Abstract
-
Objectives: This study aimed to assess the health rights of inmates
in correctional facilities from the perspective of unmet needs and to explore
institutional improvement plans that could yield substantial qualitative and
quantitative advancements.
Methods: Data on capacity and actual occupancy, external and
internal medical services, the number of inmates with mental health conditions,
and cell area were obtained from the Ministry of Justice. Overall, 1,057 inmates
were surveyed, representing 1.84% of the total inmate population of 57,560 as of
September 30, 2016. A structured questionnaire was distributed to these inmates,
and upon collection, the responses were analyzed. Furthermore, a request was
submitted to the Ministry of Justice to survey the status of healthcare
personnel and medical services across 52 correctional facilities nationwide.
Results: Between 2014 and 2015, the Ministry of Justice in South
Korea allocated approximately 14 to 22 billion Korean won for healthcare
services in correctional facilities. The major facilities with the most inmates
with mental health conditions had 160 such inmates in 2014 and 161 in 2015.
Overcrowding and insufficient cooling pose ongoing health risks. Inmates face
challenges accessing medical care, with unmet needs for dental and psychiatric
services.
Conclusion: Strategies to improve inmates’ health rights
include establishing a primary healthcare system, improving governance,
alleviating overcrowding, and introducing mental health programs. Emphases are
placed on managing severe illnesses such as cancer, strengthening emergency
care, and ensuring oversight by the National Human Rights Commission. Regular
education of prison staff is also recommended to improve inmate health
management.
-
Keywords: Health rights; Correctional facilities; Prisoner; Inmates; Republic of Korea
Introduction
Background
Assessing potential human rights violations in the context of inmate health is
challenging when considering only the medical interventions provided to
individual prisoners. Thus, it is essential to comprehensively review existing
correctional healthcare policies and to develop guidelines that align with
international human rights standards while reflecting the characteristics of the
society. This approach is intended to propose alternatives to more effectively
safeguard the health rights of inmates.
Objectives
This research aims to examine the status of health rights for inmates within
correctional facilities, which serve as a barometer of human rights in a
democracy governed by the rule of law. The goal is to assess these rights in
terms of unmet needs and to explore institutional improvement plans that could
yield substantial qualitative and quantitative advancements.
Methods
Ethics statement
Before the questionnaires were distributed to participants, they were informed of
the following regarding consent: “Your personal information will not be
disclosed without your consent. The findings of this study will be reported in a
de-identified format, such as through distribution tables or statistics. If you
encounter difficulty answering any questions, you are not obligated to
respond.”
Setting
Prior to the site visits, the National Human Rights Commission requested relevant
data from the Ministry of Justice. The Ministry provided information on several
facilities, specifically Seoul Detention Center, Anyang Correctional
Institution, Daejeon Correctional Institution, Jinju Correctional Institution,
Gyeongbuk Northern Correctional Institution No. 1, and Mokpo Correctional
Institution. These data included details on capacity and actual occupancy,
external and internal medical services, the number of inmates with mental health
conditions, and cell area.
Participants
The field research involved visits to correctional facilities to assess the
status of their medical facilities. Of 52 correctional facilities across the
country, 10 (19.2%) were selected for the survey. From each facility, a basic
sample size of 100 inmates was chosen. In total, 1,057 inmates were surveyed,
accounting for 1.84% of the total inmate population of 57,560 as of September
30, 2016 (
Table 1).
Table 1.Number of survey participants by facility
|
Capacity |
Current number of inmates |
Participants |
% |
|
Gyeongbuk Northern Correctional
Institution No. 1 |
1,270 |
1,347 |
100 |
9.5 |
|
Daejeon Correctional Institution |
2,060 |
2,935 |
133 |
12.6 |
|
Mokpo Correctional Institution |
1,040 |
1,295 |
108 |
10.2 |
|
Seoul Detention Center |
2,200 |
3,521 |
100 |
9.5 |
|
Anyang Correctional Institution |
1,700 |
1,900 |
100 |
9.5 |
|
Yeoju Correctional Institution |
1,610 |
1,603 |
101 |
9.5 |
|
Jinju Correctional Institution |
1,050 |
1,003 |
112 |
10.6 |
|
Cheonan Correctional Institution |
1,060 |
1,225 |
101 |
9.5 |
|
Cheongju Correctional Institution |
750 |
1,079 |
100 |
9.5 |
|
Cheongju Women’s Correctional
Institution |
610 |
750 |
102 |
9.6 |
|
Total |
13,350 |
15,364 |
1,057 |
100 |
Variables
The variables under investigation were all questionnaire items presented to
participants.
Data sources and measurement
A structured questionnaire was distributed to inmates, then collected and
analyzed. Furthermore, a request was submitted to the Ministry of Justice to
conduct a survey on the status of healthcare personnel and medical services
available to inmates across 52 correctional facilities nationwide.
