Few people think of jails as providers of community health. However, jails are important to the health of communities, especially to minority and low-income populations. Jails are correctional facilities operated by counties or municipal authorities. Like prisons, they are required by law to provide healthcare to inmates, but jails differ from prisons in many ways.
According to the US Department of Justice Bureau of Justice Statistics, local jails processed an estimated 13 million admissions during 2007. Of these, more than 60% are awaiting arraignment or trial.
Jail inmates generally are minor offenders. They tend to cycle in and out of jails quickly; more than 80% are incarcerated for less than a month, and many are in jail for only a few hours or days. Jail inmates serve their sentences close to home and return to those local communities after leaving jail. They are people temporarily displaced from their communities while they are in jail.
Nearly nine out of 10 jail inmates are adult men. Blacks are almost three times more likely than Hispanics and five times more likely than whites to be in jail. People in jail are among society's most disadvantaged members, as reflected in nearly every aspect of their lives-not only health but also education, poverty, and lack of social support. This is a population with a high need for public health services.
In a national survey, more than one-third of jail inmates said they had a medical problem other than a cold or a virus. A separate study reported that 64% of jail inmates were found to have a mental health problem. Seventeen percent of jail inmates said they were homeless in the year before their incarceration.
Inmates tend to have had limited contact with the healthcare system prior to entering jail. Many have never seen a doctor as adults before. When inmates return to their communities, they bring whatever health problems they have with them. Often, these problems will go untreated after release. In essence, what amounts to a massive societal investment in healthcare for inmates while they are in jail is lost the moment they leave. The health problems of ex-offenders become part of the public health burden borne by the community.
Although jails are required to provide healthcare to inmates, they have a number of options on how to provide inmate care: They may use their own staff, private contractors, community health centers, or a combination of the three. In substantial ways, jails are an extension of local public health systems. As such, they are important sites for improving the overall health and well-being of disadvantaged communities.
Partnerships between jails and community health centers offer a powerful approach to improving both inmate and public health while supporting inmate re-entry into the community. By linking inmates-often for the first time-with a local provider they can continue to see after release, these partnerships can stabilize inmates' health, protect communities from communicable disease, and alleviate the public health burden. In addition, making inmates healthier can reduce violence in the jail and in the community.
Community Oriented Correctional Health Services (COCHS) is a nonprofit organization funded by the Robert Wood Johnson Foundation to foster partnerships between local jails and community health providers. A public health approach to correctional health is taken by COCHS, addressing the health needs of the incarcerated and of the communities where these inmates will return. In COCHS' view, the jail is one of many places in the community where people receive medical care.
As part of the community, jails can improve public health and possibly reduce recidivism. Connectivity is the key. In the traditional system, jail inmates are unlikely to receive regular, routine care. Instead, they get sporadic, short-term care that addresses their most urgent and immediate problems. After seeing a physician in jail, they receive no case management and no medications for any chronic illnesses they may have when they leave jail.
An alternative to the traditional system of correctional care is offered by COCHS. When an inmate is diagnosed, his/her home ZIP code is matched with the community health center closest to his/her home, and he/she is assigned to a dually based physician and case manager. In essence, the jail becomes the entry point into the healthcare system for a population that is both medically underserved and at high risk for serious health problems.
In 2006, the Robert Wood Johnson Foundation funded COCHS to encourage jails across the country to adopt a long-term view of correctional healthcare, since the overwhelming majority of inmates return to the community after short stays. Select jurisdictions across the country are working with COCHS, providing technical assistance and counseling to help them bring community-based healthcare to jail inmates.
Under a community-based approach, inmates are much more likely to receive regular, routine care because they have a regular healthcare provider who manages their care. Treatment is ongoing, and inmates leave jail with medication prescriptions that can be filled through a community health center. Case managers set appointments for them to see their providers after release. In addition, they receive information on treatment for diseases that can infect others in the community.
Information technology is key to making this approach work. In the traditional system, information about inmates' health experiences in jail is not accessible to their providers in the community once they are out of jail. But new computerized systems make it possible to connect medical records from the jail with medical records maintained by providers in the community, so that care for inmates is based on up-to-date information, no matter where they are. It is also continuous, coordinated, and consistent.
Partnerships with jails can provide community health centers with important insights that will help them serve the needs of their communities more effectively. Jails can provide windows into the health and overall well-being of their communities. Other benefits to community health centers include new opportunities to meet their mission of providing quality care to the underserved, expanding their patient base, and tapping into a stable funding stream.
Perhaps most importantly, by linking with local jails, community health centers can reaffirm their role as drivers of community well-being and development.
To read the issue brief in full, visit the Robert Wood Johnson Foundation's Vulnerable Populations Program page at http://www.rwjf.org/vulnerablepopulations/.