Health Department Teams up With Providers to Improve Care for Patients With a History of Justice Involvement

As New York City dramatically decreases jail population, arrests and stop-question-and-frisks, new data show that people with histories of justice system involvement reported higher rates of poor physical and mental health

More than 1 in 3 adult New Yorkers, or 2.4 million people, have experience with the justice system

August 6, 2019 — The Health Department today announced a campaign to educate health care providers on how to care for patients who disclose a history of criminal justice involvement. These individuals have higher rates of chronic conditions, such as cardiovascular disease, high blood pressure and diabetes; infectious disease; substance use; and mental health conditions compared to the general population. In a study, more than 40% of men released from state correctional facilities reported discrimination by health care providers due to their criminal record. To improve care, Health Department staff will conduct one-on-one visits with health care providers and staff at nearly 160 primary care and family medicine practices in East and Central Harlem, North and Central Brooklyn and the South Bronx. The outreach campaign begins today and will continue through early January. The Criminal Justice Action Kit is available online.

In addition, the Health Department today released a report on the health outcomes of New Yorkers who have experienced criminal justice system involvement. The City has implemented dramatic reforms to make New York’s justice system smaller, safer and fairer—including reducing the jail population to its lowest level in nearly 40 years, as well as significant reforms to policing. However, more than 1 in 3 adults, or 2.4 million people, report ever experiencing criminal justice system involvement. The report, “Criminal Justice System Involvement and Measures of Health among New York City Residents, 2017, (PDF)” is available online.

“The data show that involvement with the criminal justice system – even brief contact with the police or indirect exposure – is associated with lasting harm to people’s physical and mental health,” said Health Commissioner Dr. Oxiris Barbot. “People with a history of justice involvement are one of the hardest populations to reach and engage in care. Health care providers can use the approaches outlined in our Action Kit to create a welcoming environment and build trust to ensure all patients, especially those with lived experience, get the care they need.”

“Individuals who have been involved in the criminal justice system often struggle with a host of health issues at a far higher rate than the rest of the patient population,” said Council Member Margaret S. Chin. “In order to create a truly inclusive and accessible health care system for all New Yorkers, we cannot overlook the needs of patients who are beginning the process of re-entering their communities. Discrimination at any health care facility should not be tolerated. I am proud to support the Department of Health and Mental Hygiene’s new education campaign to improve treatment and quality of care for all New Yorkers, including those involved in the criminal justice system.”

“Individuals with a history in the criminal justice system can have a different set of medical needs than other patients, but have just the same rights to be properly cared for,” said ,Council Member Keith Powers. “I recently passed legislation to ensure that incarcerated individuals receive the care they need while in city jails. I thank the Department of Health for working to educate area doctors and hospitals to ensure patients receive quality medical treatment following their involvement in the justice system.”

“I am so pleased to hear that the NYC Department of Health will be launching a campaign targeting populations who have had experience with the criminal justice system,” said Natacha Baron, RN, FNP-C, AAHIVS, Whitman Ingersoll Health Center in Brooklyn. “Unfortunately, this population often fall through the cracks when it comes to addressing their medical and mental health needs, which can be a barrier to reintegrating and adjusting back to society. This campaign will help in bridging the gap with our at-need populations and linking them to much needed medical, mental health, and substance abuse services.”

“Patients with a history of criminal justice involvement have a vast array of adverse health outcomes, many of which stem from social inequities,” said Dr. Regina Olasin, FAAP, FACP, Chief Medical Officer, Care for the Homeless. “We use a trauma-informed care approach with every patient; however, there are still challenges to develop constructive dialogue so patients with lived experience feel comfortable discussing their physical, mental and social health needs. I applaud the NYC Health Department for conducting this Criminal Justice Involvement outreach campaign, which not only raises awareness of a marginalized population, but offers sensitivity, skills and tools needed to help providers take the best possible care of these patients.”

