Chapter 12Chapter 12

Special Prison Populations:Special Prison Populations:

Prisoners Who Are Elderly, Mentally Prisoners Who Are Elderly, Mentally Challenged, and Who Have HIV/AIDSChallenged, and Who Have HIV/AIDS

McGraw-Hill/Irwin © 2013 McGraw-Hill Companies. All Rights Reserved.

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Special-Needs InmatesSpecial-Needs Inmates

Those prisoners who exhibit unique physical, mental social, and programmatic needs that distinguish them from other prisoners and for whom jail and prison management and staff have to respond to in nontraditional and innovative ways.

There is an increasing number of special needs inmates in prisons and jails.

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Special-Needs InmatesSpecial-Needs Inmates

A plan is under review in California A plan is under review in California that would put the University of that would put the University of California in charge of state prison California in charge of state prison inmates’ medical needs that some say inmates’ medical needs that some say could save the state $12 billion over could save the state $12 billion over the next decade.the next decade.

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Substance-Abusing InmatesSubstance-Abusing Inmates

Almost 83% of America’s jail and prison Almost 83% of America’s jail and prison population need some sort of substance-population need some sort of substance-abuse treatment. Only 13% receive it abuse treatment. Only 13% receive it while incarcerated. The number of drug while incarcerated. The number of drug offenders in state and federal prisons is offenders in state and federal prisons is nearly 350,000. Today 18 percent of state nearly 350,000. Today 18 percent of state prisoners and 51 percent of federal prisoners and 51 percent of federal prisoners are incarcerated for drug prisoners are incarcerated for drug offenses.offenses.

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Substance-Abusing InmatesSubstance-Abusing Inmates

In 2006, alcohol and drugs were In 2006, alcohol and drugs were involved in:involved in:

• • 78 percent of violent crimes;78 percent of violent crimes; • • 83 percent of property crimes; and83 percent of property crimes; and • • 77 percent of public order, 77 percent of public order,

immigration or weapons offenses, immigration or weapons offenses, and probation/ parole violations.and probation/ parole violations.

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Substance-Abusing Inmates - Substance-Abusing Inmates - ContinuedContinued

An incarcerated individual suffering from dependency on one or more substances including alcohol and a wide range of drugs.

The criminal justice system has become the largest source of mandated, or coerced, drug treatment in the United States.

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Treatment and RecidivismTreatment and Recidivism

Generally, drug and alcohol treatment in prison tends to reduce recidivism.

Only a small fraction of jail inmates who need substance-abuse treatment actually receive it.

Offenders who tested positive for drugs at the time of their arrest have longer criminal records and have been imprisoned more often than those who do not test positive.

Therapeutic Communities – residential treatment program (separate housing)

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HIV-Positive and AIDS InmatesHIV-Positive and AIDS Inmates

HIV (Human Immunodeficiency Virus) – a group of retroviruses that infect and destroy helper T cells of the immune system, causing a marked reduction in their numbers that is diagnostic of AIDS

AIDS (Acquired Immunodeficiency Syndrome) – a disease of the human immune system that is characterized cytologically, especially by reduction in the numbers of CD4-bearing helper T cells to 10 percent or less of normal, rendering a person highly vulnerable to life-threatening conditions

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Prevalence of HIV and AIDS Prevalence of HIV and AIDS InmatesInmates

Between 2005 and 2006, the number of state and federal HIV positive prisoners decreased from 22,676 to 21,900

In 2008 a reported 20,449 state prisoners and In 2008 a reported 20,449 state prisoners and 1,538 federal prisoners were HIV positive or had 1,538 federal prisoners were HIV positive or had confirmed AIDS, accounting for 1.5 percent of the confirmed AIDS, accounting for 1.5 percent of the total custody population.total custody population.

At year-end 2008, an estimated 5,733 state and At year-end 2008, an estimated 5,733 state and federal inmates had confirmed AIDS, down from federal inmates had confirmed AIDS, down from 5,977 in 2006.5,977 in 2006.

The prevalence of AIDS among inmates is 2½ times greater than among the general U.S. population

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Prevalence of HIV and AIDS Prevalence of HIV and AIDS InmatesInmates

During 2007 (the most recent year During 2007 (the most recent year for which data on inmate deaths are for which data on inmate deaths are available for state prisons), 120 state available for state prisons), 120 state inmates and 13 federal inmates died inmates and 13 federal inmates died from AIDS-related causes, down from from AIDS-related causes, down from an estimated 143 in 2006. Florida an estimated 143 in 2006. Florida (14), New York (11), and Texas (10) (14), New York (11), and Texas (10) reported 10 or more AIDS-related reported 10 or more AIDS-related deaths during 2007.deaths during 2007.

