U.S. Department of Corrections Compassionate Release Policies: A Content Analysis and Call to Action

Criticism, Compassion, and Conspiracy Theories: A Thematic Analysis of What Twitter Users Are Saying About COVID-19 in Correctional Settings

We examined Twitter data using thematic analysis to understand public perceptions of the impact of COVID-19 on incarcerated people and reactions to including incarcerated populations in the early phases of the vaccine rollout. Our findings from n = 513 Tweets yielded six themes: Twitter as usual, Advocacy, Deserve to suffer, Vaccine priority debate, Inadequate response, and Misinformation. Stigma-laden statements cut across themes, highlighting the role pathologizing beliefs play in forming opinions about incarcerated people in public health crises. Trust of government response and buy-in to public health communication are positively associated with adherence to guidelines. Although public health decisions are derived from logic and research, our findings indicate that public perception may be driven by personal morals and stigma associated with justice-involved individuals. We recommend that attention be turned toward effective policy messaging, and use of social media, to increase trust and decrease stigma that tends to dominate societal perception.

A stepwise guide for healthcare professionals requesting compassionate release for patients who are incarcerated

PURPOSE

Compassionate release is a process that allows for the early release or parole of some incarcerated people of advanced age, with life-limiting illness, complex medical care needs or significant functional decline. Despite the expansion of State and Federal compassionate release programs, this mechanism for release remains underutilized. Health-care professionals are central to the process of recommending compassionate release, but few resources exist to support these efforts. The purpose of this paper is to provide a guide for health-care professionals requesting compassionate release for patients who are incarcerated.

DESIGN/METHODOLOGY/APPROACH

This study is stepwise guide for health-care professionals requesting compassionate release for patients who are incarcerated.

FINDINGS

This study describes the role of the health-care professional in requesting compassionate release and offers guidance to help them navigate the process of preparing a medical declaration or request for compassionate release.

ORIGINALITY/VALUE

No prior publications have created a step-wise guide of this nature to aid health-care professionals through the compassionate release process.

Dying for a change: a systematic review of compassionate release policies

PURPOSE

The purpose of this study was to systematically review literature to investigate trends in compassionate release policies, facility implementation, barriers at both the incarcerated individual and institutional levels, as well as gaps in the literature. The absence of uniform and appropriate policies to address suitable interventions at the end-of-life has aggravated the challenges and issues facing health-care systems within a correctional facility. A response to address and alleviate these barriers is policies related to compassionate release, a complex route that grants eligible inmates the opportunity to die in their community. Despite the existence of compassionate release policies, only 4% of requests to the Federal Bureau of Prisons are granted, with evidence demonstrating similarly low rates among numerous state prison systems, signifying the underuse of these procedures as a vital approach to decarceration.

DESIGN/METHODOLOGY/APPROACH

A systematic review was completed using preferred reporting items for systematic reviews and meta-analyses guidelines. Centre for Agriculture and Biosciences International Abstracts, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Education Resources Information Center, Google Scholar, MEDLINE, PsycINFO, PubMed, Social Services Abstracts and Social Work Abstracts were searched from inception to March 2021. Inclusion criteria included: the compassionate release policy (or related policy) is implemented in the USA; reported qualitative and/or quantitative outcomes; and reported original data.

FINDINGS

Twenty studies formed the final data set. Data analysis revealed four main themes: language barriers, complexities of eligibility criteria, over-reliance on prognostication and social stigma. Barriers to inmates' access to compassionate release policies include unclear or technical language used in policy documents. Eligibility criteria appear to vary across the country, including disease prognoses and the ability to predict terminal declines in health, creating confusion amongst inmates, lawyers and review boards. Stigmas surrounding the rights of incarcerated individuals frequently influence policymakers who experience pressure to maintain a punitive stance to appease constituents, thus discouraging policies and interventions that promote the release of incarcerated individuals.

RESEARCH LIMITATIONS/IMPLICATIONS

Further research is vital to strengthen the understanding of compassionate release policies and related barriers associated with accessing various types of early parole. To promote social justice for this marginalized population, end-of-life interventions in corrections need to be consistently evaluated with outcomes that improve care for dying inmates.

PRACTICAL IMPLICATIONS

Within correctional facilities, correctional health-care workers should play an integral role in influencing prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population. Social workers should participate in research that focuses on effective guidelines for correctional facilities to provide compassionate end-of-life care for inmates.

SOCIAL IMPLICATIONS

Racial disparities in the US criminal justice system are prevalent and well documented, as individuals of color are arrested far out of proportion to their share of all individuals in the USA. This particular population is thus challenged with poor access to and quality of health care in corrections. Correctional health-care workers can play an integral role in influencing policymakers, as well as prison and medical staff attitudes toward dying inmates by providing an understanding of how to effectively support this vulnerable population.

ORIGINALITY/VALUE

Currently, there are no published research articles that provide a systematic review of compassionate release policies in the USA.

