Public Health Collaborations in a Corrections Setting: New York City's Model

Article excerpt

More than 100,000 of the sickest and most disadvantaged New Yorkers enter New York City's correctional system each year. According to the demographics and health indicators, the inmate population presents a significantly higher prevalence of communicable diseases, chronic conditions and mental illnesses than the general population. Many of these individuals are often homeless, unemployed or substance abusers with limited access to health care prior to incarceration. This certainly presents an enormous challenge to those responsible for providing health care to inmates. In order to address these needs, the New York City Department of Correction and the Department of Health and Mental Hygiene have collaborated to implement various health-related programs addressing the needs of inmates.

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A reorganization of health care for inmates in New York City has created a unique opportunity for the DOC and the Department of Health and Mental Hygiene to collaborate in the implementation of public health initiatives. The city charter mandates that the health commissioner is responsible for the delivery of health care services to inmates in the custody of the DOC. Since 1994, the health department had met its charter responsibility through an agreement with Health and Hospital Corp., which is responsible for operating all of the municipal hospitals in New York City. Health and Hospital Corp. was then authorized to provide jail-based services either directly or through contracting with a health care vendor. Health Commissioner Dr. Thomas Frieden ended this arrangement in July 2003. As a result, the health department currently assumes direct responsibility of jail-based correctional health services. This new arrangement of responsibilities enhances the city's ability to implement citywide public health initiatives inside jails, leading to a safer community upon inmate release.

An Interagency Effort

The health and correctional commissioners share a common belief that joint efforts on behalf of inmates and their families during their incarceration will have long-term, sustainable impacts on the overall health status of the entire city. By treating the inmates, counseling them on their health status and related issues, and by focusing on discharge planning and aftercare follow-up, a new continuum of services has begun to emerge. This integrated approach begins with admission to a detention facility and follows the inmate during incarceration and through reentry to the community.

The two agencies are presented with many challenges in working with the inmate population such as a large census, rapid drop-off rate, frequent transfers and stringent oversight requirements. At an average daily census of approximately 14,000, the DOC also has an exceptionally rapid drop-off rate, with 28 percent of those admitted being released within three days, 52 percent within seven days and 67 percent within 14 days. This makes identifying, assessing, and caring for physical and mental health conditions an enormous undertaking as tens of thousands of inmates are discharged after they receive a health exam, yet before their diagnostic test results are known. The average length of stay for both detainees and city-sentenced inmates is less than two months. In order to establish permanent health care connections, it is necessary to look beyond facility walls because male inmates, in particular, are frequently transferred between the 10 DOC facilities. In such a fluid environment, establishing linkages and making connections is a difficult task.

By identifying common goals for both agencies and the city, the DOC and the health department sustain a mutually beneficial, collaborative relationship. The earliest example of this successful collaboration occurred in March 2003 when Frieden spearheaded the enactment of stringent laws limiting the use of tobacco products in public places, including the city jails. …