Prison Health Care
Prison health services differ in the United States between states. In 2001, the National Commission on Correctional Health Care did a survey on the organizational structure of healthcare services in 28 prison systems. The results showed that 7 systems have health systems that are operated by the Department of Corrections, 9 contracted out their services, 8 being for-profit organizations and 1 being universities, and 12 prison systems having health care being provided by the Department of Corrections and for-profit firms. In 2004, the US Census Bureau did a survey of Inmates in State and Federal Correctional Facilities. And in 2002 a Survey of Inmates in Local Jails. Wipler and colleagues analyzed the survey and determined the access to care using the following measurements: medical examinations, access to pharmacotherapy, access to prescription medication, access to laboratory tests, and adequacy of acute care. These results show that “13.9% of federal inmates, 20.1% of state inmates, and 68.4% of local jail inmates had received no medical examination since incarceration.” Of inmates who were taking prescriptions before prison, 26.3% of federal inmate, 28.9% of state inmates, and 41.8% of jail inmates no longer take their prescriptions. Of inmates that were taking prescriptions for an active medical condition, 20.9% of federal inmates, 24.3% of state inmates, and 36.5% of jail inmates stopped taking their medication after being incarcerated. For mental health problems, only 69.1% of federal inmates, 68.6% of state inmates, and 45.5% of jail inmates were given medication for their mental conditions since they were incarcerated. In the next few paragraphs, I will be comparing health care of prison inmates based on age and gender.
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Older inmates are more likely to have chronic health conditions such as hypertension, liver disease, cancer, arthritis, kidney disease, and heart conditions. Skarupski and colleagues state that 61% of the older inmates that were surveyed have arthritis, 53% have hypertension, 30% have menopause issues, 29% have digestive disorders and ulcers, and 26% had heart conditions. Correctional prisons are the largest mental health service providers in the United States. A study of older women in prison discussed by Skarupski shows that 46% have severe levels of depression, 43% have anxiety, and 42% have “interpersonal sensitivity.” The study also showed that about 78% fear of getting sick and dying while in prison, 64% report to be fairly healthy, 30% report good health, and 6% report excellent health. The elderly inmates have difficulty with bathing, dressing, eating, and using the toilet, but must be able to perform these tasks as well as prison tasks such as dropping to the floor during an alarm, standing for count, walking while handcuffed, and climbing on bunkbeds (Skarupski, 2018). A study discussed in the paper showed that 89% of older, female, inmates have trouble walking independently and 66% have problems walking up stairs.
Elders who are incarcerated have health problems, mental health problems and cannot maintain independent living due to mobility. These issues must be fixed so there is more accommodation for the elder prison population. A solution to this problem is to develop a more systematic and effective health care model. An example is to have case managers who organize the amount of times an elder goes to the clinic or regulates their medication so they do not miss a dose. Another example is to get specialized doctors like geriatricians (Skarupski, 2018). Another solution to this is to provide more counseling to the elder population in prison to discuss their depression, anxiety, and fear of death.
According to the paper written by Mignon, “women incarcerated in jails, state prisons, and federal prisons have significant health problems.” For women in prisons, they do not get proper health care services, which includes menstruation, pregnancy, child birth, breastfeeding, and menopause. It has also been noted in a survey of women in jails, federal, and state prisons, there is a disproportionate number of women who were victims of sexual and physical assault before incarceration. These women could be a high risk for HIV/AIDS, hepatitis C, and human papillomavirus. According to Mignon, once becoming incarcerated, the women are at a greater risk of getting other STIs such as gonorrhea and syphilis due to sexual victimization and prostitution. Mignon has mentioned that in a study of 362 women in maximum security prison, they had high levels of stress, anxiety, depression, and more physical pain than non-incarcerated women. This was shown to be due to the highly stressful environment and having limited contact with their children. The women in prison are shown to have mental health issues that are not treated has caused suicide, which is accounted for majority of deaths in prison. There is also a large amount of sexual victimization in female prisons. A sample of 463 incarcerated women has shown that 17.2% of women have been sexually victimized and 3% reported rape (Mignon, 2016). Most prisons and jails do not readily have services for sexual assault. Pregnant women in prison raises a whole new challenge for prison health care. Pregnant women need more check-ups and doctor visits compared to other women. It has been noted by Mignon that of the 4% of state and 3% of federal pregnant inmates, 94% have received an obstetric exam, but only 54% have received prenatal care. It has also been reported by the women that they have been treated inappropriately and that during labor and delivery, they were forced to wear shackles.
