The Health and Health Needs of People under Community Supervision

AuthorLaura C. Hawks,Nadine Horton,Emily A. Wang
Published date01 May 2022
Date01 May 2022
Subject MatterPromoting Social Integration: Health, Housing, and Community
172 ANNALS, AAPSS, 701, May 2022
DOI: 10.1177/00027162221119661
The Health and
Health Needs
of People under
Americans under community supervision experience
high rates of chronic disease, mental illness, and sub-
stance use disorders but have poor access to high-
quality preventive care and treatment. Pervasive
barriers to healthcare and health insurance reinforce
poor health, as do restrictions to evidence-based addic-
tion treatment. We propose that community supervi-
sion agencies transfer management of the health of
supervised individuals to an expanded community-
based healthcare system and that they abandon prac-
tices at odds with the science of addiction medicine
(e.g. prohibitions on medications to treat addiction, and
revocation of community release for addiction relapse).
Further, we argue that correctional systems should
prioritize health of those under supervision by stand-
ardizing health-related protocols, including basic needs
resources in discharge planning, and leveraging the
skills of individuals with lived experiences in the
correctional system. If implemented, the success of
our recommendations would require expansion of
community-based primary care, mental health, and
addiction treatment centers.
Keywords: health; access to healthcare; probation;
parole; criminal legal system
The United States has the world’s largest system
of correctional control, involving 6.4 million peo-
ple. Two-thirds of this population (4.5 million)
are surveilled under community supervision,
including probation—a court-ordered period of
correctional supervision in the community as an
Laura C. Hawks is a primary care physician and health
services researcher in the Division of General Internal
Medicine at the Medical College of Wisconsin.
Nadine Horton is a research assistant at the Yale School
of Medicine in the section of General Internal Medicine
and a community organizer in New Haven, Connecticut.
Emily A. Wang is a professor in the Yale School of
Medicine where she is an internist and the director of
the SEICHE Center for Health and Justice.
alternative to incarceration—and parole—a period of conditional supervised
release in the community following a term in state or federal prison (The
Sentencing Project 2021).
Individuals under community supervision are at higher risk of physical illness,
mental illness, and substance use disorder; and research suggests that the dete-
riorative health effects of criminal legal involvement are largely borne out in the
community when people are released from correctional facilities (Spaulding
etal. 2011; Wildeman, Goldman, and Wang 2019). After incarceration, people
are at increased risk of mortality—especially immediately following release. Risk
of death due to drug overdose, heart attacks, and mental health emergencies
including suicidality is especially high (Binswanger etal. 2007). After incarcera-
tion, people are more likely to have worsening control of chronic health condi-
tions and to experience emergency department visits and hospitalizations at a
relatively high rate (Frank etal. 2013; Howell etal. 2016; Meyer etal. 2014;
Wang, Wang, and Krumholz 2013).
Yet mounting evidence suggests that simply being on probation (typically
accompanied by little or no time imprisoned) is associated with worse health out-
comes (Hawks etal. 2020; Wildeman etal. 2019; Winkelman etal. 2020) Compared
to people not on community supervision, those on probation have higher rates of
physical illness, mental illness, and substance use disorders. Further, they are less
likely to receive outpatient care—where people typically receive preventive care
and chronic disease management—and are more likely to present for emergency
care and to be hospitalized (Hawks etal. 2020). Moreover, those on probation are
at high risk of death, not only compared to the general U.S. population, but also
compared to those in prison and jail (Wildeman etal., 2019).1 However, despite this
research and the large number of Americans living under community supervision,
healthcare professionals often overlook the health, well-being, and health needs of
those on community supervision. Yet good health is necessary for social integration
following conflict with the law. In the first section of this article, we describe exist-
ing research on the health and well-being of Americans on community supervision,
highlight newer studies on the health effects of probation specifically, and review
the unique healthcare challenges faced by those on probation and parole. In the
second section, we describe our recommendations for improving the health of
those on community supervision. These recommendations center on reducing the
scope of supervision, incorporating the science of addiction medicine to commu-
nity supervision, and shifting the management of health needs from supervision to
the community healthcare system.
The Health of Those under Community
Supervision: Current Research
One in fifty-nine Americans is currently on community supervision, a population
that has grown by over 200 percent in the past three decades. As with all forms
of criminal legal involvement, drastic disparities exist by race, gender, and

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