Transcript Slide 1

Inmate Health Following Incarceration
and
Implications for Public Health Policy
Sung-suk Violet Yu, Ph.D
Assistant Professor
John Jay College of Criminal Justice
American Society of Criminology
Chicago, IL
November 13, 2012
Health Challenges Study
• What are “Health Challenges”?
• Morbidity and disability including chronic
illness, infectious disease, mental illness,
substance abuse, and physical or
developmental disabilities which may or may
not interfere with daily activities.
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Health Challenges Study
• Relationship between health challenges and
criminal behaviors
• Sample: a cohort of 136 male returning
prisoners from a maximum security prison
• Data collection:
– In-person baseline survey in custody
– Follow-up survey 3 months after release
Baseline Survey Topics
• Current medical and mental health conditions
• Prior to current incarceration
– Healthcare coverage, employment, substance use,
medical and mental health conditions
• Health improvement and deterioration since
incarceration
Demographics (N=136)
•
•
•
•
•
•
•
•
Hispanic:
African American:
White:
Age: Mean =
Median=
SD =
GE High school :
Single:
Married:
Have children:
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35%
66%
7%
32.5
30
9.4
77%
76%
16%
60%
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Prior (12 months) to current
incarceration
•
•
•
•
•
Homeless:
Employed:
Chronic medical conditions:
Mental health conditions:
Hard drug use(weekly or more):
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19%
54%
54%
23%
18%
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Healthcare coverage status prior to incarceration
Private health
insurance:
19%
No health
insurance:
26%
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Medicaid:87%
Public health
insurance:
55%
Medicare:13%
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Health Challenges (N=136)
Medical conditions (N=73, 54%)
Asthma
Current physical injuries
Dental
High blood pressure /hypertension
High cholesterol
Physical disabilities
Heart problems
Mental health disorders (N=34, 25%)
Depressive
Bipolar
Schizophrenia
Other
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Current
25%
16%
13%
12%
8%
8%
7%
Prior to
incarceration
32%
N/A
15%
10%
0%
11%
5%
Current
22%
12%
4%
6%
Prior to
incarceration
21%
11%
4%
7%
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Prevalence of medical conditions and mental health
disorders (N=136)
Both medical
and mental
health
disorders: 18%
Medical
condition only:
36%
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Mental health
disorder only:
7%
Neither medical
nor mental
health disorder:
N=39%
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How would you rate your health prior to incarceration? (N=135)
90
80
70
60
50
40
30
20
10
0
Health in general
Physical pain
Emotional problems
Excellent
50
79
66
Good
30
9
10
Poor
20
13
24
Since your incarceration, would you say your health has improved, stayed
the same, or deteriorated? (N=136)
60
50
40
30
20
10
0
Health in general
Physical pain
Emotional problems
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Improved
56
31
33
The same
35
52
38
Worse
10
17
29
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Association between previous health status and
current health outcomes (N=136)
• Health in general
– X2= 21.360(4), p =.000
• Physical pain
– X2 = 10.641(4), p=.036
• Emotional problems
– X2 = 16.661(4), p=.002
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Logistic Regression Analysis
Married
Hispanic
Black
High school completion
Age
Prior to current incarceration:
Ever homeless
Help from family
Employed
Chronic medical conditions
Mental health conditions
Public health insurance
Illegal substance use
Health Status: Excellent/Very good
Good
Fair/Poor
Constant
Cox & Snell R2
Nagelkerke R2
+p<.10, * p<.05, ** p < .01
General Health
Exp(B)
0.345+
0.626
0.744
0.470
0.962
1.075
1.962
1.366
0.798
0.961
0.547
2.319
--1.853
28.021**
5.413
0.263
0.353
Physical Pain
Exp(B)
0.331
0.565
0.503
0.395+
0.998
Emotional Problem
Exp(B)
0.882
1.017
1.645
0.526
1.033
1.422
1.396
1.556
0.725
1.730
1.345
1.304
--2.353
1.689
0.894
0.143
0.202
1.319
1.216
1.137
0.765
1.536
2.808*
1.911
--3.670+
3.038*
0.045
0.210
0.293
Findings and Policy Implications:
Prior poor health
• Incarceration leads to different health outcomes
• Prior perceived health conditions is the strongest predictor
of health status following incarceration. Inmates with poor
prior health are most likely to report improved health.
– For general health: 28 times more likely than those with
“Excellent/Very good” prior health in general
– For emotional problems: three to four times more likely than
those without prior mental health problems
• Those with severe medical needs at the fringe of society do
not have (adequate) access to health care in the
community
• Corrections deliver health care services to those with
severe medical needs prior to incarceration
Findings and Policy Implications:
The mentally ill
• For those with mental illness, simply providing
access to health care (i.e., public health
insurance coverage) may not alleviate their
problems even in the community
– Those covered by government health program
were almost three times more likely to state their
mental health improved
– Additional help needed: Medical homes,
structure, etc
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Findings and Policy Implications:
Dispensing correctional response
• Studies abound documenting negative impacts of
incarceration on individuals, families, and communities
• Those married or completed high school are less likely to
report improved health following incarceration
• Does equal treatment lead to inequitable health
outcomes?
– Is there a need to cater correctional responses to individual
needs?
• Does Equitable Treatment Lead to Discriminatory
Practices?
– Lesson from history: individualized sentencing vs mandatory
sentencing
Acknowledgements
We thank Mr. Philip Heath, Mr. Paul Korotkin, Mr. Brian Lane, and Dr. Koenigsmann at New
York State Department of Corrections and Community Supervision for their responsiveness
and cooperation. They worked with us to ensure that our study complied with their
department’s research protocols and assisted us with the clearance and coordination
necessary to conduct surveys with our research participants.
Funding for this presentation was made possible by grant #5P20MD006118-03 from the
National Institute on Minority Health and Health Disparities. The views expressed and
research in this presentation do not necessarily reflect the official policies of the Department
of Health and Human Services; nor does mention by trade names, commercial practices,
or organizations imply endorsement by the U.S. Government or John Jay College of Criminal
Justice.
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Inmate Health Following Incarceration
and
Implications for Public Health Policy
Sung-suk Violet Yu, Ph.D
Assistant Professor
John Jay College of Criminal Justice
For more information,
please visit www.johnjayhealth.org