Correctional Health Care System Research Articles

Training on Corrections and Health Within U.S. Academic Health Professions Education: A Scoping Review.

Despite the scale, inequity, and consequences of mass incarceration, health care provider knowledge and awareness on correctional health remain limited. Understanding the educational experiences of health professions learners and the studies used to evaluate them can provide useful information about current gaps to guide future curricular improvement. To address this need, we conducted a scoping review of peer-reviewed studies examining United States-based academic health professions educational programs on correctional health. Studies were coded based on study characteristics, learner outcomes, and degree to which they contained elements described in relevant position statements by two professional medical associations. Overall, 27 articles (1975-2021) were included. Learner outcomes were primarily documented at the "reactions" (93%) and "learning" (52%) levels of the Kirkpatrick model (1979), relative to "behaviors" (11%) and "long-term outcomes" (0%). Comparison of curricula to select position statements revealed multiple content gaps in the realms of prevalent conditions requiring expertise (e.g., violence and self-harm); ethical and medical-legal considerations (e.g., privatization of correctional health care); and correctional health care systems, structures, and administration. Taken together, findings highlight gaps in, and opportunities for, correctional health educational programs. Addressing health care workforce training needs is a necessary yet insufficient step to achieving health equity for populations affected by incarceration.

"We're Not Patients. We're Inmates": Older Black Women's Experience of Aging, Health, and Illness During and After Incarceration.

The incarcerated population is growing older and by the year 2030, more than one third of people incarcerated in the United States will be over the age of 55. This population shift will have a profound impact on correctional health care systems as older incarcerated people often have multiple chronic illnesses and correctional institutions were not designed with aging and disability in mind. Black women experience greater burdens of comorbid conditions and are disproportionately represented among incarcerated women. We utilized Black Feminist Epistemological Methodology to explore the intersection of aging, chronic illness, and mass incarceration via in-depth interviews with 13 formerly incarcerated older Black women. First, participants described needing to prove themselves to be trustworthy prior to becoming ill in order to be believed and granted access to care when they report symptoms. Next, participants report being treated, not as patients, but as "inmates." The punitive nature of prison health care disrupted the patient-provider relationship and complicated the ability of patients to maintain autonomy in health care interactions. Finally, I describe how carceral health extends beyond the walls of both the clinic and the institution. For older Black women, medical care and decision making inside prisons occur within a punitive context, which presents unique barriers when seeking care. Their experiences of health and illness while incarcerated may continue to influence if and how they seek care as they age in the community and thus must be interrogated when discussing aging in the Black community.

General and reproductive healthcare experiences of formerly incarcerated women in the United States: a qualitative study

PurposeThe US prison population has recently reached an all-time high, with women representing the fastest growing subpopulation. Correctional health-care system in the USA remains fragmented and nonuniform in practice, particularly in women’s health care, with poor transitions between incarceration and release. This study aims to examine the qualitative health-care experiences of women while incarcerated and their transition into the community health-care setting. Additionally, this study also examined the experiences of a subset of women who were pregnant while incarcerated.Design/methodology/approachAfter obtaining institutional review board approval, adult, English-speaking women with a history of incarceration within the past 10 years were interviewed using a semi-structured interview tool. Interview transcripts were analyzed using inductive content analysis.FindingsThe authors completed 21 full interviews and identified six themes that were both the most significant and most novel: “feeling stigmatized and insignificant,” “care as punishment,” “delay in care,” “exceptions to the rule,” “fragmentation of care” and “obstetric trauma and resilience.”Originality/valueWomen face numerous barriers and hardships when accessing basic and reproductive health-care services while incarcerated. This hardship is particularly challenging for women with substance use disorders. The authors were able to describe for the first time, partially through their own words, novel challenges described by women interacting with incarceration health care. Community providers should understand these barriers and challenges so as to effectively reengage women in care upon release and improve the health-care status of this historically marginalized group.

Targeted Approaches, Universalism, and Targeted Universalism: Opportunities for the U.S. Correctional Health Care System.

Social policy has traditionally been implemented in two ways: using targeted or universal approaches. Each of these mechanisms has advantages and disadvantages to the populations to whom the policies are applied and to the system applying the policies. A third approach to social policy implementation has emerged: targeted universalism. Targeted universalism is not simply a combination of targeted and universal approaches. It stands apart as a unique way of conceptualizing and implementing social policy. This viewpoint provides an overview of targeted approaches, universalism, and targeted universalism to social policy development and implementation. It examines the ways targeted universalism could be applied to the U.S. correctional health care system to ensure that people who are incarcerated receive the health care to which they are constitutionally entitled.

