Health risks associated with incarceration in jails

The fields of public and correctional health have traditionally ascribed risks to individuals who pass through correctional settings based on personal characteristics, such as mental illness, chronic medical problems and substance abuse disorders. The epidemiology of disease has clearly shown, however, that adverse medical and mental health outcomes represent a nexus of both personal and environmental risk factors. Within jails, little has been done to catalogue or quantify the spectrum of environmental risks that bear upon the health and mental health of persons who are incarcerated. We have begun this process by conducting a thorough review of all literature associated with medical and mental health within jails for data that may reflect environmental risk factors. We examined the literature for data related to the following harms which may have significant environmental components: injury, exacerbation of mental health disorders/suicide, communicable disease, substance related death (withdrawal and overdose), diabetic complications (hypoglycemia and DKA), epileptic complications (status epilepticus and pseudoseizure) and interruption or change of medication. In addition, we have initiated a system-wide review of our own health care setting, the New York City jail system, for evidence of the same. Finally, we have begun to identify areas of potential health risk to our patients that may be amenable to risk mitigation, starting with the most prevalent adverse health event encountered in jail, injury. While some component of personal health may bear on being injured in jail, there is likely a complicated environmental aspect that may represent interaction of personal characteristics with housing areas, security practices, relationships with other inmates etc. We have created structured data fields within our electronic health record to track location, intentionality, type and other variables for each injury visit with medical providers. These data can then be used to work cooperatively with the Department of Correction to inform both individual level case management and facility operations. Similarly, we have begun structured tracking of access to medical services and worsening of existing mental health problems within segregated housing areas (i.e., punitive segregation/23 hour lock-in). Though a varying component of each of these risks may be attributable to the condition of incarceration itself, quantification of specific risks will inform future interventions to attempt to mitigate harm.