Inmates have explicit healthcare needs that vary from those of the general population. This variation presents a challenge to doctors who have to provide the best care to deal with complex medical, psychiatric, physical as well as social needs in a harsh environment (Neil, 2012; Muraskin, 2010). While members of this group are labeled ‘prisoners’, in reality, they represent a vulnerable set of patients that requires help, and to be treated with respect and dignity. This is regardless of the fact that they are criminally convicted. Therefore, it is the responsibility of doctors to make hard treatment decisions, while ensuring that they keep their patients’ best interests at heart (Neil, 2012; Muraskin, 2010). The healthcare need harbored by prisoners is high. For instance, in the United States (U.S), current estimates suggest that approximately more than 50% of those in custody suffer from mental health (Sarteschi, 2013; Neil, 2012; Muraskin, 2010). Often, managing these conditions is difficult since they are coupled with other problems such as substance abuse and alcohol. On the other hand, the rate of HIV infection amongst inmates is on the rise with up to 1.5% of prisoners in the U.S being infected. Detection and treatment of psychological, medical and physical problems in a prison are not easy. Despite these shortcomings, a prison provides an ideal setting for addressing these health issues since there is ample time for doctors to establish a strong curative relationship. Informed by existing research findings, this paper, therefore, seeks to present the unique medical trends and issues associated with inmates and staff in correctional institutions.
Incidences of mental illness in U.S prisons are on the increase (Sarteschi, 2013; Neil, 2012; Muraskin, 2010; Knight & Stephens, 2009). The four categories of mentally disordered offenders include prisoners not guilty due to insanity, prisoners not competent to stand trial, sex-offenders that are mentally disordered, and lastly, the mentally disordered inmates. There have been varying definitions of mental illness by various authors. In 1999, a report by the Bureau of Justice classified the prisoners who had reported a mental health issue or an emotional condition as being mentally ill. Consequently, the report estimated that up to 283,600 prisoners were mentally ill, while 861,000 were on probation. Likewise, in 2006, a report by the Bureau of Justice Statistics (BJS) classified mentally ill inmates as those currently receiving medication from a mental health expert or those showing various symptoms. Based on this, the Bureau estimated that 1.26 million of those incarcerate were mentally ill. This figure represented 45% of all federal offenders, 56% of all state offenders, and 64% of all jail inmates. Informed by such statistics, it has researchers agree that more than half of all prisoners suffer from various forms of mental illnesses. The different forms of mental illness include anxiety, post-traumatic stress disorder and anti-social personality disorder, bipolar disorder, depressive disorder, severe depression, schizophrenia and psychosis (Sarteschi, 2013).
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There is a rise in the number of imprisoned mentally ill individuals because, annually, thousands of offenders who are mentally ill are sent to prison. Consequently, due to overcrowding and inadequate resources, these prisons are ill-equipped to provide health care to these offenders. As a result, the prisoners’ mental health deteriorates while they are subjected to solitary incarceration and various forms of punishments that are not appropriate for their present conditions as they worsen the situation (Neil, 2012; Knight & Stephens, 2009). Subsequently, mentally ill prisoners end up spending more time in prison than their counterparts. The U.S government is, therefore, mainstreaming various policy efforts to ensure that mentally ill inmates receive better treatment, For instance, judges have been called upon to prioritize inmates’ treatment and to take a defendant’s mental health condition into consideration. Other initiatives include the introduction of incentives to mental health service firms to bring down the number of infractions of mentally sick prisoners. Further, in some states, prison officials have been deterred from placing inmates suffering from severe mental illnesses in solitary confinement. Lastly, some states are expanding their mental health judicature program.
Sex offenders form an integral part of the increasing number of prisoners in the U.S (Muraskin, 2010). The society’s fear of sex offenders’ cannot be over-emphasized, and its primary expectation is that the culprits are punished by all components of the criminal justice system. Given the communities desire to have safe environments, the public has been keen on ensuring that stringent penalties are imposed on sex offenders. The communities emphasis have therefore been the criminals’ sentence, the treatment received while in prison and how it relates to rehabilitation and retribution, the amount of time spent in jail and the determination of the date of release. Lastly, emphasis is also placed on movement and the offenders’ privacy within the community once they are released. This ‘tough’ community stance, which is highly supported by the political class, has led to the passing of various policies that are designed to safeguard members of the community from victimization sexually. Some notable options include registration of all sex offenders, notification of the community, civic commitment, residential restriction, intensified sentencing regulations, and lastly, the electronic monitoring of the culprits. Little is known, concerning the effectiveness of these approaches in curbing sexual offenses.
