Download Chapter Twelve: Special Prison Populations: The Elderly, HIV/AIDS

CHAPTER 12
SPECIAL PRISON POPULATIONS: THE ELDERLY, HIV/AIDS, AND THE
MENTALLY CHALLENGED
Chapter Objectives
1.
2.
3.
4.
Define the term special-needs inmate.
Report on the management needs of special population inmates.
Report on the impact of substance abusers on the corrections system.
Discuss the five essential elements of cost-effective management of HIV/AIDS
inmates.
5. Explain why there are so many inmates with mental illnesses in prison.
6. Describe the ways that prisons may provide medical and mental health services.
7. List the cost and health issues associated with older inmates.
8. Discuss the rationale for drug treatment programs in prisons and jails.
9. Discuss why the future of drug court is promising.
10. Discuss why treating HIV in prison is difficult.
11. Review the legal issues surrounding special population inmates.
Chapter Outline
Special-Needs Inmates
 There is an increasing number of special needs inmates in prisons and jails
 These inmates require extra attention from staff
Substance-Abusing Inmates
 Over 80% of American’s jail and prison population need some sort of
substance-abuse treatment
 In the past 25 years, the number of drug offenders in state and federal
prisons has skyrocketed
 Longer prison sentences for drug offenses are only making the matters
worse in prison.
HIV-Positive Inmates
 The prevalence of HIV and AIDS is higher in correctional facilities than it
is in the United States’ population
 Due to advances in medical science, fewer inmates are advancing to AIDS
or dying of it
 The percent of total jail population with HIV has remained relatively
stable
 The highest percentage of jail inmates known to be HIV positive are in the
District of Columbia, followed by New York and Massachusetts
 Not all prisons test for HIV or AIDS
Mentally Ill Inmates
 Jails are the largest provider of mental health services in the United States

There are nearly five times more mentally ill people in jails and prisons
than in mental hospitals
Why So Many?
 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
Inmates with Tuberculosis
 Close living quarters, overcrowding, poor sanitation, and the large number
of inmates with a high risk of having TB make prison and jails at a great
risk for the spread of the disease.
Older Inmates
 Aging of the prison population in increasing and causing issues of health
care, costs, and the construction of geriatric prisons.
 Older inmates are defined as those 50 years of age or higher
 Hospice and end-of-life programs have been developed in prisons
TIP: Discuss the possibility of geriatric prisons. Would any of the
students be willing to work in a facility where all the inmates are over
60 years old? What special concerns would these inmates have? Is
there any purpose in keeping 70 or 80 year old men in prison?
Drug Treatment Programs
 The criminal justice system has become the largest source of mandated, or
coerced, drug treatment in the country.
 83% of inmates need some sort of substance-abuse treatment, but only 13%
receive it while incarcerated.
 States only spend about 5% of their prison budget on drub/alcohol treatment
Recidivism
 Treatment can reduce recidivism by 50
 Inmates without treatment, 75% will be rearrested within three years
 Offenders who test 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
Program Evaluation
 The Bureau of Prisons evaluated its drug abuse treatment program
 Inmates in the program were less likely to be rearrested, less likely to have
parole revoked, and more likely to be employed
Alcohol: The Biggest Culprit
 Alcohol is linked more closely with violent crimes than are drugs.
Recommendations for Managing Substance-Abusing Offenders
 Treatment should be intensive, be behavioral in nature, and focus on highrisk offenders
 Behavioral strategies should be enforced in a firm but fair manner by
qualified staff
 Treatment should target antisocial attitudes, vales and beliefs supportive of
criminal behavior
 Treatment providers should be responsive to offenders’ learning styles and
personalities
 Treatment providers should relate to offenders in interpersonally sensitive
and constructive ways
 Treatment should provide relapse prevention in the community
 Linkages and referrals to community services should be provided for
institution-based programs
Drug Courts
 Drug courts are a powerful tool in addressing the criminal behavior of people who
commit a disproportionately large number of crimes
 The average recidivism rate for those who complete drug court is between 4 and
29 percent, as compared to 48 percent for those who do not participate in drug
court
HIV and AIDS in Correctional Facilities
 Most correctional systems test their inmates for HIV
 Treating HIV in prison is difficult for a number of reasons:
o The issue of privacy
o The frequency of taking medication and the prison routine
o Distrust of the medical and legal system by the inmates
o Fear of side effects
o The courts have rejected the idea that the level and quality of health care
available to prisoners must be the same as is available to society at large
Education and Prevention
 Only 10% of state or federal prison systems offer comprehensive
education and prevention programs
 Incarceration offers opportunities to provide high-risk inmates with HIV
education and sexually transmitted disease education as well as prevention
programs
Sexually Transmitted Diseases in jail
 Syphilis



