General Inmate Population Research Articles

Time away is time out: narratives of intentional reimprisonment amongst inmates living with HIV in a US setting

ABSTRACT There is a growing effort from a range of professionals and institutions to develop comprehensive integrated prison-to-community healthcare, discharge planning, and community re-entry support for inmates living with HIV. This paper draws from ethnographic data to explore the ‘lived experience’ of HIV-positive inmates in a US State prison system offering an integrated case management support programme. In the US, incarceration is critical for connecting socially marginalised people and those with health needs to certain rights and resources. We present the ways in which imprisonment enables a claims-making process against the state by allowing this group access to resources and rights connected to imprisonment, healthcare, and associated social welfare support. Offenders identified incentives underpinning their expressed desire or ‘intention’ to return to prison over time. Our findings suggest that this group of inmates has increased opportunity to access material, medical, and welfare resources when compared to the general inmate population and those outside the prison system. Multiple gaps remain in this group’s sense of security in the community, ability to cope with the stress of everyday life, sustained support with substance dependency and, most importantly, consistent access to medical and welfare resources that enable them to live independently. Ironically, for many inmates living with HIV, incarceration offers a better chance of accessing public health services than living in the community.

HIV-positive in the darkness of a correctional facility: more vulnerable and less treated.

In French Guiana, 4.5-5.0% of HIV-infected persons experienced an incarceration between 2007 and 2013. A cross-sectional survey was performed to describe the epidemiology and treatment outcomes of a population of HIV-infected inmates in French Guiana. The study population was patients released between 1/2007 and 12/2013, after >30 days of incarceration (n = 147). A secondary objective aimed to identify its main specificities, relative to both the general inmate population and the nonincarcerated HIV population. The socioeconomic situation of HIV-infected inmates was particularly precarious, relative to other detainees: 58.1% had never attended school (versus 5.5%, p < 0.01), 31.0% were homeless (versus 8.5%, p < 0.01), 63.9% were repeat offenders (versus 46.6%, p < 0.01), 33.3% were crack cocaine users (versus 9.8-12%, p < 0.01). The frequency of hypertension and chronic B hepatitis was also higher. Only 50.3% of inmates were on antiretroviral therapy (ART) versus 92.6% in the hospital HIV population (p < 0.001). Among untreated patients, 15.1% refused ART. Among those treated, 81.3% were virologically suppressed. Although comparisons were biased, HIV-positive inmates had more psychosocial vulnerabilities than the general inmate population. Despite ART availability and excellent treatment outcomes, undertreatment was a fact not completely explained by patient refusal. HIV-infected inmates should benefit from increased attention by health care and social workers.

Screening and Rapid Molecular Diagnosis of Tuberculosis in Prisons in Russia and Eastern Europe: A Cost-Effectiveness Analysis

Prisons of the former Soviet Union (FSU) have high rates of multidrug-resistant tuberculosis (MDR-TB) and are thought to drive general population tuberculosis (TB) epidemics. Effective prison case detection, though employing more expensive technologies, may reduce long-term treatment costs and slow MDR-TB transmission. We developed a dynamic transmission model of TB and drug resistance matched to the epidemiology and costs in FSU prisons. We evaluated eight strategies for TB screening and diagnosis involving, alone or in combination, self-referral, symptom screening, mass miniature radiography (MMR), and sputum PCR with probes for rifampin resistance (Xpert MTB/RIF). Over a 10-y horizon, we projected costs, quality-adjusted life years (QALYs), and TB and MDR-TB prevalence. Using sputum PCR as an annual primary screening tool among the general prison population most effectively reduced overall TB prevalence (from 2.78% to 2.31%) and MDR-TB prevalence (from 0.74% to 0.63%), and cost US$543/QALY for additional QALYs gained compared to MMR screening with sputum PCR reserved for rapid detection of MDR-TB. Adding sputum PCR to the currently used strategy of annual MMR screening was cost-saving over 10 y compared to MMR screening alone, but produced only a modest reduction in MDR-TB prevalence (from 0.74% to 0.69%) and had minimal effect on overall TB prevalence (from 2.78% to 2.74%). Strategies based on symptom screening alone were less effective and more expensive than MMR-based strategies. Study limitations included scarce primary TB time-series data in FSU prisons and uncertainties regarding screening test characteristics. In prisons of the FSU, annual screening of the general inmate population with sputum PCR most effectively reduces TB and MDR-TB prevalence, doing so cost-effectively. If this approach is not feasible, the current strategy of annual MMR is both more effective and less expensive than strategies using self-referral or symptom screening alone, and the addition of sputum PCR for rapid MDR-TB detection may be cost-saving over time.

