Healthcare in Prison: A Longitudinal Exploration of Resident Experiences Accessing and Utilizing Services

Background: As access to healthcare becomes ever more challenging in the community, prisons see an effect on the ability to provide optimal services within facilities. These challenges are exacerbated by provider shortages, budgetary restraints, and the COVID-19 pandemic. In prisons, healthcare workers also face high caseloads, limited access to equipment, and disgruntled patients. Daily prison operations can also impact residents’ ability to maintain scheduled appointments whenever crises arise. Considering the additional barriers and challenges faced within a prison facility, it is imperative to explore salient needs among residents and attempt to implement solutions. This study uses participant surveys with closed and open-ended questions to identify issues and innovations related to healthcare services in the prison.

Methods: Data are part of a longitudinal study on prison culture and climate at one medium security, men’s prison in the Midwest (N=1,248). Data were collected at three time points: baseline (n=452), wave 2 (n=437), and wave 3 (n=348). This paper uses ANOVAs and Kruskal Wallis tests to analyze eight questions related to healthcare at the facility and includes data from content analysis of waves 1 and 3 that identified health-related matters at the facility.

Results: Most of the sample identified as White (n=840, 68%) and ranged from 19 to 86 years of age (m=42 years). Residents generally felt more positive about the quality of healthcare services from W1 to W3 (p<.01,F=4.35). The quality perception for mental healthcare (p=<.01, F=9.58) and dental healthcare (x²(df=2) with ties = 73.43, p<.001) both slightly decreased between W1 and W3. There was no significant difference between W1 and W3 for perceptions of the quality of substance use treatment (p=.05) and use of psychiatric medications (p=.07). Additionally, the perception of healthcare impacting the safety of residents decreased from W1 to W3 (p<.001; F=29.2). Content analysis showed at W1 residents concerned about accessing services in a timely manner, staff behavior, and preventative or early treatment for conditions. At W3 significantly fewer comments related to healthcare concerns were provided. The few comments that residents did include were about general improvement to medical services or focused solely on dental services.

Implications: Through the length of this study, multiple adjustments were implemented or considered to address the healthcare concerns of residents. Approximately halfway through the 3-year period, the department negotiated provider contracts with a new provider. Additionally, residents suggested improvements such as use of prison-issued tablets for scheduling, notifications, and quick questions related to healthcare needs. These types of solutions can assist residents in knowing information in a timely manner as well as reduce the burden of providers of having additional on-site staff. Responding to questions and appointment scheduling can be facilitated elsewhere and reduce the burden on on-site staff. As technology advances in how healthcare facilities operate in the community, so too should prisons consider pushing providers to use innovative policies and procedures to leverage technology in providing additional avenues to address healthcare needs of residents.