Bias
Bias may have been present in participant selection, as individuals were not
randomly allocated, but rather determined by each facility.
Study size
The basic sample size consisted of 100 inmates from each of 10 facilities.
Participants were selected by the respective correctional facilities;
consequently, no additional sample size estimation was performed.
Statistical methods
Descriptive statistics were used.
Results
General status data
General status
The total budget allocated by the Ministry of Justice for healthcare across
all detention facilities was 14,565.36 million Korean won (KRW) in 2014 and
15,393.87 million KRW in 2015. Healthcare expenditures for these facilities
were 16,029.2 million KRW in 2014 and 22,282.28 million KRW in 2015.
External medical consultations
When an inmate in a correctional facility requests a medical consultation
through correctional staff in the housing or work areas, the assigned
medical officer conducts either a rotating or accompanied consultation.
Based on the medical officer’s recommendation, the inmate may be
authorized to receive treatment at an external medical facility, which could
include telemedicine services or in-person visits. The average monthly
numbers of external consultations by facility were as follows: Seoul
Detention Center, 239.3 inmates sent for external consultations; Anyang
Correctional Institution, 372.5; Daejeon Correctional Institution, 288.0;
Gyeongbuk Northern Correctional Institution No. 1, 110.2; Mokpo Correctional
Institution, 248.3; and Jinju Correctional Institution, 87.1 (
Table 2).
Table 2.Number of external medical consultations by facility (May 1,
2015−April 30, 2016)
|
Time |
Seoul Detention Center |
Anyang Correctional
Institution |
Daejeon Correctional
Institution |
Gyeongbuk Northern Correctional
Institution No. 1 |
Mokpo Correctional
Institution |
Jinju Correctional
Institution |
|
15.5 |
239 |
356 |
256 |
123 |
221 |
92 |
|
15.6 |
295 |
401 |
255 |
114 |
199 |
99 |
|
15.7 |
293 |
461 |
281 |
110 |
222 |
100 |
|
15.8 |
309 |
426 |
199 |
94 |
194 |
88 |
|
15.9 |
212 |
395 |
231 |
114 |
265 |
103 |
|
15.10 |
239 |
360 |
375 |
108 |
246 |
87 |
|
15.11 |
212 |
378 |
322 |
125 |
286 |
75 |
|
15.12 |
233 |
350 |
231 |
125 |
289 |
78 |
|
16.1 |
202 |
303 |
295 |
93 |
241 |
71 |
|
16.2 |
213 |
334 |
287 |
106 |
250 |
62 |
|
16.3 |
222 |
351 |
327 |
107 |
303 |
108 |
|
16.4 |
202 |
355 |
397 |
103 |
264 |
82 |
|
Total |
2,871 |
4,470 |
3,456 |
1,322 |
2,980 |
1,045 |
Internal medical consultations
When an inmate requests a medical consultation or medication through
correctional staff in the housing or work areas, the medical officer reviews
the request. The officer then identifies inmates who require consultations
or medications and escorts those needing consultations to the medical
department for treatment. Medications are prepared and dispensed to the
inmates in need, beginning in the afternoon of the same day. The average
monthly numbers of internal consultations by facility were as follows: Seoul
Detention Center, 11,484.7 internal consultations; Anyang Correctional
Institution, 17,664.8; Daejeon Correctional Institution, 46,830.4; Gyeongbuk
Northern Correctional Institution No. 1, 14,703.7; Mokpo Correctional
Institution, 13,804.4; Jinju Correctional Institution, 7,439.8 (
Table 3).
