Unveiling the Hidden Health Care Crisis Behind Bars:
The Critical Role of NCCHC Accreditation
Amy Panagopoulous, MBA, BSN, RN
A groundbreaking randomized trial conducted across 44 U.S. jails by Marcella Alsan, MD, PhD, of the Harvard Kennedy School, and Crystal Yang, PhD, JD, of Harvard Law School, has demonstrated that NCCHC accreditation significantly improves compliance with health care standards, reduces mortality, and lowers recidivism rates.
The study, which has not yet been peer reviewed, evaluated health care quality, staff coordination, and patient outcomes.
Rising Mortality Rates: A Call to Action
Mortality in U.S. jails has surged in the past decade, with deaths often occurring within hours or days of admission. Drug- and alcohol-related deaths have quadrupled, while suicide rates remain twice the national average. The study by Harvard researchers revealed that actual mortality rates in jails are three times higher than official estimates, highlighting longstanding issues with underreporting and transparency. This reality underscores the urgent need for systemic change.
NCCHC Accreditation: A Proven Path to Improvement
The National Commission on Correctional Health Care has long championed quality health care for incarcerated individuals. Through its accreditation program, NCCHC sets rigorous standards encompassing governance, patient care, personnel training, safety, and medical-legal issues. Accreditation is not merely a checkbox exercise; it is an in-depth process that enhances the quality of care while fostering collaboration between custody and health staff and mitigating legal liability and risk for the facility.
In the study, 22 jails were randomized to undergo NCCHC accreditation, which involved a comprehensive review of compliance with the NCCHC standards. The results were striking; facilities that completed the accreditation process achieved significant improvements in health care quality, staff coordination, and mortality rates. Importantly, accreditation did not require additional staffing or expensive equipment, making it a feasible and impactful solution for facilities with constrained resources.
Key Findings from the Study
1. Life-Saving Impact
The study’s most compelling finding was an 86% reduction in mortality rates among accredited facilities, which equals nearly 20 lives over the course of the study. This underscores the life-saving potential of NCCHC accreditation, particularly in addressing preventable deaths through improved processes and early intervention.
2. Elevated Health Care Standards
Accredited facilities showed marked improvements in compliance with NCCHC standards, particularly in personnel training, patient care, and treatment. Compliance rates for these categories increased by 15% and 11%, respectively, demonstrating that NCCHC accreditation drives measurable enhancements in quality.
3. Strengthened Staff Coordination
NCCHC accreditation facilitated better coordination between custody and health staff, addressing a longstanding challenge in correctional health care. Facilities reported improved communication and collaboration, with custody staff supporting medical decisions more effectively. This level of coordination was pivotal in ensuring timely and appropriate care for inmates.
4. Potential for Reduced Recidivism
In addition to health improvements, NCCHC accreditation showed potential for reducing recidivism rates. Individuals released from accredited facilities were 52% less likely to be rebooked within six months, hinting at the broader community benefits of improved health care in jails.
These findings are reflected in the comments NCCHC has received from facilities who have achieved accreditation. Oscar Aviles, CJM, CCHP, deputy county administrator for Hudson County (NJ), said that his facility has been accredited since 2013. In the last decade, they’ve seen improvements in the delivery of correctional health care and drastically reduced grievances and litigation: “I also can’t underestimate the sense of pride that it’s given our health care and custody staff. Even our relationships with the public and the advocacy community have improved.”
Jail Experiences
While some have asked if accreditation is a “rubber stamp” process, the quantitative findings from this study should reassure those looking to tangibly improve quality that NCCHC accreditation is an effective solution. One facility noted that “NCCHC reviewers caught everything. Her ability to point out areas needing improvement was great.” Another facility commented that the “process in general is awesome... It’s about finding shortfalls and closing the gap. Staff has become more involved in the medical process and have a better understanding of why we are doing those things. Building relationships between medical and security was another piece.”