There are some very clear-cut solutions to the problems that female inmates have. One solution is to mandate prisons to have a mental health assessment of inmates once admitted and be placed in a program with other people with the same mental conditions. An example is women with prior substance abuse or group therapy for women who are victims of sexual assault. Another solution could be to use telemedicine. Telemedicine would work great for women in prison since they do not have direct access to medical professionals and are in a very remote location. It is especially useful for female inmates since they have reproductive issues and cannot reach a specialist when needed.
“Over the past decade, there has been a dramatic increase in the population of juvenile offenders in the United States” (Kaplan, 2001). The juveniles that are in the correctional facilities have shown to have many health and emotional problems including parental neglect, physical, sexual, and drug abuse, STDs, HIV, depression, and ADD. According to Kaplan, adolescents entering juvenile hall are at a higher risk of getting STDs, abusing drugs, getting HIV, and having issues regarding pregnancy and parenting. Adolescence entering juvenile hall are also more likely to have preexisting mental health disorders. It has been reported that 46% of incarcerated youths have documented medical problems; only a third of these youths had regular medical care and only a fifth had a private physician. A survey of a group of incarcerated, male youths showed that more than 50% have gonorrhea and 90% have chlamydia, which were only visible through screening. The survey also showed that the mean age for sexual intercourse was 13 years old with a median of 8 partners and only 37% or the youths always used condoms. HIV rates may be low (less than 1%), but risk-taking behavior like sexual intercourse with multiple partners, inconsistent use of condoms and drug use increases the chances of developing HIV or AIDs. A national survey shows that “approximately two thirds of 261 correctional facilities housed between 1 and 5 pregnant adolescents on any given day” (Kaplan, 2001); only about a third of correctional facilities provide prenatal service and provided parenting classes. 12% to 26% youths have been inpatient psychiatric hospitalized prior to juvenile hall have and high posttraumatic stress disorder has been shown to occur after admission. It has also been shown that 25% to 31% of incarcerated youths have been abused or neglected (Kaplan, 2001).
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Youths in juvenile need to be treated differently compared to adults in prison. A solution for these children is to not be treated like adult criminals. They are young and cannot make the right decisions because of their environment. The youths need to have counseling and proper education in order for them to learn through punishment alone. There are such high rates of STDs and risk-taking behaviors that need to be addressed properly through therapy, counseling, and education. Another problem that needs to be addressed is the lack of prenatal services and parenting classes. It has been reported in the article that quite a few of these children are abandoned by their family, and it is important for these pregnant youths to get proper parenting education and to understand what is going on during pregnancy. It should be a requirement for all juvenile halls.
A pattern is visible with elders in prison, women in prison, and youths in juvenile hall. All these people need proper counseling and therapy. For elders, it is dealing with death, and for all three it is therapy for mental health problems. There is a pattern of lack of medical treatments. It seems like a lot of prisoners do not have the medications that they need or proper checkups, especially pregnant women. In conclusion, prison health care system is very broken and needs to be reformed for people to get the proper treatment for their conditions.
- Kaplan, D., Feinstein, R., Fisher, M., Klein, J., Olmedo, L., Rome, E., ... & Frankowski, B. (2001). Health care for children and adolescents in the juvenile correctional care system. Pediatrics, 107(4), 799-803.
- Kimberly A Skarupski, Alden Gross, Jennifer A Schrack, Jennifer A Deal, Gabriel B Eber, The Health of America’s Aging Prison Population, Epidemiologic Reviews, Volume 40, Issue 1, 2018, Pages 157–165, https://doi-org.ezaccess.libraries.psu.edu/10.1093/epirev/mxx020
- Mignon, S. (2016). Health issues of incarcerated women in the united states. Ciência & Saúde Coletiva, 21(7) doi:http://dx.doi.org.ezaccess.libraries.psu.edu/10.1590/1413-81232015217.05302016
- US Department of Justice. Correctional Health Care; Guidelines for the Management of an Adequate Delivery System. 2001.Washington, DC: US Department of Justice, National Institute of Corrections.
- Wilper, A. P., Woolhandler, S., Boyd, J. W., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). The health and health care of US prisoners: results of a nationwide survey. American journal of public health, 99(4), 666–672. doi:10.2105/AJPH.2008.144279
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