Table 3.Number of internal medical consultations by facility (May 1,
2015−April 30, 2016)
|
Time |
Seoul Detention Center |
Anyang Correctional
Institution |
Daejeon Correctional
Institution |
Gyeongbuk Northern Correctional
Institution No. 1 |
Mokpo Correctional
Institution |
Jinju Correctional
Institution |
|
15.5 |
10,390 |
16,600 |
44,317 |
14,281 |
11,700 |
6,960 |
|
15.6 |
11,150 |
19,320 |
43,383 |
13,576 |
10,764 |
7,794 |
|
15.7 |
12,170 |
19,612 |
43,557 |
12,984 |
11,181 |
7,455 |
|
15.8 |
10,632 |
17,127 |
42,435 |
12,944 |
11,705 |
6,145 |
|
15.9 |
11,122 |
16,767 |
46,720 |
13,148 |
11,742 |
7,323 |
|
15.10 |
12,787 |
18,906 |
50,297 |
14,031 |
13,334 |
7,152 |
|
15.11 |
11,618 |
19,020 |
48,244 |
14,512 |
14,215 |
7,018 |
|
15.12 |
12,874 |
19,388 |
51,958 |
15,166 |
15,376 |
8,345 |
|
16.1 |
11,248 |
17,324 |
51,678 |
15,035 |
15,261 |
7,919 |
|
16.2 |
10,155 |
15,134 |
47,353 |
14,692 |
16,864 |
7,337 |
|
16.3 |
11,660 |
17,238 |
48,244 |
16,591 |
17,334 |
8,775 |
|
16.4 |
11,470 |
15,542 |
43,778 |
19,484 |
16,177 |
7,045 |
|
Total |
137,816 |
211,977 |
561,965 |
176,444 |
165,653 |
89,277 |
Inmates with mental health conditions
In 2014, Seoul Detention Center reported a total of 160 inmates with mental
health conditions, while Daejeon Correctional Institution and Jinju
Correctional Institution had 123 and 119, respectively (
Table 4). At Seoul Detention Center,
the most common mental illness was depression, affecting 67 inmates; 39 had
anxiety disorders, and 23 had schizophrenia. At Daejeon Correctional
Institution, 52 inmates had depression, 30 had anxiety disorders, and 18 had
schizophrenia. Jinju Correctional Institution reported 76 inmates with
schizophrenia and 36 with depression. In 2015, Mokpo Correctional
Institution had the highest number of inmates with mental health conditions,
totaling 161. This was followed by Seoul Detention Center, with 140, and
Jinju Correctional Institution, with 123. Of the inmates at Mokpo
Correctional Institution, 70 were affected by sleep disorders, 52 by
depression, and 27 by anxiety disorders (
Table 5).
Table 4.Number of inmates with mental health conditions (2014)
|
Total |
Behavior disorders
(F10-F19) |
Schizophrenia (F20-F29) |
Depression (F30-F39) |
Anxiety disorders (F40-F49) |
Sleep disorders (F50-F99) |
Etc. |
|
Seoul |
160 |
6 |
23 |
67 |
39 |
5 |
20 |
|
Anyang |
114 |
|
37 |
43 |
|
|
34 |
|
Daejeon |
123 |
3 |
18 |
52 |
30 |
14 |
6 |
|
Kyungpook |
82 |
7 |
26 |
18 |
17 |
10 |
5 |
|
Mokpo |
103 |
2 |
10 |
49 |
13 |
25 |
4 |
|
Jinju |
119 |
|
76 |
36 |
|
|
7 |
Table 5.Number of inmates with mental health conditions (2015)
|
Total |
Behavior disorders
(F10-F19) |
Schizophrenia (F20-F29) |
Depression (F30-F39) |
Anxiety disorders (F40-F49) |
Sleep disorders (F50-F99) |
Others |
|
Seoul |
140 |
|
24 |
33 |
35 |
3 |
45 |
|
Anyang |
110 |
5 |
30 |
29 |
17 |
29 |
|
|
Daejeon |
107 |
3 |
18 |
46 |
21 |
14 |
5 |
|
Kyungpook |
93 |
3 |
19 |
20 |
29 |
15 |
7 |
|
Mokpo |
161 |
3 |
8 |
52 |
27 |
70 |
1 |
|
Jinju |
123 |
24 |
86 |
11 |
|
|
2 |
Inmate deaths
The survey of correctional facilities conducted in 2014 and 2015 reported a
total of 11 deaths. Of these, Seoul Detention Center accounted for two
deaths, Daejeon Correctional Institution for six, Gyeongbuk Northern
Correctional Institution No. 1 for one, and Jinju Correctional Institution
for two.
Inmates with health-related sentence suspensions
In 2014 and 2015, a total of 92 inmates from the surveyed correctional
facilities had their sentences suspended for health reasons. The breakdown
of these numbers by facility is as follows: Seoul Detention Center, 20,
Anyang Correctional Institution, 20, Daejeon Correctional Institution, 28,
Gyeongbuk Northern Correctional Institution No. 1, six, Mokpo Correctional
Institution, seven, and Jinju Correctional Institution, 11.
Inmate housing conditions
The range of cell area by facility is as follows:
Seoul Detention Center: The area of shared cells for male prisoners ranges
from 8.96 to 12.84 m2, while that of shared cells for female
patients ranges from 5.16 to 17.52 m2.
Anyang Correctional Institution: The area of shared cells for male prisoners
ranges from 3.6 to 24.4 m2.
Daejeon Correctional Institution: The area of shared cells for male prisoners
ranges from 6.7 to 33.27 m2, while that of shared cells for
female patients ranges from 59 to 88.5 m2.
Gyeongbuk Northern Correctional Institution No. 1: The area of shared cells
for male prisoners ranges from 6.72 to 10.08 m2.