About half of the facilities in the study noted substantial changes in the relationship between health and custody staff. Medical leadership at one facility told researchers, “The staff had to have conversations about how processes will work, which meant discussing how custody versus medical execute certain processes.”
About the NCCHC Standards for Health Services in Jails
The NCCHC Standards for Health Services establish comprehensive guidelines to ensure high-quality care in correctional facilities. These standards address critical aspects of health care delivery, including:
• patient care and treatment
• governance and administration
• personnel and training
• safety and disease prevention
• special needs and services
• medical-legal issues
Designed to improve health outcomes, promote ethical practices, and ensure compliance with constitutional requirements, the standards emphasize effective health care administration, evidence-based practices, and the well-being of both patients and staff. By adhering to these rigorous guidelines, facilities can enhance health care quality, reduce risks, and foster accountability, ultimately contributing to safer correctional environments and healthier communities. The standards are being updated and will be released in the second half of 2025.
Chief Jerry Collins, director of Louisville Metro Department of Corrections Main Jail, says that NCCHC standards are the best practice and a necessity for large jails. “In the last 10 years, we’ve seen a huge increase in addiction and mental health issues in the people who are booked. NCCHC accreditation has helped us instill best practices and raised our staff’s skill set.” He also pointed out that correctional health care is under public scrutiny by politicians and the public and that accreditation has helped them avoid bad outcomes and be ahead of problems before they occur.
Broader Implications of NCCHC Accreditation
Improving health care in jails is not only a moral imperative but also a public health necessity. The incarcerated population faces a dual burden of chronic and infectious diseases, with higher rates of mental health issues, substance use disorders, and communicable diseases than the general population. These health disparities extend beyond jail walls, as individuals return to their communities, potentially exacerbating public health challenges.
Moreover, the legal obligation to provide adequate health care, established by landmark cases such as Estelle v. Gamble (1976), underscores the constitutional stakes. NCCHC accreditation helps facilities meet these obligations, reducing litigation, grievances, and reputational risks .
Conclusion
The findings from this groundbreaking study illuminate a path forward for addressing the health care challenges behind bars. NCCHC accreditation offers a proven framework for improving health care quality, saving lives, and enhancing outcomes for incarcerated individuals and the broader community.
By investing in NCCHC accreditation, policymakers and correctional leaders can transform jails into environments where health care is not an afterthought but a cornerstone of humane and effective custody. The stakes are high, but the potential rewards—measured in lives saved and communities strengthened—are immeasurable.
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Amy Panagopoulos, MBA, BSN, RN, is vice president of accreditation at the National Commission on Correctional Health Care. For more information, she can be contacted at accreditation@ncchc.org
A Step-By-Step Guide To Ncchc Health Services Accreditation
1. Become knowledgeable about the NCCHC Standards
• Read the NCCHC Standards for Health Services in Jails and evaluate how they apply to your facility
2. Complete the application
• The application requests information on average daily population, electronic health records, satellites, and the health services administrator, the physician responsible for medical care, the official legally responsible for the facility, and other key people.
3. Submit survey fees
• NCCHC will invoice your facility after your application is approved. Survey fees are dependent upon the size of your facility and cover the initial survey and the two years after the accreditation is complete.
4. Conduct a self-assessment and prepare for the survey
• Use the self-assessment tool and the Survey Preparation Guide (sent to you after application). Evaluate your compliance with the standards.
5. Schedule the survey
• NCCHC will schedule your survey when you are ready. Initial surveys require 10-12 months of documentation.
6. NCCHC conducts the survey
• The survey team will work collaboratively with you to determine compliance with the standards through observation of the health care delivery services. Each survey will include:
– An entrance conference
– Review of health records and other documents, including policies and procedures
– Facility tour
– Structured interviews with health staff, administrators, custody staff, other personnel, and incarcerated individuals
– An exit conference to provide preliminary feedback and answer questions
NCCHC also offers accreditation for mental health and opioid treatment programs. The process is similar. For more information, contact info@ncchc.org.