Ignored, Ill, and Incarcerated
Why Prison Healthcare Is Everyone’s Problem
7/6/20256 min read
How the System Fails
As of 2025, nearly 2 million people are incarcerated in American prisons, (Sawyer 2025) and nearly 40% of those people have been diagnosed with a mental health disorder (National Alliance on Mental Illness). Under the eighth amendment of the constitution, prisoners are protected from cruel and unusual punishment, which means they have a right to access an adequate amount of food, shelter, clothing, and crucially, healthcare. Because of the sheer number of prisoners living within the U.S Prison System, the state is responsible for attending to all of the healthcare needs of the incarcerated.
Despite this responsibility, the state fails to provide the incarcerated with adequate healthcare, which leads to widespread preventable disease and death in prisons. This problem disproportionately impacts disadvantaged communities who already face structural barriers to healthcare and economic stability like African Americans, Latinos, and Native Americans. Native American Reservations, inner city neighborhoods that are predominantly black, and other neighborhoods that are predominantly made up of members of a disadvantaged group feel this issue much more than the rest of the nation. Since 95% incarcerated individuals end up returning to their communities, the systemic dangers of inadequate prison healthcare extends beyond prison walls and affects public health in these communities.
How it got this bad
The eighth amendment didn’t always protect a prisoner's right to healthcare. The major landmark case that granted them this protection was Estelle v. Gamble in 1976. The case was brought to the Supreme Court when Gamble, a prisoner working on a Texas prison farm, was rejected medical care after he was injured in a way that prevented him from working. The court ruled that at worst, the refusal of medical care could result in “lingering death” for the prisoner, which was unconstitutional through the 8th amendment. They then ruled that prisons cannot have a “deliberate indifference to serious medical needs,” which meant that prisons could not ignore treating a prisoners' serious medical needs. Although this is extremely vague, subsequent cases identified three basic rights for prisoners: the right to access to care, the right to the care that has been ordered, and the right to a professional medical judgement.
Additionally, part of the reason why prisons often don't offer adequate medical care is because of how costly it can be. After the 1970s, new sentencing policies introduced in the Reagan era created things like “life without parole” and “mandatory minimum sentencing,” which caused the incarcerated population in America to skyrocket. In an attempt to cut costs, states often use private health contractors to carry out their prison healthcare duties, which creates a paradox.
Prisons are not contractually bound to a single private healthcare provider and can switch between contractors as they please. This does a good job of creating a “competitive market,” but instead of improving care, it encourages cost-cutting measures that leave incarcerated people with only the bare minimum level of treatment. As a result, many prisoners remain either untreated or perpetually on the verge of sickness. Some critics of the privatized prison healthcare system say that it disincentivizes the state from providing a reasonable amount of oversight of prison health providers (Weiss 2015). There have also been documented cases across the U.S where prisons continue to seek care from certain healthcare providers despite those providers having a known history of unconstitutional denials of care for the incarcerated (Christensen 2013).
Who Pays the Price
Research shows that people from disadvantaged communities are disproportionately represented in the prison system. This is linked to systemic failures that fail to combat the root causes of crime in these communities and the after effects of racial policies from the Jim Crow era. While disadvantaged communities are the ones most affected by the injustices in the criminal justice systems, people from these communities with mental illnesses are even More likely to be affected by the prison healthcare crisis.
