Health and Justice最新文献

{"title":"Racial discrimination and perceptions of police among US adults.","authors":"Madalyn Huang, Jemar R Bather, Adolfo G Cuevas, Saba Rouhani","doi":"10.1186/s40352-026-00408-1","DOIUrl":"10.1186/s40352-026-00408-1","url":null,"abstract":"<p><p>BACKGROUND: Mistrust of law enforcement across the United States has implications for public health and safety. While direct police encounters shape perceptions of law enforcement, the influence of broader experiences with racial discrimination remains understudied. This study examined associations between racial discrimination and perceptions of police among US adults. METHODS: Data were from a web-based cross-sectional survey across 13 northeastern states in March–April 2023 (N = 5,048). Racial discrimination was measured in childhood, adolescence, adulthood, past year, and in the healthcare setting specifically. Perceptions of police were measured on an 8-item scale ranging from 8–40, with higher scores denoting more negative attitudes. Multivariable linear regression (1) quantified associations between racial discrimination and perceptions of police; and (2) tested whether these associations differed across racial/ethnic groups, controlling for age, gender identity, homelessness, behavioral health history, and direct positive and negative police encounters. RESULTS: Participants had mean age of 47 years old, and half identified as male (50%). The majority were White (48%), with 17.5% identifying as non-Hispanic Black and 21.3% as Hispanic. In adjusted models, both cumulative racial discrimination across the life course and healthcare discrimination were significantly associated with negative perceptions of police. We observed evidence of interaction between race/ethnicity cumulative racial discrimination: the association between racial discrimination and negative perceptions of police were significantly stronger in Black, relative to White respondents. CONCLUSIONS: Experiences of racial discrimination beyond direct policing encounters—particularly cumulative lifetime discrimination and healthcare discrimination—are independently associated with negative police perceptions. These findings suggest spillover effects across institutions, with implications for system avoidance behaviors and institutional trust that may affect both public health and public safety outcomes. </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"County-level social determinants of health and suicide mortality trends among formerly incarcerated persons in North Carolina, 2010-2018.","authors":"Monica E Swilley-Martinez, Brian W Pence, Kate Vinita Fitch, Vanessa E Miller, Matthew M Turnure, Pasangi S Perera, Timothy S Carey, Shabbar I Ranapurwala","doi":"10.1186/s40352-026-00409-0","DOIUrl":"10.1186/s40352-026-00409-0","url":null,"abstract":"<p><p>BACKGROUND: Suicide mortality represents a growing public health crisis in the United States, disproportionately affecting people with recent incarceration histories. The purpose of this study was to assess how county-level Social Determinants of Health—including educational attainment, unemployment, poverty, aging, racial composition, and rurality—are associated with suicide mortality among formerly incarcerated individuals in North Carolina in order to develop geographically focused, socially responsive suicide prevention resources. METHODS: We conducted a retrospective cohort study of people released from North Carolina prisons between 2010 and 2018 and compared suicide mortality with that of the North Carolina general population aged 18–69 years. Using linked administrative data, we calculated age-, sex-, and year-standardized suicide mortality rates and standardized mortality ratios (SMRs) by county-level social determinants of health, including educational attainment, unemployment, poverty, aging, racial composition, and rurality. RESULTS: Suicide mortality among formerly incarcerated individuals was consistently higher than in the general population, with the greatest disparities in counties that are urban (SMR: 2.04, 95% CI: 1.50, 2.58), have below average educational attainment (SMR: 2.53, 95% CI: 1.69,3.37), below average unemployment (SMR: 2.33, 95% CI: 1.66, 3.01), low poverty (SMR: 2.13, 95% CI: 1.56, 2.70), below-average racial diversity (SMR: 3.12, 95% CI: 2.20, 4.04), or an above-average proportion of older adults (SMR: 2.40, 95% CI: 1.22, 3.57). CONCLUSIONS: These findings suggest that suicide mortality disparities between formerly incarcerated individuals and the general population are greatest in more advantaged counties, where community-level protective factors appear to benefit the general population but do not extend to those returning from prison. Addressing these disparities will require investments in