Federal inmates in correctional facilities are some of the most neglected people in Canadian society. Inmates locked behind bars have very little political voice, and are disenfranchised and ostracized by society even after their release. The public tends to have a negative view of the imprisoned and is often reluctant to view these individuals as what they are – fellow human beings. Consequently, there is great disparity in access to quality healthcare between Canadian prisoners and the general public.
Compared to the general Canadian population, federal inmates have especially poor health with regards to mortality, substance abuse, mental illnesses, and infectious diseases. The reason for this is multi-factorial; social determinants play a defining role, as many inmates often come from families of lower socioeconomic status and may have had adverse experiences in childhood. To make things even worse, the prison experience can give rise to new health issues while exacerbating existing ones. In Ontario, Canada, individuals who experience or have experienced imprisonment have higher rates of healthcare utilization, perhaps due to both high morbidity and poorer access to quality healthcare.
Correctional facilities in North America are often conducive to a sedentary lifestyle, social stressors and abuse, thoughts of self-harm, vulnerability to infectious diseases, as well as the inability for inmates to make their own food choices. These elements, tacked onto inmates with existing mental and physical health struggles, create a greater need for quality and comprehensive healthcare in correctional facilities. In fact, the most common complaint from federal inmates is inadequate access to quality healthcare.
Dr. Peter Ford, Professor Emeritus at Queen’s University and retired Head of the HIV Clinic at Kingston Hospital, spoke about his frustrations with the compartmentalized nature of healthcare in the prison system. Patients in correctional facilities, who require tricyclic antidepressants to treat their peripheral neuropathy (a disease characterized by nerve injury), were only able to get those drugs from a psychiatrist. In a prison system, however, a visit with the psychiatrist is seen as an open admission of mental illness, and can expose an inmate to bullying and ostracization in the prison. These social factors therefore discourage patients from obtaining the medications that could significantly improve their health. Not only are we disregarding the obvious need for increased healthcare in prisons, but patients are not utilizing what they do have access to because of stigma, further worsening their conditions.
Mental illnesses, which are extremely common in Canada’s prisoner population, are not being adequately addressed by mental health services in correctional facilities. Many inmates with mental illnesses are dying in Canadian prisons, through suicide and a lack of medical attention.
Howard Sapers, the former Correctional Investigator of Canada, believes that the care (ranging from mental health services to dentistry work) provided to federal inmates is inadequate. Part of the reason lies with staffing difficulties – the relatively small pool of physicians, nurses, pharmacists, and allied health professionals is simply unable to adequately handle Canada’s vulnerable inmate population. In a country where prison overcrowding is a problem, the dilution of limited healthcare resources for inmates is detrimental to quality and timely care.
The government has an obligation to protect the people under its care, especially when the individuals are forcefully confined as part of their sentencing. Human rights do not disappear behind prison gates, and every individual deserves quality access to healthcare. The prison population, rife with pre-existing comorbidities that are only worsened by the dehumanizing and disenfranchising experience of incarceration, is in especially great need of healthcare – healthcare that they are not adequately receiving, because of a lack of public interest in the welfare of offenders.
There is no easy solution here. The road to improving the health of inmates in Canada involves a multi-faceted approach. At the forefront should be increased transparency on the part of Canada’s correctional facilities regarding prison conditions. On the other front, we as the public should put more pressure on the government to improve prison policies in a way that would seek to prevent and ameliorate chronic, infectious, and mental illnesses among inmates. There is a desperate need for more healthcare professionals dedicated to working in correctional facilities, with an emphasis on delivering mental health services to this critically underserved population. Initiatives can take on the form of annual reports regarding the health of inmates, increased emphasis in medical schools on the need for healthcare professionals in correctional facilities, and advocating for more funding. In the long-term, the Canadian government’s approaches should be informed by social determinants of health and criminal behavior, to create a society that is healthier both inside and outside of correctional facilities.
By Jim Chen
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