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Correctional Health: Healthcare within the Correctional SystemWhile correctional facilities across Canada vary according to jurisdiction, the health of those who are incarcerated remains considerably poorer than the general population. Historically, prisons have always illustrated the inequalities and problems that exist in the larger society in which it functions, whereby discrimination, stigma around mental illness and substance use, poverty, and social exclusion continues to "define and shape modern Canadian correctional policy, practice and populations" (p.2). Among the many health concerns presented within correctional facilities, mental illness, substance use, and infectious diseases are the most prevalent. While nursing would suggest that many of these health issues require proactive intervention and treatment, the access to, and quality of healthcare services is increasingly being impacted by competing priorities such as "security, population movement, institutional routines, and staff availability to provide escort to access community health care specialists and providers." (p.8).
Within Canada, the federal, provincial and territorial governments share jurisdiction over correctional institutions. The Corrections and Conditional Release Act applies to federal facilities, whereas the Canada Health Act applies to the delivery of healthcare within provincial and territorial correctional facilities. While Section 86 of the Corrections and Conditional Release Act states that every single inmate should be provided with "essential healthcare", reasonable access to nonessential mental healthcare services, and that the provision of healthcare "shall conform to professional acceptable standards," the healthcare provided to this population is often varied and substandard across the country.
According to the Office of the Correctional Investigator, the most frequent area of complaint received to the Office involves the delivery and accessibility of healthcare services. Further contributing to this issue are the constraints and challenges that are faced within the federal correctional system such as inadequate bed space, inappropriate infrastructure, drug use, infectious diseases, difficulty with meeting the needs of aging inmates, and inadequate mental health services, which all impact the correctional systems’ capacity to provide accessible and quality care. Similarly, provincial correctional facilities in B.C. experience many issues due to resource constraints leading to overcrowding, inadequate mental health and substance use and rehabilitation services, which are the top concerns.
Nurses recognize that marginalized populations such as Indigenous peoples and visible minorities continue to be disproportionately represented within the correctional system. Further, many inmates have poor health prior to being incarcerated due to a history of trauma, sexual and physical abuse, violence, living in poor conditions, or being involved with the child welfare system. Most nurses who work within the corrections system would suggest that programs and services within correctional facilities should support a "healthy prison model" encompassing health promotion, screening and assessment, disease prevention, treatment and control and harm reduction.
Through a health promotion perspective, time spent within a correctional facility provides an opportunity "for an ordered approach to assessing and addressing the health needs of prisoners who have led chaotic lifestyles prior to imprisonment." The majority of those who are incarcerated are ultimately released back into mainstream society, and nurses recognize that improving the accessibility and availability of healthcare within corrections, as well as ensuring continuity of supports within the community is essential. Failing to meet these needs can have significant implications not only on the health of inmates, but on public health and safety.
- Healthcare delivery within correctional facilities across Canada is highly inconsistent and often times substandard.
- Accessing basic and preventative healthcare continue to be a challenge for many inmates across Canada.
- Stigma and discrimination continue to influence policies, practices and populations within the correctional system.
- Nurses interact with vulnerable and marginalized individuals on a daily basis and understand the importance of non-judgemental and supportive care.
- Nurses are the primary healthcare providers within correctional facilities and recognize that working towards a "healthy prison model" will facilitate better health outcomes among inmates, which has significant positive impacts on public health and safety.