place-based mental health infrastructure and reentry support tailored to local community contexts. </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrest discretion and training needs for interacting with people with substance use disorders: a qualitative secondary analysis among police recruits in Washington State.","authors":"Samuel Janson, Leif Layman, Melody McKee, Christine Rickert, Brandon Rogel, Becky Starnes, Mandy D Owens","doi":"10.1186/s40352-026-00404-5","DOIUrl":"10.1186/s40352-026-00404-5","url":null,"abstract":"<p><p>BACKGROUND: Frequent interactions between law enforcement and individuals with substance use disorders carry significant public health implications. Pre-arrest diversion programs rely on officer discretion to redirect individuals toward a range of medical and social services rather than make an arrest. To inform more effective evidence-based training, this study examines how police recruits anticipate exercising this discretion and identifies their self-reported training needs for navigating encounters with this population. RESULTS: A qualitative thematic analysis of open-ended survey responses from 115 recruits at the Washington State Basic Law Enforcement Academy was guided by the Focal Concerns Theory and Theory of Planned Behavior. Four themes emerged: (1) divergent views on addiction as a matter of personal choice versus disease, influencing perceptions of blameworthiness; (2) a primary concern for community protection, shaped by distinctions between violent and non-violent offenses; (3) a belief that incarceration can be a practical pathway to rehabilitation; and (4) a tension between adhering to departmental policy and being guided by personal and professional experiences. For future training, recruits requested more practical knowledge on drugs and de-escalation and strongly recommended experiential learning, including interactions with people with lived experience. CONCLUSIONS: Recruits’ anticipated use of discretion is shaped by core beliefs, practical considerations, and personal history. Training must move beyond knowledge transfer to actively address underlying attitudes and heuristics influencing arrest decisions. Effective implementation will also require aligning this training with supportive departmental policies and leadership. </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13188370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"There's (no) accounting for taste: identifying and predicting subgroups of incarcerated persons based on perceived food sufficiency and personal and lifestyle characteristics.","authors":"Bram de Heide, Miranda Sentse, Miranda Boone","doi":"10.1186/s40352-026-00406-3","DOIUrl":"10.1186/s40352-026-00406-3","url":null,"abstract":"<p><p>BACKGROUND: In recent decades, research focus on prison climate and normalization has increased, highlighting food as a particularly important dimension of prison life. This has recently led to policy reforms in Western Europe, aimed at improving dietary quality, meeting incarcerated persons’ food needs, and supporting sustainability goals. Meeting food needs can benefit health, well-being, and the overall prison experience, however, little is known about how food sufficiency may vary across the prison population. This study aims to identify subgroups of incarcerated persons based on their perceived food sufficiency and examines how personal and lifestyle characteristics predict membership of these subgroups. RESULTS: Survey data from 3,010 incarcerated persons revealed three distinct subgroups, characterized by their overall level of perceived food sufficiency: Far too little (18%), Too little (44%), and Enough (38%). Several characteristics were associated with subgroup membership, including gender, age, physical activity level, health orientation, and the opportunity to self-cater. The opportunity to self-cater appeared as the strongest predictor; individuals without this opportunity were more likely to belong to the Far too little (OR = 2.2) and Too little (OR = 1.7) subgroups compared to the Enough subgroup. CONCLUSIONS: Food was regarded as insufficient by a considerable proportion of participants, particularly by those without the opportunity to self-cater. These findings suggest that the standard meal system may not accommodate the diverse needs within the prison population. Meeting these needs can offer multiple benefits, including supporting autonomy, agency and identity, promoting physical and mental well-being and social interactions, and reducing antisocial attitudes, thereby contributing to effective prison management and humane treatment. </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health and routine police work: a systematic scoping review.","authors":"Martin Webber, Elizabeth