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  • 1. Chapter 12 Special Prison Populations: Prisoners Who Are Elderly, Mentally Challenged, and Who Have HIV/AIDSMcGraw-Hill/Irwin © 2013 McGraw-Hill Companies. All Rights Reserved.
  • 2. Special-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. 12-2
  • 3. Special-Needs Inmates A plan is under review in California that would put the University of California in charge of state prison inmates’ medical needs that some say could save the state $12 billion over the next decade. 12-3
  • 4. Substance-Abusing Inmates Almost 83% of America’s jail and prison population need some sort of substance-abuse treatment. Only 13% receive it while incarcerated. The number of drug offenders in state and federal prisons is nearly 350,000. Today 18 percent of state prisoners and 51 percent of federal prisoners are incarcerated for drug offenses. 12-4
  • 5. Substance-Abusing Inmates In 2006, alcohol and drugs were involved in: • 78 percent of violent crimes; • 83 percent of property crimes; and • 77 percent of public order, immigration or weapons offenses, and probation/ parole violations. 12-5
  • 6. Substance-Abusing Inmates - Continued 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. 12-6
  • 7. Treatment 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) 12-7
  • 8. HIV-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 12-8
  • 9. Prevalence of HIV and AIDS Inmates 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 1,538 federal prisoners were HIV positive or had confirmed AIDS, accounting for 1.5 percent of the total custody population. At year-end 2008, an estimated 5,733 state and federal inmates had confirmed AIDS, down from 5,977 in 2006. The prevalence of AIDS among inmates is 2½ times greater than among the general U.S. population 12-9
  • 10. Prevalence of HIV and AIDS Inmates During 2007 (the most recent year for which data on inmate deaths are available for state prisons), 120 state inmates and 13 federal inmates died from AIDS-related causes, down from an estimated 143 in 2006. Florida (14), New York (11), and Texas (10) reported 10 or more AIDS- related deaths during 2007. 12-10
  • 11. Cost-Effective Management of HIV and AIDS Inmates  Early detection and diagnosis  Medical management and treatment  Inmate classification and housing  Education and training of staff and inmates  Adequate funding 12-11
  • 12. 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 12-12
  • 13. Mentally 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. 12-13
  • 14. Mentally Ill Inmates It is estimated that there are nearly eight times more people who are mentally ill in the nation’s jails and prisons (nearly 478,000) than there are in mental hospitals (60,000). 12-14
  • 15. 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 coverage  Three-strikes laws Recommendations of the American Association for Community Psychiatrists Committee on the Mentally Ill Behind Bars 12-15
  • 16. 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 12-16
  • 17. Inmates 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 12-17
  • 18. 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 12-18
  • 19. Older Inmates Aging of the prison population is increasing and causing issues of health care, costs, and the construction of geriatric prisons. On January 1, 2010, almost 11 percent of state and federal prisoners were 50 years of age or older 12-19
  • 20. Older Inmates - Continued “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 12-20
  • 21. 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 12-21
  • 22. Housing Older Inmates The estimated national cost per year to confine an inmate over 55 years old is $70,000. If a 55-year-old inmate lives to 80, this figure would project to $1.75 million. 12-22
  • 23. Sexually Transmitted Diseases in Jail  Most studies focus on prisons  Rapid turnover and frequent movement of inmates make jails difficult settings in which to study the prevalence 12-23
  • 24. 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 12-24
  • 25. Gonorrhea 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. 12-25
  • 26. 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. 12-26
  • 27. 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 12-27
  • 28. Legal 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 12-28