recidivism, and support offender reentry.
Local correctional officials seeking to provide better health care for detainees face many challenges, not least of which are cost constraints. In addition, jails today are forced to deal with complex community issues like mental health, substance abuse and social disparities that they were not designed or funded to do. They manage both serious and minor offenders, coming from tremendously diverse populations, with various medical, mental health, emotional and substance problems.
Offender Health Profiles
Most people entering jail have had little access to health care professionals, and many lack health insurance. Some detainees cycle in and out of jail frequently. Average length of stay ranges from two weeks to two months, depending on the jurisdiction, and many detainees are released within 48 hours.
COCHS emphasizes that people in jail are temporarily displaced from their communities, not separate from them. Once released, their health problems--which may include communicable diseases, substance abuse and mental disorders--frequently go untreated. This increases the risk of assaults and domestic violence while adding to the public health burden in the community.
Consequently, the substantial societal investment in health care provided to offenders while they are in jail must be continued once offenders are released. A community-based approach that ensures continuity of care after release can help protect society's investment and improve public safety. However, implementing a community-based care approach is not a simple task. It requires jails and community health centers to work together and combine their resources, establish shared health information records, and create mechanisms to ensure better care in jail, as well as continuity of care after release from jail. For the best outcomes, health care must be dually based, both inside and outside the jail.
Connecting the Jail and The Community
How does a community-based approach to correctional health care work? In the traditional correctional care system, people entering jail receive basic health screening. …