Hughes, Tobias Kammersgaard, Charlie Lloyd, Andrew Papworth, Oznur Yardimci","doi":"10.1186/s40352-026-00405-4","DOIUrl":"10.1186/s40352-026-00405-4","url":null,"abstract":"<p><p>BACKGROUND: There is increasing attention to the amount of contact between police and those experiencing mental health problems. This includes the amount of time and resource spent by police in attending to calls related to mental health, as well as what the role of the police should be in relation to other agencies, including mental health and social care services. The aim of the scoping review was to identify what research has been conducted about police response to mental health in terms of decision making, responses, as well as skills and interventions. METHODS: A scoping review using the PRISMA extension for scoping reviews was conducted. Papers were included if they reported research on routine police work when responding to people with mental health problems or experiencing mental distress. Seven databases were searched and a two-stage searching procedure was followed. Screening and data extraction was completed by two researchers working independently. RESULTS: A total of 14,608 texts were found; 7,164 were removed as duplicates and 7,281 were removed after screening titles and abstracts. After full text screening a further 100 were excluded, leaving 63 papers for data extraction. About half of the papers included police only as participants (n = 31) and only 10 papers were from the perspective of people with lived experience. Three themes emerged from the thematic analysis: “policing decisions and actions”; “coordinating with other providers” and “lived experience”. CONCLUSIONS: Police have skills that have been developed experientially rather than through formal training. There is often a lack of shared understanding between police and other agencies leading to uncertainty about how to best help the person with mental health concerns. Police can and do make a positive contribution to the multi-agency response to people with mental health problems, though should not necessarily be the first (or only) response to mental health calls. Most of the research to date has focused on the police role in mental health crisis. Further research is needed on understanding the police role in encountering mental health problems in routine work (as victims, witnesses or perpetrators). REGISTRATION: The protocol was published on Open Science Framework (tcs45). </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High prevalence of criminal legal involvement among non-fatally injured ED patients - an exploratory retrospective observational cohort analysis.","authors":"Vidya Eswaran, Raphael Cohen, Taylor Kaser, Alysse G Wurcel, Michael Mancini, Kateri Chapman-Kramer, Nicholas Szoko, Keyria Page, Melik Coffey, Kristen Mueller","doi":"10.1186/s40352-026-00407-2","DOIUrl":"10.1186/s40352-026-00407-2","url":null,"abstract":"<p><strong>Background: </strong>Individuals who have been incarcerated are at high risk of death by homicide after release from carceral settings. Our study aimed to assess the prevalence of criminal legal system involvement (CLSI) among non-fatal violently injured patients enrolled in a hospital-based violence intervention (HVIP) program and describe demographic and clinical characteristics specific to this population.</p><p><strong>Methods: </strong>This is an exploratory retrospective cohort study of all patients enrolled in the St. Louis, Missouri based HVIP, Life Outside of Violence (LOV), between 08/15/2018 and 12/31/2024. LOV enrolls patients aged 8-30 who receive violent injury care at a partner hospital. We collected data on patient demographics, substance use, self-reported CLSI, source of medical care, and other clinical and social variables. We compared characteristics between participants with and without CLSI status using two proportions Z-tests and basic bootstrapping.</p><p><strong>Results: </strong>During the study period 67 of 206 participants (33%) reported CLSI. Individuals with CLSI were more likely to be men (difference 37.7%; 95%CI 25.2%, 50.2%), uninsured (difference 28.9%; 95%CI 14.7%, 43.0%), and to use the emergency department (ED) or urgent care as their primary source of care (difference 18.6%; 95%CI 4.2%, 33.0%).</p><p><strong>Conclusion: </strong>These data show evidence for the intersectionality of CLSI and experiencing violent injury among ED patients. These data suggest the need for injury prevention efforts among this population, and potentially targeted case management for this population after injury.