The United States' Youth Detention System Poses Serious Threats to Health Care
There are over 43,00 youth currently held in juvenile detention and correctional facilities across the United States. Long before the COVID-19 crisis, the conditions of confinement in these facilities threatened the wellness and proper development of incarcerated youth. Today, with COVID-19 wreaking havoc on our country and the world, that threat has grown exponentially. Our communities have failed to adequately protect some of our most vulnerable youth, but we cannot continue to fall short.
Typical conditions of juvenile detention and correctional facilities include, but are not limited to, inadequate access to proper educational and developmental programs, physical and emotional abuse, claustrophobic and unsanitary spaces, limited contact with family/support systems, and lack of adequate healthcare resources. Research has shown that these conditions lead to adverse physical, emotional, and mental health outcomes. During a pandemic, such adverse conditions are only exacerbated.
Research by public health experts shows that incarcerated populations are among the most vulnerable during pandemics. Prisons and detention centers often act as epicenters for highly contagious viruses like COVID-19 due to extremely confined living quarters and unsanitary conditions. Behind bars, youth are not able to participate in proactive measures to keep themselves safe, such as social distancing, frequent hand washing, accessing personal protective equipment, or staying in sanitized spaces. Further, youth detention and correctional facilities are often unequipped to meet the medical needs of youth if an outbreak should occur.
Lack of resources allotted for prison health, as well as various security policies, increase the likelihood for delays in both diagnosis and treatment of the disease. Once diagnosed, youth are unlikely to have the capacity to properly isolate themselves from other youth. Further, higher rates of chronic health conditions in incarcerated youth have the potential to lead to more serious complications of the virus. If staff become ill, it will be difficult to provide care and support to youth, and if lockdowns are utilized, they will only exacerbate the spread of the virus.
In addition to the physical health threats this pandemic poses on incarcerated youth, there is a growing concern about mental and psychiatric stressors. We know there is an increased prevalence of adverse childhood experiences (ACE) among youth who are incarcerated. Outbreaks of the virus in detention facilities threaten to lead to further ACEs and exacerbate the effects of previous traumas. For example, many facilities are currently prohibiting visitations from family, legal representatives, and other community members, as well as canceling school and other regular programming, leading to further isolation and lack of social support. In several facilities, there are reports of children being locked in their rooms for more than 23 hours a day as a form of “isolation” to mitigate the spread of COVID-19, not much different from solitary confinement. Aside from the trauma of being isolated for this long, these actions may in turn lead to increased self-harm and suicidal ideation. Such circumstances jeopardize both short-term and long-term health outcomes for these youths.
In such dire conditions, what can be done to help keep incarcerated youth safe? The medical community must join the fight to protect incarcerated youth alongside human rights organizations and family members. We can do this by urging our local government and boards of health to tackle the issue in a variety of ways including:
Release youth who can be safely cared for in their home communities. Create transition plans for youth released from custody that ensure their basic needs are met.
Within the constraints of public safety, reduce new admissions to juvenile detention & correctional facilities and increase the use of diversion strategies.
Develop and publish COVID-19 response plans and ensure data regarding suspected and confirmed cases are publicly available.
Ensure all staff members are trained on the implementation of the response plans.
Ensure that youth and families are notified of suspected and confirmed cases in a timely manner.
Ensure that appropriate access to medical and mental health prevention, treatment, and care is the norm.
Provide emergency funding to expand community-based services and supports for youth diverted to or released from detention facilities.
The COVID-19 pandemic is only highlighting problems that are deeply ingrained in the juvenile justice system. Highlighting and advocating for solutions during this time can lead to more long-term change. As healthcare professionals and medical students, we have an obligation to help prevent the injustices and adverse health outcomes of youth in the juvenile justice system. This issue is not new. Injustices have always existed, but there has never been a more urgent time to act than now.
Chris Diaz is a fourth-year medical student at The Ohio State College of Medicine. If you would like to get more involved in the #FreeOurYouth initiative, you may contact him at christopher.diaz@osumc.edu.
Sources:
Akiyama MJ, et al. "Flattening the Curve for Incarcerated Populations - Covid-19 and Jails and Prisons." New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/ NEJMp2005687
Cullen K and Ndudom E. "Doctors Call for Releasing Youth from Secure Custody During COVID-19 Crisis." Juvenile Justice Information Exchange. https://jjie.org/2020/04/28/public-health-officials-call-for-releasing-youth-from-secure-custody-during-covid-19-crisis/
Kinner SA, et al. "Prisons and custodial settings are part of a comprehensive response to COVID-19." The Lancet. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30058-X/fulltext
Teplin LA, et al. "HIV and AIDS Risk Behaviors in Juvenile Detainees: Implications for Public Health Policy." American Journal of Public Health 93, no. 6 (June 2003): 906–12, https://doi.org/10.2105/AJPH.93.6.906; Committee on Adolescence, “Health Care for Youth in the Juvenile Justice System.”
Fatos Kaba, et al. "Solitary Confinement and Risk of Self-Harm Among Jail Inmates." American Journal of Public Health 104, no. 3 (March 2014): 442–47, https://ajph.aphapublications.org/doi/ 10.2105/AJPH.2013.301742
Logan-Green P, et al. "Childhood Adversity among Court-Involved Youth: Heterogeneous Needs for Prevention and Treatment." 5 J. Juv. Justice 68 (2016).
Yael Cannon & Dr. Andrew Hsi. "Disrupting the Path from Childhood Trauma to Juvenile Justice: An Upstream Health and Justice Approach." 43 Fordham Urb. L. J. 425 (2016).
American Academy of Pediatrics. "Responding to the Needs of Youth Involved With the Justice System During the COVID-19 Pandemic." https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/responding-to-the-needs-of-youth-involved-with-the-justice-system--during-the-covid-19-pandemic/
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