Gonorrhea
Chlamydia
Genital herpes
Legal Issues
 Estelle v. Gamble (1976) – inmates have a constitutional right to reasonable,
adequate health services for serious medical needs but they do not have
unqualified access to health care
 Principle of least eligibility
Inmates with Disabilities
 State prisons fall within the ADA’s definition of a “public entity”
 Prisons cannot discriminate against prisoners with disabilities
Inmates with HIV/AIDS
 Many legal issues with regard to the care, housing and privacy of these
inmates
 Correctional officials must base their policy on legitimate penological
concerns.
TIP: Should inmates be given the most up to date medical treatment
available for AIDS? Why or why not?
Inmates with Mental Illness
 Mentally ill inmates have aright to treatment when
o The prisoner’s symptoms demonstrate a serious mental disease or
brain injury
o The disease or injury is curable or at lease 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
Chapter Summary
Some inmates require special treatment or care because they suffer from mental
illness, chemical dependency, a communicable disease, or typical problems associated
with the elderly. These inmates present unique problems for correctional staff and
administrators.
Special-needs inmates present significant management problems because they are
typically more violent and prone to be disruptive, require close monitoring as suicide
risks, tax scarce medical resources, and are often targets of abuse by other inmates.
A tenfold increase in prison populations over the past 25 years caused a
commensurate increase in the number of inmates with substance-abuse problems. These
inmates tremendously drain finite resources, are disruptive to daily life within the walls,
and create unique management problems in all areas of prison life.
The five essential elements of cost-effective management of HIV/AIDS inmates
are early detection and diagnosis, medical management and treatment, inmate
classification and housing, education and training of staff and inmates, and funding.
The increase in the number of mentally ill inmates is attributable to several
factors: the deinstitutionalization of the mentally ill to nonsecure residential
environments; stricter commitment laws; failure to know who should and should not be
in jail; failure to treat them before they enter the criminal justice system; less stringent
discharge criteria; and reduction or elimination of public funding.
Some states provide medical and mental health services through contracted
services, while others have professional service providers on staff. Services vary by state
and may include intake screening, psychiatric assessment, therapy and/or counseling,
psychotropic medication, and referral of released prisoners to community mental health
services.
Estimates are that, on average, each older inmate is afflicted with three chronic
illnesses that require ongoing and expensive medical treatment. Some question the
equity of providing such free treatment to criminal offenders when the same free
treatment is not provided to the public at large. The annual cost of incarcerating an
elderly inmate is significantly higher than the average per-inmate cost of incarceration.
Drug treatment programs in prisons and jails serve as “behavior management”
tools to control inmate behavior, expose a greater number of inmates to treatment than
might otherwise seek help, and increase rehabilitative success.
The future of drug court is promising because many adults and juveniles have
enrolled and graduated, the retention rate is high, net-widening is avoided, drug-free
babies have been born, drug-free parents have regained custody of their children, drug
court graduates have found employment, federal funding is available for planning and
implementing drug courts, and policy makers recognize that traditional criminal justice
policies shave little impact on substance abuse.
Special difficulties related to HIV/AIDS among prison populations include
privacy issues, disruption of the prison routine due to the frequency of taking medication,
inmate distrust of the medical and legal systems, fear of side effects, and the legal
dilemma embodied in the principle of least eligibility.
Inmates with disabilities, infectious diseases, and/or mental illness present unique
legal and moral dilemmas for correctional administrators and the courts. The legal issues
threaten to overwhelm the court systems with suits brought by prisoners. Meanwhile, the
moral issues frequently mandate compassion, flexibility, and creativity among staff and
administrators in navigating the daily routine of prison life.
Key Terms
Special-needs inmates:
Incarcerated individuals who require special treatment
because they suffer from mental illness, chemical
dependency (drug or alcohol), or communicable diseases
(such as HIV/AIDS and tuberculosis), and general
problems of the elderly.
Substance-abusing inmate:
An incarcerated individual suffering from dependency on
one or more substances including alcohol and a wide range
of drugs.
HIV (human immunodeficiency virus): A group of retroviruses that infect and destroy
helper T cells of the immune system, causing the 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 number of CD4-bearing helper T cells to 20 percent
or less of normal, rendering a person highly vulnerable to
life-threatening conditions. J The disease is caused by
infection with HIV commonly transmitted in infected blood
and bodily secretions (as semen), especially during sexual
intercourse and intravenous drug use.
HIV-positive inmates:
Incarcerated individuals infected with HIV>
Tuberculosis (TB):
A highly variable communicable disease that is
characterized by toxic symptoms or allergic manifestations
that in humans primarily affect the lungs.
“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.
Therapeutic community (TC): A residential treatment program in which substance abuse
inmates are housed in a separate unit within a prison or jail
facility.
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.
Gonorrhea:
The second most common sexually transmitted disease.
Often called the clap, gonorrhea is caused by the Neisseria
gonorrhea bacteria found in moist areas of the body.
Infection occurs with contact to any of these areas.
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.
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.
Americans with Disabilities Act (ADA): Public Law 101-336, enacted July 26, 1990,
which prohibits discrimination and ensures equal
opportunity for people with disabilities in employment,
state and local government services, public
accommodations, commercial facilities, and transportation.
It also mandates the establishment of TDD/telephone relay
services.
Homework Assignments
1. Divide the class into to groups and then assign them sides in the debate about
providing medical care to inmates. Should inmates be given heart transplants?
Should they receive expensive medical treatment for AIDS?
2. Have the students write a paper on the problems an inmate could experience if
they have serious mental illness (e.g., schizophrenia). Should these people be
placed in prison? Where else could they go?
3. What risks are there to correctional officers when inmates have commutable
illnesses (AIDS, TB, etc.)? Have the students write up precautions officers
should take when working with inmates.
4. Officers are not aware of who has AIDS. Debate the issue having some students
argue for the inmate’s right to privacy and the other side argue for the officers
safety issues.