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.
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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.
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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.
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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.
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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.
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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)
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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
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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
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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.
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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
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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
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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.
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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).
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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.
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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.
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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
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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
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