Security is the Foundation, But Not the House
Addressing Healthcare and Rehabilitation in U.S. Jails
Crayman Harvey, CJM, CCHP
Security functions have predominated over facility operations since the establishment of correctional institutions in the United States, to the extent that security professionals have adopted an omniscient approach to institution management. This perspective often prioritizes safety and control over rehabilitation and inmate welfare, leading to a rigid environment that can stifle personal growth and transformation among the population. As a result, the balance between security and the humane treatment of incarcerated individuals remains a contentious issue among policymakers and corrections reform advocates.
Progressive agencies have adopted a holistic approach to managing the population. These agencies emphasize the importance of rehabilitation programs, mental health support, and vocational training, recognizing that addressing the root causes of criminal behavior can lead to more successful reintegration into society. By fostering an environment that promotes personal development, they aim to reduce recidivism rates and ultimately enhance community safety. A high focus on health care that incorporates medical and mental health has been essential in creating a comprehensive support system. This integration not only addresses immediate health concerns but also supports long-term well-being, enabling individuals to lead more productive lives and contribute positively to their communities.
The Necessity of Adequate Health Care in Correctional Facilities
Health care is a fundamental human right, yet one population often overlooked in conversations about access to adequate medical services is the incarcerated. Jails house individuals who are awaiting trial or serving short sentences, making them a critical point of contact for addressing public health disparities. However, many jails across the United States and beyond fail to provide adequate health care, creating not only ethical dilemmas but also significant public health and social justice concerns. A study analyzing health and prescription data from 2018 to 2020 found that incarcerated individuals are substantially less likely to receive treatment for common and serious conditions than those in the general U.S. population (Johns Hopkins Bloomberg School of Public Health, 2023).
Why Health Care in Jails Matters
People in jails experience disproportionately high rates of chronic illnesses, mental health disorders, and substance use issues compared to the general population. According to the Bureau of Justice Statistics, nearly 40% of individuals in jail have at least one chronic medical condition, such as diabetes or hypertension. Additionally, mental health diagnoses are far more prevalent among incarcerated individuals, with over 60% of jail incarcerated individuals exhibiting symptoms of a mental health condition (Bureau of Justice Statistics, 2015).
Jails are often entry points for the broader criminal justice system, meaning they serve as a critical juncture for identifying and addressing unmet health needs. Without proper care during incarceration, individuals are more likely to experience worsening health outcomes, which can lead to higher mortality rates post-release and increased strain on community health systems. In Washington State, for instance, a study discovered that the risk of mortality in the initial two weeks following release from a correctional facility was 12 times greater than that of the general population (Binswanger et al., 2007). In addition, a study that examined data from numerous countries discovered that the greatest risk of mortality among formerly incarcerated individuals arises during the immediate post-release period (Kinner et al., 2023). As individuals transition from incarceration to community life, the discontinuity of healthcare services is frequently associated with these elevated mortality rates (Wang et al., 2023).
Challenges to Adequate Health Care in Jails
There are a multitude of obstacles that impede the provision of sufficiently comprehensive health treatment in jails:
1. Short Stays and Overcrowding:
Unlike prisons, where individuals typically serve longer sentences, jails often house people for short periods, ranging from a few days to several months. This rapid turnover makes it difficult to establish consistent care or address ongoing medical needs. Overcrowding exacerbates these challenges, leading to delays in medical evaluations and treatment. The Bureau of Justice Statistics (BJS) reported that the weekly turnover rate in jails nationwide was 50% in 2020, indicating that half of the jail population was either admitted or released within a given week (BJS, 2021). The continuous provision of healthcare services is complicated by this high turnover rate.
Furthermore, these obstacles are exacerbated by overcrowding. As of mid-2022, local institutions were housing 663,100 individuals in custody, which represents a 4% increase from the previous year (BJS, 2023). In 2023, approximately 20% of institutions that could accommodate 2,500 or more incarcerated individuals were operating beyond their capacity (BJS). Medical evaluations and treatment are delayed due to overcrowding, which occurs when the demand for healthcare services exceeds the available resources.
2. Lack of Funding:
Many jails operate on limited budgets, prioritizing security and basic operations over comprehensive medical care. This often results in insufficient staffing, outdated medical facilities, and inadequate supplies to meet the needs of the incarcerated population.
3. Stigma and Neglect:
Incarcerated individuals are frequently dehumanized, leading to public and institutional indifference toward their healthcare needs. This stigma perpetuates a cycle of neglect, where their medical issues are dismissed or inadequately addressed.
4. Continuity of Care:
Once released, many individuals face challenges in accessing health care due to a lack of insurance, stable housing, or connection to community services. Jails rarely provide effective discharge planning, leaving individuals without a clear path to continue treatment.