Caring for the Rapidly Aging Incarcerated Population: The Role of Policy.

The population of incarcerated adults in the United States is aging rapidly. Incarcerated adults experience accelerated aging, the process in which exposure to incarceration speeds up biological aging. The current article highlights unique structural factors and care practices that incarcerated older adults face in correctional and community health systems. These factors and practices are often in direct opposition to age-friendly care. Opportunities exist to expand research, modify existing policies, and change current care practices. Given their expertise in health system processes, gerontological nurses in correctional and community health care systems can play a pivotal role in improving the care of this growing and vulnerable population. [Journal of Gerontological Nursing, 49(3), 7-11.].

Prisoners' experience of health self-management: A qualitative study.

Among the noninstitutionalized population, health care is increasingly shifting from a paternalistic model toward promoting patients' involvement in decision-making and in managing their condition. This paradigm shift toward health self-management is less applicable to individuals in prison whose health management choices are limited. The aim of this study was to explore prisoners' health self-management needs and the strategies used to maintain health self-management in a highly restrictive prison environment. A qualitative phenomenological study design was selected for this research. An interpretive phenomenological analysis was chosen to present the narratives of prisoners regarding their health self-management. Semi-structured interviews were conducted with 15 male prisoners followed by content analysis. The analysis of the participants' narratives revealed four major themes: (1) "I thrive on the anger so I can turn it into some more sit-ups:" Initiating sporting activities (2) "Food shouldn't be that white…:" Prisoners' quest for healthier eating (3) "I felt I want more out of life…:" Avoiding an unhealthy lifestyle (4) "I want to be taken care of:" The struggle for better health care. The findings suggest that prisoners can overcome the challenges of maintaining health in prison and become committed to better health management. Prisoners who serve as health resources may help reduce the load on correctional facilities' health care systems and the public.

Corruption and Healthcare Delivery: Towards a Progressive Intervention in Nigerian Correctional Centres

Corruption is a complex and multifaceted challenge of global concern. The correctional setting in Nigeria is not exempted from the more general context of this issue. Nigeria has a poorly structured service for correctional healthcare system driven by a collection of socioeconomic and legal factors especially corruption. One of the pressing challenges in Nigerian public health is to provide services to those who need them the most, particularly those behind bars and therefore hard to reach. Yet, it remains obvious that, a significant majority of those with health problems are incarcerated in the correctional centers of Nigeria. This study which is anchored on Economic Theory of Corruption examined corrupt practices associated with healthcare delivery in Kano Central and Goron Dutse Correctional Centers. The study utilized quantitative and qualitative methods in eliciting data from convicted and awaiting trial inmates and healthcare providers. Thus, a total of 350 inmates were sampled across convicts and awaiting trial inmates through the simple random sampling technique using Wiseman’s 1999 table of sample size. In addition, two respondents (healthcare officials) were purposively sampled for in-depth interview. The findings revealed some level of negation especially as it concerns referrals and the inmates’ treatment charges outside the correctional setting. The study recommends the need for complete overhaul of the correctional healthcare delivery system in line with recommended global best practices.

Clinician Experiences of Care Provision in the Correctional Setting: A Scoping Review.

Little is known about the experiences of correctional health care providers and how their experiences impact the correctional health care system. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines, multiple databases were searched. Each abstract was read by two reviewers with a third for consensus as needed. Full-text articles were selected through a second round of review. Of 4,467 citations, 61 were selected for full-text evaluation and 23 were ultimately included. Major themes identified were the distinctive working environment, burnout, and the presence of ethical dilemmas, including the tension between security and clinical considerations. This scoping review identified a limited number of articles centered on the health care provider experience in the correctional setting.

