Celebrating Milestones, Looking Ahead
by Jayne Russell, MEd, CCHP-A
We all know the saying “time flies,” and many of us with appreciable years in correctional health care can reflect on significant and necessary changes, although some at a slow rate. For those of you less seasoned in this field, this may serve to give you perspective and insight on what work remains to be done—and the time is now. Our NCCHC conferences in 2016 will focus on three historic milestones:
• This year is the 40th anniversary of Estelle v. Gamble, the Supreme Court landmark case that spurred action in correctional health care.
• The first National Conference on Correctional Health Care was held 40 years ago and we will mark this milestone at this year’s meeting, Oct. 22-26 in Las Vegas.
• NCCHC’s Certified Correctional Health Professional program celebrates it 25th anniversary.
Crusade for Humane Treatment
Looking back prior to Estelle, that was a time when medical care was often performed by inmates in the absence of trained clinical staff. Custody operations were mainly uncensored with little accountability; inmates were truly the property of the state. Movies like “Brubaker” and “The Shawshank Redemption” awakened the general public and remind us that the crusade for justice and humane treatment was not that long ago. We who work in corrections have heard similar shocking stories about the past.
Since 1976, the courts have protected an inmate’s constitutional right to health care as established by Estelle v. Gamble. This ruling guaranteed three basic rights: the right to access to care, the right to care that is ordered and the right to a professional medical judgment. NCCHC’s accreditation standards for jails, prisons and juvenile facilities were developed to support constitutionally mandated care and they promulgate an effective and efficient service delivery system. During the past 40 years, our field has expanded far beyond the basic tenets of guaranteed rights to care. Today we grapple with complex public health issues, widespread substance abuse and treatment, mental health challenges, costly and evolving psychopharmacology, telemedicine, specialty services, HIPAA, LGBT guidelines and cultural competency and sensitivity.
A Respected Profession
The American Medical Association held its first conference on Improved Medical Care and Health Services in Jails in 1977 with about 75 attendees. A decade later, the NCCHC annual conferences were well rooted with a steadily growing attendance. Today, several thousands of correctional health professionals participate in our educational programs each year. There is no question that correctional health care has earned its status as a qualified, respected profession.
That status is underscored by professional certification. Twenty-five years ago, a small group of NCCHC leaders and supporters initiated the Certified Correctional Health Professional program. This year the program boasts 3,600 participants, including those who have achieved advanced certification or specialty certification for RNs, mental health professionals and physicians. This demonstration of commitment and competency is a strong testament to our colleagues who share our goals and advance our efforts every day.
Challenges and Progress
We have reason to be proud of what we do and the progress we’ve made; looking back, it gives us cause to celebrate the advancements in our field. Yet we will not lose sight of our current challenges. Opioid use is advancing rapidly into all neighborhoods. The mentally ill have few treatment options in the community. Consequently, correctional systems are strained with mentally ill populations and substance abusers. Jails, in particular, are the first stop for offenders high on unknown substances. Often there is little to no medical history available, and jails bear the burden of keeping these people alive under constant threat of litigation. In addition, correctional agencies continually struggle with fiscal restraint and sometimes minimal staffing.
These community challenges are prevalent in all states and have escalated over decades, while resources remain inadequate. Yet, we are making strides. We now have specialized courts for defendants with substance abuse disorders and mental illness. Multiagency collaborations created these services to facilitate community-based treatment for those who are not a public safety risk. This significant criminal justice component seeks to divert populations from incarceration and offers less costly alternatives. We are experiencing a slow but major shift to reform criminal justice views, and to provide options, treatment and appropriate placement—which need not always be incarceration.
Will there be a landmark case in our future that will allow us to look back 40 years from now and say, “How shocking—we used to lock these folks up and force jails to be their caretakers”? We’re not there yet, but looking ahead 40 years, corrections demographics should most certainly shift in accordance with our evolving perspective on criminal justice and social justice.
Jayne Russell, MEd, CCHP-A, is chair of NCCHC’s board of directors and serves as the Academy of Correctional Health Professionals’ liaison to the board. She works as an independent consultant in correctional health care.