Supporting people leaving prisons during COVID-19: perspectives from peer health mentors

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Abstract

Purpose

Currently, people leaving prisons face concurrent risks from the COVID-19 pandemic and the overdose public health emergency. The closure or reduction of community services people rely on after release such as treatment centres and shelters has exacerbated the risks of poor health outcomes and harms. This paper aims to learn from peer health mentors (PHM) about changes to their work during overlapping health emergencies, as well as barriers and opportunities to support people leaving prison in this context.

Design/methodology/approach

The Unlocking the Gates (UTG) Peer Health Mentoring Program supports people leaving prison in British Columbia during the first three days after release. The authors conducted two focus groups with PHM over video conference in May 2020. Focus groups were recorded and transcribed, and themes were iteratively developed using narrative thematic analysis.

Findings

The findings highlighted the importance of peer health mentorship for people leaving prisons. PHM discussed increased opportunities for collaboration, ways the pandemic has changed how they are able to provide support, and how PHM are able to remain responsive and flexible to meet client needs. Additionally, PHM illuminated ways that COVID-19 has exacerbated existing barriers and identified specific actions needed to support client health, including increased housing and recovery beds, and tools for social and emotional well-being.

Originality/value

This study contributes to our understanding of peer health mentorship during the COVID-19 pandemic from the perspective of mentors. PHM expertise can support release planning, improved health and well-being of people leaving prison and facilitate policy-supported pandemic responses.

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Most cited references 36

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Using community-based participatory research to address health disparities.

Nina B Wallerstein, Bonnie Duran (2006)

Community-based participatory research (CBPR) has emerged in the past decades as an alternative research paradigm, which integrates education and social action to improve health and reduce health disparities. More than a set of research methods, CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of colearning, mutual benefit, and long-term commitment and incorporates community theories, participation, and practices into the research efforts. As CBPR matures, tensions have become recognized that challenge the mutuality of the research relationship, including issues of power, privilege, participation, community consent, racial and/or ethnic discrimination, and the role of research in social change. This article focuses on these challenges as a dynamic and ever-changing context of the researcher-community relationship, provides examples of these paradoxes from work in tribal communities, discusses the evidence that CBPR reduces disparities, and recommends transforming the culture of academia to strengthen collaborative research relationships.

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Release from prison--a high risk of death for former inmates.

Ingrid A Binswanger, Marc F Stern, Richard A Deyo … (2007)

The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons. We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race. Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide. Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison. Copyright 2007 Massachusetts Medical Society.

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Prisons and custodial settings are part of a comprehensive response to COVID-19

Stuart Kinner, Jesse T Young, Kathryn Snow … (2020)

Prisons are epicentres for infectious diseases because of the higher background prevalence of infection, the higher levels of risk factors for infection, the unavoidable close contact in often overcrowded, poorly ventilated, and unsanitary facilities, and the poor access to health-care services relative to that in community settings. 1 Infections can be transmitted between prisoners, staff and visitors, between prisons through transfers and staff cross-deployment, and to and from the community. As such, prisons and other custodial settings are an integral part of the public health response to coronavirus disease 2019 (COVID-19). One of the first documented influenza outbreaks in prison occurred in San Quentin prison in California, USA, during the 1918 influenza pandemic. In three separate instances, infection was introduced by a newly received prisoner, and a single transfer to another prison resulted in an outbreak there. Isolation was central to containment. 2 More recently, prison influenza outbreaks have been described in the USA, Canada, Australia, Taiwan, and Thailand.3, 4 We are unaware of any published reports of influenza outbreaks in youth detention or immigration detention centres, although modelling suggests that outbreaks would progress similarly in these settings. 5 Since early 2020, COVID-19 outbreaks have been documented worldwide, including Iran, where 70 000 prisoners have been released in an effort to reduce in-custody transmission. 6 Prisons concentrate individuals who are susceptible to infection and those with a higher risk of complications. COVID-19 has an increased mortality in older people and in those with chronic diseases or immunosuppression. Notably, multimorbidity is normative among people in prison, often with earlier onset and greater severity than in the general population, and prison populations are ageing in many countries. 7 Furthermore, inadequate investment in prison health, substantial overcrowding in some prison settings, and rigid security processess have the potential to delay diagnosis and treatment. As such, COVID-19 outbreaks in custodial settings are of importance for public health, for at least two reasons: first, that explosive outbreaks in these settings have the potential to overwhelm prison health-care services and place additional demands on overburdened specialist facilities in the community; and second, that, with an estimated 30 million people released from custody each year globally, prisons are a vector for community transmission that will disproportionately impact marginalised communities. What must be done to mitigate the impact of large outbreaks of COVID-19 in prisons? The public health importance of prison responses to influenza outbreaks has been recognised in the USA, 8 where the Centers for Disease Control and Prevention have developed a checklist for pandemic influenza preparedness in correctional settings. WHO has also issued prison-specific guidance for responding to COVID-19 (panel ). 9 Panel Prison-specific guidance for responding to COVID-19 Joint planning Include prison health and correctional authorities in the overall public health response, rather than permitting them to plan and operate in isolation. Risk management Design and implement adequate systems for limiting importation and exportation of cases from or to the community, and transmission and spread within prisons. Prevention and control Develop protocols for entry screening, personal protection measures, social distancing, environmental cleaning and disinfection, and restriction of movement, including limitation of transfers and access for non-essential staff and visitors. Treatment Explicitly and transparently align prison health systems with the wider health and emergency planning systems, including transfer protocols for patients requiring specialised care. Isolate cases and contacts if required to control the spread of infection in prisons. However, special consideration of the potentially serious mental health effects of isolation in these settings is essential.10, 11 In high-income countries, maintaining isolation without depriving incarcerated people of human contact might be possible. 12 Information sharing Close collaboration between health and justice ministries should be established to ensure continuity of information, which is a crucial component of an effective, coordinated, whole-of-government response. Governance of prison health by a ministry of health, rather than a ministry of justice or similar, is likely to facilitate timely information sharing. 13 Prison health is public health by definition. Despite this and the very porous borders between prisons and communities, prisons are often excluded or treated as separate from public health efforts. The fast spread of COVID-19 will, like most epidemics, disproportionately affect the most disadvantaged people. Therefore, to mitigate the effects of prison outbreaks on tertiary health-care facilities and reduce morbidity and mortality among society's most marginalised, it is crucial that prisons, youth detention centres, and immigration detention centres are embedded within the broader public health response.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Prison Health

