Medical homelessness and candidacy: women transiting between prison and community health care

Penelope Abbott,Parker Magin,Wendy Hu,Joyce Davison

doi:10.1186/s12939-017-0627-6

Abstract

BackgroundWomen in contact with the prison system have high health needs. Short periods in prison and serial incarcerations are common. Examination of their experiences of health care both in prison and in the community may assist in better supporting their wellbeing and, ultimately, decrease their risk of returning to prison.MethodsWe interviewed women in prisons in Sydney, Australia, using pre-release and post-release interviews. We undertook thematic analysis of the combined interviews, considering them as continuing narratives of their healthcare experiences. We further reviewed the findings using the theoretical lens of candidacy to generate additional insights on healthcare access.ResultsSixty-nine interviews were conducted with 40 women pre-release and 29 of these post-release. Most had histories of substance misuse. Women saw prison as an opportunity to address neglected health problems, but long waiting lists impeded healthcare delivery. Both in prison and in the community, the dual stigmas of substance misuse and being a prisoner could lead to provider judgements that their claims to care were not legitimate. They feared they would be blocked from care even if seriously ill. Family support, self-efficacy, assertiveness, overcoming substance misuse, compliance with health system rules and transitional care programs increased their personal capacity to access health care.ConclusionsFor women in transition between prison and community, healthcare access could be experienced as ‘medical homelessness’ in which women felt caught in a perpetual state of waiting and exclusion during cycles of prison- and community-based care. Their healthcare experiences were characterized by ineffectual attempts to access care, transient relationships with healthcare providers, disrupted medical management and a fear that stigma would prevent candidacy to health care even in the event of serious illness. Consideration of the vulnerabilities and likely points of exclusion for women in contact with the criminal justice system will assist in increasing healthcare access for this marginalised population.

Highlights

Women in contact with the prison system have high health needs
Poor access to health care is common for women in contact with the criminal justice system
In a national survey of people in prison in Australia in 2015 [10], 48% of women reported they did not access the health care they needed when they were in the community

Summary

Introduction

Women in contact with the prison system have high health needs. Short periods in prison and serial incarcerations are common. In Australia, women are usually in prison for less than 6 months, re-incarceration is common and the majority report problematic substance misuse [3,4,5,6]. Aboriginal and Torres Strait Islander women are over represented in prison, related to historical and systemic disadvantage, and these women are even more likely to experience serial incarcerations with short sentences or on remand [5]. In a national survey of people in prison in Australia in 2015 [10], 48% of women reported they did not access the health care they needed when they were in the community. Additional barriers in the community were reported to be cost, substance misuse and competing priorities, while in prison, waiting times and health care not being available when needed were the other major barriers. Affiliated with formal release support program Transitional support by prison-based health linkage programsb 7

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