By Fiona Kouyoumdjian
and Stephen Hwang
St. Michael’s Hospital
During his decade-long tenure as Canada’s top prison watchdog, Howard Sapers has often been a vocal critic of Canada’s prison system, including the treatment of mentally ill and aboriginal inmates, as well as the use of solitary confinement, among other issues.
Canadian prisons, he maintains, are often unhealthy spaces. It doesn’t have to be this way.
It may surprise you to know that about one in 200 Canadians is detained or incarcerated in jail or prison every year, and that the average length of stay in these facilities is only a few weeks.
Most of these individuals are dealing with both serious medical problems and difficult social situations, and they lack good access to health and social services in the community.
Time spent in jail or prison can serve as an opportunity to improve health. But achieving this goal will require a change in attitudes about healthcare in custody and reforming healthcare in correctional facilities.
In Fiona’s work as a physician providing healthcare at a jail in southern Ontario, she often hears patients describe something good about being in jail (as well as lots of bad things of course), like having a chance to “detox” from drinking or drug use, or to get away from unhealthy relationships. These are incidental consequences of being in custody.
We could be more purposeful in using time in custody to help people improve their lives.
We have good evidence about ways to do this. We recently reviewed with colleagues the scientific literature on interventions to improve health in people in custody and in the year after release, and we identified more than 50 interventions that clearly improve health.
Some of these interventions seem obvious: for example, linking people with chronic medical and psychiatric problems to a family physician when they are released from jail. Others are treatments that are available for people in most communities in Canada, such as pharmacological therapy and counselling for people with addictions. But these interventions have not been implemented in many correctional facilities across Canada.
Transforming jails and prisons into places where people can improve their health and where we integrate evidence on best practices will require changing our attitudes and changing how healthcare is delivered. We need to recognize that people in custody have the right to the same standard of care and level of service as people in the community, regardless of what crimes they may have committed or what lifestyle choices they have made.
We need oversight of healthcare in correctional facilities by people with expertise in health and not only those with expertise in security. This important change may be best achieved by transferring the responsibility for healthcare from Ministries responsible for corrections to Ministries responsible for health. Where not already in place, healthcare services in correctional facilities should be accredited as a means of ensuring quality and consistency of care across institutions and jurisdictions.
Does it make sense to focus on the health of people serving jail time? We firmly believe, yes. Jail and prison offer a unique opportunity to access an often marginalized population, to provide needed treatment and services, and to link people with community-based care and programming.
Improving health in this population would also benefit the general population. Better health and healthcare for people who are detained or incarcerated could reduce healthcare costs, for example, by linking people with family physicians we could reduce expensive and unnecessary use of emergency departments. Appropriately diagnosing and treating infectious diseases such as hepatitis C and HIV could lead to less transmission of these diseases to others in custody and to the general population after release from custody. Effective treatment of mental illness and substance use disorders could lead to less crime, which would positively affect public safety and reduce re-incarceration and associated costs.
A focus on improving health and healthcare for our most vulnerable populations is an important agenda that we need to advance. Innovation and excellence should be integral to the provision of healthcare and services for persons in jails and prisons, with potential benefits for all Canadians.
Fiona Kouyoumdjian is an assistand professor at McMaster University. Stephen Hwang is a practicing 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.