Journal of Correctional Health Care

Jails across the country are struggling to meet the increasing demand for mental health care and to contain the resulting escalating costs. Most larger jails provide some level of mental health care such as suicide screening and psychopharmacological treatment, but services such as psychotherapy, counseling, and behavioral treatment are less frequently available. This article outlines a systems approach employed at one large jail that used managed care methods to contain costs while delivering a high quality of mental health care. Managed care strategies utilized include medication formularies, medical necessity and level-of-care guidelines, preauthorization, provider profiling, treatment algo-rithms, and case management for challenging inmates. Outcomes on cost reductions and how the provider met challenges related to changing to a managed care model are discussed.

Incarcerated persons have a high prevalence of medical and mental health conditions. This study involved 83 inmates consecutively released to the local community, each of whom who had spent at least three days in custody. Their medical records were reviewed for the pres-ence of medical or mental health conditions warranting discharge planning as well as documentation of such discharge planning. A total of 39% of these inmates had either a medical condition or a mental health condition, or both. Medical conditions were documented in 28% and mental health conditions in 16% of these inmates. Some documentation of discharge planning was present in 31% of the cases in which the reviewers felt that this activity was warranted. This approach to assessing the local impact of inmates rejoining the community offers advantages over other approaches.

The application of telemedicine in corrections has grown rapidly. A comprehensive literature review was conducted to develop a status report on the value that telemedicine has added to health care delivery in the prison setting. When most state and federal correctional telemedicine projects started, operation costs were high and applications were limited. However, with technologies increasingly affordable, access to specialized consultations for prisoners expanded greatly. Further, many legal barriers to service have been resolved. The number of health complaints that result in trips outside of a secure facility has dropped significantly. Each avoided trip saves hundreds of dollars in transport and security expenses, which has been the best indicator of success. Published material supports the value of telemedicine as a highly effective tool in health care delivery without compromise to patient safety or confidentiality. In fact, telemedi-cine can increase quality of care due to interaction between specialist and caregiver, as well as greater access to specialty care.

Knowledge of demographics, risk factors, and infection rates is essential to the design of effective HIV counseling and testing programs for incarcerated women. This study analyzed data from 19,057 females counseled and tested for HIV in the Harris County Sheriff’s Office jail from 1992 through 2000. Important findings include the inmates’ open-ness in disclosing high-risk behaviors, the decrease in reports of intra-venous drug use, and the increased use of noninjection drugs during sex. Identified characteristics of high-risk inmates such as relatively high percentages of Black females and of females over age 30-present new challenges when considering how that may affect HIV transmission and how to design effective HIV prevention programs.

Diabetic ketoacidosis is a complication of relative or absolute insulin deficiency. It can present in a myriad of ways and can be life threatening if not detected early enough. High index of suspicion is required to diagnose the condition. This is a report of experience with two newly diagnosed cases of diabetic ketoacidosis in a correctional facility. Considerations for correctional health care are discussed.

A pilot methadone maintenance program for heroin-dependent sentenced inmates in a men’s prison in San Juan, Puerto Rico, was begun in 2002. One year later, data were collected from all 20 program partici-pants and a random sample of 40 inmates who did not participate. The data included (a) inmate self-reports concerning their drug use, attitudes about drug treatment, and expectations about behaviors upon release from prison, and (b) urine specimens for heroin and methadone testing. It was found that inmates enrolled in the program had been heavy users of heroin and reduced their heroin use by more than 94%. There was a high correlation between self-report and urine test results. Program participa-tion was associated with increased acceptance of methadone maintenance as a prison-based treatment for heroin dependence. The program appeared successful in reducing heroin abuse among heroin-dependent prisoners. Prison officials planned to expand the program.