Economic evaluation of a prerelease substance abuse treatment program for repeat criminal offenders

Substance use disorders are common conditions among repeat criminal offenders. Without addressing these underlying substance use behaviors, parolees are significantly more likely to recidivate within 1 year of release. New Jersey is one of the first states to actively pursue substance abuse treatment options for inmates who are in the final stages of their sentences. Given the fiscal realities of taxpayer-supported programs, such initiatives must clearly demonstrate economic benefits for sustainability and growth. This article conducted one of the few comprehensive economic evaluations of prerelease substance abuse treatment to determine whether Community Education Centers' programs in New Jersey generated desirable outcomes, significant economic benefits, and positive net benefits. Relative to a matched comparison group of offenders who did not receive treatment, the intervention group returned an average economic benefit of $4,307 to $6,209 over the 1-year postrelease period. These economic benefits are underscored by the fact that the treatment program is housed in a separate facility, with a lower average per diem from that of the general inmate population. These results provide quantitative economic evidence that prerelease substance abuse treatment programs have the potential to reduce recidivism and save taxpayer dollars without adding to existing prison resources.

The Association Between Aging Inmate Housing Management Models and Non-Geriatric Health Services in State Correctional Institutions

One of the current debates in the literature on aging inmates asks, what is the most efficient housing/health care model for this “special needs” population? State and federal correctional systems place elderly inmates either in specialized segregated housing units away from the general inmate population, consolidate elderly inmates in housing units within the prison, or provide a combination of both models. In general, proponents of the segregated housing model argue that aging inmates will receive specialized medical services in geriatric units. However, proponents of consolidated housing model argue that aging inmates will have the benefit of both geriatric and non-geriatric health services. This paper examines the association between the type of housing management model for aging inmates and the availability of non-geriatric physical and mental health services. Data for the analysis come from the 2000 Bureau of Justice Statistics Census of State and Federal Adult Correctional Facilities. The results suggest that institutions offering consolidated geriatric care provide more mental health services and that these effects are independent of the characteristics of prison facility.

Alcohol dependence: international policy implications for prison populations

BackgroundIn light of the emphasis on drug abuse, this study explored the relative prevalence of substance use disorders among United Kingdom (UK) prison inmates in the context of findings from a general inmate population in the United States (US). The lead author of the report conducted a structured diagnostic interview with 155 new admissions to one of two prisons in the UK using the CAAPE (Comprehensive Addiction And Psychological Evaluation), a structured diagnostic interview, to ensure consistent assessments. The US sample consisted of 6,881 male inmates in a state prison system evaluated with an automated version of the SUDDS-IV (Substance Use Disorder Diagnostic Schedule-IV) interview.ResultsAlcohol dependence emerged as the most prevalent substance use disorder in both UK prisons and in the US sample. Relative frequencies of abuse and dependence for alcohol and other drugs revealed that dependence on a given substance was more prevalent than abuse ad defined by the current diagnostic criteria.ConclusionDespite the emphasis on drugs in correctional populations, alcohol dependence appears to be the most prominent substance use disorder among the incarcerated in both the US and UK and must be considered in developing treatment programs and policy priorities.

In This Issue

In This Issue

Peer suicide prevention in a prison.

Suicide rates among inmate populations in prisons are considerably higher than in the general population. Suicide prevention is a common need among penal institutions around the world. Traditional approaches involving only correctional staff in suicide prevention efforts have proven to have their limitations. The involvement of inmates in peer prevention efforts seems to be a reasonable alternative approach. This study examines such a program, called SAMS in the Pen, operated jointly between the prison and the Samaritans of Southern Alberta. This service, the first of its kind in Canada, involved inmate volunteers, known as SAMS, who were trained in listening skills, suicide prevention, and risk assessment. Data was collected for the research from volunteers, correctional staff, general inmate population, and professional staff. However, given the low absolute number in the one institution where the study was carried out, statistical analyses were not practical. As with any new service, the SAMS in the Pen experienced some developmental problems but was perceived to be a worthwhile service to both inmates and staff of the prison.

Syphilis control among incarcerated men who have sex with men: public health response to an outbreak.

After the epidemic years of 1986 through 1990, rates of syphilis steadily declined in the United States to an all-time low of 2.5 cases per 100 000 population in 1999.1 Such declines led the Centers for Disease Control and Prevention (CDC) to create a national plan for syphilis elimination.2 Nevertheless, multiple areas of the United States continue to experience disease outbreaks and a resurgence of sexually transmitted diseases (STDs) among men who have sex with men (MSM).3–8 Because syphilis is increasingly characterized by sporadic outbreaks, rapid outbreak response should include enhanced surveillance of groups at high risk (e.g., incarcerated MSM). Although correctional facilities have historically been a useful setting for control of infectious syphilis through screening and prophylactic treatment,9,10 the mass screening and treatment of a population segregated on the basis of sexual orientation has not been previously reported. Los Angeles County Men’s Central Jail (LACMCJ) maintains an inmate unit that houses approximately 300 selfidentified MSM voluntarily segregated from the general inmate population. During an outbreak of syphilis among MSM,7,8 the Los Angeles County Sexually Transmitted Diseases Program (LACSTDP) initiated a syphilis control program in the MSM unit of LACMCJ that consisted of screening, mass prophylactic treatment, high-risk behavior detection, and education. The segregation of MSM from other inmates presented the opportunity to screen and treat patients with syphilis and detect risk behaviors among newly incarcerated MSM.

