If prisoners received better health care while behind bars and after release, both their health and the community's health would improve, new research has found.
Offering treatment to prisoners or by linking them to community-based family physicians and psychiatrists after they are released leads to less substance abuse, mental health problems, chronic diseases and health service utilization, as well as a reduced spread of infectious diseases, according to a systematic review published today in the American Journal of Public Health.
"Improving health in people in jails and prisons can also improve the health of the general population, improve the safety of our communities and decrease health care costs," said Dr. Fiona Kouyoumdjian, a post-doctoral fellow with the Centre for Research on Inner City Health of St. Michael's Hospital. "For example, treating infectious diseases can prevent ongoing transmission, treating people with mental illness can decrease crime, and providing access to primary care can cut down on expensive Emergency Department use."
Dr. Kouyoumdjian, a public health physician, reviewed 95 international studies about inmates receiving health care treatments in prison or after release. In 59 studies, interventions led to improved health.
"The fact that there is promising evidence suggests we should be paying close attention to these interventions and if we think they're relevant, then we should be implementing these interventions in Canada," said Dr. Kouyoumdjian.
Not only is the health of prisoners poor, but releasing them untreated back into the general population could lead to an increase in communicable diseases such as HIV, hepatitis C, tuberculosis and sexually transmitted infections, according to the study. Mental illness that isn't appropriately treated can also lead to increased criminal activity and greater reincarceration rates. As such, public safety suffers and health-care costs rise when untreated people are released from detention. Also, costs associated with relapses into crime and substance abuse are extremely expensive.
"Linking people with primary care after they are released from jail could improve health and decrease emergency department use," said Dr. Kouyoumdjian. "Despite having significant physical and mental health problems, many people in Canada are currently released from prison without a family physician, and this may lead to unnecessary and expensive use of emergency departments."
Something as simple as providing information about a prisoner's health status and the available community services upon his or her release greatly improved the prisoner's likelihood of seeking primary care. This information can help people as they manage their health problems and choose to access services that will help them get their lives in order.
"For people who are addicted to opiates such as heroin, starting methadone while in prison can lead to less drug use and less risky behaviours like injecting drugs and sharing needles," said Dr. Kouyoumdjian. "Addictions are a common and serious problem for many people in jails and prisons in Canada. The time in custody can provide a unique opportunity to initiate a substitution treatment like methadone, which can improve their health and general well-being. Many people in jails in Canada do not have access to these substitution therapies."
Dr. Kouyoumdjian said that given the government's financial constraints, more high quality research is needed about treating people while in custody and after release because the evidence can lead to cost-saving decisions that will also improve overall health.
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