COVID-19 and the reimaging of compassionate release

PURPOSE

The purpose of this paper is to provide a historical overview of compassionate release policies in the USA and describe how these policies have been used during the COVID-19 pandemic. The authors then describe how these programs have been shaped by COVID-19 and could be reimagined to address the structural conditions that make prisons potentially life limiting for older adults and those with chronic illness.

DESIGN/METHODOLOGY/APPROACH

This paper is primarily descriptive, offering an overview of the history of compassionate release policies before and during the COVID-19 pandemic. The authors augmented this description by surveying state Departments of Corrections about their utilization of compassionate release during 2019 and 2020. The findings from this survey were combined with data collected via Freedom of Information Act Requests sent to state Departments of Corrections about the same topic.

FINDINGS

The findings demonstrate that while the US federal prison system saw a multifold increase in the number of individuals released under compassionate release policies in 2020 compared to 2019, most US states had modest change, with many states maintaining the same number, or even fewer, releases in 2020 compared with 2019.

ORIGINALITY/VALUE

This paper provides both new data and new insight into compassionate release utilization during the COVID-19 pandemic and offers new possibilities for how compassionate release might be considered in the future.

Palliative care needs and experiences of people in prison: A systematic review and meta-synthesis

BACKGROUND

Globally, the prison population is growing and ageing, as is the need for palliative care. Yet, little is known about how people in prison perceive palliative care provision in this setting.

AIMS

To identify the: (i) perceptions of palliative care provision and dying in custody by people in prison; and (ii) perceived barriers and facilitators of person-centred palliative care provision in prison.

DESIGN

A systematic review and meta-synthesis was registered and undertaken in accordance with the reporting guidelines.

DATA SOURCES

Keywords and MeSH headings encompassing (i) palliative care, end-of-life care, death; and (ii) prison; were used to search Pubmed, Medline, CINAHL, PsycINFO, Web of Science, CINCH and ProQuest Central. Articles published in English, from high income countries, and containing qualitative data exploring perceptions of people in prison of palliative care in custody were included. Findings were reporting using the ENTREQ guidelines.

FINDINGS

Of the 2193 articles identified, 12 were included. Experiences of people in prison regarding palliative care related to two themes: (1) expectations versus experiences of palliative care; and (2) prison context complicates access to and provision of palliative care. People in prison with palliative care needs want to feel safe, cared for, and acknowledged as they face an expected death. The prison environment can severely restrict access to palliative care, leaving people in prison feeling isolated and powerless.

CONCLUSIONS

People in prison expect to receive high-quality palliative care, but their experiences often do not match their expectations. Numerous structural and organisational challenges complicate the provision of palliative care in prisons, limiting accessibility of care.

Caring, sharing, preparing and declaring: how do hospices support prisons to provide palliative and end of life care? A qualitative descriptive study using telephone interviews

BACKGROUND

Older adults in prison have complex healthcare needs, and many will need palliative care before their sentence ends. Compared with prison-based hospices, little is known about the role played by community-based hospices in providing palliative care to people in prison.

AIM

To describe the roles Scottish hospices have adopted to support prisons to provide palliative care, and to discuss the international relevance of these findings in addressing the knowledge gap around community hospices supporting people in prison.

DESIGN

A qualitative descriptive study using semi-structured telephone interviews.

SETTING/PARTICIPANTS

Representatives from all Scottish adult hospices were invited to take part in a short telephone interview and all (N = 17) participated.

RESULTS

Four roles were identified: caring, sharing, preparing and declaring. Most hospices employed different combinations of roles. Five (30%) hospices were engaged in caring (providing direct care at the prison or the hospice). Eleven (65%) hospices were engaged in sharing (supporting the prison by sharing knowledge and expertise). Eleven (65%) hospices were engaged in preparing (making preparations to support prisons). All seventeen hospices were described as declaring (expressing a willingness to engage with prisons to provide care).

CONCLUSIONS

There are differences and similarities in the way countries provide palliative care to people in prison: many are similar to Scotland in that they do not operate prison-based hospices. Variations exist in the level of support hospices provide. Ensuring that all people in prison have equitable access to palliative care will require close collaboration between prisons and hospices on a national level.

Older adults incarcerated in state prison: health and quality of life disparities between age cohorts

OBJECTIVES

This research sought to describe the physical and psychological health and quality of life among older adult men incarcerated in a state prison and to examine the role of age and historical time between age cohorts.

METHODS

Survey responses from male respondents incarcerated in a medium-security prison (N = 186) were described using frequencies and descriptive statistics; chi-square and analysis of variance analyses were used to examine differences between age cohorts.

RESULTS

The average number of chronic health conditions for the sample was higher than those in similar samples; the proportion of older adults with four or more chronic conditions was 10% higher than the national average for adults age 65 or older. Depression and post-traumatic stress (PTS) symptom severity scores were higher than those found in community-based samples. Significant differences were identified between cohorts regarding physical (number of chronic conditions, F = 12.48, p < .01); functional impairment, F = 4.28, p < .05) and psychological health (PTS symptom severity, F = 3.16, p < .05).

CONCLUSION

Policy and practice implications are discussed including the expansion of on- and off-site services for older adults in prisons, enhanced accessibility, and the use of grief counseling and stress management strategies.