As a nurse who specializes in the treatment and education of incarcerated patients, Alison Colbert, PhD, APRN-BC, knows the typical corrections facility is not a "healthy" place, mostly due to overpopulation and the incidences of infectious diseases among inmates.
Ironic as it may seem, she also knows that for many of the more than 1.6 million Americans the U.S. Bureau of Justice Statistics says are currently serving prison terms their time spent behind bars is also the best chance that many of them have for receiving dedicated, routine healthcare treatment.1
"Prisoners are the only people in the country with a constitutional right to healthcare," said Colbert, an assistant professor at Duquesne University in Pittsburgh who teaches a prenatal class to women at Allegheny County Jail.
"Most people think the healthcare in jail is terrible, but the truth is a lot of our patients get care that they've never gotten before while they're here."
However, as the chance for being paroled approaches for inmates it brings along a slew of opportunities for lack of treatment just as it brings about a new sense of freedom and the chance to re-enter society as one rehabilitated by the criminal justice system.
For those who live with chronic physical conditions and mental illness, the concept of "rehabilitation" has to include proper healthcare guidance and assistance before and during the transition by healthcare professionals if they are going to remain healthy and avoid poor habits such as substance abuse that could lead them back to imprisonment.
"Nurses are the best people to provide this care because we think about the individual and all their circumstances that contribute to where they are," said Colbert, who also serves as a nurse faculty scholar with Robert Wood Johnson University, New Brunswick, NJ. "We're not just looking at disease processes and numbers - we're looking at where this person is, emotionally and socially, and what resources they need."
But that balance can be tough to achieve.
Back to the Start
From attempting to establish work and a living situation to rebuilding relationships with family and friends, the agenda for an individual being released from jail is often as overcrowded as the facility they're leaving.
Then, there are their ongoing legal obligations.
"It's a very difficult and tenuous balance of issues," Colbert explained. "The pressures of probation and parole, being reunited with family, some potential relationship issues, having to regain custody of kids, finding a job - the competing demands are significant, and the stressors of those demands are often completely overwhelming. When you walk out of jail you're hardly done with your experience with the criminal justice system."
At risk for being lost in the shuffle is one's healthcare management, which was likely fragile at best prior to sentencing.
"Often times, I've found that people actually start taking their medications for the first time while they're in jail," Colbert said. "It may be that they think about their health more while they're here or they're sober for the first time in a long time and begin to 'feel' their age."
Conditions like HIV/AIDS, heart disease and cancer are prevalent, as are mental health diagnoses-particularly depression, anxiety and schizophrenia.
Colbert said research she's conducted shows compliance is generally favorable among those inmates who are given appropriate access to care, but can become difficult to maintain on the outside when people are unable to secure health benefits through full-time employment or if they lack the resources to acquire care.
At Allegheny, a transition program is in place that helps patients prepare for their self-care management by educating them on when to take their medications and when to see their doctor, and assists in the coordination of their medical records.
"There's an ideal way we prepare people for the transition that frankly looks very similar to when people leave the hospital," Colbert explained. "We want discharge planning that starts at the beginning of their release and gets people to where they need to be."
Managing Mental Health
For those who live with a diagnosed mental health illness or don't have access to permanent shelter, extra assistance is needed. At Allegheny, nurses and officials will work with local housing facilities and community clinics to help establish living arrangements and care for their patients.
"Someone who's been in jail for years is very different when they leave compared to those who are in for only a few weeks or months, so the degree of planning is highly dependent on the needs and capabilities of the person you're dealing with," Colbert said.
"For instance, someone with a severe mental illness is much more vulnerable to being homeless. The nurse then has an obligation to make sure they help find a shelter or treatment facility and provide follow-up." Colbert said mentally ill patients are also more likely to unfortunately end up back in jail due to a disease state ravaged by years of inadequate patient care and frequent drug use.
"This is a very vulnerable patient population," she continued. "Years ago, people who would have been admitted to a mental facility typically ended up in jail, and when they go home they don't always have the same resources that they have essentially at their fingertips while in jail."
This makes it imperative that nurses take the time to assess each individual's situation holistically and not form opinions or rush to assumptions for those who experience difficulty developing stability in their lives.
"It's all about assessment and individualization," Colbert added. "It's about talking to patients and listening to what their goals are, understanding their issues and knowing how to help them.
"The nurse needs to be compelled to get a good, clear picture of where each patient is, just as they are in any setting. You're a nurse first, and that's how we approach our patients. A byproduct to this devoted care, however, is the emotional strain that comes with trying to help those who may come up against challenging barriers beyond their health maladies."
"You can't work in this field very long without being confronted repeatedly and relentlessly with issues like poverty, racism and mental health," Colbert said. "It's incredibly distressing. People are really struggling, and every day you're being creative and trying to help people get their needs met with very limited resources at times.
Other obstacles faced by the patients and caregivers alike are reduced funds to provide care related to mental and public healthcare across the U.S.
"Today we're seeing public health programs and other safety nets being cut, and it's very devastating and frustrating at times," Colbert said. "So, for the nurse, it becomes not about tackling that whole problem, but about trying to dismantle the individual's problems that can be addressed - and lots of them can be by nurses."
Joe Darrah is a contributor to ADVANCE.