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent profiles of psychopathological and criminological characteristics in prisoners: associations with suicide risk.","authors":"Jue Deng, Jianping Ma, Yuanhua Ou, Liqin Lu, Jianhan Cai, Xiaoli Zhu","doi":"10.1186/s40352-026-00403-6","DOIUrl":"10.1186/s40352-026-00403-6","url":null,"abstract":"<p><p>BACKGROUND: Prison suicide continues to be a global public health concern. Based on the stress-diathesis model, there may be interactions between psychopathological vulnerabilities and criminological stressors that contribute to suicide risk. However, no prior studies have empirically elucidated how these factors jointly configure distinct risk profiles among prisoners. METHODS: We conducted a latent profile analysis of 1,031 male prisoners from two correctional facilities in mainland China. This involved integrating criminological stressors (sentence length and remaining sentence) and psychopathological vulnerabilities (intolerance of uncertainty, sense of control, and interpersonal security). Suicide risk was assessed by the Suicidal Behaviors Questionnaire-revised. RESULTS: Four latent profiles emerged: Class 1, high intolerance of uncertainty (IU), low sense of security, and a short sentence (39.2%, OR = 5.16, 95%CI = 3.06–8.70); Class 2, longer sentence, moderate IU, and moderate sense of security (14.0%, OR = 2.60, 95%CI = 1.30–5.19); Class 3, longest sentence, moderate IU, and moderate sense of security (9.9%, OR = 2.28, 95%CI = 1.04–5.00); and Class 4, low risk (37.0%, reference). Class 1, 2 and 3 had a significant increase in suicide risk compared to that of Class 4. CONCLUSIONS: This is the first study to use person-centered integration of criminological and psychological variables to identify prisoner subtypes with a differential suicide risk. The high-risk profile demands urgent clinical prioritization that advocates for routine screening of IU and sense of security during prison intake and also policy reforms to reduce systemic uncertainties (e.g., transparent sentence adjustments). </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13169873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to implementing status-neutral HIV care in an urban jail system.","authors":"Brindet Socrates, Amy M LeClair, Kaitlyn Jaffe, Linnea Evans, Abigail W Batchelder, Emily Moner, Denise Daudelin, Whitney Irie, Yvane Ngassa, Yoelkys Morales, Julie Levison, Elizabeth A Evans, Alysse G Wurcel","doi":"10.1186/s40352-026-00402-7","DOIUrl":"10.1186/s40352-026-00402-7","url":null,"abstract":"<p><p>BACKGROUND: People who use drugs face barriers to accessing HIV prevention tools. The status-neutral model for HIV care starts with the HIV test and offers linkage to HIV treatment if the person tests positive and linkage to pre-exposure prophylaxis (PrEP) if the person tests negative. The goal of this study was to evaluate barriers and facilitators impacting the implementation of a status-neutral HIV model of care in the jail setting. METHODS: Between June and August 2024, we recruited people working in and incarcerated in the jails operated by the Suffolk County Sheriff’s Department (Jail and House of Correction) for in-depth interviews. The Consolidated Framework for Implementation Research (CFIR) 2.0 guided interview development. Interviews were recorded, transcribed, coded, and analyzed using rapid thematic analysis (RTA) methods. Relevant themes were mapped onto CFIR domains. RESULTS: We conducted 28 interviews: 13 with correctional and clinical staff and 15 with incarcerated people. Clinical and administrative staff members indicated that strong relationships with state and local agencies and the state’s proactive approach to preventative carceral healthcare helped facilitate HIV treatment and prevention pathways. Incarcerated individuals identified issues in the system used to report health needs and unreliable test result delivery mechanisms as major barriers. Staff also identified barriers, including understaffing, but overwhelmingly endorsed the jails’ existing systems of accessing and delivering care. CONCLUSIONS: Findings identified multiple potential intervention targets to enhance a status-neutral approach to HIV testing and treatment in jail settings, including leveraging existing partnerships, and educational opportunities for staff. Strategies that reinforce a patient-centered institutional culture (with a focus on incarcerated individuals’ health), improve care continuity for transitions into and out of jail, and highlight gaps in healthcare delivery are critical for successful implementation of status-neutral HIV care in jails. </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somebody's going to emergency, somebody's going to jail: pre-booking diversion and officer discretion.","authors":"Kyle McLean, Emily Suiter, Naomi Shneibaum, Bryan Lee Miller","doi":"10.1186/s40352-026-00401-8","DOIUrl":"10.1186/s40352-026-00401-8","url":null,"abstract":"<p><p>BACKGROUND: The