The Health and Health Needs of People under Community Supervision

• DOI: http://doi.org/10.1177/00027162221119661
• Published date: 01 May 2022
• Date: 01 May 2022
• Subject Matter: Promoting Social Integration: Health, Housing, and Community

172 ANNALS, AAPSS, 701, May 2022

DOI: 10.1177/00027162221119661

The Health and

Health Needs

of People under

Community

Supervision

By

LAURA C. HAWKS,

NADINE HORTON,

and

EMILY A. WANG

1119661ANN THE ANNALS OF THE AMERICAN ACADEMYHEALTH OF PEOPLE UNDER COMMUNITY SUPERVISION

research-article2022

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

Introduction

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.

Correspondence: lhawks@mcw.edu

HEALTH OF PEOPLE UNDER COMMUNITY SUPERVISION 173

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