COVID-19, Mental Health and Substance Use in Correctional Settings – Policy Brief: Highlights

ABOUT THE ISSUE

During a pandemic, attention to mental health and substance use is needed more than ever. For people involved in the criminal justice system, including those who are incarcerated, the risks and service gaps are particularly pronounced.

People in correctional facilities often face multiple vulnerabilities, including the double or triple stigma of criminal justice involvement, mental illness, and substance use, which make it difficult to access the services they require. At the same time, the very nature of the corrections system has made it hard for facilities to adhere to public health guidance or maintain continuity of their health and social programming. Together, these factors put people experiencing incarceration at disproportionate risk of contracting COVID-19—while intensifying their existing mental health and substance use risks.

Key Facts

• COVID-19 infections were 6–9x higher in federal/provincial correctional facilities vs. the general population
• 65–70% of people who are incarcerated are living with problematic substance use
• Some people have been kept in their cells 23 hours a day due to lockdowns and restrictions

CHALLENGES

People experiencing incarceration have a higher risk of contracting COVID-19.

Higher rates of pre-existing health conditions among incarcerated populations increase the likelihood of infection and can lead to poorer health outcomes post-infection. Environmental factors (e.g., overcrowding, reduced airflow in older buildings, movement of staff between communities and facilities) also contribute to a higher risk of infection.

The heightened COVID-19 risk is having an adverse impact on mental health.

Concerns about dying, financial worries, and other mental health impacts of COVID-19 are intensified for incarcerated people because they have little control over their risk of exposure. These impacts are particularly challenging for people with pre-existing mental health issues or substance use concerns, who are over-represented in the correctional system.

COVID-19 has added to the service delivery challenges in correctional settings.

Routine assessment, treatment, and referral are affected not only by the infection control measures adopted by correctional facilities but also by difficulties recruiting and retaining healthcare professionals to work in those facilities during a pandemic. Some specialized programs and services (e.g., harm reduction) have also been disrupted or suspended due to COVID-19.

CONSIDERATIONS

Medical isolation should not be set up in the same way as solitary confinement.

While medical isolation is an important infection-control measure, physical space limitations have led some facilities to place people in rooms used for solitary confinement. This poses significant human rights risk and should be done only as a last resort. Especially without ample human contact, it may further strain mental health and increase already high risk for self-harm and suicide.

Decarceration is a key approach for preventing and mitigating the impacts of COVID-19.

For people who are incarcerated and are considered low-risk, are near the end of their sentence, or have pre-existing medical conditions, decarceration (removing people from correctional facilities) and early release can reduce the impacts of COVID-19 on mental health and substance use. It can also help curb infection rates among correctional staff and in nearby communities.

More focus is needed on discharge planning and continuity of care.

To be effective, decarceration must be coupled with adequate community services and resources. Yet planning for discharge and transition into the community is under even more strain due to COVID-19. Many people reentering the community during the pandemic worry about their access to health care as well as key economic and social supports, such as housing and employment.

HIGHLIGHTS OF POLICY RECOMMENDATIONS

To better support the mental health needs and substance use concerns of people who are incarcerated or involved in the criminal justice system during and beyond the COVID-19 pandemic, policymakers and correctional facilities should aim to:

• Ensure universal, routine COVID-19 screening and reporting for all correctional staff and incarcerated persons entering a correctional setting.
• Prioritize access to COVID-19 vaccinations for incarcerated populations, especially those with pre-existing chronic health conditions that increase the risk of COVID-19 complications and death.
• Increase transparency and information-sharing around infection prevention and control measures, and the related impacts on mental health and substance use outcomes in correctional settings.
• Prioritize the integration of substance use services, including harm reduction, into the broader continuum of correctional health and medical services.
• Set up alternatives to medical isolation and limit its use whenever possible. In cases where it is needed, provide a clear justification and get oversight from health professionals and third-party watchdogs.
• Create a national correctional decarceration strategy that is linked with national emergency measures and public health responses.
• Integrate medical records into discharge planning to ensure all relevant medical information is provided at release, supplemented by the systematic collection of gender and race-based data.
• Increase funding for collaborations between correctional facilities and community service providers.
• Ensure continued access to medications, treatment and supports for those being discharged, including alternative housing arrangements for those who are homeless or at risk of becoming homelessness.

VOICES OF PEOPLE WITH LIVED AND LIVING EXPERIENCE

I’ve been doing this for 15 years. People ask me what can we do to make things better, but then it just stays in a report. Everyone in this room knows where the barriers are and what needs to be changed. I just want to see action be taken.