CHAPTER 12
Special Prison Populations: Prisoners Who are Substance Abusers, Who Have HIV/AIDS, Who are Mentally Challenged, and Who are Elderly
Chapter Objectives
1. Define the term inmate with special needs.
2. Report on the management needs of special population inmates.
3. Report on the impact of substance abusers on the corrections system.
4. Discuss why treating HIV in prison is difficult.
5. Discuss the five essential elements of cost-effective management of HIV/AIDS inmates.
6. Explain why so many inmates that have mental illnesses.
7. Describe the ways to divert persons with mental illness from the criminal justice system.
8. List the cost and health issues associated with older inmates.
9. Review the legal issues surrounding special population inmates.
Chapter Outline
I. Inmates with Special Needs
Inmates with special needs are “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.”
· Increasingly, prisons and jails are dealing with a growing population of inmates with special needs.
· A statewide research study on jail management in New Mexico found that inmates with special needs require extra attention from jail staff.
A. Substance-Abusing Inmates
· Today, between 60 and 80 percent of individuals under supervision of the criminal justice system have a substance use related issue. However, only 11 percent receives any treatment while incarcerated.
Drug Use and Dependence
· Today 17 percent of state prisoners are incarcerated for drug offenses, down from 21 percent a decade ago. At the federal level, it’s 48 percent, down from 56 percent a decade ago. 51 percent of federal prisoners are incarcerated for drug offenses.
Drug Treatment Programs
· The longer inmates participate in treatment, the more likely they are to adopt prosocial attitudes and overcome their initial resistance.
· The criminal justice system has become the largest source of mandated, or coerced, drug treatment in the United States.
Therapeutic Community
· A therapeutic community (TC) is a residential treatment program in which inmates are housed in a separate unit within a prison or jail facility and is characterized by highly structured treatment involving resocialization, intensive counseling, and an increasing level of responsibility as the inmate progresses through the program.
Postrelease Outcomes
· Evaluations of prison-based TC programs conducted in several states and the federal prison system have provided empirical support for the effectiveness of these programs in reducing recidivism and relapse to drug use, especially when combined with continuity of care in the community following release from prison to parole.
· The federal BOP published the results of a three-year evaluation of its residential drug abuse treatment programs that are designed for inmates with moderate to severe substance abuse problems.
· The evaluation revealed that male inmates who completed residential drug abuse treatment were 16 percent less likely to be rearrested or have their supervision revoked than were inmates who did not receive such treatment; the comparable figure for female inmates was 18 percent.
What Works? Principles of Drug Abuse Treatment for Criminal Justice Populations
· The National Institute on Drug Abuse (NIDA) looked at all the research that had been published on drug abuse treatment for the last 40 years and discovered 13 principles that constitute effective drug treatment.
· They are:
o Drug addiction is a brain disease that affects behavior and the brain’s anatomy and chemistry, and these changes can last for months or years after the individual has stopped using drugs.
o Effective drug abuse treatment engages participants in a therapeutic process, retains them in treatment for an appropriate length of time, and helps them learn to maintain abstinence over time.
o Effective drug abuse treatment must last long enough to produce stable behavioral changes.
B. HIV-Positive and AIDS Inmates
· HIV is the acronym for human immunodeficiency virus, which is any of a group of retroviruses that infect and destroy helper T cells of the immune system. When enough of a person’s T cells have been destroyed by HIV, he or she is diagnosed with AIDS, or acquired immunodeficiency syndrome.
· Recently, the Bureau of Justice Statistics reported on HIV in prison. The major finding is that the number of HIV-positive state and federal inmates continues to decline.
· The decrease in HIV/AIDS deaths among state prisoners was driven mainly by declines among males, black non-Hispanics, and inmates age 35 or older.
Dealing with HIV/AIDS Inmates
· Most correctional systems test their inmates for HIV, but testing policies vary widely:
o All states (except Kentucky, Missouri, New Hampshire, and Utah) and the federal BOP test inmates if the inmates request a test.
o All states (except Georgia, Massachusetts, Michigan, Oregon, and West Virginia) and the federal BOP test inmates if they have HIVrelated symptoms.
o 42 states and the federal BOP test inmates after they are involved in an incident.
Education and Prevention
· HIV education and prevention programs are becoming more common in correctional facilities.
o The types of education and prevention programs provided vary among correctional systems but may include instructor-led programs, pretest/posttest counseling, multisession prevention counseling, and audiovisual and written materials.
o Another method of reducing high-risk behavior among incarcerated populations is peer-led counseling.
· However, what is done in prison may be undone in the community if ex-prisoners do not continue their treatment after they leave prison.
C. Inmates with Mental Illness
· The three largest de facto psychiatric hospitals in the United States are now the Los Angeles County Jail, Rikers Island Jail in New York City, and Cook County Jail in Chicago. The L.A. County Jail spends $10 million a year on psychiatric medication!
· It is estimated that there are nearly eight times more mentally ill people in jails and prisons than there are in mental hospitals.
Why So Many?
· Given that a significant expansion of resources for state mental health care systems is highly unlikely, the key to curbing recidivism of the mentally ill is to expand public health services into the jails and prisons so that inmates can begin therapy the moment they walk into custody.
