Engage people and respect their preferences

Table 1 compiles a list of commonly used terms to describe people involved in the criminal justice system and examples of health conditions and situations that can fuel negative stereotypes. We list problematic terms to be avoided and propose preferred wording. Policymakers, researchers, program managers, healthcare providers, criminal justice professionals, and custodial service commissioners should engage people who are currently or formerly incarcerated – such as two contributors to this article (SC, CG) and one of the co-authors (PB), respectively – and ask them about the language they prefer using to identify themselves. The Marshall Project in the USA [26] and User Voice in the UK [27] are examples of meaningful engagement with people involved in the criminal justice system. As terminology requires adaptation in local languages and cultures, each linguistic and professional community should be engaged in discussing and contextualizing these terms so that they are acceptable in the circumstances they are to be used.

Table 1 Examples of terminology to avoid (in alphabetical order), problems related to its use, and preferred wording to describe people who are incarcerated Full size table

Use stigma-free and accurate language

People experiencing incarceration are family and community members, friends, students, teachers, or co-workers. Indeed, as stated by UNAIDS in 1996 at the United Nations Commission on Human Rights, ‘Prisoners are the community. They come from the community, they return to it. Protection of prisoners is protection of our communities.’ However, people leaving imprisonment often face daunting barriers to reintegrate into their community and exercise their rights to housing, employment, health insurance coverage, education, voting or parenting, among others. Enabling them to re-enter society and preventing recidivism are primary objectives of detention. Terms that devalue, exclude, discriminate, stereotype, objectify, dehumanize, and reinforce a ‘criminal self-image’, such as offender, criminal, felon, prisoner, convict, should be avoided. Inmate should not be used as it is ambiguous and refers to people living in any institution, including psychiatric hospitals [28].

The language we use to conceptualize and talk about incarcerated people and their characteristics reflects our personal views and understanding, or, too often, our biases (conscious or unconscious) and lack of understanding. It also helps shape our own and others’ attitudes about people involved in the criminal justice system and the way we grant or limit (at times unknowingly) their access to services. Therefore, defining people by the crime for which they were convicted (e.g., drug dealer, murderer, rapist, sex offender, paedophile) or by their legal status (e.g., illegal immigrant), and using moralistic language regarding substance use (e.g., drug abuser) or work (e.g., prostitute) is not helpful in supporting respectful interaction.

Use of the term correctional, which has been common since the 1950s in North America to describe the criminal justice system and related institutions (e.g., correctional health services), should be re-examined: it is linked to the sombre history of forced correctional labour camps [29], can be construed as moralistic, and is underpinned by the concept of ‘deviant’ behaviours to be corrected (while many people instead require treatment and care, rather than ‘behaviour correction’ such as for substance use disorders or mental health conditions). We should also reconsider the use of the term penitentiary (from penitens in Latin, meaning regretting or repenting) due to the strong religious connotation: ‘God’s forgiveness’ requires penitence and implies a sad and humble regret for one’s sins or wrongdoing.

Double denomination, such as prisoner-patient, should not be used in health service guidelines or by healthcare professionals [30]. The term puts the detention status of people before their needs for medical attention. It emphasizes the dual loyalty confusion for health professionals: one that often obfuscates the provider’s primary relationship (towards healthcare principles and ethics or towards the prison authorities) [31]. Healthcare providers, even if they are directly employed by prison authorities, must first attend to their patients as patients and act independently of prison or judicial authorities [32].

Prioritize the individual

Incarceration is often perceived as the worst experience of one’s life. However, individuals in detention are not defined only by the experience. Even when restricted in their freedom of movement, people must be given the resources to keep living with dignity and respect. Healthcare professionals have learned not to label patients by their medical diagnosis (e.g., we use person with body packing or with internal concealment of psychoactive substance instead of body packer; person on hunger strike instead of hunger striker). Likewise, we recommend placing individuals at the centre, and their characteristics or medical conditions second in the description. Therefore, the use of person-centred language should be preferred to describe what people have or the circumstances in which they live, which in the end should not define who they are and how we treat them. For instance: person who is incarcerated or living in detention/prison/jail (instead of prisoner) or person living with HIV (instead of HIV-infected patient) emphasize the fact that individuals are not powerless and can continue to live with dignity despite their environment or condition; person formally incarcerated, person with convictions (instead of ex-con) factually describes people in a specific phase of their life.

Cultivate self-awareness

Professionals working with people who are incarcerated should be conscious of the language they use as it can convey powerful images and meanings. They should favour in their clinical practice, policy, and research the use of humane and constructive language that promotes respect, dignity, understanding, and positive outlooks, and should encourage colleagues, friends, and their community to do so. Likewise, recognizing their influence in positively shaping public opinion, we call upon scientific journals, the media, governments, national and international organizations, including the legal community, to strive to adopt language that respects the dignity of people involved in the criminal justice system. While some people may not use preferred terminology, it is important for professionals of all sectors to develop cultural humility and self-reflection [33], be mindful, and refrain from repeating negative terms that discriminate, devalue, and perpetuate harmful stereotypes and power imbalances. Values clarification workshops for healthcare (and non-healthcare) professionals and researchers working with people involved in the criminal justice system could be transformative in clarifying values and changing attitudes to improve interactions with others [34], as may interventions to transform self-stigma and build the coping skills of individuals incarcerated, their families, and children [35]. Such interventions have the power of challenging prejudices, stigma, and self-stigma by increasing an individual’s awareness of values that may have a bearing on decisions and actions in their lives. Values clarification can therefore enhance our understanding of the complex sociocultural, psychological, and behavioral determinants of incarceration, redirect personal values, and address potential barriers to change the use of inappropriate language (e.g., through supportive supervision of staff working with incarcerated people). These actions can work to assist professionals to prioritize the use of terminology that adheres to our professional mandate: caring for people and supporting them in their journey of recovery and reintegration into society. Our use of language must promote such processes.