Editorial

In many respects, depriving a prisoner of contact with other inmates is the most punitive action taken by penitentiary administrators. The use of administrative segregation has been an important problem in Canada’s penitentiaries for years. How serious are the consequences of being segregated from the general inmate population? This question has generated a considerable amount of debate over the past 30 years, since landmark research by Paul Gendreau was published in 1969. Experts have disagreed - sometimes heatedly - about the scope and seriousness of the problem. Much of this issue of the Journal is devoted to an examination of the problem from a number of different perspectives.

Mental Health Promotion and Prison Health Care Staff in Young Offender Institutions in England

This paper presents the findings of an investigation into a mental health promotion initiative in young offender institutions across England. The study involved a survey of staff attitudes towards mental health promotion, and surveyed practice run by these staff. Analysis of staff descriptions of mental health promotion revealed a degree of confusion and a lack of clarity over the definition of mental health and mental health promotion. The concept of a mental health promotion initiative which aimed to improve the well‐being of the general inmate and staff population was not a shared vision and not part of the core work of either health care staff or prison officers. It is recommended that any future campaigns on mental health or health promotion should have a central lead, with some flexibility to allow for the development of local initiatives, fostering local relationships and partnerships.

Sex Offender Rehabilitation Programs in State Prisons

The general inmate population is at an all time high in America, and in fact, today our prisons house a higher proportion of sexual deviants than any time in history. Consequently, sex offender treatment programs are receiving increased scrutiny. No longer are sexual deviants imprisoned for the purpose of incapacitation, but rather questions are being raised pertaining to the strategy of treatment intervention to reduce the likelihood of sex offenders committing new sex crimes upon release. This study identifies 73 adult sex offender treatment programs in state correctional institutions and describes three treatment modalities behavior modification, organic treatment, and psychotherapy.

AIDS Education and Incarcerated Women

Attitudes and perceptions about health, AIDS, and the need for AIDS education were explored among inmates in a women's prison in the southeastern U.S. Forty short-term inmates participated in a series of focus group interviews. A separate sample of sixteen women completed a 103-item questionnaire. Focus group participants expressed concern about AIDS within prison, sexual activity between inmates, and the institution's policy of housing seropositive women with the general inmate population. Close to half (44%) of the survey respondents believe that they were likely to be exposed to HIV in prison; most (81%) felt that AIDS education programs should discuss female homosexual activity, and nearly all respondents (94%) felt that inmates should be given an HIV antibody test upon entering prison. The study's findings confirm the need for tailoring AIDS education and prevention activities for incarcerated women.

Persistent ony Offenders in Kentucky: A Comparaison of Incarcerated Felons

This study compares inmates convicted and incarcerated as persistent felony offenders (PFO's) to the general inmate population in Kentucky. Data on all incarcerated persistent felony offenders (N = 1,261 as of May 1, 1985) and on a ten percent random sample of other incarcerated felons (N = 356) were collected. The comparison group was subdivided into two parts: 1) first offenders (incarcerated for their first conviction, N = 125) and 2) repeat offenders (incarcerated with at least one prior conviction but not sentenced as PFO's, N = 231). The primary distinction between the PFO and repeat offender groups is the length of sentence. Although the criminal histories of the PFO's revealed that they had been involved in violent crime, it appears that the PFO statute was not consistently applied to all repeat offenders.

Comparability of the Standard and Interview Versions of the Lifestyle Criminality Screening Form

An interview schedule was developed for use with the Lifestyle Criminality Screening Form (LCSF). Results achieved through use of this interview procedure were compared with findings obtained by means of the standard version (i.e., records review) of the LCSF. Subjects were 35 successively sampled maximum security prison inmates in the process of completing an admissions and orientation program as part of their induction into the general inmate population at the United States Penitentiary, Leavenworth. The standard and interview versions of the LCSF were found to correspond modestly when LCSF diagnosis and several individual items were considered; moderately when the majority of individual items and section scores were examined; and moderately high in the case of one individual item (confining offense), one section score (interpersonal intrusiveness) and the total LCSF score.

