The Health of Prisoners

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More than 10 million people are incarcerated worldwide; this number has increased by about a million in the past decade. Mental disorders and infectious diseases are more common in prisoners than in the general population. High rates of suicide within prison and increased mortality from all causes on release have been documented in many countries. The contribution of prisons to illness is unknown, although shortcomings in treatment and aftercare provision contribute to adverse outcomes. Research has highlighted that women, prisoners aged 55 years and older, and juveniles present with higher rates of many disorders than do other prisoners.

The contribution of initiatives to improve the health of prisoners by reducing the burden of infectious and chronic diseases, suicide, other causes of premature mortality and violence, and counteracting the cycle of reoffending should be further examined.

In this Review, we discuss the prevalence and risk factors for some of the major physical and psychiatric diseases in prisoners, and the challenges to provide health-care services for this population. We first discuss the prevalence of mental disorders and evidence-based treatments for them, the prevalence, transmission, and prevention of infectious diseases, and the prevalence of chronic diseases. We then review mortality rates in prisoners and discuss populations with particular health needs. Finally, we present information on health-care services and make several recommendations for improvements. Where possible, we use the term prison apart from in the USA, where jails (detention centres before trial or remand centres that house prisoners on sentences shorter than 1 year) and state prisons (for sentenced prisoners) are distinguished. Jails tend to have higher turnover rates than do prisons, and hence provide fewer opportunities to diagnose and treat disease. 

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References:

Fazel S, Baillargeon J. Lancet. 2011 Mar 12;377(9769):956-65.