Mokpo Correctional Institution: The area of shared cells for male prisoners
ranges from 10.8 to 17.3 m2, while that of shared cells for
female patients ranges from 10.8 to 14.0 m2.
Jinju Correctional Institution: The area of shared cells for male prisoners
ranges from 10.8 to 17.3 m2, while female shared cells range from
10.8 to 18.9 m2.
Field research results
General situation
The average age of respondents was 43.8 years (SD, 10.5 years), and the
median age was 45 years. Most respondents—762 individuals
(95.4%)—were in their 20s to 50s. Prior to incarceration, 436
respondents (42.3%) were married. In terms of administrative classification,
the largest group was classified as grade 3 (411 respondents, 41.5%),
followed by grade 2 (378 respondents, 38.1%), grade 1 (187 respondents,
18.9%), and grade 4 (15 respondents, 1.5%). Most participants (786 inmates,
95.9%) were housed in shared accommodations, and 774 inmates (77.9%) were
assigned to work-release cells. Regarding criminal history, 641 respondents
(64.2%) were first-time offenders, while 358 (35.8%) were repeat offenders.
The average sentencing period was 6.3 years (SD, 5.1 years), and the average
time served was 4.2 years (SD, 4.0 years). On average, respondents spent
55,000 KRW per month on personal medical expenses (SD, 120,000 KRW).
Living environment: residential conditions and overcrowding
Regarding heating in the winter, out of 1,021 respondents to the item, 356
inmates (34.9%) reported that it was “very cold,” while 419
individuals (41.0%) described it as “cold.” Conversely, during
the summer, 705 inmates (68.5%) characterized their living quarters as
“very hot,” while 288 (28.0%) reported them to be
“somewhat hot.” Of 1,031 inmates who responded to the survey
regarding ventilation, a total of 638 (61.9%) reported issues with
ventilation in their rooms. Concerning the lighting conditions for sleep,
out of 1,026 respondents, 252 (24.6%) indicated that lights were on during
sleep time, whereas 293 respondents (28.6%) reported that lights were not on
during this period.
Regarding access to shower facilities, 465 of 958 respondents (48.5%)
reported being unable to use showers, while 378 respondents (45.3%)
indicated that they primarily used showers during the summer. Furthermore,
772 respondents (84.1%) stated that hot water was available only in the
winter.
When asked about their laundry habits, 745 respondents (80.6%) reported
washing their clothes in the bathroom rather than in a laundry room.
Regarding washing methods, 755 respondents (81.9%) indicated that they
hand-washed their clothes.
When asked whether clothing was distributed on time, 875 of 1,020 respondents
(85.8%) answered in the affirmative. However, regarding satisfaction with
the quality of the clothing, 464 of 1,008 respondents (46.0%) expressed
dissatisfaction.
Concerning the allocation and cleanliness of bedding, 670 of 1,021
respondents (65.6%) reported receiving one mattress per person.
Additionally, 557 respondents (55.0%) indicated they were provided with two
blankets each, and 939 respondents (92.2%) confirmed receiving one pillow
per person. In terms of the cleanliness and suitability of the bedding, 328
out of 1,014 respondents (32.3%) described the bedding as not clean or
suitable for use, while 169 respondents (16.7%) stated that it was not at
all clean.
Regarding compliance with the planned diet in the correctional facility, 816
out of 1,041 respondents (78.4%) reported that the facility adhered to the
planned menu. However, when asked about satisfaction with the meals, 345 out
of 1,038 respondents (33.2%) indicated dissatisfaction. Regarding the
quality of purchased supplementary food (self-funded), 571 out of 1,039
respondents (55.0%) expressed dissatisfaction.
Concerning daily exercise duration, 507 out of 1,036 respondents (48.9%)
reported exercising for 15 to 30 minutes a day, while 390 respondents
(37.6%) indicated that they exercised for 30 to 45 minutes daily.
Emotional state
Depression: The 11-item Center for Epidemiologic Studies Depression Scale was
administered to assess the presence of depression among the inmates. Scores
of 21 to 24 indicated mild depression, while scores of 25 or higher
indicated severe depression. Of 1,003 respondents, 115 (11.5%) were
identified as having mild depression and 199 (19.8%) severe depression.
Consequently, a total of 314 participants (31.3%) were classified as
experiencing depression.
Sleep disorders: Among 938 respondents, the average time to fall asleep was
33.2 minutes (SD, 28.0 minutes), and the median time was 30 minutes. The
shortest time recorded to fall asleep was 5 minutes, while the longest was
250 minutes. A total of 652 respondents (69.5%) took between 10 minutes and
1 hour to fall asleep. On average, respondents woke up 3.4 times per night
(SD, 2.1 times), and the median number of awakenings was three. The maximum
number of awakenings reported by a respondent in a night was 20, and 35
respondents (3.8%) reported waking up more than 10 times. On average,
respondents had trouble sleeping 2.8 days per week (SD, 2.2 days), and the
median was 2 days. The maximum number of days per week with sleep
difficulties was seven, with 99 respondents (12.5%) indicating they had
trouble sleeping every night. Additionally, 194 respondents (24.4%) reported
having difficulty sleeping at least one night per week, while 180
respondents (22.6%) experienced difficulty sleeping for two nights per
week.
Intentional self-harm: Of 846 respondents, 118 inmates (13.9%) reported
having considered intentional self-harm within the past year. Among these
individuals, 31 inmates (3.7%) indicated that they had formulated a suicide
plan during the past year, and 11 inmates (1.3%) reported that they had
attempted suicide.
General health condition
Over the past year, the most frequently reported health issues were headaches
and eye fatigue, affecting 740 respondents (15.1%). This was followed by
muscle pain in the shoulders, neck, and arms, reported by 708 respondents
(14.5%). Muscle pain in the lower body, including the hips and legs,
affected 588 respondents (12.0%). Among the 93 respondents (2.4%) who
reported other health issues, conditions mentioned included chronic
prostatitis, colds, acute pyelonephritis, toothaches, cystitis, ascites,
rhinitis, asthma, pulmonary fibrosis, and endometriosis. When asked if they
had developed new health problems after being incarcerated, 541 out of 727
respondents (60.4%) answered “yes.” Furthermore, when asked
whether pre-existing health issues had worsened since entering the
correctional facility, 420 out of 831 respondents (50.5%) answered in the
affirmative.
Medical utilization: internal/infirmary care and external medical
services
Internal medical care: Out of 978 respondents, 619 (63.3%) reported that they
had urgently needed to visit the medical department due to illness. When 606
inmates were questioned about the feasibility of being escorted to the
infirmary, 336 (55.4%) indicated it was “somewhat possible.”
In contrast, 179 (29.5%) found it “somewhat difficult,” 48
(7.9%) stated it was “not at all possible,” and 43 (7.1%)
considered it “very possible.” Overall, 227 respondents
(37.4%) expressed difficulty in being escorted to the infirmary.
When asked about their visit to the infirmary, 785 out of 968 respondents
(81.1%) reported that they were examined by a doctor (
Table 6). Additionally, 869 of 1,016 respondents (85.6%)
confirmed that they had received medical treatment from a healthcare
professional within the facility.
Table 6.Medical personnel who conducted medical examinations
|
2016 |
2010 |
2022 |
|
Number |
% |
Number |
% |
Number |
% |
|
Doctor |
785 |
81.1 |
634 |
81.3 |
543 |
71.0 |
|
Nurse |
38 |
3.9 |
37 |
4.7 |
58 |
7.6 |
|
Correctional officer |
90 |
9.3 |
65 |
8.3 |
119 |
15.6 |
|
Inmate |
4 |
0.4 |
3 |
0.4 |
35 |
4.6 |
|
Others |
51 |
5.3 |
41 |
5.3 |
10 |
1.3 |
|
Total |
968 |
100 |
780 |
100 |
765 |
100 |
Of 956 respondents, 277 (29.0%) reported being asked to cover personal
medical expenses within the facility. Among those inmates, 83 respondents
(30.6%) said they had been unable to receive treatment due to the inability
to pay for medical expenses (
Table
7).
Table 7.Inmates experiencing inability to receive medical treatment due
to medical expenses
|
2016 |
2010 |
2022 |
|
Number |
% |
Number |
% |
Number |
% |
|
Yes |
83 |
30.6 |
66 |
47.8 |
127 |
49.2 |
|
No |
188 |
69.4 |
89 |
52.2 |
131 |
50.8 |
|
Total |
271 |
100 |
155 |
100 |
258 |
100 |
When asked whether they had ever desired dental treatment, 733 out of 1,015
respondents (72.2%) answered “yes.” Of the 693 respondents who
provided further details, 104 (15.1%) reported being unable to receive any
dental treatment, and 514 (74.2%) indicated that they had received treatment
but experienced an excessive wait time.
Concerning the desire for psychiatric treatment, 166 out of 997 respondents
(16.6%) reported wanting such treatment. Among the 133 inmates who gave
additional details, 46 (33.1%) reported being unable to receive any
psychiatric treatment, while 52 (37.4%) indicated that they had received
treatment but experienced an excessive wait time.
When asked to prioritize the top three most essential healthcare services in
the facility (calculated using weighted averages), participants ranked
“dental consultation and treatment” as the most necessary,
followed by “regular health check-ups” in second place and
“increased use of external hospital services” in third.
