IN THIS ISSUE

Insights on Being Inside

This is a very timely issue of MetroDoctors as our country is coming to grips with the serious deficiencies and inequities of our criminal justice system. Community correctional supervision (incarceration plus those on probation or parole) rose to 6.8 million Americans in 2014 (1 in 36 adults). This escalation began in the early 80s when it became a political tool (War on Drugs) with the “get tough on crime” laws. We are fortunate to have Tyler Winkelman, MD as our Colleague Interview. He provided many of the sources for the articles and other valued suggestions. You can read more about the gravity of the American incarceration problem, including the physical, mental, and situational problems of incarceration and recovery in the articles submitted. Rachel Silva, MD, Medical Director of the Hennepin County Jail, outlines the complex problems of providing healthcare delivery to over 56,000 incarcerated persons yearly. It’s a great challenge to manage chronic disease, substance abuse, mental health, and communicable disease in a population with varying lengths of stay. We are all familiar with the opioid crisis in our country. Sean Young-Stevens discusses the management of this problem in the Washington County Jail where they have begun to actively treat opioid addiction with medication to stabilize inmates for eventual release. The program requires coordination with community programs upon release and more physicians who provide Buprenorphine treatment are needed. The Biden Administration recently issued new practice guidelines that eliminates the need for credentialed practitioners to hold a separate registration to prescribe medications for OUD treatment. http://bit.ly/OUDtreatment. The first of two articles involving incarcerated females is by Raelene Baker and Erica Gerrity on the Minnesota Prison Doula Project. Four-to-six percent of incarcerated Minnesota women are pregnant at any given time. This Doula program has been quite successful in maintaining quality birth outcomes for both mother and child. The expansion outside of the Minnesota Correctional Facility-Shakopee is encouraging. The second article is by Dr. Rebecca Shlafer and Marvin So, MPH, MS4 and deals with parenteral incarceration. It amazes me that 1 in 14 US children have had an incarcerated parent. The many problems this produces are discussed in addition to the ways that physicians can help to address the needs of these children and families. What is being done to educate and rehabilitate those in prison is a question often asked. Jim Verhoye, PhD provides an excellent overview of the problem including its causes and the debate on how to manage the two million incarcerated people in the U.S. He also provides excellent references for those seeking more in-depth information. Unfortunately, there are serious problems with the health care provided in some Minnesota prisons and jails. Incarcerated people are not protected under the MN Health Care Bill of Rights. The Minnesota Dept. of Corrections has direct supervision over state prisons, however, not the county jails; therefore, there is no mechanism for oversight and accountability. Hannah Lichtsinn, MD and Calla Brown, MD describe how the system functions without this proper oversight. Mark Groves M.S.Ed.’s article provides valuable insight into the path a previously incarcerated person takes as he or she transitions to a productive life. The importance of mentoring and transitional programs, safe and affordable housing, a supportive community, and employment are cited. A resource list for post-incarceration mentoring opportunities is provided. The article on community supervision and health is by Marin Olson, a 2021 graduate of the U of M Medical School. Those under community supervision (probation or parole) are twice the incarcerated population in Minnesota. Ms. Olson discusses the system’s three main problems: racial, health, and social inequities. The Environmental Health Task Force article underscores the importance of “health justice,” which encompasses physical, mental, social, and environmental health. The medical student page submission is by Noah Sanders, MS4 and Kristin Chu, MS3 both TCMS Public Health Advocacy Fellows. They emphasize the value of including incarceration health topics in the medical school curriculum and the importance of respecting the personal autonomy of correctional patients we encounter in practice. We still have a lot to do in this country to improve criminal justice. It comes down to: 1) slowing down the number of people entering jails and prisons; 2) better sentencing guidelines and early release for many non-violent crimes; and 3) finding ways to lower the recidivism rate. I hope you will gain some valuable insights from these excellent articles that will help you to become a better medical provider and social advocate.

By Robert R. Neal, Jr., MD Member, MetroDoctors Editorial Board