Reproductive Healthcare Experiences of Incarcerated Women: A Qualitative Study [30F

INTRODUCTION: The U.S. prison population has reached an all-time high, with women representing the fastest growing sub-population. Recently, national medical organizations recognized inadequate correctional health care as a major problem. Despite this awareness, the U.S. correctional health care system remains fragmented and non-uniform in practice, particularly in women’s healthcare, with poor transitions between incarceration and the community. The purpose of this study was to examine how formerly incarcerated women navigate this system to address their reproductive healthcare needs. METHODS: Adult, English-speaking women with history of incarceration within the last 10 years were interviewed using a semi-structured interview tool. Interviews were analyzed using modified grounded theory and stopped upon thematic saturation. Interview themes were used to create a conceptual framework to describe this fragmentation. RESULTS: 21 women completed the study interview. They were on average 43 years old, with 7 periods of incarceration. 80% had children, and 52% were pregnant while incarcerated. Most women described fragmentation of care with inability to consistently access reproductive and prenatal healthcare services. Frequent transitions between institutions exacerbated problems with access. A high prevalence of mental health issues, including high rates of substance use disorder contributed to difficulty accessing needed services. Women suggested better coordination of care could improve their long-term health. CONCLUSION: This study illuminates the persistent reproductive health barriers that face formerly incarcerated women. Programs are needed to address the physical and mental health needs for women transitioning from incarceration back into the community.

Caring for Terminally-Ill Incarcerated Patients: What to Say, Ask, and Do Across Different Settings (SA527)

•Describe health care disparities and challenges regarding access to palliative care and hospice for incarcerated individuals.•Identify and examine unique barriers to providing optimal symptom management to incarcerated people with serious illness.•Explain the eligibility criteria of compassionate release and the processes involved. The United States criminal justice system holds approximately 2.3 million people in correctional facilities—state and federal prisons, jails, and juvenile facilities—which disproportionately impacts people of color and low income. Incarcerated individuals 55 years or older account for four times the healthcare cost compared to their younger counterparts. They often experience accelerated aging because of substance use disorders, insufficient primary care screening, and stress associated with incarceration. Though some correctional facilities have robust medical facilities, many seriously-ill incarcerated patients end up being hospitalized and may interact with palliative care (PC) consultants for symptom management or assistance with complex decision-making. PC teams may desire to provide equitable and quality treatment regardless of their patient's background, yet there is little training that exists on how to work within and through the confines of the correctional system. Due to system barriers, patient's autonomy may be easily compromised. Most state prison systems have a version of “compassionate release.” However, many incarcerated patients are denied compassionate release for not meeting medical requirements. Well-equipped interdisciplinary PC teams can be essential in these settings—with physicians providing accurate prognostication and documentation of hospice eligibility, and social workers and chaplains guiding healthcare staff, incarcerated patients, and their families through the process of compassionate release and preserving dignity for terminally-ill patients. Through didactics, discussion, and case studies, this session will highlight key differences in incarcerated patients' rights and how that impacts their healthcare, particularly regarding symptom management, communication, and medical-decision making. This will include the identification of individuals that may be eligible for compassionate release, and what is involved in that process. By gaining a deeper understanding of the correctional healthcare system, interdisciplinary PC teams will be empowered to better advocate and care for their incarcerated patients.

Sex and Gender Role Differences in Occupational Exposures and Work Outcomes Among Registered Nurses in Correctional Settings.

The correctional environment exposes registered nurses to unique occupational health hazards including, but not limited to, an increased risk for workplace violence. Gender role expectations regarding femininity and masculinity may influence occupational exposures and outcomes differently. Risk comparisons between male and female registered nurses working in correctional settings, have been minimally examined. With the proportion of male registered nurses working in corrections higher than that of nurses working in other healthcare sectors, and with the increasing number of males entering the nursing workforce in general, it is important to characterize and understand occupational exposures and outcomes of male and female registered nurses, especially those working in correctional settings. This paper aims to describe and compare sex and gender role differences in occupational exposures and work outcomes among correctional registered nurses. A cross-sectional web-based survey using Qualtrics was administered to registered nurses working in a northeastern correctional healthcare system between June and October 2016. The survey was composed of 71 items from the CPH-NEW Healthy Workplace All Employee Survey, Assessing Risk of Exposure to Blood and Airborne Pathogens and General Health Survey, Bem Sex Role Inventory-Short Form (BSRI-SF), and the Negative Acts Questionnaire-Revised. Of 95 registered nurse participants, 75% were female with the highest percentage identified as belonging to the feminine group (37%), while the highest percentage of male participants were identified as belonging to the androgynous group (33%). Females worked primarily on the first shift, while males tended to work the second and third shifts (P < 0.05). Over one third of all participants (37%) reported having experienced a sharps-related injury and having been exposed to blood-borne pathogens and body fluids within the previous 2-5 years. The majority of the participants (>95%) reported being at risk for workplace violence and having been victims of workplace violence perpetrated by an inmate. Significant gender differences (P < 0.0001) were noted in the bullying exposure with androgynous nurses having higher occasional bullying. There was a marginal difference in burnout for females (M = 6.8, SD = 2.1) and males (M = 5.8, SD = 1.9, P = 0.05). Effective interventions are needed to address the sex and gender role-based differences in bullying exposure and burnout in order to promote the overall health and well-being of correctional registered nurses.