· Why are there so many people who are mentally ill in the nation’s jails and prisons? The reasons include the following:
o Failure to differentiate who should be in jail and who shouldn’t.
o Failure to treat people before they enter the criminal justice system.
o Deinstitutionalization
o Stricter commitment laws
o Less stringent discharge criteria
o Reductions or curtailment of public funding
o Lack of adequate insurance coverage
o Three-strikes laws
Innovative Alternatives
· There are many successful and innovative ways to divert persons with mental illnesses from the criminal justice system, including the creation of law enforcement–mental health liaison programs, increased training of law enforcement personnel, and a general improvement in the funding and effectiveness of community mental health services.
· Developing innovative alternatives for keeping people with mental illness out of jail and prison requires staff who are educated and trained in multidisciplinary perspectives.
D. Inmates with Tuberculosis
· It is estimated that the risk of incurring a tuberculosis infection is 4 to 17 times higher for those incarcerated than for those who live in the general population because of very close living quarters, overcrowding, poor sanitation, ignorance of preventive measures, failure to supervise and ensure adherence to treatment, and the large number of inmates with a high risk of having TB, such as HIV-positive detainees, intravenous drug users, and immigrants.
· Experts concerned about TB in correctional facilities have indicated that the most important issues for corrections professionals are to understanding the causes and control of TB, implement appropriate and cost-effective screening programs, and develop working relationships with local health authorities.
E. Older Inmates
The Aging of the Prison Population
· After careful study of the issue, the National Institute of Corrections recommended that correctional agencies nationwide adopt age 50 as the chronological starting point for defining older inmates.
· Some prison officials predict that by 2025, people 50 and older will constitute one-fourth of the prison population.
Geriatric Prison Facilities
· Advocates of age-segregated prisons argue that age-segregated prisons could reduce a correctional system’s civil liabilities if they centralize disability services in age- segregated institutions that fully comply with ADA requirements.
· The majority confine only male prisoners who are elderly. Older female prisoners, who constitute close to 6 percent of the total population of prisoners who are elderly, are generally kept in a state’s only women’s prison.
Prison Hospice Programs
· Hospice programs provide a wide array of services, including pain management, spiritual support, and psychological counseling as well as grief counseling for bereaved families.
· Compassionate, medical, or geriatric prisoner release laws exist in 41 states, but some argue they are rarely if ever used. From 2001 until 2008, Colorado released just three prisoners under its compassionate release policy.
· Options states are looking to save money and respond to the needs of prisoners who are terminally ill include releasing terminally ill, disabled, and dying inmates (sometimes called compassionate release) who pose no threat outside prison, providing volunteer inmate aides as in the program at Angola, and increasing family visitation.
Health Issues
· It is estimated that a prisoner who is elderly suffers from an average of three chronic illnesses. Additionally, men and women who are elderly require screening for colon cancer, prostate cancer, breast cancer, and many other conditions that become more prevalent as people age.
· Designing prison spaces that are accessible for prisoners who are elderly with ramps, handrails, good lighting, and subtle grades, is now law under ADA.
Cost and Recidivism Issues
· Estimated national cost per year to confine a prisoner age 50 and older is $68,270.
· Recidivism drops dramatically with age.
II. Sexually Transmitted Diseases in Jail
· Recently, the Society of Correctional Physicians published a report by Dr. Karl Brown, infectious disease supervisor at New York City’s Rikers Island Jail, on the increase of STDs in jail and the difficulties diagnosing and treating four of the most common STDs found in jail today:
o Syphilis
o Gonorrhea
o Chlamydia
o Genital herpes
III. Legal Issues
· In 1976, the U.S. Supreme Court ruled in Estelle v. Gamble inmates have a constitutional right to reasonable, adequate health services for serious medical needs. However, the Court also made clear that such a right did not mean that prisoners have unqualified access to health care.
A. Inmates with Disabilities
· In 1998 in a unanimous opinion, the U.S. Supreme Court held that state prisons fall within the ADA’s definition of a “public entity.”
· Reacting to the decision, Yeskey’s attorney noted, “The court’s ruling means that Prisons cannot discriminate against prisoners with disabilities and must make reasonable modifications to prison operations so that these prisoners will have reasonable access to most prison programs;” otherwise, prisoners can sue for monetary damages.
B. Inmates with HIV/AIDS
· In 1988, officials in Erie County, New York, placed an HIV-positive female prisoner in a segregated prison wing reserved for inmates with mental illness. They also placed on her possessions red stickers revealing her HIV-positive status. The inmate sued, claiming denial of her rights to privacy and due process. The district court agreed (Nolley v. County of Erie, 1991). In the same year, however, the Eleventh Circuit Court of Appeals held that an Alabama policy of isolating all HIV-positive inmates did not violate the Fourth or Eighth Amendments (Harris v. Thigpen and Austin v. Pennsylvania Dept. of Corr.).
· Correctional officials had based their policy on “legitimate phenological concerns.”
C. Inmates with Mental Illness
· The federal courts have recognized the right of inmates who are mentally ill to treatment. According to a district court in Illinois, this right is triggered when it becomes reasonably certain that:
o The prisoner’s symptoms demonstrate a serious mental disease or brain injury.
o The disease of injury is curable or at least treatable.
o Delaying or denying care would cause substantially more harm to the inmates.
· Inmates may be given psychoactive drugs against their will if it is in the best interest of the inmate’s mental health.