Infirmary admission: Of 885 respondents, 52 (5.9%) reported having applied
for admission to the infirmary. Of these, 36 inmates (66.7%) were
successfully admitted, indicating that approximately one in three inmates
who applied were not admitted. The average time from application to
admission was 13.4 days (SD, 26.9 days). Among the 37 inmates who gained
admission to the infirmary, five respondents (13.5%) reported that gaining
admission was somewhat difficult, while 11 (29.8%) described it as very
difficult.
Of the 24 respondents who reported being denied admission to the infirmary,
12 inmates (50.0%) indicated that they were refused without receiving a
medical examination. This suggests that half of the refusals occurred
without a proper medical evaluation.
External medical treatment: Among 866 respondents, 204 inmates (23.6%)
reported having wanted to receive treatment at an external hospital but
being unable to apply. Additionally, 140 out of 823 respondents (17.0%)
indicated that their requests for external hospital treatment had been
denied. Among 125 inmates who had been denied external treatment and
provided further details, 24 (19.2%) reported being denied without receiving
a medical examination.
Regarding the cost of external hospital treatment, 155 out of 216 respondents
(71.8%) reported that they had to cover the full cost themselves. The
average time elapsed from applying for external hospital treatment to
receiving it was 41.0 days (SD, 82.2 days).
When inmates were transferred to external hospitals, they were accompanied by
an average of four correctional officers (SD, 0.8). The median number of
officers present during these transfers was also four, with a range of two
to six officers and a mode of four officers.
Health check-ups
Of 1,027 respondents, 825 (80.3%) reported receiving a health check-up upon
admission to the facility. When asked whether they received follow-up care
after the check-up, 293 out of 791 respondents (37.0%) answered in the
affirmative, while 311 (39.4%) indicated they did not receive follow-up
care.
Only 99 of 797 respondents (12.4%) reported having undergone a mental health
check-up at admission. Among 76 inmates who experienced a mental health
check-up, only 13 respondents (17.1%) were examined by a psychiatrist.
Regarding general health check-ups during incarceration, 842 out of 1,003
respondents (83.9%) reported receiving one. Among 792 respondents queried
about follow-up care after the check-up, 281 (35.5%) confirmed they had
received care, while 320 (40.4%) indicated they had not.
Additionally, 70 out of 790 respondents (8.9%) reported having received a
mental health check-up while incarcerated. Among 55 of the respondents who
indicated having received a mental health check-up, 16 (29.1%) reported
being examined by a psychiatrist.
Medication usage
Out of 922 respondents, 345 inmates (37.4%) reported obtaining medication
through self-funded purchases, while 324 inmates (35.1%) indicated they
received medication via prescription following a medical consultation.
Furthermore, 172 inmates (18.7%) reported acquiring medication by submitting
a request form without a doctor’s visit.
Of 915 respondents, 439 inmates (48.0%) indicated having been prescribed
medication without meeting with a doctor. On average, inmates took
medication 4.4 days per week (SD, 0.6 days).
Among 879 respondents, 72 inmates (8.2%) reported having been refused when
applying to purchase self-funded medication. Of 947 respondents, 806 inmates
(85.1%) had experience with purchasing self-funded medications. The most
frequently purchased self-funded medications were vitamins and supplements
like calcium (673 inmates, 31.6%), followed by skincare medications (445
inmates, 20.9%) and analgesics (328 inmates, 15.4%).
Emergency situations
Of 747 respondents, 157 inmates (21.0%) reported having requested a
consultation with a doctor or nurse at night or on Saturday afternoons,
Sundays, or public holidays due to illness. Among 151 inmates who requested
a consultation, 48 (31.8%) were able to meet with a doctor or nurse, while
103 inmates (68.2%) were unable to do so.
The average waiting time for inmates to see medical staff after submitting a
request was 3.5 days (SD, 2.9 days). The median waiting time was 1 day. Of
the 54 inmates who provided detailed information, 20 (37.0%) were able to
meet with medical staff within 1 to 3 days.
Medical complaints
Out of 826 respondents, 18 inmates (2.2%) reported having filed complaints or
petitions concerning medical issues. Among these 18 inmates, eight (44.4%)
stated that they experienced interference from the correctional facility
when filing their complaint. After the petitions were processed, only two
inmates (12.5%) out of 16 who reported further information indicated that
the desired action was taken.
Status of medical staff and facilities across correctional
institutions
Medical staff and inmate demographics across correctional
facilities
As of September 30, 2016, a total of 57,541 inmates were housed across 52
correctional facilities in South Korea. The breakdown by gender and age
revealed that 27.9% (16,072 inmates) were in their 40s, followed by 25.2%
(14,526 inmates) in their 50s and 21.5% (12,398 inmates) in their 30s. The
inmate population was 71% male and 29% female, with 70% of the inmates
between 30 and 50 years old.
