Locked in, Left Behind: Clinical, Psychosocial, and Ethical Dimensions of Prison Health—A Narrative Review

Abstract

The global prison population has expanded over recent decades, straining correctional systems and positioning detention facilities as critical, yet frequently overlooked, sites of health inequity. With an estimated 11.5 million people currently incarcerated worldwide, prisons have become pivotal settings for examining the convergence of clinical vulnerability, psychosocial adversity, and human rights concerns. The aim of this narrative review was to examine how clinical, psychosocial, and bioethical factors interact to shape the health of incarcerated populations and to address four questions: (i) what is the burden and distribution of disease in correctional settings; (ii) which psychosocial consequences of confinement are most consistently reported and through which mechanisms; (iii) what bioethical tensions arise in the delivery of prison healthcare; and (iv) how do these patterns manifest across global, European, and Romanian contexts? We conducted an integrative narrative review reported against the SANRA criteria, searching PubMed, ScienceDirect and Scopus databases, alongside institutional sources from the World Health Organization, the United Nations Office on Drugs and Crime, the Council of Europe, and national correctional authorities, and synthesizing the evidence thematically across the three domains. The evidence indicates that incarcerated populations experience increased rates of infectious disease, chronic illness, mental disorders, and substance use disorders, combined with overcrowding, resource-limited healthcare systems, and restricted access to preventive care. Psychosocial stressors are consistently associated with elevated risk of anxiety, depression, self-harm, and suicide. Ethical tensions persist between institutional security requirements and the obligation to protect the autonomy, dignity, and right to healthcare of people deprived of liberty, equivalent to that available in the community. The contribution of this review is to integrate three literatures that are usually examined separately, the epidemiological, the psychosocial, and the bioethical, into a single conceptual framework spanning three nested levels of analysis and to apply that framework to a Central and Eastern European system that is under-represented in the prison health literature. Because the majority of incarcerated individuals eventually return to their communities, improving prison health is not solely a correctional priority but a public health and social justice imperative; the policy implications set out here follow from the broader literature synthesized in this review rather than from outcomes demonstrated by the review itself.