How does the integration of health and justice systems impact on health and care inequalities in marginalised populations? A mixed methods systematic review.

Abstract

<h4>Purpose</h4>People experiencing marginalisation are over-represented in the criminal justice system (CJS) worldwide. CJS involvement exacerbates health and care inequalities, with poorer outcomes amongst people released from prison. Fragmented care and support persist upon release, but little is known about how health and justice systems intersect. The aim of this systematic review was to synthesise global evidence on: 1) integration of health and justice systems focused on people's experiences of returning to their community after prison; 2) the impact of CJS involvement on health, and care inequalities.<h4>Methods</h4>Six databases (MEDLINE, EMBASE, PsycINFO, CINHAL, ASSIA and Scopus) were searched for primary studies, of any design, conducted from 2013 onwards. Using a mixture of controlled search vocabulary (e.g. MeSH) and free text, search terms were derived using the SPIDER framework. All empirical studies were included which contained data relating to system links between CJS settings and the community which impacted on health in OECD countries. Thematic analysis was used to identify common themes across extracted data.<h4>Results</h4>20,104 studies were initially identified and screened for inclusion, with 43 included in the review. Our synthesis of the literature demonstrates that the CJS can have a considerable detrimental impact on health. We identified five themes: 1. (In)equivalence of healthcare in prison; 2. Public health interventions which bridge the gap from prison to the community; 3. Discontinuities in care and system-level precarity; 4. Social determinants of health impeding resettlement; 5. Elements of successful resettlement after prison: bridging the gap.<h4>Conclusions</h4>The identified themes show how marginalised, justice-involved populations are at a greater risk of experiencing detrimental health and care where health and justice systems fail to connect. We highlight the need for system level data sharing; cultural competency; and clarity in the role of 'resettlement hubs' in bridging the gap.