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Correctional Healthcare Article


Lorry Schoenly, PhD, RN, CCHP Correctional Healthcare
with Lorry Schoenly, PhD, RN, CCHP


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Top correctional health care news from 2010

Editor’s note: This article is part of the 2010 CorrectionsOne End of the Year Report. Please visit the main page for the end of the year report here.

By Lorry Schoenly

Several correctional health care news stories top the list as we near the end of the first decade of the 21st century. These stories define the year past and help frame the year ahead. Here are my picks for the top four news stories in correctional health care this year.

#1 – California Prison System at the Bench
California’s Prison system (CDRC), the largest in the nation at over 150,000 inmates, has been embroiled in a legal battle that spans two decades and culminated in a hearing by the Supreme Court this fall. At issue is the flagging healthcare provided by the CDRC. Prior court rulings have focused on reducing the prison population in order to allow for better provision of healthcare based on available resources. But a solution to the California case requires creativity. Balance is needed between the demand for public safety and the necessity for humane treatment of inmates. Every state and county system is struggling to maintain this balance as trends show an increasing healthcare burden in the correctional system.

Why is this important? Although seems like a local issue, the final decision on the constitutionality of the healthcare delivered to this state’s prison population will affect all US correctional systems. Correctional healthcare practices have been court-driven since the landmark 1976 Estelle v. Gamble, when the Supreme Court ruled that lack of medical care constituted cruel and unusual punishment prevented by the 8th Amendment. Since that time, case law has fleshed out the parameters of required medical and mental health care for citizens behind bars.

#2 – It’s All in Your Head
Mental health takes the number two slot this year with increasing reports of deficient mental health care in jails and prisons across the country. Social advocates suggest that, too often, America has decided to criminalize mental conditions rather than treat them. This year, a national report chronicled the distressing news that our largest mental health facilities are now jails. Mental health care is expensive, requiring increased staff support and medications. Seriously mentally ill inmates are a management issue and can be extremely difficult to handle in the general population. Small facilities are particularly vulnerable to these challenges. As the inmate population ages (See news story #3 below) new concerns such as dementia and organic brain disease emerge. Add to this mix the growing awareness of Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) as contributing factors to criminality, and we have the makings of a major news story for this year and the next.

Why is this important? Our society and our corrections systems must grapple with how to handle mental illness as a component of criminal activity. Custody officers need to understand underlying mental illness to effectively manage inmate behavioral problems. Specialized mental hospitals, closed in the 1980’s, may be revitalized to handle nonviolent mentally ill offenders. Mental health courts are advocated in many sectors.

#3 – Another Day Older and Deeper in Debt
It is no secret that the US inmate population is getting older, and inmate population statistics show marked growth in the over-50 segment. The PEW report, published a little over a year ago, documents aged federal prison inmates as a third of total population. Similar numbers exist at state and local facilities. This year, much media attention was placed on the high cost of caring for elder inmates and possible options for alleviating the financial burden or creatively managing their health care. From sea to shining sea, correctional systems are adding assisted living complexes, in-prison oncology units and hospice facilities. Some systems are looking at ways to reduce the burden of end-of-life medical care, such as relaxing medical parole requirements.

Why is this important? Managing aging inmates with increasing chronic conditions and terminal illness will consume a greater portion of resources in coming years. This may mean expanding medical units, building specialized facilities for older inmates, or creatively involving community services to provide needed care.

#4 – Suicides are Down!
After years of effort and attention, suicides in US jails are down and prisons suicides remain at a low. A national study, released this year by the National Center for Institutions and Alternatives (NCIA), documents a near three-fold decrease in jail suicide rate from 20 years prior. This extraordinary improvement is attributed to increased awareness, staff training and enhanced intake assessment of vulnerable detainees. Prison suicide rates have remained stable at 15 per 100,000, only slightly higher than the general population figures (11 per 100,000).
Why is this important? This significant decrease in jail suicides and stability of a low rate of prison suicides indicates that prevention efforts are working. With all the bad news we read over the course of a year, it is a delight to see positive change in a significant health and legal risk. Of course, there is always room for improvement. The jail study findings indicate a shift in suicide attempts from the first 24 hours to the 2-14 day period of confinement. It is recommended that further prevention efforts focus on this time period.

The coming New Year promises to continue to provide significant correctional health care news. We live in most interesting times!

Is there a significant correctional healthcare news story I missed? Add your picks to the comments on this post.

About the author

Dr. Schoenly has been a nurse for over 25 years and is currently specializing in correctional healthcare. She is a clinical education specialist and author actively advocating for excellence in this practice setting. Her web-presence www.correctionalnurse.net provides a forum to interpret correctional healthcare to the public and healthcare community. Lorry is a strong advocate for development of the specialty practice of correctional nursing. She speaks and writes frequently on correctional nursing practice issues. Her book, Essentials of Correctional Nursing, will be published in July, 2012.

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