Work and Health Correlates of Sleep Quantity and Quality Among Correctional Nurses.

The correctional environment exposes nurses to unique physical and psychosocial work stressors, such as inmate violence and safety concerns. Nurses often experience short and poor sleep; however, the quantity and quality of sleep in this specialty practice group of nurses are underexplored. The study objective was to examine a wide range of work and health correlates of sleep quantity and quality in correctional nurses. A Web-based survey was administered to nurses within a Northeastern State Correctional Healthcare System, covering questions on sleep quantity and quality, working conditions, health outcomes, and work outcomes. Among the 89 correctional nurses who participated, 56.2% reported short sleep duration (≤6 hours/day) and 31.8% reported poor sleep quality. Multivariate Poisson regression modeling suggested that night shift (prevalence ratio [PR] = 1.95, p < 0.05) and single marital status (PR = 2.25, p < 0.05) were significantly associated with increased prevalence of short sleep duration, whereas none of the work and health variables were significantly associated with increased prevalence of poor sleep quality, after adjustment for sociodemographics and other covariates. Correctional nurses experience a high prevalence of short and poor sleep. Similar to previous studies, we found that short sleep duration was associated with night shift work. Interventions targeting work schedule remodeling (e.g., reduce the number of consecutive night shifts) and shift work coping mechanisms may promote sleep health of correctional nurses.

"We Take Care of Patients, but We Don't Advocate for Them": Advance Care Planning in Prison or Jail.

To investigate correctional healthcare providers' knowledge of and experience with advance care planning (ACP), their perspectives on barriers to ACP in correctional settings, and how to overcome those barriers. Qualitative. Four prisons in 2 states and 1 large city jail in a third state. Correctional healthcare providers (e.g., physicians, nurses, social workers; N=24). Participants demonstrated low baseline ACP knowledge; 85% reported familiarity with ACP, but only 42% provided accurate definitions. Fundamental misconceptions included the belief that providers provided ACP without soliciting inmate input. Multiple ACP barriers were identified, many of which are unique to prison and jail facilities, including provider uncertainty about the legal validity of ACP documents in prison or jail, inmate mistrust of the correctional healthcare system, inmates' isolation from family and friends, and institutional policies that restrict use of ACP. Clinicians' suggestions for overcoming those barriers included ACP training for clinicians, creating psychosocial support opportunities for inmates, revising policies that limit ACP, and systematically integrating ACP into healthcare practice. Despite an increasing number of older and seriously ill individuals in prisons and jails, many correctional healthcare providers lack knowledge about ACP. In addition to ACP barriers found in the community, there are unique barriers to ACP in prisons and jails. Future research and policy innovation are needed to develop clinical training programs and identify ACP implementation strategies for use in correctional settings. J Am Geriatr Soc 66:2382-2388, 2018.

