Conversation Stresses Health Care Challenges Women Face In Detention and After

In November, women with expertise in many facets of prison systems came together at Yale Law School to discuss the health care of women in detention and once they are released. The discussion was co-organized by Yale University’s Women Faculty Forum (WFF), the Arthur Liman Center for Public Interest Law, the SEICHE Center for Health & Justice at Yale, and the Solomon Center for Health Law and Policy.

The session began with welcome remarks from Nina Stachenfeld, WFF chair and senior research scientist in obstetrics, gynecology, and reproductive sciences, Yale School of Medicine. Marisol Garcia, a Yale Prison Education Initiative fellow who has been incarcerated, opened the exchange by underscoring how detention affects mental health.

“The carceral system is a horrific, dehumanizing experience,” Garcia said. “It is hard to come back from incarceration and reconnect — not only with your family — but with yourself.”

Brittany Lamarr, also a Yale Prison Education Initiative Fellow, explained that another challenge is the lack of basic health screening upon entry into a facility.

“Women who are coming into carceral facilities often have a lot of unmet physical and mental health needs,” Lamarr said.

Lamarr, who also had spent time in detention, described the lack of health education in facilities and the difficulties of accessing healthcare.

“There is pushback because they feel you are either being dramatic about a medical concern or you are seeking attention,” she said. “You have to get a correctional officer to believe you before you can see a medical professional, so that is a huge barrier to healthcare.”

Jaimie Meyer, a physician who has worked in prisons and an associate professor of medicine and epidemiology at Yale’s schools of medicine and public health, described the steps a woman in prison must take to receive health care.

“For women to access me or access care, it meant that they had to write a handwritten note, pass it to a corrections officer, and then if the corrections officer deemed it important enough, it would get passed on to a nurse and maybe eventually to some sort of healthcare provider,” she said.

Another challenge comes from co-pays. Meyer explained that people in prison who do work are generally “paid next to nothing per hour” and may need that money to pay for items from food and toiletries to court fines and fees.

Meyer pointed to the harm that follows when women move back to their communities after being released.

“The risk of death is 14 times higher than that of the general population in the first two weeks after release,” Meyer said. “The most common cause of death is overdose, unintentional overdose.”

Marisol Orihuela ’08, clinical professor of law at Yale Law School and a 2008 Liman fellow, works at the intersection of criminal and immigration law and criminal and mental health law. Orihuela highlighted the difficulties facing subpopulations of gender-nonconforming individuals and individuals with significant mental disabilities.

“Both groups are at risk in law enforcement settings, whether it is carceral settings or in police custody,” Orihuela said. “They can be subject to increased instances of sexual assault and also face a host of other issues, such as stigma and disbelief from those around, which affects their health outcomes and their experiences of carceral settings.”

Judith Resnik, moderator, and Arthur Liman Professor of Law at Yale Law School, provided the historical backdrop. Federally-funded research from the late 1970s identified the harms of density in prisons, where no privacy is possible, noise levels are high, and the risk of infection is elevated. The recommendations from the American Correctional Association and other organizations were for single cells. Unfortunately, that research is disregarded.

“In a 1981 ruling, the U.S. Supreme Court concluded that putting two people in a cell built for one was not unconstitutional in itself,” Resnik explained.  

Nothing that the harms that are dislocating and disabling have been recognized and documented in official and professional sources, Resnik asked the group what would help the situation. Garcia said that one start would be educating social workers and healthcare providers about the needs of and challenges faced by women who are incarcerated. Lamarr proposed that the management of health care be removed from the Department of Corrections.

“They do not have the expertise to be able to administer, advise, and direct healthcare,” she said. “Corrections is not the place to make those decisions, and they should not be in charge of deciding what quality and access look like.”

Orihuela suggested a two-pronged effort: make things better in existing criminal settings and work hard to decrease our reliance on carceral systems.

“We need to do as much as we can to keep people in the community,” she said. “If we had more options in communities, we could decrease our reliance on carceral settings.”

A big part of the problem, Meyer pointed out, is that prisons and jails were not designed to be healthcare providers but to punish.

“How can you punish people and also deliver compassionate and patient-centered evidence-based care?” she asked. “Those two activities are often very much at odds.”

The discussion ended with Garcia encouraging students and others in the audience to recognize the humanity and dignity of individuals who are incarcerated.

“As you go into medical school and law school, understand that these are people first,” she said.