The United States is the world leader in incarceration, with an estimated 355 people out of every 100, 000 residents being incarcerated at any given time. Each year, more than 600,000 people are released from state and federal prisons, back into the community, where they are expected to reintegrate into society (1). People who are incarcerated or have ever experienced imprisonment are more likely to experience higher rates of mental illness, infectious diseases, chronic disease, substance use, and overall mortality compared to the general population (3). As Emergency Departments become increasingly relied upon as the safety net for a weakened social infrastructure, it is imperative that providers understand the nuanced care that is required for patients who have ever experienced incarceration. Awareness of the profound limitations of healthcare services in prison and recognizing the challenges post incarceration can allow us to better serve this specific patient population and reduce recidivism. So where can we, as medical providers, intervene within this system?
Checkpoint 1: During incarceration - Mass incarceration is a public health crisis. Prisons make up some of the world’s most socially and medically vulnerable patients, yet are extremely under-resourced to effectively meet the needs of their population. Overcrowding and poor sanitation in prisons perpetuate the spread of communicable diseases, most recently illuminated by the COVID-19 pandemic (4). Examples of public health failures included refusal of the government to decarcerate, no prioritization of effective vaccine roll out, and doing little to address vaccine hesitancy among incarcerated people (5). Other barriers to care in prison include cost prohibitive co-pays, physician-patient distrust, and limitations to discharge equipment/prescriptions (ie splints, non-formulary medications, etc)
Interventions:
Develop health education materials specifically for people within the justice system
Keep informed regarding disease outbreaks and health patterns specific to local correctional facilities and screen patients coming through the ED accordingly
Consider every interaction an opportunity to build trust within the healthcare system, as incarcerated patients are particularly vulnerable to biases from healthcare workers.
Communicate closely with our healthcare colleagues working within prisons. By asking direct questions, doing a thorough work up, and being comprehensive/safe in our discharges, we reduce the potential for bouncebacks and avoid putting extra strain on prison/jail staff
Familiarize yourself with the resources/capabilities of prisons within the area
Checkpoint 2: Post-incarceration - In a systematic review of qualitative evaluations of reentry programs, findings suggest that access to social support, housing and employment, the interpersonal skills of case workers, personalized approaches to case management, and continuity of care throughout the pre-release and post-release period are the key social and structural factors in program success (2). While exiting the prison system, patients who have been incarcerated also disproportionately face social stigma upon re-entry which can further impact both their physical and mental health.
Interventions:
Screen patients who have a history of incarceration in their chart for social/medical comorbidities that may lead to recidivism
Familiarize ourselves with community resources dedicated to serving this specific population
Work closely with our social workers to create individualized plans of care for incarcerated patients
Destigmatize incarceration and continue to emphasize rehabilitation.
It is also important to recognize the profound economic detriment incarceration imposes on patients and their families. In a study done by the Prison Policy Initiative, an estimate of 60% people remain jobless at 6 months post-release; a number that only increases every year post-incarceration. Those that do find work only make 84 cents for every dollar of the US median wage (7). Without the ability to pay for the basic needs to survive for themselves and their families, post-incarcerated individuals are even more susceptible to recidivism. Post incarceration integration is influenced by a complex network of psychosocial determinants that healthcare workers must have an understanding of in order to provide effective care.
The Cook County Emergency Medicine Residency works alongside Cermak Health Services (CHS) to provide healthcare for one of the largest incarcerated populations in the country. We affirm our commitment to helping this specific population through interventions such as our Resident as a Resource program, where we have established partnerships with several organizations in the Chicago area that specialize in rehabilitation for formerly incarcerated individuals. The Howard & Evanston Community Center, for example, works towards mitigating the aforementioned joblessness epidemic by hosting resume workshops and the CTA Second Chance program. The Safer Foundation and Transforming Re-Entry are other organizations that have proved valuable to our patients.
Emergency Medicine is founded upon the principle that healthcare is a human right for ALL, regardless of circumstance. We will continue to serve as the bridge between society and the healthcare system, and rehabilitation for our patients who have been incarcerated.
Citations
US Department of Health and Human Services. (n.d.). Incarceration & reentry. ASPE. https://aspe.hhs.gov/topics/human-services/incarceration-reentry-0
Kendall S, Redshaw S, Ward S, Wayland S, Sullivan E. Systematic review of qualitative evaluations of reentry programs addressing problematic drug use and mental health disorders amongst people transitioning from prison to communities. Health Justice. 2018 Mar 2;6(1):4. doi: 10.1186/s40352-018-0063-8. PMID: 29500640; PMCID: PMC5834412.https://pmc.ncbi.nlm.nih.gov/articles/PMC5834412/
Centers for Disease Control and Prevention. (n.d.). Public Health Considerations for Correctional Health. Centers for Disease Control and Prevention. https://www.cdc.gov/correctional-health/about/index.html
Pearce, L. A., Southalan, L., & Kinner, S. A. (2025, November 15). Prison health data collection: Transforming prisons from public health risks to opportunities for global health equity. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S0277953625011244#bib65
Initiative, P. P. (n.d.). Mass incarceration, covid-19, and community spread. Prison Policy Initiative. https://www.prisonpolicy.org/reports/covidspread.html
Mourão, A., Sousa , M., Ferreira, M., Gonçalves, L., Caridade, S., & Cunha, O. (2025, May 3). Beyond Recidivism: A Systematic Review Exploring Comprehensive Criteria for Successful Reintegration After Prison Release. SageJournals. https://journals.sagepub.com/doi/full/10.1177/00938548251335322?__cf_chl_tk=feK6oboM7HE6BXK4dR73uxA5EJ7_j91OE9WWSFir_U0-1777931442-1.0.1.1-PQ3txHFsQBfB0JxF3iEhcv4e6zLa55gO0Pd5GFC3QhM
Initiative, P. P. (2022, February 8). New Data on formerly Incarcerated People’s employment reveal labor market injustices. Prison Policy Initiative. https://www.prisonpolicy.org/blog/2022/02/08/employment/
Authored by Alison Mascarenhas MD & Rashid Kysia MD