HEALTH AND
INCARCERATION

A Workshop Summary

Amy Smith, Rapporteur

Committee on Causes and Consequences of High Rates of Incarceration


Committee on Law and Justice
Division of Behavioral and Social Sciences and Education


Board on the Health of Select Populations
Institute of Medicine

NATIONAL RESEARCH COUNCIL AND
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Amy Smith, Rapporteur Committee on Causes and Consequences of High Rates of Incarceration Committee on Law and Justice Division of Behavioral and Social Sciences and Education Board on the Health of Select Populations Institute of Medicine

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THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Gov- erning Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engi- neering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Grant No. 70863 from the Robert Wood Johnson Foundation, Grant No. 99472-0 from the John D. and Catherine T. MacArthur Foundation, and Grant No. 2011-DJ-BX-2029 from the National Institute of Jus- tice. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13:  978-0-309-28768-5 International Standard Book Number-10:  0-309-28768-5 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council and Institute of Medicine. (2013). Health and Incarceration: A Workshop Summary. A. Smith, Rapporteur. Committee on Law and Justice, Division of Behavioral and Social Sciences and Education and Board on the Health of Select Populations, Institute of Medicine. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the ­ cademy has a mandate that requires it to advise the federal govern- A ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of out- standing engineers. It is autonomous in its administration and in the selection of its ­ embers, sharing with the National Academy of Sciences the responsibility m for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in pro- viding services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON CAUSES AND CONSEQUENCES OF HIGH RATES OF INCARCERATION JEREMY TRAVIS (Chair), John Jay College of Criminal Justice, City University of New York BRUCE WESTERN (Vice Chair), Department of Sociology and the Malcolm Wiener Center for Social Policy at the Harvard University Kennedy School of Government JEFFREY BEARD, California Department of Corrections and Rehabilitation ROBERT D. CRUTCHFIELD, Department of Sociology, University of Washington TONY FABELO, Council of State Governments Justice Center MARIE GOTTSCHALK, Department of Political Science, University of Pennsylvania CRAIG HANEY, Department of Psychology, Graduate Program in Social Psychology, and Program in Legal Studies, University of California, Santa Cruz RICHARDO H. HINOJOSA, U.S. District Court, Southern District of Texas GLENN C. LOURY, Department of Economics, Brown University SARA S. McLANAHAN, Department of Sociology and Public Affairs, Princeton University LAWRENCE M. MEAD, Department of Politics and Public Policy, New York University KHALIL GIBRAN MUHAMMAD, Schomburg Center for Research in Black Culture, New York Public Library DANIEL S. NAGIN, Department of Public Policy and Statistics, Carnegie Mellon University DEVAH PAGER, Department of Sociology and the Joint Degree Program in Social Policy, Princeton University ANNE MORRISON PIEHL, Department of Economics and Program in Criminal Justice, Rutgers University JOSIAH D. RICH, Department of Medicine and Epidemiology, Warren Alpert Medical School of Brown University, and the Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center ROBERT J. SAMPSON, Department of Sociology, Harvard University HEATHER ANN THOMPSON, Department of History, Temple University MICHAEL TONRY, University of Minnesota Law School AVELARDO VALDEZ, School of Social Work, University of Southern California v

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STEVE REDBURN, Study Director MALAY MAJMUNDAR, Senior Program Officer JULIE SCHUCK, Senior Program Associate BARBARA BOYD, Administrative Coordinator vi

