The Medicaid expansion under President Barack Obama’s Affordable Care Act allows states to give inmates across the country access to some health coverage that continues after they are released. But access to health insurance is just a small part of the health-related challenges inmates face on the other side.
At CNN, Dr. Emily Wang writes that many former inmates with chronic health problems “have their first exposure to health care as adults in prison.” This is a sad state of affairs to begin with, and as facilities have become overcrowded and medical programs outsourced to private contractors in recent decades, prisoners have found it increasingly difficult to get the care they need.
Dr. Wang notes that 13 million Americans return from prison each year, and many have been exposed to a variety of mental and physical abuses by both fellow prisoners and corrections staff, including punitive solitary confinement and violent conditions. Prisoners therefor suffer acute trauma from the experience of their incarceration in addition to any other health problems they might have.
Bias towards formerly incarcerated people perpetuates their abuse and neglect during and after incarceration. A study in the Health and Justice Journal, which includes Dr. Wang on its byline, found that 42% of the 172 former inmates surveyed, “reported a history of criminal record discrimination by healthcare workers.”
Further complicating matters is the fact that inmate medical treatment is tightly controlled by the prison, and many prisoners don’t know how to manage their own healthcare needs after release. Prisoners with mental health needs on strict drug regimens or those diagnosed with diabetes in prison who have never injected their own insulin may find it difficult to provide for themselves without any kind of exit counseling or support system.
Medical professionals need to be sympathetic to the fact that formerly incarcerated patients may need help adjusting to this new setting. As Dr. Wang describes in her piece, someone who has spent years without meaningful social contact in solitary confinement may not find it easy to be examined closely by a doctor. Those who cannot find help in doctors offices often end up in emergency rooms, which means even higher medical costs for the individual, perpetuating the cycle of poverty and injustice.
There are many ways to tackle this problem. The first would be to end mass incarceration policies that lock up increasing numbers of people with addiction and mental health issues, who are certainly not getting the treatment they need in prison, and to get them the care and attention they need. Those of us advocating for reduced sentencing, bail reform and other routes to release should also be calling for increased medical support for those inside and coming out of prison so that these individuals do not continue to suffer.
Dr. Wang notes that healthcare providers also need to become more familiar with the experience of incarceration and work in prison environments more often. They should devise strategies to meet the various, specific needs of those returning from prison rather than succumbing to the ‘otherness’ that perpetuates their abuse.
In my opinion, aside from combating the pervasive discrimination that former inmates face, we should also be providing more support in terms of “exit counseling” to help former prisoners know what to expect when they return to society, and how they can work to overcome some of the challenges they may face.
The more we as a society neglect the critical medical needs of current and former prisoners, the bigger the economic and social burden we will collectively bare in the long run.
Brian Sonenstein
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