Regarding the medical staff available in these facilities, as of September
30, 2016, the staffing fulfillment rates in comparison to the required
personnel were as follows: doctors at 79%, pharmacists at 85%, nurses at
98%, and medical technicians at 100%.
Average daily number of patients and prescriptions in correctional
facilities
The average daily medical consultation rate varied significantly across
correctional facilities, ranging from 3.1% to 30.0%. The Pyeongtaek Branch
of Suwon Detention Center reported the highest consultation rate at 30.0%.
This was followed by Chuncheon Correctional Facility at 20.9% and the Seosan
Branch of Hongseong Correctional Facility at 20.3%. In contrast, Pohang
Correctional Facility had the lowest daily consultation rate at 3.1%.
Regarding the daily number of prescriptions issued, as of September 30, 2016,
Daejeon Correctional Facility recorded the highest figure, with 3,677
prescriptions. This was followed by Daegu Correctional Facility, with 2,313
prescriptions, and Seoul Detention Center with 1,386 prescriptions.
Discussion
Directions for improving health rights
Inmates in correctional facilities face considerable barriers to accessing
essential healthcare services, resulting in serious violations of their right to
health and meaningful disparities in health determinants. From a human rights
standpoint, inmates retain the right to health, and correctional institutions
are intended to facilitate social reintegration. Supporting inmates in adopting
healthy behaviors can positively influence community health, underscoring the
importance of improving health rights for inmates [
1–
3].
Establishing a primary healthcare system and community linkages within
correctional facilities
While recent investigations indicate an increase in healthcare staff and a
rise in the frequency of in-person doctor consultations, many inmates
continue to receive exclusively medication-focused treatments, without the
benefit of direct consultations. Deficiencies remain in comprehensive
services, such as counseling, health education, psychological support, and
ongoing monitoring. Notably, dental and mental health services face a
substantial unmet demand. Therefore, it is essential to ensure that
sufficient healthcare personnel are available to address the gaps in primary
healthcare services within correctional facilities. Additionally, a medical
information system must be established that maintains continuity of care
before and after an inmate’s admission. This should be complemented
by the standardization of operational manuals for medical services in these
facilities, as well as the development of comprehensive healthcare programs
that encompass screening, consultation, and management. Furthermore, efforts
must be directed toward medical officers in correctional facilities,
focusing on improving their capabilities and education in human rights. For
medical officers who repeatedly violate human rights, the adoption of a
“three-strike rule” is recommended to prevent them from
continuing to provide medical services.
Establishment of a healthcare control tower and governance system in
correctional facilities
Establishing a high-quality primary healthcare system within correctional
facilities and integrating it with the community healthcare system is a
complex task that cannot be accomplished solely through the efforts of
individual facilities. The specialized nature of healthcare means that
addressing healthcare issues within correctional facilities through the
standard correctional administration framework is structurally limited. To
ensure the robustness of primary healthcare within these facilities and to
facilitate a seamless connection with community healthcare services, it is
necessary to create a dedicated healthcare service system within the
Ministry of Justice. This system should be separate from the regular
correctional administration. Such an approach would enable medical offices
in each facility to be directly managed by the Ministry of Justice, rather
than being subordinate to the individual correctional facilities.
If a separate healthcare service organization is not created, a control tower
should instead be implemented within the Ministry of Justice. This
Correctional Healthcare Support Unit could monitor and evaluate the medical
offices within each correctional facility.
Additionally, the formation of a Primary Healthcare Enhancement Committee for
Correctional Facilities is recommended. This governance body should include
members from human rights organizations, representatives from regional
public hospitals, community representatives, and experts. The existence of
this committee would promote open communication and oversight. Furthermore,
improvements to the official Borami system should be made to enable medical
officers to access inmates’ medical information from before their
incarceration. This access would facilitate improved healthcare management
within correctional facilities.
Plans regarding the general environment and medical facilities in
correctional institutions
With overcrowding, many inmates who previously lived alone are now struggling
to adapt to confined spaces where six or more individuals share a small
cell. Such an environment has been identified as a cause of increased
conflict among inmates. Additionally, surveys reveal that cooling facilities
are notably lacking compared to heating, creating heightened health risks
during the summer due to overcrowding, inadequate cooling, and limited water
supply.
To address these issues, it is essential to assess whether the capacities of
the facilities are set appropriately. Initially, a minimum living space
should be established that does not adversely affect the basic quality of
life and health of inmates, and the current facility capacities should be
adjusted accordingly. Furthermore, to alleviate overcrowding, early release
options should be implemented for minor offenders.
Cooling and water supply must be consistently provided during the summer,
rather than being restricted to certain times. Ensuring access to adequate
cooling and water for bathing is not only a basic human right but also
crucial for infection prevention and the management of inmate health during
the hotter months. Finally, for patients requiring dialysis, such as those
with chronic renal failure, inmates should be housed in designated
facilities within regional correctional jurisdictions. This and similar
approaches would improve the quality of medical services provided for
specific health conditions.