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COMMITTEE ON LAW AND JUSTICE 2013 JEREMY TRAVIS (Chair), John Jay College of Criminal Justice, City University of New York RUTH D. PETERSON (Vice Chair), Department of Sociology, Ohio State University CARL C. BELL, Community Mental Health Council, Inc. JOHN J. DONOHUE III, Stanford Law School MARK A.R. KLEIMAN, Department of Public Policy, University of California, Los Angeles GARY LAFREE, Department of Criminology and Criminal Justice, University of Maryland, College Park JANET L. LAURITSEN, Department of Criminology and Criminal Justice, University of Missouri GLENN LOURY, Department of Economics, Brown University CHARLES F. MANSKI, Department of Economics, Northwestern University DANIEL S. NAGIN, Department of Public Policy and Statistics, Carnegie Mellon University ANNE MORRISON PIEHL, Department of Economics and Program in Criminal Justice, Rutgers University DANIEL B. PRIETO, Public Sector Strategy and Innovation, IBM Global Business Services, Washington, DC DAVID WEISBURD, Center for Evidence-Based Crime Policy, George Mason University PAUL K. WORMELI, Integrated Justice Information Systems, Ashburn, VA CATHY SPATZ WIDOM, Psychology Department, John Jay College of Criminal Justice, City University of New York ARLENE LEE, Director vii

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BOARD ON THE HEALTH OF SELECT POPULATIONS 2013 DAN G. BLAZER (Chair), Duke University Medical Center KATHLEEN BRADY, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina JOHN C.S. BREITNER, Department of Psychiatry, McGill University, Montreal, Quebec, Canada MICHAEL L. COWAN, Broadlands, VA WALTER R. FRONTERA, Vanderbilt University School of Medicine and Vanderbilt University Medical Center GREGORY C. GRAY, Department of Environmental and Global Health and Department of Infectious Diseases and Pathology, University of Florida, Gainesville KURT KROENKE, Department of Medicine, Indiana University School of Medicine JANICE L. KRUPNICK, Department of Psychiatry, Georgetown University School of Medicine STANLEY M. LEMON, Department of Medicine and Microbiology and Immunology Inflammatory Diseases Institute, University of North Carolina at Chapel Hill VICKIE M. MAYS, Department of Psychology, University of California, Los Angeles, Fielding School of Public Health M. JEANNE MIRANDA, Center for Health Services and Society, University of California, Los Angeles FRANCES M. MURPHY, Sigma Health Consulting, LLC, Silver Spring, MD KENNETH OLDEN, National Center for Environmental Assessment and Human Health Risk Assessment Research Program, Environmental Protection Agency MICHAEL D. PARKINSON, UPMC Health Plan and WorkPartners, Pittsburgh, PA JENNIFER D. PECK, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center CAROL K. REDMOND, Department of Public Health, University of Pittsburgh GRACE S. ROZYCKI, Emory University School of Medicine/Grady Memorial Hospital GEORGE W. RUTHERFORD, Department of Epidemiology, University of California, San Francisco School of Medicine MURRAY B. STEIN, Department of Psychiatry and Family and Preventive Medicine, University of California, San Diego FREDERICK (RICK) ERDTMANN, Director viii

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Preface O ver the past four decades, the rate of incarceration in the United States has skyrocketed to unprecedented heights, both histori- cally and in comparison to that of other developed nations. At far higher rates than the general population, those in or entering U.S. jails and prisons are prone to many health problems. This is a problem not just for them, but also for the communities from which they come and to which, in nearly all cases, they will return. A changing policy environment calls for a fresh look at the con- nections between health and incarceration. Costs of providing care to prisoners are rising, driven partly by an aging of that population. Fiscal pressures, litigation, and judicial oversight are pushing states to look for alternatives that better meet health needs of the incarcerated. The Patient Protection and Affordable Care Act (ACA), in addition to insuring mil- lions of previously uninsured people, creates specific new opportunities to ensure continuity of medical coverage and care when prisoners are released. On December 5, 2012, the Committee on Law and Justice of the National Research Council (NRC) and the Board on Health and Select Populations of the Institute of Medicine (IOM) sponsored a workshop on health and incarceration that brought together leading academic and practicing experts to review what is known about these health issues and what appear to be the best opportunities to improve healthcare for those who are now or will be incarcerated. The workshop was designed as a ix

