Inmate Population Most Underserved for Healthcare
Mass incarceration takes its toll on the health of inmates and former inmates. At any one time in this country more than 6.9 million people are on probation, in jail, in prison or on parole. Each year more than 600,000 individuals are released from state and federal prisons. Roughly 1 in 28 children has a parent behind bars.
Recently, Supreme Court Justice Michael Boggs reported on the state of the Judiciary . Currently state-wide in Georgia one in 33 adults is behind bars. Since 1980 in Georgia the number of people going to jail has tripled, and the length of the sentence has increased by 160%. Twenty five percent of these inmates enter with mental health issues. Mental health inmates tend to stay 4-8 times longer in jail and at seven times the cost. They are 10 times more likely to be incarcerated than hospitalized and 19 times more likely to find a bed in the criminal justice system than in a state hospital.
The intersection of mental health and law enforcement creates a situation where more mental health care occurs in jails and prisons than in state-wide treatment facilities, taxing the law enforcement community and underserving those with mental health impairments as their primary condition.
In 2022 the Criminal Justice Coordinating Council (CJCC) released its study of the prevalence of mental illness among county jail inmates. The study found that people with a mental illness represented in county jails at twice the rate in the general population. The Georgia Sheriff’s Association stated the report confirmed their long standing view that county jails have become de facto mental health institutions. The study found that people with mental illness stay in jail twice as long as those without an identified mental illness (54 days on average). They are in the community 29 fewer days on average between booking episodes. While in jail, they are moved around twice as much due to behavioral risks.
In addition to the problematic and widespread issue of mental health problems among the incarcerated, forty percent of all inmates have underlying chronic medical conditions. While inmates are constitutionally required to receive medical care while incarcerated, a gap occurs in the discharge process. Often inmates do not receive necessary prescription medications on discharge, are not provided current medical records during the period of incarceration, and are not provided a plan for continuity of care. While the federal courts have held that the duty to provide medical care includes discharge planning, that often does not occur. People in jail and prison have high rates of chronic physical and behavioral health conditions, but often go without needed healthcare and return home without adequate access to medications or care coordination.
Often upon discharge from jail or prisons, former inmates experience the highest rate of death. During the first 2 weeks after release, the risk of death among former inmates as 12.7%. This rate is 3.5 times higher than among other state residents. The leading cause of death is drug overdose, cardiovascular disease, homicide and suicide.
The Biden Administration in the Build Back Better Act which passed in August 2022, lifted the inmate exclusion policy which allowed for Medicaid to cover healthcare services for 30 days prior to release of people who were incarcerated. This covers the gap in discharge planning and continuity of care. However, when former inmates reenter society, they often struggle with homelessness and unemployment, making healthcare a third tier priority if one at all.
In Georgia, The Behavioral Health Reform and Innovation Commission issued its report on this problem in 2022. A full copy of the report is attached here. In short, the report identifies that there is a work shortage for behavioral health professionals; there is a lack of full continuity of care state-wide for mental health; Medicaid lacks the capacity to cover the mental health needs; and there is a lack of local community support for behavioral health. As to the inmate population, the commission recommended diverting eligible non-violent defendats away from prisons/jail and into supervised mental health programs.
Georgia’s failure to expand Medicaid and other gaps in healthcare services contribute to poor healthcare access among many residents. When you add these deficiencies with the ongoing problem created by mass incarceration, many citizens – particularly those with mental health conditions – face insurmountable problems which often lead to early death.