Prison Health is Public Health: Inside the ICPA Healthcare Network's Mission to Transform Correctional Care

Correctional facilities hold some of society's most vulnerable people. Rates of mental illness, substance use disorders, chronic and infectious disease, disability, and trauma are all significantly higher among people in custody than in the general population. For too long, healthcare in correctional settings has been treated as a secondary concern. The ICPA Healthcare Network exists to change that. 

Bringing together healthcare professionals, correctional leaders, academics, policymakers, and researchers from around the world, the Network is united by a shared belief: health is fundamental to safe, humane, and effective correctional systems. In this spotlight, the Network shares its perspective on some of the most pressing issues in correctional healthcare today, from mental health and equity to workforce shortages and the powerful idea that prison health is public health. 

Could you introduce the ICPA Healthcare Network and explain why dedicated attention to health and wellbeing in correctional settings is so essential within the broader corrections community? 

The ICPA Healthcare Network exists to advance health, wellbeing, and healthcare quality across correctional systems globally, bringing together professionals who share a common belief that health is fundamental to safe, humane, and effective correctional systems. 

Dedicated attention to health and wellbeing is essential precisely because correctional facilities concentrate some of society's most vulnerable populations. People entering custody often have significantly higher rates of mental illness, substance use disorders, chronic disease, infectious disease, disability, and histories of trauma than the general population. These challenges do not disappear at the prison gate. In many cases, they become more visible and more urgent. 

Too often, healthcare in correctional settings has been viewed as a secondary function. The reality is that health is central to institutional safety, rehabilitation, and successful reintegration. A person whose mental illness is untreated, whose substance use disorder is unmanaged, or whose chronic health condition is neglected is less likely to engage positively in their sentence and more likely to experience poor outcomes both in custody and after release. 

The Network advocates for healthcare grounded in evidence, ethics, human rights, and professional excellence, supporting the principles outlined in the United Nations Nelson Mandela Rules, including the principle of equivalence of care, which states that people deprived of liberty should receive healthcare of the same standard available in the community. 

Ultimately, correctional healthcare is not simply about treating illness. It is about protecting dignity, reducing health inequities, supporting rehabilitation, and contributing to safer communities. When correctional systems invest in health, they invest in better outcomes for individuals, institutions, and society as a whole. 

People in custody often come from backgrounds marked by complex health needs, trauma, and limited access to care. How should correctional health services respond to this reality, and what does truly equitable healthcare in a custodial setting look like? 

Many people who enter custody have experienced significant disadvantage long before their involvement with the justice system. Histories of poverty, homelessness, trauma, violence, addiction, untreated mental illness, and limited access to healthcare are common across correctional populations worldwide. In many respects, prisons and jails concentrate existing health inequities rather than create them. 

Correctional health services must therefore move beyond a purely reactive model of care. Equitable healthcare means recognising the complex realities that people bring with them into custody and responding with services that are person-centered, trauma-informed, culturally responsive, and clinically appropriate. 

The principle of equivalence of care is fundamental, but true equity goes further. Two people may have equal access to healthcare services while having very different healthcare needs. Equitable care requires correctional health systems to identify and address those differing needs in a way that enables individuals to achieve comparable health outcomes. 

This includes comprehensive health assessments on entry, integrated physical and mental healthcare, effective management of substance use disorders, access to specialist services where required, and continuity of care upon release. It also means recognising the particular needs of women, older adults, young people, Indigenous populations, and other groups who may experience additional vulnerabilities. 

At its core, equitable healthcare in custody respects the inherent dignity and humanity of every person. The loss of liberty should never result in the loss of access to quality healthcare. Correctional systems have both an ethical obligation and a public health responsibility to ensure that people leave custody healthier, more stable, and better connected to care than when they entered. 

Mental health remains one of the most significant and challenging areas in correctional healthcare. What approaches or models is the Network seeing that are making a genuine difference for individuals in custody? 

Mental health is arguably the greatest healthcare challenge facing correctional systems globally. In many jurisdictions, prisons and jails have become the default destination for individuals whose primary needs are mental health, addiction, housing, or social support services rather than incarceration. 

The scale of the challenge requires more than additional clinicians or more beds. It requires a whole-system approach. Across the Network, encouraging examples are emerging of correctional systems adopting trauma-informed models of care that recognise how past experiences shape behaviour, engagement, and wellbeing. These approaches can reduce conflict, improve therapeutic relationships, and create safer environments for both staff and people in custody. 

Positive results are also being seen from multidisciplinary teams that bring together healthcare professionals, mental health specialists, correctional staff, social workers, and community providers. Effective mental healthcare in custody cannot operate in isolation; it requires coordinated support that addresses the broader determinants of health and wellbeing. 

Peer support programmes are another area of growing promise. Individuals with lived experience often have unique credibility and can help engage people who might otherwise be reluctant to access services. Similarly, telepsychiatry and digital health technologies are helping expand access to specialist care, particularly in remote or resource-constrained settings. 

