Complementary and alternative medicine in corrections: How can we supplement treatment provided on the inside to increase compliance on the outside?

Author:Miskell, Mike

Western medicine has led to many beneficial advances to promote harm reduction and prolong life. Pharmaceuticals and surgical interventions can "fix" someone quickly and have a patient getting back to their normal routine at an incredibly faster pace than a century ago. Even a decade ago, for that matter.

But at what cost do some of these options occur? That's not meant to be figurative costs. There are literal, financial costs associated with modern medicine. Some public health systems, like state departments of corrections, operate within a limited budget with minimal governmental support. On an annual or semiannual basis, correctional administrators must approach their state legislatures to support funding requests to ensure their inmate-patients receive community standards of comprehensive healthcare. With budgets being tightened, correctional healthcare administrators are expected to be doing more with less. This can lead to more scrutiny over utilization review, constant revisions of pharmacy formularies, and increased oversight of how every component of treatment is being delivered.

This provides correctional agencies an opportunity to get creative with the different types of care they're able to provide and how they provide it. An option that has growing efficacy in the community are complementary and alternative medicines (CAM).

This article provides CAM options and justifications for healthcare administrators to consider as treatment and programming options for their inmate-patient population. The hope is that implementing CAM programs will benefit correctional agencies financially and, more importantly, improve their inmate-patient medical and mental health.

Inmate-patient population

The incarcerated population housed in correctional facilities within the United States (U.S.) need more options to improve their overall health. Chronic illnesses such as hypertension, heart disease and asthma have higher prevalence with the justice-involved population (Katzen, 2011). Access to care in the community has historically been a difficult issue for many justice-involved individuals due to a variety of reasons that relate to socioeconomic backgrounds (Katzen, 2011).

Physical exams are required for all individuals in the weeks following intake to a facility. For a large portion of this population, they are being diagnosed and provided with physical and mental health treatment for the first time in years. But upon reentry to society, many individuals will not continue to access healthcare and regular treatment. Noncompliance with follow-up of treatment plans is typical for the population reentering the community.

Complementary and Alternative Medicines

If a non-mainstream practice is used together with conventional medicine, it's considered "complementary." If a non-mainstream practice is used in place of conventional medicine, it's considered "alternative" (National Institutes of Health, 2018). To have better success for achieving higher quality of life, physical and mental health is of the utmost importance. In addition to compliance with regular treatment plans, CAM should be taught to incarcerated individuals.

This is not to replace medical orders, but to act as the name implies. These should complement and, if possible, be an alternative to existing interventions when symptoms can be effectively managed using CAM. Many CAM options find their roots in holistic and ayurvedic medicine. Finding cost-effective resources that will assure maintaining treatment compliance can benefit the incarcerated population and correctional institutions. This can lead to better outcomes for public health.

Correctional Facility Capabilities

Prescription drugs are very effective in managing symptoms of illness, but CAM can be made more readily available to offenders to promote overall wellness. There are facilities that currently utilize these modalities, but exemplary practices with peer-reviewed research that justify programs as evidence-based are not readily available.

Potential environments to introduce CAM options can exist at nearly all levels of housing units within a correctional agency. Wherever group programming space is available, CAM programs can be taught. This is also achievable during individual treatment or therapy sessions. Many CAM options can be performed alone in a single cell.

Some CAM programming can be very useful in specialized units. As increases in various segments of correctional populations increase, departments have grown accustomed to housing similar cohorts in similar environments. For example, a housing unit for geriatric patients may benefit from a certain CAM option while a unit designed for residential mental health treatment or a different unit that houses military veterans may find interest and compliance in other CAM programs. The main point is that there are a variety of different options that can be attempted with minimal physical plant and security constraint.

CAM Interest

Picking a CAM that is suitable for the incarcerated population is no simple task. There is growing evidence that various types of CAM can be effective for different sections of populations and these cohorts are also representative of inmate-patients. Offering various CAM program options can lead to a reduction in severity and frequency of a variety of symptoms. These can also be cost-effective and yield physiological and psychological improvement. CAM is also easily translated back into the community upon reentry. Research has shown it is useful for individuals with a variety of medical problems, mental health issues, and substance use disorders. CAM also benefits the elderly and those diagnosed with cancer. All of these critical issues are representative of inmate-patients.

Physical and mental health issues

There is a common theme in CAM research relating to pain management. Globally...

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