Prison Health

September 23, 2011

In 1998 more than 950,000 women were under correctional supervision, comprising about 7% of the overall imprisoned population in the United States. Women represent the fastest growing incarcerated population. The highest percentage has been convicted of property crimes such as check forgery and illegal credit card use. The next largest percentage has been convicted of nonviolent drug offenses, followed by violent felonies. The majority of violent felonies are associated with women’s attempts to defend themselves or their children from abuse. Ninety percent of women in prison are single mothers, 40% having children under the age of 18; 58% have not finished high school; 54% are women of color; 80% have incomes of less than $2,000 per year; and 92% have incomes under $10,000 per year.

The imprisonment of women impacts both the family and the community. When women go to prison, their children often end up in foster care; in many cases the women lose their parental rights altogether. Alternatively, other family members may care for the children but often they are older and may need additional care themselves.

In general, the health status of women prisoners is poor. This is a result of many factors. The majority of people in prison are poor and/or minorities who have lacked access to health care throughout their lives and often have not received prior medical treatment. Consequently, many female prisoners suffer from latestage disease complications such as cirrhosis and diabetes; communicable diseases such as HIV, hepatitis B, and tuberculosis; and diseases of addiction, such as endstage alcoholism and drug addiction. Many incarcerated women are survivors of physical and sexual abuse, which puts them at a greater risk for developing lifethreatening illnesses such as HIV/AIDS, hepatitis C, and human papillomavirus/cervical cancer. Women in correctional institutions are often victims of sexual abuse by prison staff or by predatory prisoners. Women who give birth while incarcerated often remain restrained during delivery, are denied labor support from family members, and are not permitted to breast-feed. In addition, they are often required to relinquish their infant within 72 hr of delivery. There are some model programs in existence where the mother is allowed to be with her child during her prison sentence, but these programs are few and far between.

An estimated 25% of all women in prison suffer from mental health illnesses such as major depression, bipolar disease, schizophrenia, posttraumatic stress disorder, and addiction disorder. Death from suicide is common in prison. Some believe this is a result not only of a mental illness but also because of the isolative and disempowering nature of imprisonment, solitary confinement, overcrowding, longer prison sentences, and an often hostile prison environment. Mental health care providers are in short supply within correctional institutions. Correctional officers often lack an understanding about appropriate management of mental illnesses and treat mentally ill prisoners as if they are or will become violent, restraining or placing them in isolation, which often serves to aggravate the psychiatric condition. Many prisons have reduced funding for rehabilitation programs for prisoners with addictions, even though tougher laws are resulting in more people being imprisoned for nonviolent drug crimes.

Access to care and the quality of care received vary between federal prison and state and county correctional institutions. In many states, a request for care is first reviewed by a medical technical assistant (MTA) who often has minimal medical training. The MTA decides whether or not the prisoner will see a physician. Even if the prisoner is granted permission to see the prison doctor, it does not mean they will get timely care. Many prisoners must wait all day to see a physician. If the clinic closes before they are seen, they have to come back the next day. Many prisoners work within the institution and they forego their pay for the days spent waiting to obtain care. In some prisons, a missed day of work results in another day added to their prison sentence. Additionally, some states require a prisoner to contribute a co-pay for care. Such policies act as a disincentive for a prisoner to seek medical attention when they need it, often resulting in a medical condition that is more advanced, threatening, and difficult to manage.

Prisoners face a confidentiality problem when receiving their medication. They must wait in line to receive their medication. In some states, medications like those for HIV are dispensed in a unique packet that signifies to others in line the confidential medical condition of a prisoner. This can result in prisoners’ avoidance of testing or treatment for some conditions. The dispensing of medication is also interrupted during security situations, which can result in the development of drug resistance or the exacerbation of a medical condition. Many prisons require patients to take the medication in the “med line,” which can interfere with the patient’s ability to take the medication properly, for instance, with food.

Preventive care such as regular Pap smears and breast exams are nearly nonexistent in prison systems, as are health education programs and materials. If a prisoner is referred to an outside physician there is often difficulty with continuity of care and refusal or inability of prison medical staff to follow the outside physician’s order.

Many health care workers see prisoners as unlawful, dangerous, and irreparable. A belief that prisons should “lock prisoners up and throw away the key” and that prisoners should “lose their rights” makes it easier for the prison systems to continue with a system of less than adequate health care for inmates. These biases also exist among health care workers treating former prisoners.

The relative inaccessibility of care and the lack of preventive measures while incarcerated can lead to worsening medical conditions which, when eventually treated, are more costly. The price is paid either by the prison system, by the public health system when a prisoner eventually returns to the community, by the community itself in potential transmission of disease, and/or by the prisoner or former prisoner in terms of pain, suffering, and deteriorated health.

SEE ALSO: Domestic violence, Prostitution, Violence

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Category: P