Abstract
BackgroundWhile incarcerated people are known to experience trauma at higher rates than the general population, little is known about how the correctional health system contributes to trauma rates.MethodsWe conducted 20 semi-structured qualitative interviews with men who were recently released from a correctional system to understand their experiences with healthcare systems and medical staff during incarceration. Using reflexive thematic analysis within a critical realist framework, we coded and analyzed the data iteratively to refine and unify emerging themes.ResultsThe unanticipated concept of healthcare-induced trauma emerged and was revealed in three overall themes: (1) healthcare leading to fear of serious illness or death, (2) healthcare leading to fear of people, including healthcare providers, correctional staff, and other incarcerated people, and (3) the correctional institutional, social, and physical environment leads to fear of place.ConclusionsHealthcare in correctional settings has the potential to induce trauma, even when the medical conditions addressed are not life-threatening. Future research should examine the factors contributing to the development of healthcare-induced trauma in correctional settings and develop interventions to prevent and address this phenomenon.
Highlights
While incarcerated people are known to experience trauma at higher rates than the general population, little is known about how the correctional health system contributes to trauma rates
Almost half of the participants (45%) had been diagnosed with post-traumatic stress disorder (PTSD) and two or more psychiatric conditions. The men described their experiences being incarcerated in local jails, state prisons, and in federal correctional facilities
Several themes related to healthcare-induced trauma emerged in our study, namely (1) healthcare leads to fear of serious illness or death, (2) healthcare leads to fear of people, and (3) the correctional institutional, social, and physical environment leads to fear of place (Table 1)
Summary
While incarcerated people are known to experience trauma at higher rates than the general population, little is known about how the correctional health system contributes to trauma rates. Gamble has required that correctional facilities provide basic healthcare for acute conditions In this seminal case, the Supreme Court ruled that refusal of these services constituted “cruel and unusual punishment” under the Eighth Amendment. People in prison are entitled to mental health treatment if they have symptoms a medical professional has deemed serious and curable, and there is substantial potential for harm if care is denied or delayed (Klein, 1978). These constitutional protections have meant that many people first access physical and mental health care while incarcerated, engaging in care for health conditions that were undiagnosed, unmonitored, or untreated in the community (Meyer et al, 2014)
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