In April of this year, I was lucky enough to travel to Louisville, Kentucky, USA with two healthcare colleagues to attend the National Commission on Correctional Healthcare (NCCHC) Spring Conference 2025. This was on foot of Caron McCaffrey (Director General of the Irish Prison Service) challenging me and my team to seek out more solutions to the healthcare challenges we face in corrections, with a particular emphasis on reviewing what is happening in other jurisdictions.
Scrolling LinkedIn one evening in Dublin, I came across the NCCHC Spring Conference in Kentucky. The itinerary was broad, relevant, and looked really interesting. Our Director General agreed to three of us travelling, including myself, Executive Clinical Lead Dr. David Joyce, and Chief Nurse Officer Mr. Liam Philips.
I think it’s fair to say that we had no idea how we would experience this conference. The prison population of Ireland is circa 5,350 at present and we imprison 97 per 100,000 population. In 2022, the US was reported to incarcerate 541 per 100,000 population, according to the World Prison Brief. We do not have capital punishment or super-max prisons. Prison healthcare is free in Ireland; this is not the case in the US. There are times, rightly or wrongly, when we judge the US prison system as one which is harsh, extreme, and punitive. What would we learn at a US healthcare conference that would inform our own prison healthcare system, which is very different in many ways? Or would our experience only fuel our assumptions about US prisons? In the end, we came away with really positive experiences — both in terms of learning and connections. Here are just some of our observations from our first US correctional healthcare conference.
Considering we were travelling a distance, we attended the pre-conference workshops which included:
- An in-depth review of NCCHC’s Standards for Health Services in Jails and Prisons by Jeffrey Alvarez and Tracey Titus
- An in-depth review of NCCHC’s Standards for Mental Health Services by Sharen Barboza and Marci MacKenzie
Whilst we understand various standards exist, our collective experience of these was that they were straightforward, comprehensive, well structured, easily understood, and overall, transmissible across jurisdictions. The standards mirrored many of the standards in the Irish Prison Service, however, it was a useful exercise in the anticipated modernisation of our own healthcare standards.
On Sunday, my colleagues visited the Louisville Metro Department of Corrections Main Jail. This jail has a large throughput of prisoners with an average of 1,452 bookings per month. When touring the jail, they gained insight into the healthcare structure within the jail, the use of peer-to-peer interactions, the use of the infirmary and isolation procedures for infectious disease, and the mental health challenges that were evident in the prison. One of the starkest realities was that despite the daily overcrowded population of almost 1,400, the number of staff on duty that day was only 42.
Whilst the challenges in Louisville mirror many of the difficulties in the Irish Prison Service, we reflected on how challenging it must be to provide high-quality custodial care with such a challenging staff ratio. What was particularly interesting about this visit was an opportunity to witness the use of “Signs of Life” technology, which the Irish Prison Service is currently working to pilot in two prisons over the coming months. One of our biggest questions during this planning, and because we had not “seen it in action,” was how operational staff experience the technology, which was largely positive.
Workshops were numerous, and unfortunately it was impossible to attend them all. However, a number stood out as particularly relevant and helpful in our continuous improvement programme within the Irish Prison Service, including:
- The Importance of Accurate Head Trauma Assessment (Susan Minter and P. Daniel McConnell)
- Emergency! Nursing Response and Clinical Decisions (Susan Laffan)
- Multidisciplinary Collaboration to Combat Hepatitis B (Neil Fisher)
- Hazardous Duty: The Invisible Effects of Working in Corrections (Sharen Barboza)
- Improving your Infection Prevention and Control Program (Sue Medley-Lane)
- Hepatitis C: The Cascade of Care in Corrections (Alexander Brorbry and Barbara Skidmore)
- The 4-Square Model of Suicide Prevention (Joseph Obegi)
- Suicide Precautions: Clinical Risks, Legal Risks, and Solutions (Joel Andrade and Benjamin Rice)
- Continuous Quality Improvement: Strategies and Techniques to Measure Change (Cheryl Esposito and Karen Riley)
- Serious Mental Illness: The Impact on Individuals and Systems (Joel Andrade and Corey Brawner)
- ACGME Carceral Fellowships: Physician Recruitment and Credentialing (Michelle Staples-Horne, Johnny Wu, and Elisa Crouse)
- Effective Clinical Supervision in Correctional Substance Use Treatment Programs (Lisa Dagnello)
- Retaining and Engaging Correctional Nurses (F. Brian Liebel and LaToya Duckworth)
Throughout the conference, we were struck by the mature and collaborative multi-disciplinary approach to workshops, with psychiatrists, psychologists, social workers, nurses, attorneys, and other disciplines all seemingly working cohesively, respectfully, and without a sense of one-upmanship or competition. Everyone seemed to understand each other’s role comprehensively and spoke respectfully of each other’s profession. This was clear demonstration of a mature workforce and one we could learn from.
Those who attended the conference were very obviously passionate about and committed to rehabilitation and recovery with the justice-involved individuals they worked with, despite the obvious challenges associated with security demands. It was really enjoyable and inspiring to spend time with people from another jurisdiction whose values were closely aligned. We were surprised by how much we had in common despite many differences running alongside. There is no doubt, the US correctional healthcare system is ahead of us in relation to technological advances. Areas in common included, but were not exclusive to:
- Treating and supporting people with dual diagnosis and personality disorder/difficulties
- Managing suicide and self harm
- Healthcare staff recruitment and retention
- Aging prison populations and palliative care
- Neurodiversity
- Chronic disease management
I am a huge advocate of international peer-to-peer support and learning. I am lucky enough to have a Director General who is willing to support this meaningfully and I appreciate not everyone has this opportunity — either in terms of financial or other support. There are other options. NCCHC is just one of many correctional healthcare/rehabilitative conferences available worldwide. For example, there is a UK Health and Justice Summit scheduled for 16th and 17th October 2025 — closer to home for those in Europe. There are also online options, from International Corrections and Prisons Association workshops to NCCHC (and other) online conferences, which support those unable to travel distances. Later this year, IACFP will also provide online learning through the enhancement of its Mental Health Leadership Network and the commencement of online Continual Professional Development options. The schedule for both will be available soon via LinkedIn and on our website https://www.myiacfp.org/
Prison work is hard work. Connection is key to sustaining us in these jobs. Connections are to be found all around the globe as long as you’re willing to travel, link in online, reach out over email, and tolerate the odd 10pm or 6am meeting time! Do it. You’ll find you have more in common with your international colleagues than you expect and it WILL sustain, refresh, and enhance you (and ultimately those you work with).
Dr Emma Regan
Clinical Psychologist
President, IACFP
