Bringing it all back home: Understanding the medical difficulties encountered by newly released prisoners in New Orleans, Louisiana - a qualitative study

Abstract

Formerly incarcerated persons (FIPs) face a disproportionate risk of death and serious illness in the immediate post-release period. Therefore, it is a critical time to initiate community-based care for chronic illnesses and behavioural disorders. Little is known about the unique transitional health and social support needs of FIPs in Louisiana, which has the highest incarceration rate in the world. As the average age of prisoners in the United States rises, the release of older prisoners with chronic conditions will become increasingly common. The aim of this study was to explore the healthcare experiences of FIPs in Louisiana in order to inform delivery of services tailored to this population. This research was done in partnership with a community organisation that advocates for restoration of voting rights to FIPs and helps newly released individuals transition back into society. This organisation identified FIPs in the Greater New Orleans area, and from January to May 2015, we conducted 24 semi-structured, in-person, audio-recorded interviews at the community organisation's transitional living facility. The interviews assessed FIPs' experiences with and barriers to receiving healthcare during and after incarceration. These discussions also explored FIPs' desires for services and attitudes towards health and healthcare. Interviews were transcribed and independently coded by two researchers. Interviewees reported negative experiences with healthcare during incarceration, and limited health guidance during the pre-release process. Post-release concerns included lack of insurance, difficulty accessing care and medication, and interest in learning about healthy lifestyles. Results suggest a need for a formalised system of transitional healthcare for FIPs. Findings are being used to inform a pilot transitional care clinic in New Orleans, Louisiana.

Barriers between offenders and primary health care after release from prison: a case study

“…While some research has found health benefits of incarceration, with improvements in mental and physical health while in prison because of improved access to services while incarcerated (Shaw, 2011), there is a dramatic decline in health following release from prison, making post-release prisoners a higher risk population than currently incarcerated offenders (Kinner et al, 2015). As a result of this decline in health, and the high mortality and suicide rates post-release from prison (Binswanger et al, 2012;Vail et al, 2017) it is essential that this transition period is made as smooth as possible.…”

“…The transition period from prison to the community is a high risk time for offenders, with post-release prisoners reporting a lack of support and increased levels of stress resulting from the process of reintegrating into the community (Binswanger et al, 2012;Vail et al, 2017). Mortality rates during the first two weeks following release can be as much as 12.5 times higher than the general population (Binswanger et al, 2012), and suicide peak one month after release from prison (Pratt et al, 2006).…”

“…Primary healthcare is a necessary support for post-release prisoners, and is the first step in accessing more specialised healthcare services -such as substance misuse programmes and mental health treatment (Lord Bradley, 2009;Kinner et al, 2015). Continuity of care can be particularly poor during high risk transition periods for offenders, such as the transition from prison to the community (Clinks, 2014;Vail, 2017).…”

Lessons on Patient and Stakeholder Engagement Strategies for Pipeline to Proposal Awards

“…However, numerous social, logistical, and financial barriers may preclude recently released individuals from accessing much-needed care. 19,20 In 2013, a university-based physician, an executive director of a nonprofit agency that organizes and advocates for FIPs, and a researcher with expertise in community-academic partnered research agreed to collaborate to improve health services for FIPs in New Orleans, Louisiana. All three shared the common experience of caring for incarcerated or formerly incarcerated individuals.…”

“…Along with a medical student, the team conducted formative research on the needs of FIPs in Louisiana. 20 Based on findings, the As a separate, but related effort, the team began the Prisoner to Patient project in 2015 to develop a research agenda focused on the unique health needs of FIPs. The researcher and the executive director agreed to co-lead the P2P-supported project.…”