Public Health and Moral Obligations
Providing adequate health care in jails is not just an ethical obligation, but also a public health necessity. Diseases such as tuberculosis, HIV, and hepatitis C are more prevalent in incarcerated populations and can spread to the wider community if untreated. Addressing these issues within jails helps prevent outbreaks and reduces the overall burden on public health systems. In the United States, approximately 25% of individuals living with HIV and nearly 30% of those with hepatitis C have spent time in correctional facilities (Spaulding et al., 2010.). Also, incarcerated individuals are disproportionately affected by tuberculosis (TB), with rates that are up to ten times higher than those in the general population (Centers for Disease Control and Prevention [CDC], 2023).
Moreover, improving health care in jails aligns with the principles of equity and justice. Incarcerated individuals are still members of society, and neglecting their healthcare needs perpetuates cycles of marginalization. Ensuring that jails provide adequate care can also reduce recidivism by addressing underlying health issues that contribute to criminal behavior, such as untreated mental illness or substance dependence.
The Strategies to Avoid Relapse and Recidivism (STARR) initiative, which is implemented in Colorado’s county facilities, is an example of a jail-based program that addresses health issues to reduce recidivism. The objective of this initiative is to enhance the outcomes of incarcerated individuals in the areas of mental health, substance use, and associated criminal activity. STARR’s objective is to mitigate the probability of reoffending upon release by addressing the underlying issues that contribute to criminal behavior through the provision of targeted behavioral health services (Corrections1, 2023).
Pathway to Improvement
To ensure adequate health care in jails, several measures should be prioritized:
1. Increased Funding:
Governments must allocate sufficient resources to support comprehensive medical and mental health care in jails. This includes hiring qualified medical professionals and upgrading facilities. To guarantee that jails provide comprehensive medical and mental health care, substantial financial investment is necessary. The expense of employing qualified medical professionals is contingent upon the scale of the facility, its location, and the type of healthcare services required for incarcerated individuals. As an illustration, the Federal Bureau of Prisons allocated approximately $952 million for medical care in fiscal year 2014, which encompassed salaries for medical personnel, medical supplies, and payments to external providers (U.S. Department of Justice, 2016).
To create a more therapeutic jail environment, several evidence-based upgrades can be implemented:
• Therapeutic Communities (TCs): These structured environments focus on cognitive-behavioral therapy and peer support to address addiction. Research suggests that TCs effectively reduce recidivism rates and improve rehabilitation outcomes (InmateAid, n.d.).
• Occupational Therapy Programs: Providing incarcerated individuals with life skills training and therapeutic activities has been linked to improved mental health and lower recidivism (NeuroLaunch, n.d.).
• Telemedicine Services: Expanding telehealth capabilities can enhance access to psychiatric care while mitigating the shortage of mental health professionals in correctional facilities (Morris & Edwards, 2022).
• Facility Design Enhancements: Adopting elements from Scandinavian corrections models—such as increased natural light, open spaces, and private rooms—has been shown to improve staff morale and reduce violence among incarcerated individuals (The Times, 2023).
2. Screening and Early Intervention:
Routine medical screenings upon intake can help identify and address health issues early, reducing the risk of complications and improving outcomes.
3. Training and Awareness:
Jail staff should receive training on the importance of health care and how to respond to medical emergencies compassionately and effectively.
4. Collaboration with Community Health Providers:
Partnerships with community health organizations, substance abuse clinics, and the Veterans Health Administration can facilitate continuity of care during and after incarceration, improving overall health outcomes and easing reentry into society.
5. Policy Reform:
Advocacy for systemic change, such as mandating health care standards for jails and ensuring accountability, is crucial for lasting improvements.
Conclusion
Access to adequate healthcare in jails is not only a moral obligation but also essential for public health and safety. Addressing these needs can break cycles of neglect, reduce disparities, and foster a more just system. Just as security is a fundamental component of corrections, so too must healthcare be recognized as essential. By investing in comprehensive medical and mental health care, we uphold human dignity while strengthening the justice system as a whole.
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Crayman Harvey, CJM, CCHP holds a Bachelor’s degree in Psychology and a Master’s degree in Administration and Justice. He is a Certified Jail Manager (CJM) with the American Jail Association (AJA) and a Certified Correctional Health Professional (CCHP) with the National Commission on Correctional Health Care (NCCHC). Currently, he serves as the Agency Director for the Alvin S. Glenn Detention Center in Richland County, South Carolina. In addition to his leadership role, he is an adjunct Criminal Justice professor at a technical college and a jail consultant with Harvey Consultant LLC. For more information, He can be contacted at harvey.crayman@richlandcountysc.gov
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