Given the risk posed by sex offenders, the U.S government has been keen to mainstream holistic approaches to managing sex offenders that range from their conviction, throughout their incarceration, and lastly, their release into the community. Moreover, various rehabilitative options coupled with mandatory treatment, and active monitoring and supervision have been emphasized. According to existing research, emphasis should be placed on the identification of sex offenders of high risk to focus on them to deter further offenses and adequately ensure public safety. There are also efforts to assess the risks posed by sex offenders objectively. Further, the U.S has been keen on ensuring that the potential for the culprits to re-offend is reduced.
The prevalence of HIV/AIDS is on the rise in U.S prisons. Research shows that rather than originating from inside the jail, most HIV/AIDS infections originate from outside. Due to this, some states are currently initiating compulsory testing for all the inmates (Muraskin, 2010). Although this move is yet to be accepted widely, it provides a critical approach towards ensuring that the number of incoming prisoners who are infected is known, and therefore appropriate measures are put in place to ensure that they are treated. The fact that prisons are not the ideal environments for HIV/AIDS patients make this move appropriate. For instance, the sick inmates are likely to get sick twice as fast as their counterparts. On the other hand, if a prisoner’s status is known early enough, there is a high likelihood of the inmate receiving treatment when it’s too late resulting in deteriorated health and death in some instance. The BJS estimates that approximately, 1.5% of prisoners in federal and state prisons are currently infected with HIV/AIDS. This figure represents a rate of prevalence that is about four times more than that of the general population. Likewise, infection amongst female prisoners is higher than their male counterparts at 1.9% and 1.5% respectively. Though data on transmission and infection is currently inadequate, there is a consensus that intravenous drug use (IDU) and sex are the main routes of transmission. Despite advancements in the identification of transmission routes and the epidemic’s social contexts, fear, anxiety and stigma still surround it. To address these challenges and beef up the existing knowledge on HIV/AIDS in prisons, a national discourse is necessary for the U.S. Likewise, the community-prison link, and alternative approaches ought to be sought. These, coupled with various policy options will help unearth the various issues and angles of HIV/AIDS in prison by focussing on specific preventive efforts. Overall, a multi-disciplinary approach to HIV/AIDS prevention in prisons should incorporate the structural, institutional and behavioral contexts of the scourge.
Informed by the current, as well as the projected prison populations, existing U.S prison policies have been challenged to incorporate a public health angle. The looming evolution of correctional systems is in line with the evolving legal and administrative mandates and is as a result of the various illnesses and events that have become common in prisons. These developments will continue to strain correctional practice and policy. As a result, the field of Epidemiological Criminology has emerged as a conduit for which the use of public health in criminal justice and criminology can be better understood (Muraskin, 2010). The emergence of this inter-disciplinary approach is informed by the myriad challenges affecting prison health care. For instance, the number of aging prisoners in the U.S is on the rise. While the provision of health care for this group is presently straining the government, the challenge will be exacerbated on their release and transferred to their respective families and communities in the long run. The emergence of Epidemiological Criminology, therefore, presents an opportunity for the U.S government to integrate methods, theory, and policy in its bid to ensure that inmates eventually become useful members of the society.
In conclusion, the health care needs of prisoners are myriad and are a challenge to not only the medical practitioners but also the government. The challenges vary from psychological, to medical and physical. Due to the failure of the various efforts to address the challenges, a more holistic approach is necessary. In this respect, adoption of Epidemiological Criminology is not only necessary but also crucial.
References
Knight, L. & Stephens, M. (2009). Mentally disordered offenders in prison - A tale of neglect? Internet Journal of Criminology, 1-16.
Muraskin, R. (2010). Key Correctional Issues (2nd ed.) . Upper Saddle River, NJ: Prentice Hall.
Neil, C. (2012). Prisoner or patient - the challenges of forensic health services . Scottish Universities Medical Journal, 1(2) . p. 119‐122.
Sarteschi, C. (2013). Mentally ill offenders involved with the United States Criminal justice system: A synthesis. SAGE Open , 1-11.