Highlights of the Criminal Justice Action Kit

• Screen comprehensively for chronic diseases, infectious diseases, and behavioral health conditions including substance use.
• Connect patients with local organizations familiar with the needs of justice-involved individuals.
• Use “people-first” language. For example, instead of “former felon” or “ex-criminal,” say “person with a history of criminal justice involvement.”
• Explain that your clinician-patient relationship means that the care you provide is not connected with the criminal justice system and information shared is confidential.
• If your patient discloses a history of criminal justice involvement, do not ask for information about specific charges or convictions. Ask only about their previous health care experiences while involved with the criminal justice system.
• The physical care environment should promote a sense of safety for your patients. Consider minimizing the presence of uniformed security guards in the practice environment.
• Clearly explain what the examination will entail so your patients know what to expect. Ask for consent from patients so they feel in control of their body and do not feel anxious or threatened during the visit.
• Ask patients if they are uncomfortable changing into a gown; if so, let them know they can stay fully clothed while you conduct the exam.
• Emerging evidence suggests that geriatric conditions, such as functional impairment and chronic disease multimorbidity, may appear at significantly younger ages among people with a history of incarceration, indicating premature aging. Consider screening patients with a history of criminal justice involvement earlier for chronic diseases and conditions typically associated with older adults.

Data highlights

• In 2017, 29% of adult New Yorkers (an estimated 1.9 million people) reported ever being stopped, searched or questioned by police. People stopped, searched, or questioned by police were more likely to report poor physical health (18% versus 11%); poor mental health (20% versus 12%); poor physical or mental health preventing them from doing daily activities (15% versus 9%); and binge drinking (27% versus 18%).
• Nine percent of adult New Yorkers (an estimated 577,000 people) reported ever being physically threatened or abused by police. People physically threatened or abused by police reported poor physical health (29% versus 12%); poor mental health (27% versus 14%); and poor physical or mental health preventing them from doing daily activities (22% versus 10%) twice as often as people who were not. They were also more likely to report high blood pressure (39% versus 30%) than people never physically threatened or abused by police.
• One in 10 adult New Yorkers (an estimated 639,000 people) reported ever being incarcerated or on probation or parole. People who had been incarcerated or on probation or parole were twice as likely to report poor mental health (27% versus 13%) and poor physical or mental health preventing them from doing daily activities (19% versus 10%). They were also more likely to report binge drinking (31% versus 20%) and fair or poor general health (28% versus 18%) than people who had never been incarcerated or on probation or parole.
• Black adult New Yorkers were almost twice as likely as White adult New Yorkers to have ever been incarcerated or on probation or parole (14% versus 8%); over three times as likely to have ever been physically threatened or abused by police (16% versus 5%); and over three times as likely to have an immediate family member incarcerated or on probation or parole in the past five years (13% versus 4%).

Since 2013, the City has worked to reduce the impact of the criminal justice system:

• Arrests decreased 37%, from 396,299 in 2013 to 250,983 in 2018.
• Stop and frisks decreased 94%, from 193,839 in 2013 to 11,079 in 2018.
• The jail population decreased 30%, from 11,696 in 2013 to 8,397 in 2018.
• Admissions decreased 46%, from 80,508 in 2013 to 43,396 in 2018.

In 2017, New York City had about 50,000 jail discharges and 19,000 people on parole.

All New Yorkers, including those with a history of criminal justice involvement, can access resources for smoking, high blood pressure, mental health and substance use concerns:

• Contact NYC Well if you or someone you know needs support with depression, drug use or suicidal thoughts by calling 1-888-NYC-WELL, texting “WELL” to 65173 or going to nyc.gov/nycwell. Free, confidential support is available at any hour of the day accessible in over 200 languages.
• For opioid use, treatment with buprenorphine or methadone is highly effective and can reduce the risk of overdose. Contact NYC Well for treatment options.
• Naloxone, the medication to reverse an opioid overdose, is available to all New Yorkers who need it. Find a list of upcoming naloxone trainings and pharmacies and other programs that offer naloxone at nyc.gov/health/naloxone.
• Complete a Mental Health First Aid course to learn how to identify, understand and respond to signs of mental health challenges, including suicidal behavior, anxiety, depression, psychosis, overdose and withdrawal. Mental Health First Aid is a free, one-day training offered six days a week in all five boroughs. New Yorkers interested in taking the class can sign up at nyc.gov/mhfa.
• For information on quitting smoking, visit the New York State Smokers' Quitline, or call 311 or 866-NY-QUITS (866-697-8487) to apply for a free starter kit of quit-smoking medications and to talk to a quit coach. You can also talk to your doctor about medications and counseling to help you quit.
• The Health Department’s NYC Health Map has more than 1,200 locations where New Yorkers can get their blood pressure checked.
• People with criminal justice involvement can also connect to community-based organizations and other services through the Fortune Society’s online reentry resource directory.

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MEDIA CONTACT: Patrick Gallahue/Stephanie Buhle, (347) 396-4177
pressoffice@health.nyc.gov