Introduction of mental health programs in correctional facilities
A survey revealed that inmates exhibit significantly higher levels of stress
and depression compared to the general population. Poor mental health among
the incarcerated not only diminishes their overall health status but also
contributes to adverse outcomes, including conflicts, violence, and
self-harm. These findings underscore the importance of proactive mental
health management. Correctional facilities might benefit from adopting a
mental health program akin to that of Jinju Correctional Institution, which
focuses on managing psychiatric disorders.
An initial mental health evaluation by a psychiatrist should be incorporated
into the intake health screening process. Individuals identified as
high-risk should receive psychiatric care, whereas other inmates should have
access to mental health programs, such as those offered at Jinju
Institution. The mental health of inmates should be regularly assessed, with
mental health nurses and clinical psychologists available on-site in
collaboration with psychiatrists. For inmates with high depression scores,
targeted psychological support should be provided, and measures should be
taken to mitigate or eliminate exacerbating factors.
Post-release, these mental health programs should continue in partnership
with community mental health centers, such as regional and metropolitan
facilities, as integral components of community mental health initiatives.
This approach includes the provision of training and support for program
coordinators to establish a robust support system. For a detailed
description of the program, refer to
Supplement 1.
Management plan for severe illnesses, such as cancer, and emergency
medical systems in correctional facilities
A robust healthcare management system is crucial in correctional facilities,
especially for managing severe illnesses such as cancer and for establishing
an effective emergency medical response. For conditions like cancer,
thorough monitoring should commence at intake via the cross-referencing of
health insurance records, ensuring that undiagnosed cases are not
overlooked. When new cases of cancer or other severe illnesses are
identified within a correctional facility, it is crucial to coordinate
closely with public health centers and community medical institutions to
ensure patients are registered for specialized care. Those registered with
cancer must receive proactive management both within the facility and
through external healthcare services.
Within correctional facilities, patients with cancer and other severe
illnesses must be immediately assigned to medical units, with specialized
medical rounds tailored to their needs. Effective management of these
patients and the ability to respond to potential emergencies necessitate
ongoing training to improve the skills of medical officers, as well as the
securing of sufficient medical personnel. This goal also entails minimizing
delays in emergency medical services that may result from staffing
shortages, especially on weekends and holidays.
For cases in which adequate care cannot be provided within the facility, a
robust protocol should be in place to secure external treatment from
community healthcare institutions. Active medical intervention from these
external facilities should be readily accessible to manage severe conditions
effectively.
Ongoing efforts by the National Human Rights Commission
The National Human Rights Commission should conduct periodic investigations
into the cases of inmates with suspended sentences, deceased inmates, and
individuals who frequently file health-related complaints. Additionally, it
is necessary to conduct a comprehensive health rights survey encompassing
all inmates in correctional facilities across the country every 3 to 5
years. Finally, health rights-focused human rights education must be
provided to prison wardens, medical officers, and key senior staff members.
Since the primary responsibility for upholding inmate health rights rests
with the management of these facilities, particularly the prison wardens,
medical officers, and senior officials, their awareness of health rights is
directly linked to the protection of these rights among inmates within their
respective institutions. Therefore, as a component of the
Commission’s human rights education initiatives, it is vital to
deliver targeted health rights education to these key supervisory
figures.
Authors' contributions
-
Project administration: Ju YS, Kim M, Yim J, Choung M
Conceptualization: Ju YS, Kim M, Yim J, Choung M
Methodology & data curation: Ju YS, Kim M, Yim J, Choung M
Funding acquisition: Ju YS, Kim M, Yim J, Choung M
Writing – original draft: Ju YS, Kim M, Yim J, Choung M
Writing – review & editing: Ju YS, Kim M, Yim J, Choung M
Conflict of interest
-
No potential conflict of interest relevant to this article was reported.
Funding
-
This study was conducted as part of a research project commissioned by the
National Human Rights Commission of Korea for the investigation of human rights
conditions.
Data availability
-
Not applicable.
Acknowledgments
Not applicable.
Supplementary materials
-
Supplementary materials are available from: https://doi.org/10.12771/emj.2024.e75.
Supplement 1. Original Korean report of this article
Editor’s note
-
Inmates may represent a marginalized group within healthcare.
References
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detailed research topic 1: a study on international standards related to
correctional treatment; Seoul: Korean Institute of Criminology and Justice; 2014.
- 2. Keum YM. Study on international rules for the treatment of
prisoners. Correct Res 2016;71:161-190.
- 3. Park YK. Medical treatment for prisoners. Correct Rev 2010;48:73-105.
