Barragan Melissa, Gonzalez Gabriela, Strong Justin Donald, Augustine Dallas, Chesnut Kelsie, Reiter Keramet, Pifer Natalie A
Department of Sociology, California Polytechnic University, Pomona, CA 93407, USA.
Department of Public Administration, California State University, Dominguez Hills, Carson, CA 90747, USA.
Healthcare (Basel). 2022 Feb 1;10(2):289. doi: 10.3390/healthcare10020289.
Incarceration, along with its most restrictive iteration, solitary confinement, is an increasingly common experience in America. More than two million Americans are currently incarcerated, and at least one-fifth of incarcerated people will experience solitary confinement. Understanding the barriers to care people experience in prison, and especially in solitary confinement, is key to improving their access to care during and after incarceration. Drawing on in-depth qualitative interviews with a random sample of 106 people living in solitary confinement and a convenience sample of 77 people working in solitary confinement in Washington State, we identify two key barriers to care that people in solitary confinement face: cultural barriers (assumptions that incarcerated people do not need or do not deserve care) and structural barriers (physical spaces and policies that make contacting a healthcare provider difficult). While scholarship has documented both the negative health consequences of solitary confinement and correctional healthcare providers' challenges navigating between the "dual loyalty" of patient care and security missions, especially within solitary confinement, few have documented the specific mechanisms by which people in solitary confinement are repeatedly triaged out of healthcare access. Understanding these barriers to care is critical not only to improving correctional healthcare delivery but also to improving healthcare access for millions of formerly incarcerated people who have likely had negative experiences seeking healthcare in prison, especially if they were in solitary confinement.
监禁，连同其最具限制性的形式——单独监禁，在美国正变得越来越普遍。目前，超过200万美国人被监禁，且至少五分之一的被监禁者会经历单独监禁。了解人们在监狱中，尤其是在单独监禁期间所面临的医疗障碍，是改善他们在监禁期间及出狱后获得医疗服务的关键。通过对华盛顿州106名单独监禁者的随机样本以及77名在单独监禁环境中工作的人员的便利样本进行深入定性访谈，我们确定了单独监禁者面临的两个关键医疗障碍：文化障碍（认为被监禁者不需要或不配得到医疗服务的假设）和结构障碍（使与医疗服务提供者取得联系变得困难的物理空间和政策）。虽然已有学术文献记录了单独监禁对健康的负面影响以及惩教医疗服务提供者在患者护理和安全任务的“双重忠诚”之间进行权衡时所面临的挑战，特别是在单独监禁环境中，但很少有人记录单独监禁者被反复排除在医疗服务之外的具体机制。了解这些医疗障碍不仅对于改善惩教医疗服务的提供至关重要，对于改善数百万曾经被监禁者的医疗服务获取情况也至关重要，这些人在监狱寻求医疗服务时可能有过负面经历，尤其是如果他们曾处于单独监禁状态。
