“When you first walk out the gates…where do [you] go?”: Barriers and opportunities to achieving continuity of health care at the time of release from a provincial jail in Ontario

Abstract

We aimed to explore continuity of health care and health barriers, facilitators, and opportunities for people at the time of release from a provincial correctional facility in Ontario, Canada. We conducted focus groups in community-based organizations in a city in Ontario, Canada: a men's homeless shelter, a mental health service organization, and a social service agency with programs for people with substance use disorders. We included adults who spoke English well enough to participate in the discussion and who had been released from the provincial correctional facility in the previous year. We conducted three focus groups with 18 total participants. Participants had complex health needs on release, including ongoing physical and psychological impacts of time in custody. They identified lack of access to high quality health care; lack of housing, employment, social services, and social supports; and discrimination on the basis of incarceration history as barriers to health on release. Access to health care, housing, social services, and social supports all facilitated health on release. To address health needs on release, participants suggested providing health information in jail, improving discharge planning, and developing accessible clinics in the community. This pilot study identified opportunities to support health at the time of release from jail, including delivery of programs in jail, linkage with and development of programs in the community, and efforts to support structural changes to prevent and address discrimination. These data will inform ongoing work to support health and continuity of care on release from a provincial correctional facility.

Physicians’ perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study

“…The barriers to continuity of care identified by providers, including disruptions to patientprovider relationships, medication access and health insurance coverage, align well with findings from previous research that explored experiences of individuals recently released from incarceration, as well as physicians who work in jail or prison settings [22][23][24][25]. Such disruptions to care may contribute to poor health outcomes and an increased risk of recidivism.…”

Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era

“…There is a growing body of evidence on successful transitional programs to engage patients with healthcare services after release—mainly conducted by community-based providers and NGOs—ranging from reminder calls to intensive case management [ 43 ]. Three studies from the USA have reported that only one-quarter of patients who returned to the community were linked to HCV care after incarceration [ 15 , 30 , 44 ].…”

Quality of Antenatal Care for Women Who Experience Imprisonment in Ontario, Canada

“…These factors would differ while in prison and in the community: in the community, housing, family responsibilities, and substance use may play a bigger role, and in prison, women may need to deal with medical issues, such as withdrawal, and logistical issues, such as court attendance and challenges in accessing health care. 24 In addition, the time around imprisonment may represent a period of increased challenges for women who experience imprisonment, for example, related to illicit drug use, which may lead to imprisonment itself in the context of criminalization and could also be associated with less antenatal care. This issue could further explain the difference between prison pregnancies and prison control pregnancies (ie, worse antenatal care use for women during prison pregnancies may be associated in part with a challenging period in women’s lives as well as with imprisonment itself).…”