For example, African Americans with severe or moderate mental illness face significantly worse economic and health outcomes compared to their white counterparts, including higher rates of poverty, unemployment, and arrest. For Native American individuals, even mild mental illness is associated with disproportionately high rates of incarceration and economic hardship due to structural racism. Latinos are already disadvantaged because of the barriers to healthcare access within their communities, especially for undocumented people. However, with the addition of untreated mental illness, Latinos experience even more economic vulnerability. (Snowden 2023)
Prisons have become places holding people failed by every other part of the system. Since so many incarcerated people come from communities that have barriers to accessing healthcare, prisons have a responsibility to step in. Unfortunately, when prison healthcare looks like it does today, those same under-resourced and over-policed communities have to pay the price again and again. (Weiss 2015)
Why It’s Everyone’s problem
Because of the fact that 95% of incarcerated people return to their communities, correctional facilities have an obligation to provide adequate care for those most in need, and doing so will help communities where health disparities are most commonly seen. For example, a Hepatitis C epidemic was declared in U.S correctional facilities in the 1990s, and for the early years of the epidemic, treatments were costly and ineffective. After the mortality rate started rising, prisons and jails were forced to increase their minimum standards for hepatitis C treatment and screening. Hepatitis C treatment has remained costly, but evolved to be extremely effective since the 1990s, yet prisons are still not mandated to provide the most effective care for incarcerated members who are infected. Since prisons have high concentrations of hepatitis C cases, and considering how 30% of all infected individuals have been incarcerated, inadequate treatment in correctional facilities might contribute to the disease spreading in communities after release. This is why addressing the cost of providing effective treatment in prisons is essential for improving public health. The incarcerated are also more likely to have substance abuse and mental health problems, but oftentimes aren’t able to receive even the minimum standard of care that they would have received outside of prison.
The standard of care outside of prison for mental health and substance abuse is already very low in disparaged areas, and some research suggests that this lack of community support is why people commit crimes that lead to incarceration. This is significant because the lack of adequate addiction and mental health care within the prison system may be reinforcing the behavior that leads to incarceration in the first place, which creates a cycle of imprisonment, especially in disadvantaged communities. (Rich 2015)
Helpful Resources to Check Out Today
While I’ll be covering potential solutions and resources in more detail in my next blog, you don’t have to wait for help. Whether you or someone you know is impacted by incarceration, these organizations and guides can help right now:
The National Reentry Resource Center offers tools for navigating reentry, including healthcare, housing, and legal support.
Transitions Clinic Network connects people leaving prison to community-based primary and mental healthcare.
The Root & Rebound Reentry Toolkit is a step-by-step guide for people preparing to reenter their communities and helps locate specific reentry programs and support services by state.
Before President Trump dismantled the Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA's Offender Reentry Resources offered crucial assistance for mental health and addiction treatment during and after incarceration. While all official SAMHSA web pages have been taken down, some of the same information exists here
Stay tuned for my next post, where I’ll discuss potential solutions to the carceral healthcare problem, break down these, along with other resources to help make sure no one is left behind when it comes to their health and dignity.
References
Sawyer, Wendy, and Peter Wagner. Mass Incarceration: The Whole Pie 2025. Prison Policy Initiative, 2025, https://www.prisonpolicy.org/reports/pie2025.html.
Rold, William J. "Thirty years after Estelle v. Gamble: A legal retrospective." Journal of Correctional Health Care 14.1 (2008): 11-20.
Rich, Josiah D., Scott A. Allen, and Brie A. Williams. "The need for higher standards in correctional healthcare to improve public health." Journal of General Internal Medicine30 (2015): 503-507.
Weiss, Dan. "Privatization and its discontents: The troubling record of privatized prison health care." U. Colo. L. Rev. 86 (2015): 725.
Christensen, Dan. Florida Prison Officials Didn't Ask, Companies
Didn't Tell About Hundreds of Malpractice Cases, BROWARD BULLDOG (Oct. 2,
2013, 6:09 AM), http://www.browardbulldog.org/2013/10/florida-prison-officials-
didnt-ask-companies-didnt-tell-about-hundreds-of-malpractice-cases/, archived at
Snowden, Lonnie R., Katharan Cordell, and Juliet Bui. "Racial and ethnic disparities in health status and community functioning among persons with untreated mental illness." Journal of racial and ethnic health disparities 10.5 (2023): 2175-2184.
Garfield, Rachel, et al. Health Coverage and Care for the Adult Criminal Justice-Involved Population. KFF, 2014, https://www.kff.org/wp-content/uploads/2014/09/8622-health-coverage-and-care-for-the-adult-criminal-justice-involved-population1.pdf.