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Cost-Effective Management of HIV Cost-Effective Management of HIV and AIDS Inmatesand AIDS Inmates

Early detection and diagnosis Medical management and treatment Inmate classification and housing Education and training of staff and

inmates Adequate funding

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Treating HIV Treating HIV

Treating HIV in prison is difficult due to: Privacy issues The frequency of medication and its disruption

of the prison routine Inmates’ distrust of the medical and legal

systems Inmates’ fear of side effects The principle of least eligibility

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Mentally Ill InmatesMentally Ill Inmates

At midyear 2005, more than half of all prison and jail inmates had a mental health problem such as schizophrenia, major depression, bipolar disorder, or post-traumatic stress disorder. 90% went untreated

As special needs inmates, people who are mentally ill do not do well in prison. They are perceived as disruptive, unpredictable, and sometimes dangerous.

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Mentally Ill InmatesMentally Ill Inmates

It is estimated that there are nearly It is estimated that there are nearly eight times more people who are eight times more people who are mentally ill in the nation’s jails and mentally ill in the nation’s jails and prisons (nearly 478,000) than there prisons (nearly 478,000) than there are in mental hospitals (60,000).are in mental hospitals (60,000).

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Why So Many Mentally Ill Behind Bars?Why So Many Mentally Ill Behind Bars?

Failure to differentiate who should be in jail and who shouldn’t Failure to treat people before they enter the criminal justice

system Deinstitutionalization Stricter commitment laws Less stringent discharge criteria Reductions or curtailment of public funding Lack of adequate insurance coverageLack of adequate insurance coverage Three-strikes laws

Recommendations of the American Association for Community Psychiatrists Committee on the Mentally Ill Behind Bars

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Tuberculosis (TB)Tuberculosis (TB)

A highly variable communicable disease that is characterized by toxic symptoms or allergic manifestations that in humans primarily affect the lungs

TB is reported to be more than four to seven times as prevalent in jails and prisons as it is in the general population

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Inmates with TBInmates with TB

Very close living quarters, overcrowding, poor sanitation, and large numbers of inmates with a high risk of having TB make jails prime breeding grounds for the disease

Jail professionals must understand the causes and control measures, implement effective screening programs, and develop close working relationships with local health authorities

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Older Inmates Older Inmates

Correctional agencies nationwide have adopted age 50 as the chronological starting point for defining older inmates

By the year 2025, inmates over the age of 50 will comprise 25% of the total prison population

California’s three-strikes law has significantly altered the demographics of that state’s prison population

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Older InmatesOlder Inmates

Aging of the prison population is Aging of the prison population is increasing and causing issues of increasing and causing issues of health care, costs, and the health care, costs, and the construction of geriatric prisons. On construction of geriatric prisons. On January 1, 2010, almost 11 percent January 1, 2010, almost 11 percent of state and federal prisoners were of state and federal prisoners were 50 years of age or older50 years of age or older

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Older Inmates - Older Inmates - ContinuedContinued

“End-of-life” programs – formalized measures to assist terminally ill inmates through their passing

Hospice – an interdisciplinary, comfort-oriented care facility that helps seriously ill patients to die with dignity and humanity in an environment that facilitates mental and spiritual preparation for the natural process of dying

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Housing Older Inmates Housing Older Inmates

The ADA mandates that prisons must be designed that are accessible for elderly prisoners with ramps, handrails, good lighting, and subtle grades

Some experts suggest age segregated prisons to manage costs (and risks)

Only 2% of inmates who are 55 or older when paroled return to prison

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Housing Older Inmates Housing Older Inmates

The estimated national cost per year to The estimated national cost per year to confine an inmate over 55 years old is confine an inmate over 55 years old is $70,000.$70,000.

If a 55-year-old inmate lives to 80, this If a 55-year-old inmate lives to 80, this figure would project to $1.75 million.figure would project to $1.75 million.

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Sexually Transmitted Diseases in Sexually Transmitted Diseases in JailJail

Most studies focus on prisons Rapid turnover and frequent

movement of inmates make jails difficult settings in which to study the prevalence

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Syphilis Syphilis

A sexually transmitted disease caused by the bacteria Treponema pallidum

If left untreated syphilis can cause serious heart abnormalities, mental disorders, blindness, other neurological problems, and death

Syphilis is transmitted when an infected lesion comes in contact with the soft skin of the mucous membrane

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GonorrheaGonorrhea

The second most common sexually transmitted disease

Often called the clap Caused by the Neisseria gonorrhea

bacteria found in moist areas of the body; infection occurs with contact to any of these areas.

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Chlamydia Chlamydia

The most common sexually transmitted disease

Caused by the bacteria Chlamydia trachomatis

It can affect the eyes, lungs, or urogenital (urinary-genital) area, depending on the age of the person infected and how the infection is transmitted.

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Genital Herpes Genital Herpes

A sexually transmitted disease caused by the herpes simplex virus or HSV

It is one of the most common STDs in the United States

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Legal IssuesLegal Issues

Estelle v. Gamble – Inmates have a constitutional right to reasonable, adequate health services for serious medical needs; this does not mean that prisoners have unqualified access to health care

American with Disabilities Act – prohibits discrimination and ensures equal opportunity for people with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation