**3. The health of incarcerated persons**

Even prior to their incarceration, people who are incarcerated tend to have worse health than the general population. This can be explained through the lens of the social determinants of health (SDoH), which the World Health Organization explains as the '*the conditions in which people are born, grow, live, work, and age, including the health system. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries'* [6: n.p.].


**Table 1.** *Terms relating to incarceration.*

*Patient Safety and People Who Are Incarcerated DOI: http://dx.doi.org/10.5772/intechopen.108942*

People who are incarcerated are more likely to have low-income status [7], to be homeless, unemployed, had poor quality education and have poorer health [8, 9]. They are also more likely to be First Nations peoples and/or people with a disability, both groups with worse health than the general population – quite apart from their potential incarceration [9–13] – but these factors act as multipliers of disadvantage [14].

Incarcerated peoples and detainees also have *"… higher rates of mental health conditions, chronic physical disease, communicable disease, tobacco smoking, high-risk alcohol consumption, illicit drug use, and injecting drug use than the general population … This means that people in prison often have complex, long-term health needs.* [This means that] *the health of people in prison is much poorer compared with the general community, and people in prison are often considered to be elderly at the age of 50–55 (compared with 65 and over in the general community). This is known as 'accelerated ageing'"* [8: 4]. It is important to note that while this quotation is from an Australian publication, the detainees and incarcerated people demonstrate similar patterns of ill health around the globe [14–19], although it should also be noted that knowledge about the health of prisoners demonstrates *"… critical evidence gaps, notably the lack of evidence from low- and middle-income countries"* and in relation to the health of detained adolescents [4, 20].

It is also important to note that while for some incarcerated individuals, prison offers access to healthcare services that were not available prior to incarceration [see for example 21] for most people, incarceration is associated with a worsening of both their mental and physical health [22, 23], including significantly higher *"Rates of infectious diseases, such as tuberculosis, HIV, hepatitis B and C, and sexually transmitted diseases, are higher among the incarcerated population than among the general … population"* [14: 4S]. This has also been highlighted during the COVID epidemic where factors such as close proximity and delayed or limited prevention strategies [24] mean that *"Carceral facilities are epicenters of the COVID-19 pandemic"* [25: 1].

#### **3.1 Mental health and patient safety of incarcerated person**

The mental health of incarcerated individuals is of particular concern, both prior and subsequent to incarceration. The compounding nature of ill-health and incarceration is particularly evident in relation to mental health. As David Satcher argues *"Far too many people enter our criminal justice system due to an untreated or under-treated mental illness. Too often, we find our prison system substituting for the mental health care once provided in mental hospitals and other medical settings. It is estimated that one in six people in the correctional system lives with a serious mental illness. Compounding the problem is the co-occurrence of mental illness and substance abuse"* [26: vi]. Rekrut-Lapa & Lapa [15: 69] speak to a similar conclusion, but also noted that such conditions "*… require both emergency and routine care."* They also found evidence that about a third of medications possessed by detainees at arrest were for the management of psychiatric illnesses.

Even for people without a prior mental illness, the experience of incarceration can act to facilitate these conditions. One high profile example of this is the rapid mental deterioration of many asylum seekers incarcerated while they await a review of their situation, in detention centres around the world [27, 28]. Commonly reported mental health issues experienced by long term detainees included "*Depression and demoralisation, concentration and memory disturbances, and persistent anxiety … Standardised measures found high rates of depression, anxiety, PTSD and low quality of life scores*" [29: 2070].

Suicide is also a recurrent risk for incarcerated persons, accounting for about a half of prison deaths worldwide [30] and is 13 times higher in released prisoners

than in the general population [31]. Rekrut-Lapa & Lapa [15: 70] quoted a UK report which showed that 46% of near misses (defined as *any incident which resulted in, or could have resulted in, serious illness or self-harm of a detainee*) in police custody were attempted suicides and self-harming behaviour, in contrast to medical emergencies which only made up 14% of such incidents.
