In the early 1990s, doctors from the Brightwood Health Clinic in Springfield, Mass., noticed that some chronically ill patients were not making their appointments. The patients had been incarcerated in the Hampden County Jail and House of Corrections.
The Sheriff's Department decided to allow the health center medical staff into the facility to provide treatment for a chronically ill patient. Upon release, an appointment was made for the inmate to continue treatment at the health center. The continuity of care for this chronically ill inmate revealed a unique public health opportunity within the jail.
The Sheriff's Department realized that most inmates came from neighborhoods that had a community health center. Beginning in 1996, the Sheriff’s Department contracted for medical services with four non-profit neighborhood health centers in greater Springfield. This became the model for COCHS – Community Oriented Correctional Health Services.
When an inmate is diagnosed, his home zip code is matched with the community health center closest to his home and he is assigned to a dually-based physician and case manager. In essence, the correctional center becomes the entry point into the health care system for a population that is both medically underserved and at high risk for serious health problems, including HIV/AIDS, substance abuse, tuberculosis, severe mental disorders, and a host of communicable illnesses.
It’s important to remember that jail inmates are part of their communities – not separate from them. They cycle in and out of the local jail, bringing their health problems back with them to their community. With 12 million people passing through our nation’s jails each year, local correctional agencies are more than enforcers of law and public safety – they are in a unique position to improve public health and reduce recidivism.
In 2006, the Robert Wood Johnson Foundation took notice of the Hampden County program and saw in it a promising model for improving community health. The Foundation funded COCHS to encourage jails across the country to adopt a long-term view of correctional health care, since the overwhelming majority of inmates return to the community after short stays.
Although enforcement and public safety will always be at the core of what jails are about, these facilities are meanwhile becoming de facto providers of health care. That’s a tough job. Local corrections officials need help addressing the multitude of health and human service issues present in their jail populations. COCHS offers an approach that works.
Bringing health care into jails makes sense both for jails and for their communities. By linking jail inmates – often for the first time – with a local doctor or other health care providers they can continue to see when released, a connection is formed that ultimately will help improve the health of the community.