Perhaps most importantly, successful systems recognise that mental health is everyone's responsibility. Every interaction within a correctional environment can either contribute to wellbeing or undermine it. Creating psychologically safe, humane, and respectful environments benefits not only individuals in custody but also staff wellbeing, institutional stability, and public safety outcomes. 

Healthcare professionals working in corrections often navigate a difficult tension between their duty of care to patients and the custodial environment they operate in. How does the Network support its members in upholding medical ethics and professional independence in that context? 

Healthcare professionals working in correctional settings occupy a uniquely challenging position. They are required to deliver care within environments where legitimate security considerations exist, while maintaining their professional, ethical, and legal obligations to patients. 

The ICPA Healthcare Network strongly supports the principle of clinical independence. Healthcare decisions should be based on clinical need, evidence, ethics, and professional standards rather than operational convenience or custodial priorities. This principle is recognised within international human rights frameworks, including the Nelson Mandela Rules, and remains fundamental to quality correctional healthcare. 

In practice, maintaining that independence is not always straightforward. Healthcare professionals may encounter situations where security requirements, operational pressures, or resource limitations create tension with clinical priorities. Navigating these situations requires strong professional leadership, clear governance arrangements, and a culture of mutual respect between healthcare and correctional services. 

The Network provides a forum where members can openly discuss these challenges, share lessons learned, and explore practical solutions, facilitating international dialogue on ethical practice, professional standards, leadership, and system design, recognising that many of these challenges are shared across jurisdictions. 

Importantly, clinical independence should not be viewed as being in opposition to correctional objectives. In reality, healthcare and security are often mutually reinforcing. Effective healthcare contributes to safer facilities, reduced violence, improved rehabilitation outcomes, and better institutional stability. The most successful correctional systems understand that healthcare professionals and correctional staff are partners working toward a common goal: safe, humane, and effective environments that respect the dignity and rights of all individuals. 

What would you identify as the most urgent and underaddressed healthcare challenges in correctional settings globally, and where does the Network believe the field most needs to move forward? 

Several healthcare challenges demand urgent attention across correctional systems globally. Mental health and substance use disorders remain among the most significant and persistent issues. Many facilities continue to house individuals whose primary needs are healthcare and social support rather than incarceration, yet resources often remain inadequate to meet those needs effectively. 

Workforce shortages also represent a growing crisis. Recruiting and retaining qualified healthcare professionals in correctional settings is increasingly difficult in many parts of the world. Without a sustainable workforce, even the best policies and clinical models cannot achieve their intended outcomes. 

Infectious diseases continue to require focused attention. HIV, tuberculosis, hepatitis B, hepatitis C, and other communicable diseases often occur at disproportionately high rates among incarcerated populations. While significant progress has been made in many jurisdictions, substantial gaps remain in screening, diagnosis, treatment, prevention, and continuity of care. 

Another under-addressed challenge is the transition from custody back into the community. Too many individuals experience disruptions in medication, treatment, housing, and social support immediately following release. This period is associated with elevated risks of overdose, suicide, relapse, and poor health outcomes. 

Looking forward, the field must embrace greater integration with public health systems, stronger workforce development, improved use of data and evidence, and responsible adoption of technology. Digital health records, telehealth, predictive analytics, and innovative screening approaches have the potential to improve quality, continuity, and access to care. However, technology alone is not the solution. Progress ultimately depends on leadership, investment, partnerships, and a sustained commitment to placing health and human dignity at the center of correctional practice. 

The ICPA Healthcare Network has championed the idea that prison health is public health. What does this mean in practice, and how can correctional and public health systems work more closely together to benefit both people in custody and the wider community? 

The phrase “prison health is public health” captures a simple but profoundly important reality: correctional facilities do not exist in isolation from the communities around them. People in custody eventually return home. Staff move between facilities and communities every day. Families maintain connections with loved ones in custody. The health of correctional populations is therefore inseparable from the health of society as a whole. 

This principle becomes particularly clear when considering infectious diseases, mental health, substance use disorders, and chronic illnesses. Failure to diagnose, treat, and manage these conditions in correctional settings has consequences that extend far beyond prison walls. Conversely, effective healthcare in custody contributes directly to healthier communities, reduced healthcare costs, and improved public safety outcomes. 

In practice, treating prison health as public health requires far greater integration between correctional and community healthcare systems. Healthcare governance should align with national health priorities. Clinical standards should be equivalent. Information sharing should support continuity of care while protecting privacy and professional ethics. Release planning should begin well before an individual leaves custody. 

The COVID-19 pandemic reinforced the importance of this approach, demonstrating how rapidly health challenges can move between correctional facilities and the broader community. Similar lessons apply to tuberculosis, HIV, hepatitis, mental health crises, and substance use disorders. 

The future lies in stronger partnerships between correctional agencies, health ministries, community providers, academic institutions, and civil society organisations. When correctional healthcare is integrated into broader public health systems, everyone benefits. Healthier people in custody become healthier people in communities, and healthier communities contribute to safer and more effective correctional systems.