Journal ID (iso-abbrev): Int J Prison Health

Journal ID (publisher-id): IJPH

Journal ID (doi): 10.1108/IJPH

Title: International Journal of Prisoner Health

Publisher: Emerald Publishing Limited

ISSN (Print): 1744-9200

ISSN (Electronic): 1744-9219

Publication date (Electronic): 17 February 2021

Publication date (Print, pub): 2021

Volume: 17

Issue : 3 Issue title : Managing Covid-19 and other epidemics in prisons and places of detention Issue title : Managing Covid-19 and other epidemics in prisons and places of detention

Pages: 206-216

Affiliations

[1]School of Population and Public Health, University of British Columbia , Vancouver, Canada and the Collaborating Centre for Prison Health and Education, University of British Columbia , Vancouver, Canada

[2]Interdisciplinary Studies, University of British Columbia , Vancouver, Canada

[3]School of Population and Public Health, University of British Columbia , Vancouver, Canada and the Collaborating Centre for Prison Health and Education, University of British Columbia , Vancouver, Canada

[4]Justice Studies, Nicola Valley Institute of Technology , Burnaby, Canada and the Collaborating Centre for Prison Health and Education, University of British Columbia , Vancouver, Canada

[5]School of Population and Public Health, University of British Columbia , Vancouver, Canada; the Collaborating Centre for Prison Health and Education, University of British Columbia , Vancouver, Canada and the BC Centre for Disease Control, Vancouver, Canada

[6]School of Population and Public Health, University of British Columbia , Vancouver, Canada and BC Children's Hospital Research Institute , Vancouver, Canada

[7]School of Population and Public Health, University of British Columbia , Vancouver, Canada and the Collaborating Centre for Prison Health and Education, University of British Columbia , Vancouver, Canada

Author notes

Corresponding author: Katherine E. McLeod can be contacted at: kate.mcleod@ 123456ubc.ca

Article

Publisher ID: 658834

DOI: 10.1108/IJPH-09-2020-0069

PMC ID: 8753623

PubMed ID: 33656310

SO-VID: 0f6a3dd5-2f5a-4a24-8b42-24251c614e12

Copyright © © Katherine E. McLeod, Kelsey Timler, Mo Korchinski, Pamela Young, Tammy Milkovich, Cheri McBride, Glenn Young, William Wardell, Lara-Lisa Condello, Jane A. Buxton, Patricia A. Janssen and Ruth Elwood Martin.

License:

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at https://creativecommons.org/licenses/by/4.0/

History

Date received : 21 September 2020

Date revision received : 23 November 2020

Date revision received : 18 December 2020

Date accepted : 18 December 2020

Page count

Figures: 0, Tables: 0, Equations: 0, References: 46, Pages: 1, Words: 6513

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ScienceOpen disciplines: Health & Social care

Keywords: public health,prison,throughcare,qualitative research,covid-19,peer health mentor

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ScienceOpen disciplines: Health & Social care

Keywords: public health, prison, throughcare, qualitative research, covid-19, peer health mentor

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Supporting people leaving prisons during COVID-19: perspectives from peer health mentors

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Abstract

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Design/methodology/approach

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Originality/value

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Emerald: Healthier Lives

Most cited references 36

Using community-based participatory research to address health disparities.

Release from prison--a high risk of death for former inmates.

Prisons and custodial settings are part of a comprehensive response to COVID-19

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Cited by 7

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