The selective correctional healthcare system and stigma

본 연구는 교정의료처우에 대한 보건학 중심의 접근이 환자로서 치료받을 권리를 적극 주장하기 어려운 교정시설 수용자들의 상황을 구체화하지 못하였다는 문제의식에서 출발한다. 이에 본 연구는 교정시설에 수용되어 있는 기간 중 의료 처우를 경험한 수용자 8명의 구술을 Goffman(1963)의 스티그마 논의를 연결지어선별적으로 작동하고 있는 교정의료처우 체계와 크게 낙인, 고정관념, 구분, 지위상실, 차별의 다섯 가지 유형으로 나타나는 수용자들의 스티그마 경험을 드러내 고자 했다. ‘환자’와 ‘수용자’에 대한 고정관념에 기반하여 의료과 직원은 ‘치료할 가치 있는 수용자’를 구분하게 되는데, 이는 감시하는 ‘우리’와 감시하는 ‘그들’간의 위계적 역학관계 및 구별짓기와도 깊이 연결되어 있다. ‘치료할 가치 있는 수용자’에 대한 감독자들의 고정관념은 수용자들에게 전이되어 수용자들 간에도 한정된 의료자원 배분을 둘러싸고 아픔의 경중을 구분하는 ‘걸러내기’가 이루어지고 있다. 수용자들에게 외부진료로 발생한 비용을 전액 또는 일부 부담토록 하는 현 교정의료처우 체계는 이러한 걸러내기를 정당화하고 합리화하며, 그 결과 수용자들에게 교정시설 내 의료과는 아픔과 고통을 치유하는 공간이라기보다는 원하는 진 료를 받기 위해 거쳐야 하는 ‘창구’로 인식되고 있다. 교정의료처우 체계가 사회적 자원이 제한된 구금 환경의 수용자에게 건강을 회복하고 존엄성을 유지하는 마지막 수단으로 재인식되기 위해서는 교정의료처우와 관련하여 스티그마를 경 험한 수용자들의 목소리에 귀 기울이고 이를 공유하는 작업의 지속과 확산이 전제되어야 할 것이다.The study starts with the critical review on the perspectives of public health regarding healthcare in correctional settings that fail to describe situations of inmates in correctional facilities who have difficulty in claiming actively their rights to healthcare. In respond to the criticism, the study links Goffman (1963)’s discourse on stigma to the verbal presentations of 8 inmates for interpreting a selective character of correctional healthcare system and their stigma experiences that can be largely defined by 5 components &#8212;labeling, stereotyping, separation, status loss, and discrimination. Based on the stereotype on ‘patient’ and ‘inmate’, the personnel of healthcare department in the facilities sort ‘inmates worthy of care’ out, which is deeply related to the hierarchical dynamics and the distinction between us/the watcher and them/the watched. The stereotype of the personnel on ‘inmates worthy of care’ shifts to the inmates, resulting in ‘filtering’ among inmates to win limited medical resources in the facilities and weigh the relative seriousness of an illness. The current healthcare system in correctional facilities that makes inmates to bear all/some expenses of outpatient healthcare justifies and rationalizes this filtering. The healthcare department in the facilities, as a result, is regarded to the inmates as a ‘counter’ to pass over for a desired healthcare service, rather than a place for healing illness and pain. A continuance and proliferation of the research that focuses on the ‘voice’ of stigmatized inmates is a prerequisite to reappraise the correctional healthcare system as a last resort that maintain health and dignity for incarcerated inmates.

Transitions Clinic Network: Challenges And Lessons In Primary Care For People Released From Prison.

Low-income and minority communities are disproportionately affected by incarceration, which exacerbates health disparities. Through enhanced primary care, the Transitions Clinic Network (TCN) seeks to improve the health of people with chronic conditions who return to their communities from prison. Using TCN data, we assessed the impact of early engagement in primary care and referral from correctional systems to TCN on the use of acute care (emergency department visits and hospitalizations) and recidivism. Of 751 patients, 29.8percent were referred by correctional partners, and 52.7percent were engaged in TCN care within one month after release. In the twelve months after release, patients referred by correctional partners had fewer acute care visits, compared to those referred by community-based partners, while early engagement was associated with more acute care visits. Neither referral by correctional partners nor early engagement was significantly associated with recidivism. Our findings suggest that health equity for this vulnerable population could be achieved through improved coordination between correctional and community health care systems.

Ageing prisoners: An introduction to geriatric health-care challenges in correctional facilities

AbstractThe rise in the number of older prisoners in many nations has been described as a correctional “ageing crisis” which poses an urgent financial, medical and programmatic challenge for correctional health-care systems. In 2016, the International Committee of the Red Cross hosted a conference entitled “Ageing and Imprisonment: Identifying the Needs of Older Prisoners” to discuss the institutional, legal and health-care needs of incarcerated older adults, and the approaches some correctional facilities have taken to meeting these needs. This article describes some of the challenges facing correctional systems tasked with providing health care to older adults, highlights some strategies to improve their medical care, and identifies areas in need of reform. It draws principally on research and examples from the United States to offer insights and recommendations that may be considered in other systems as well.

Underascertainment of acute hepatitis C virus infections in the U.S. surveillance system: a case series and chart review.

