Stemming the tide of inmate deaths after release

Time in custody offers a perfect opportunity to intervene and prevent health issues from arising after release

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By Fiona Kouyoumdjian
and Stephen Hwang
EvidenceNetwork.ca

HAMILTON and TORONTO, Ont. May 27, 2016/ Troy Media/ – The tragic stories of Ashley Smith, Edward Snowshoe and other inmates who have died in Canadian correctional facilities have rightly made headlines. Less well known are the premature deaths of hundreds of Canadians every year from preventable causes after they are released from jails and prisons.

Canadians might be surprised to learn that many health and social services widely available in the community are not available in most Canadian correctional facilities. We are missing a critical opportunity to reframe incarceration as a time to help people improve their health and well-being before returning to our communities.

inmate deaths
Fiona Kouyoumdjian

We recently [popup url=”http://cmajopen.ca/content/4/2/E153.full.pdf” height=”1000″ width=”1000″ scrollbars=”1″]published[/popup] a study in the Canadian Medical Association Journal Open that looked at the rates and causes of death for people who had been incarcerated. When we examined instances of death in almost 50,000 former Ontario provincial inmates over a 12-year period, we found a shocking discrepancy in life expectancy.

Compared to the general population, the average life expectancy of people who had experienced incarceration was four years shorter for men (73.4 years of age compared to 77.6 years) and 10 years shorter for women (72.3 from 82.9 years). The likelihood of dying while in custody was two times what we would expect for people of the same age in the general population. But even after people returned to their communities, the chances of dying was four times what we would expect for the general population.

inmate deaths
Stephen Hwang

We can’t clearly distinguish the specific impact that incarceration has on life expectancy. But we know that those in prison have a [popup url=”http://www.cfp.ca/content/62/3/215.full.pdf” height=”1000″ width=”1000″ scrollbars=”1″]higher risk[/popup] of early death for a variety of reasons beyond incarceration itself, and that this high risk extends far beyond the period of imprisonment.

People who spend time in jails and prisons in Canada often experienced serious adverse events in childhood, such as physical or sexual abuse. As well, the majority have not completed high school. They have high rates of diseases including mental illnesses, substance use disorders, HIV and hepatitis C. They also tend to have low rates of employment and high rates of homelessness.

So what can we do to prevent these premature deaths?

The time in custody offers a valuable opportunity for evidence-based [popup url=”http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302498″ height=”1000″ width=”1000″ scrollbars=”1″]interventions[/popup]. One obvious focus is preventing the harms associated with substance use, which is very common among inmates. Substance use leads to premature death directly, for example through overdose. It also leads to premature death indirectly, via infection with HIV or hepatitis C in people who share needles, or through cirrhosis and liver cancer in people who drink heavily.

We have a lot of evidence about ways to treat problems with substance use and to prevent associated harms. However, many of these standard treatments widely available in the community are not accessible in correctional facilities. This includes nicotine replacement therapy to help people quit smoking and methadone maintenance therapy for people who are addicted to opiates like heroin and morphine.

We know that people inject drugs in prisons but we don’t provide access to clean needles, which leads to people sharing needles and becoming infected with HIV and hepatitis C.

Even though the risk of overdose in the weeks after release from prison is 56 times what we would expect for the general population, in most jurisdictions [popup url=”http://www.ohrdp.ca/opioid-overdose-prevention/” height=”1000″ width=”1000″ scrollbars=”1″]we don’t train inmates[/popup] on how to prevent overdoses or offer them the opioid overdose reversal medication naloxone when they are released.

We also fail to facilitate access to primary care when people get out of jail. With relatively high rates of early death from a variety of diseases, including cancer (1.6 times as likely as the general population) and heart disease (3.1 times as likely), primary care would provide former inmates with access to prevention programs and to be screened for, diagnosed with and treated for diseases.

Supporting people who experience incarceration is good for these individuals, their families and our communities. Improving access to appropriate treatments could help them improve their health, support their social functioning, improve public safety and decrease re-incarceration. Let’s not waste this opportunity.

Fiona Kouyoumdjian is a postdoctoral fellow at the Centre for Research on Inner City Health at St. Michael’s Hospital in Toronto and a family physician at a provincial correctional facility in Hamilton, Ont. Stephen Hwang is an expert advisor with EvidenceNetwork.ca, a practising physician in general internal medicine at St. Michael’s Hospital and a research scientist at the Centre for Research on Inner City Health in Toronto.

Fiona and Stephen are Troy Media [popup url=”http://marketplace.troymedia.com/our-contributors/” height=”1000″ width=”1000″ scrollbars=”1″]contributors[/popup]. [popup url=”http://www.troymedia.com/become-a-troy-media-contributor/” height=”600″ width=”600″ scrollbars=”1″] Why aren’t you?[/popup]

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