opioid use epidemic has resulted in dramatic increases in drug overdoses and deaths. Traditional criminal justice approaches to drug use focus on making arrests to deter individuals from engaging in criminal behavior. To reduce the negative impacts generated by criminal justice system involvement for individuals with substance use disorders, police departments have begun turning to pre-booking diversion programs. Unlike traditional diversion programs, where individuals are diverted from the criminal justice system after an arrest, these programs authorize police officers to exercise discretion in referring individuals to treatment resources in lieu of arrest. This study uses a conjoint survey experiment administered to 329 officers in five agencies that were implementing pre-booking diversion programs. Officers are presented with five forced-choice tasks involving individuals eligible for a pre-booking diversion program to assess the factors officers use to decide which individuals they encounter should be referred to treatment. RESULTS: The findings from this study indicate that officers consider a variety of demographic and legal characteristics when determining which individuals they are most likely to refer to treatment in a pre-booking diversion program. Officers indicated a preference for referring younger individuals (age=35, AMCE=-0.095, p<0.001; age=45, AMCE=-0.099, p<0.001), females (AMCE =0.033, p=0.042), and Black individuals (AMCE =0.056, p=0.007). Officers were also more likely to refer individuals with less serious criminal histories (drug convictions only, AMCE=-0.099, p<0.001; violent crime convictions, AMCE=-0.317, p<0.001), individuals possessing smaller amounts of drugs (AMCE=-0.070, p<0.001), and individuals who had not committed a crime other than drug possession (shoplifting, AMCE=-0.083, p<0.001; burglary, AMCE=-0.185, p<0.001). Finally, officers were more likely to refer individuals whose current drug of choice involved opioids (fentanyl, AMCE=0.114, p=0.001; oxy, AMCE=0.102, p=0.002; heroin, AMCE=0.099, p=0.003) as compared to marijuana. CONCLUSIONS: This study demonstrates considerable promise for pre-booking diversion programs. The success of pre-booking diversion programs hinges on officers’ willingness to refer individuals with serious substance use issues to treatment. Our study provides experimental evidence that officers are more likely to make treatment referrals for opioids as compared to marijuana, demonstrating promise for pre-booking diversion’s potential to address the opioid epidemic. </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare in a system of punishment: how clinicians experience care work within carceral settings.","authors":"Natalie Keller, Andrew Sudler, Leslie Riddle, Jennifer Elyse James","doi":"10.1186/s40352-026-00399-z","DOIUrl":"10.1186/s40352-026-00399-z","url":null,"abstract":"<p><p>BACKGROUND: The harms experienced by individuals incarcerated in prisons and jails have been well-documented; however, little is known about the experience of healthcare clinicians in their work in carceral institutions. Using qualitative methods, we interviewed 20 clinicians who deliver care in California’s prisons and jails to better understand their experiences. RESULTS: Participants described a carceral culture which impeded the delivery of care. These barriers to providing healthcare included limiting the clinicians’ ability to develop a trusting patient-clinician relationship and structural limitations which prevented clinicians’ capability to deliver care informed by their expertise. Participants also described forms of institutional control that affected clinicians on a personal level and in their provision of care. We found that clinicians often attempted to advocate on behalf of their patients; however, clinicians struggled to balance their dual loyalties to patients and the carceral system. This often led them to experience moral distress which ultimately led to burnout. These experiences resulted in clinicians developing self-protection strategies by accepting parts of the system, leaving the system, or continuing to try to change the system. CONCLUSIONS: The barriers to providing healthcare described by participants are inherent components of prisons and jails, which the clinicians had to adapt to in order to treat their patients. Findings from this study demonstrate the system-wide impacts of the punitive nature of carceral institutions which can even permeate the delivery of healthcare. These findings emphasize the need for additional research examining the impact of carceral culture on clinicians and the care they deliver in carceral facilities. </p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13020200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}