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x PREFACE roundtable with brief presentations from 16 experts and time for group discussion. The purpose of the workshop was to inform a current consensus study by the NRC Committee on Causes and Consequences of High Rates of Incarceration. In addition, participants hoped that a stand-alone document of the workshop proceedings could educate the healthcare and policy communities and provide a platform for visions of how the world of incarceration health can be a better place. I thank the Robert Wood Johnson Foundation for the generous support to enable this publica- tion. This summary provides an objective report of what occurred at the workshop, drawing on views presented by individual participants and focusing on the possibilities for improving the health of incarcerated and formerly incarcerated populations and implications of the implementa- tion of the ACA on public health. As the vice chair of the committee that co-organized the workshop, I extend our thanks, first to committee member Josiah (Jody) Rich, Depart- ment of Medicine and Epidemiology, Warren Alpert Medical School of Brown University, and the Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center, for his key role in identi- fying the expert participants and moderating the event. The success of the workshop was a result of a talented and thoughtful group who gave generously of their knowledge and time, whom we thank: Scott Allen, University of California, Riverside; Redonna Chandler, National Insti- tute on Drug Abuse; Jennifer Clarke, Brown University Medical Center; Jamie Fellner, Human Rights Watch; Robert Greifinger, John Jay College of Criminal Justice, City University of New York; Newton Kendig, Fed- eral Bureau of Prisons; Marc Mauer, The Sentencing Project; Fred Osher, Council of State Governments; Steven Rosenberg, Community Oriented Correctional Health Services; Faye Taxman, George Mason University; Emily Wang, Yale University; Christopher Wildeman, Yale University; and Brie Williams, University of California, San Francisco. In addition, my fellow committee member, Craig Haney, University of California, Santa Cruz, joined Jody Rich and me at the workshop. I also thank Steve Redburn, study director for the committee, and Rick Erdtmann, director of IOM’s Board on Health and Select Popula- tions, for their ongoing consultation in preparation for the workshop. Barbara Boyd and Julie Schuck from the NRC’s Committee on Law and Justice also provided valuable support to the workshop and production of the workshop summary. I also thank the executive office reports staff of the Division of Behavioral and Social Sciences and Education, espe- cially Eugenia Grohman, who provided consultation with staff and the rapporteur on the writing and editing of this summary; Kirsten Sampson

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PREFACE xi Snyder, who managed the report review process; and Yvonne Wise, who managed the production process. Finally, I thank our rapporteur, Amy Smith, who did a wonderful job capturing the many visions presented at the workshop. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with pro- cedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integ- rity of the deliberative process. We thank the following individuals for their review of this report: Ingrid Binswanger, Primary Care Residency Research, School of Medicine, University of Colorado, Denver; Josiah D. Rich, Department of Medicine and Epidemiology, Warren Alpert Med- ical School of Brown University, and the Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center; Emily Wang, General Internal Medicine, Yale School of Medicine; Brie Williams, Divi- sion of Geriatrics, University of California, San Francisco; and Lester N. Wright, Discipline of Public Health, University of Adelaide. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report nor did they see the final draft of the report before its release. The review of this report was overseen by Philip J. Cook, Sanford School of Public Policy, Duke University. Appointed by the NRC, he was respon- sible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution. Bruce Western, Vice Chair Committee on Causes and Consequences of High Rates of Incarceration

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Contents INTRODUCTION 1 1 IMPACT OF INCARCERATION ON HEALTH 7 Inmate Health, 7 The Legal Basis for Healthcare for Inmates, 9 Continuity of Care, 10 Quality of Correctional Healthcare, 12 Healthcare Providers, 13 2  VULNERABLE POPULATIONS AND OPPORTUNITIES FOR REDUCING HEALTH RISKS 15 Mental Illness and Addiction, 16 Older Adults, 21 Women, 23 Youth, 25 Families, 25 Release and Re-Entry, 26 Cultures of Care, 28 3 ACCESS TO HEALTHCARE 31 Medicaid Enrollment, 31 Workforce, 33 Quality of Care and Accountability, 34 States and Health Plans, 35 xiii

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xiv CONTENTS Cost Shifts, Savings, and Recidivism, 35 Equity and Rights, 36 CLOSING 37 BIBLIOGRAPHY 41 APPENDIX: Workshop Agenda and Participants 49