Cover: Caring for Those in Custody

Caring for Those in Custody

Identifying High-Priority Needs to Reduce Mortality in Correctional Facilities

Published Nov 27, 2017

by Joe Russo, Dulani Woods, John S. Shaffer, Brian A. Jackson

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Research Questions

  1. What challenges do correctional facilities and agencies face in providing health care and reducing inmate mortality, and how can these challenges be addressed?
  2. What are the key needs associated with improving outcomes so that the system performs as it should?

Correctional facilities are responsible for the care, custody, and control of individuals who are detained while awaiting trial or who have been convicted of a crime and sentenced to a term of imprisonment. The true scope of this mission is much broader than simply protecting the public from those accused or convicted of criminal acts by keeping these individuals behind bars. These facilities also have a constitutional obligation to provide for the health and well-being of those under their charge. Administrators are responsible for not only developing and implementing strategies to prevent violence among the inmate population and inmate self-harm, but also for providing general health care through medical and mental health services.

Maintaining inmate health and safety is a significant challenge. Correctional facilities are often overcrowded, understaffed, and underfunded. Many inmates suffer from chronic medical conditions, mental health disorders, infectious diseases, and substance dependence in numbers that are often disproportionate in comparison to the general population. Further, the incarceration experience itself can be detrimental to overall health and safety in a variety of ways.

While some level of in-custody deaths are inevitable — for example, the passing of elderly inmates from old age — certain types of mortality are highly preventable with the proper interventions. This effort convened a panel of prison and jail administrators, researchers, and health care professionals to consider the challenges related to inmate mortality in correctional facilities and opportunities for improved outcomes. Through structured brainstorming and prioritization of the results, the panel identified a series of needs that, if addressed, could significantly reduce inmate mortality rates.

Key Findings

High-Priority Needs Identified by the Panel on Reducing Mortality in Corrections

  • Facilities should provide medical and mental health services at a community-level standard of care.
  • Correctional facilities need to better manage organizational and cultural conflicts between security and care objectives.
  • There is a need for greater capacity for medical, mental health, and substance abuse care, both within facilities during incarceration and in the community after release.
  • The availability of medication-assisted therapies and drug overdose countermeasures should be expanded.
  • There is a need for more-uniform adoption of best practices in suicide risk assessment and prevention.
  • More and better data are required in order to develop targeted interventions to reduce mortality.
  • Compliance with national standards for medical screening and care provision should be better incentivized and supported.
  • There is a need for uniformity in how internal death reviews are conducted, including multidisciplinary participation.
  • There is a need for more-effective discharge planning and "warm hand-offs" to community-based health providers.
  • Greater electronic information sharing between and among correctional institutions and community-based health providers can improve care and reduce inmate mortality.

The research described in this report was prepared for the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice and conducted by the Justice Policy Program within RAND Justice, Infrastructure, and Environment.

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