In 2010, the incidence of hepatitis C virus (HCV) infection in the United States was estimated to be 17000 cases annually, based on 850 acute HCV cases reported to the Centers for Disease Control and Prevention by local public health authorities. Absence of symptomatic disease and lack of a specific laboratory test for acute infection complicates diagnosis and surveillance. To validate estimates of the incidence of acute HCV infection by determining the reporting rate of clinical diagnoses of acute infection to the Massachusetts Department of Public Health (MDPH) and Centers for Disease Control and Prevention. Case series and chart review. Two hospitals and the state correctional health care system in Massachusetts. 183 patients clinically diagnosed with acute HCV infection from 2001 to 2011 and participating in a research study. Rate of electronic case reporting of acute HCV infection to the MDPH and rate of subsequent confirmation according to national case definitions. 149 of 183 (81.4%) clinical cases of acute HCV infection were reported to the MDPH for surveillance classification. The MDPH investigated 43 of these reports as potential acute cases of HCV infection based on their surveillance requirements; ultimately, only 1 met the national case definition and was counted in nationwide statistics published by the Centers for Disease Control and Prevention. Discordance in clinical and surveillance classification was often related to missing clinical or laboratory data at the MDPH as well as restrictive definitions, including requirements for negative hepatitis A and B laboratory results. Findings may not apply to other jurisdictions because of differences in resources for surveillance. Clinical diagnoses of acute HCV infection were grossly underascertained by formal surveillance reporting. Incomplete clinician reporting, problematic case definitions, limitations of diagnostic testing, and imperfect data capture remain major limitations to accurate case ascertainment despite automated electronic laboratory reporting. These findings may have implications for national estimates of the incidence of HCV infection. National Institutes of Health.

The Current State of Correctional Health Care and the Prisoner’s Right to Healthcare in South Korea

There is increased recognition of prisoners’ rights to healthcare and the right to be protectedagainst inhumane and degrading treatment. A prisoner has a right to the healthcare equivalent of any person in their community. This trend has encouraged many correctionalpolicymakers to engage in efforts to improve the levels of correctional healthcare in thecontext of human rights and to establish international standards of correctional healthcare,such as those cited in ‘Making Standard Work’ and ‘Health in Prisons’. This study compressed the issues of the right to healthcare into four parts and applied to the correctional healthcare system in Korea. In Korea, according to the results of the study,the right to healthcare of inmates in correctional institutions is guaranteed to some extent, but the gap between the normative frame and the reality is prominent. First, in the living conditions at correctional institutions, the problem of overcrowding is remarkably noticeable. With respect to ensuring correctional medical resources, a shortage of medicalpersonnel and the inferior state of the sickrooms that do not meet the criteria were found.Particularly, focusing on outside medical care, the issue of correctional medical expenditurehas been highlighted, due to the continuous increase in medical costs. Finally, the efforts for health promotion and treatment of mental health care are merely formalities. In orderto reduce the gap between international standards and actual conditions of correctionalinstitutions and to promote these rights effectively, close cooperation between the responsiblebodies is required.

Prioritization of inpatient hospital services to prisoners: a method for justifying care and costs.

As a response to rising health care costs and substantial cuts in state funding for correctional health care in Texas, we developed and applied a process framework for systematically prioritizing the provision of inpatient hospital services to prisoners. Specifically, all inpatient services provided from September 2009 through August 2011 at the University of Texas Medical Branch/Texas Department of Criminal Justice Hospital were sorted according to levels of care consistent with those previously defined by the Oregon Department of Corrections and the Federal Bureau of Prisons. Nearly all inpatient services (94%) were deemed medically mandatory (Level 1) or medically necessary (Level 2). These services must be funded to ensure an adequate level of care, and capitated-funding mechanisms may not be sufficiently flexible to cover their costs. Correctional health care systems may adapt the framework used here to inform state policymakers regarding provision of inpatient services and funding requirements.

Measuring the Prevalence of Current, Severe Symptoms of Mental Health Problems in a Canadian Correctional Population

This study measured the prevalence of current, severe symptoms of a mental health problem in an adult population of inmates in Ontario, Canada. The Resident Assessment Instrument-Mental Health was used to measure the prevalence of symptoms among a sample of 522 inmates. Propensity score weighting was used to adjust for nonrandom selection into the sample. Prevalence estimates were derived for the total inmate population, remand and sentenced, males and females, and Aboriginal and non-Aboriginal inmates. It is estimated that 41.1% of Ontario inmates will have at least one current, severe symptom of a mental health problem; of this group, 13.0%, will evidence two or more symptoms. The number of symptoms is strongly associated with presence of a psychiatric diagnosis and level of mental health care needs. Female (35.1%) and Aboriginal (18.7%) inmates are more likely to demonstrate two or more current, severe symptoms. Greater efforts must be made to bridge the gap between correctional and mental health care systems to ensure inmates in correctional facilities can access and receive appropriate mental health care services.