Preventive Detention in Canada

The current investigation traces the development of special legislation for sexual offenders. Unlike many American jurisdictions, Canada continues to use preventive detention as a means of control for both physically and sexually violent offenders. Survey data on all 97 persons held as dangerous sexual offenders in Canada were used to evaluate complaints found in the literature. Charges of inconsistent application were substantiated in that regional and socioeconomic disparity was revealed. The disproportionate use of DSO designations for child molesters was also noted. Complaints of poor reliability were supported, both in terms of sexual assessment results and clinical opinions about the status of individual DSOs. Findings pertaining to the difficulty of predicting future behavior were mixed. Predictive instruments suggested that DSOs were low-risk offenders compared to the general inmate population. However, those who were incarcerated at the time of the study were uniformly high-risk DSOs. Moreover, a simple retrospective psychometric clinical prediction strategy was reasonably accurate (77%) in predicting postrelease recidivism. Objections to the lack of treatment in prison and the community were partially supported. Preventive detention is also discussed in its sociopolitical context.

Capital Punishment and Corrections: Is there an Impending Crisis?

As of March 1, 1985, there were 1479 persons on death row across the United States, and the best estimate is that we will continue to add another 150 to that number for the foreseeable future. We must now begin to face the question of whether we actually intend to execute that number of people. Avoiding the traditional philosophical arguments and debates over empirical data, we argue that there are three options that corrections must consider - execution, commutation and concentration, or commutation and dispersal through the inmate population - because it is unavoidable that one of the three will come into being in the near future. The potential systemic effects and external factors that would follow if we were to execute all of these persons, or if we were to reduce their sentences to avoid such a large number of executions, are considered. The conclusion is that one of the more probable scenarios is the enactment of life-without-release statutes in a number of states, and return of a proportion of the death row population to institutions under that provision. Finally, if this is to occur, the alternative models of concentration of this population in segregated facilities or their dispersal among the general inmate population are considered.

Risk factors for victimization during the 1980 riot at the Penitentiary of New Mexico.

The New Mexico Penitentiary riot of February 2, 1980, resulted in death for 33 inmates at the hands of their fellow prisoners, and the hospitalization of 62 inmates for treatment of drug overdose or trauma. A case-control study of dead and hospitalized inmates was conducted to determine risk factors for victimization. Twelve (12.5%) of the 96 inmates housed in the protective custody unit were killed, compared with an overall penitentiary death rate of 2.9% (p = 0.0003). These 12 individuals were similar to the general inmate population with respect to age, race, years of education, crimes, time served, and prison rule infractions committed. In contrast, the 21 homicide victims housed in other areas were younger and had committed significantly greater numbers of rule infractions during incarceration. Prisoners hospitalized for drug overdose, but not those hospitalized for traumatic injuries, could be differentiated from the remaining prison population by increased convictions for homicide and higher prison infraction rates. Inmates in protective custody were targeted selectively for death; other subgroups of victims of violence appear to share characteristics often associated with perpetrators of violence.

Training prison inmates as paralegals: An experimental project

A program to train inmates as paralegals was established at a large state prison in the Midwest. Qualified inmates were randomly assigned to the training or to a control condition. Both groups were administered measures assessing legal knowledge, the use of legal knowledge, attitudes about the criminal justice system, and self-perceptions before and after training. The trainee group showed a significant increase in its amount of legal knowledge after training. Members of the trainee group also reported a significant increase in the number of other inmates requesting aid from them on legal problems. In addition, interviews were conducted with two random samples of the general inmate population, before and after the paralegal training program. These interviews revealed strong support for the training program, and this support increased over the period of the program. Limited data on longer-term effectiveness of the paralegal's performance in the prison legal aid clinic and in paralegal jobs following parole supported the positive, shorter-term results.

Treatment strategies for juvenile delinquents : Alex Hawryluk American Judicature Society (1155 East 60th Street, Chicago, Illinois 60637), 1971, 29 pp., paperback

Substance use disorders are common conditions among repeat criminal offenders. Without addressing these underlying substance use behaviors, parolees are significantly more likely to recidivate within 1 year of release. New Jersey is one of the first states to actively pursue substance abuse treatment options for inmates who are in the final stages of their sentences. Given the fiscal realities of taxpayer-supported programs, such initiatives must clearly demonstrate economic benefits for sustainability and growth. This article conducted one of the few comprehensive economic evaluations of prerelease substance abuse treatment to determine whether Community Education Centers' programs in New Jersey generated desirable outcomes, significant economic benefits, and positive net benefits. Relative to a matched comparison group of offenders who did not receive treatment, the intervention group returned an average economic benefit of $4,307 to $6,209 over the 1-year postrelease period. These economic benefits are underscored by the fact that the treatment program is housed in a separate facility, with a lower average per diem from that of the general inmate population. These results provide quantitative economic evidence that prerelease substance abuse treatment programs have the potential to reduce recidivism and save taxpayer dollars without adding to existing prison resources.