Healthcare Design - October 2017 - 53

AIA-AAH

HEALTHCARE BEHIND
BARS

The provision of healthcare in correctional
environments requires traditional healing designs
that also support optimal safety and security
By David Redemske, Laurence E. Hartman, and
Gail Dahlstrom

HERE WERE 2.2 million people incarcerated in the
U.S. in 2014, with 1.5 million in state or federal prisons, according to the Bureau of Justice Statistics.
This makes the U.S. home to the greatest number
of incarcerated individuals in the world. The U.S.
Constitution requires healthcare to be provided to
inmates, and in fiscal year 2011, states spent $7.7 billion on correctional healthcare-one-fifth of their
overall expenditures, reports the Pew Charitable Trusts.
In addition to healthcare complications associated with aging, inmates are commonly diagnosed with alcohol or drug abuse disorders and mental illness. Many may not have had substantial access to
healthcare prior to incarceration and without proper treatment often
continue to deal with these conditions upon release, putting inmates
at risk for recidivism and potentially causing public health issues to be
introduced back into communities. Given the constitutional mandate
and obvious need to provide healthcare services to incarcerated individuals, it's important that treatment spaces in prisons and jails be designed for effective care delivery while meeting the safety and security
needs of patients and staff.
VA R I A T I O N S I N C A R E E N V I R O N M E N T S

A few certification organizations focus on correctional health facilities, including the American Correctional Association and the National
Commission on Correctional Health Care (NCCHC); however, there
aren't specific space standards or guidelines covering healthcare in correctional environments. This means the level of care delivery can vary
from state to state and sometimes from facility to facility. Most states provide a medical
EVEN IN THE MOST
and mental health screening area, clinic space
HARDENED FACILITY,
(with exam rooms, a procedure room, and basic imaging), dental area, "sick call" where
DESIGN CAN PROMOTE
requests for medical consultations are made
HEALING AND IMPROVE
(usually located in housing units), and an inOUTCOMES.
firmary for overnight acute care.
States with a smaller inmate population
typically provide medical and mental health assessments, light treatment, and some skilled nursing within a facility, as well, with all other
care-such as surgery, specialized imaging, orthopedics, cancer care,
and dialysis-outsourced to a local hospital. States with a larger prison

population often provide more in-house care,
including specialty exam/treatment, dialysis,
chemotherapy, and acute medical and mental
health inpatient treatments. Many states also
now provide or are developing hospice and
palliative care programs. Emergency/trauma
care, surgery, and childbirth are typically
treated in a hospital.
BALANCING SAFETY AND HEALING

Although care levels may vary, all correctional
health environments must focus on maintaining the safety and security of the inmatepatient and the staff. For example, healthcare
inherently involves items that could be used as
weapons, including syringes and medicines, so
it's important to keep in-room storage to a minimum. Locking up all supplies that need to be
stored within the room and maintaining accurate accounting of those items can further improve safety. All medical staff should be able to
easily and discreetly call for officer assistance
in an emergency, as well.
However, even within the most hardened facility, designers must still create spaces that
promote healing and improve outcomes. Evidence-based design solutions used in traditional medical facilities can also be successfully
applied within the correctional health environment, including:
* Sense of safety. Threats of violence constitute a significant source of stress for inmates.
Any inmate-patient who appears weak or
vulnerable can become a target for a predatory inmate. Arranging spaces to achieve
clear lines of sight for staff, combined with
adequate supervision, will add to the sense of
safety, limit chances of violence, and reduce
patients' overall stress level.
* Nature view. Patients experience less stress
and pain if they can view nature and other
positive distractions. While this is a tremendous challenge in a correctional environment where security precludes the use of
large glass openings due to cost and vulnerability to attacks, a view to the sky can be provided with clerestories that are inaccessible
to inmates. If windows or clerestories are not
achievable, the use of a nature mural can provide a positive effect.
* Noise. Noise is a frequent problem in correctional healthcare environments due to
the abundance of hard surfaces, clanging
doors, mechanical equipment, and televisions. Products that can mitigate this

OCTOBER 2017

Healthcare Design - October 2017

Table of Contents for the Digital Edition of Healthcare Design - October 2017