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The current statistics show that the mentally ill patients encompass a large number of the population in prison which has led to a significant problem with the administration and therapeutic specialists. It is evident that the number of the prisoners with mental illnesses has increased and also the seriousness of the disease has become more severe. Due to this occurrence, a lot of efforts have been put by the concerned people to deal with the problem (Thompson 2009).
Specifically, discussions have been held on actuarial devices that would be used to predict and classify the illnesses, best ways to control of treat the disease, how treatment and management relate, best methods of isolation and medication and also the role of the health officers that would be responsible for correcting the problem. Researchers say that there is the need for more efficient approaches to dealing with the mentally ill inmates that need therapy. This paper focuses on the situation of the mentally ill inmates, evaluating the seriousness of the illness and what is being done to deal with the problem as well as the recommended steps that should be taken (Steadman, Osher Robbins Case and Samuels 2009).
According to the research that was done in 2004 by the American Psychiatric Association, facilities that offer correction of mental illnesses in the United States has become the most significant institutions. In 1956 to 1996, the population of the psychiatric patients reduced by almost 90% because the mentally ill persons were released to the community. The worst of this was that they had been published without enough support and the criminal justice system later caught them.
It is evident from the research that, most of the mentally ill persons are found in the prisons. The percentage of the mentally ill prison inmates is estimated to be 16%, although this data may vary with researchers and the methodologies used according to the mental health service record provided. The mentally ill inmates in prison are becoming a critical issue over the years, and the situation may be worse by day. Records show that 16.5% of prisoners in Florida receive continuous mental treatment (Moran 2014).
The data that has been collected in the past indicate that the inmates that were found to have a mild illness from 2002 to 2006 remained unchanged in a long time. Patients that had moderate disease increase from 8,053 to 10,553 and those with severe cases from 402 to 812, which was a double count. Florida is the third rated prison service provider, and it has been admitting prisoners with critical mental illnesses (Thompson 2009). However, it may not serve the other entire nation. Prisoners tend to have similar disorders that occur frequently and with great intensity. The American Psychiatric Association reported in 2004 that the most common disorder among the prisoners includes bipolar disorder, schizophrenia, and depression, which a common occurrence in both the United States and the United Kingdom.
The inmates are also frequently found with personality disorders which have a basis of antisocial personality disorder which primarily fall into the classification of antisocial or criminal behavior in which most inmates succeed (Moran 2014).
According to the data by many researchers, it is clear that mental illness among the prisoners has become a serious problem. Dealing with the issue is becoming urgent with time because the situation is becoming worse as days advance. More inmates with severe mental illnesses are getting into prisons, and the occurrence is not expected to be contrary. State psychiatric care system is not likely to develop more room to deal with the situation; therefore, prison administration has to meet the need of developing techniques, programs, and strategies to manage the ill persons.
Research has identified this as still a challenge that still needs to be addressed particularly by the prison administration (Moran 2014).
According to the data given by a bureau of justice statistics about 70% a state prison screen the inmates during the intake in 2000. Various screening devices have been discovered and used, some being evaluations and interviews, actuarial statistics approaches and clinical interviews that do not insinuate judgment of people. The essence of assessment is to identify the mental health illnesses and determine the best methods to deal with them. Another reason is to define people who may be a threat to themselves and others. There has been a notable improvement in the assessment and management of the mental illness within the health practitioners and prisons (Levin 2015).
In the past, there have discussions over the versions of data that has been released, questioning the accuracy of the clinical and actuarial methods regarding determining the seriousness of the conditions with the inmates. Apparently, the actuarial models have been credited for the ability to predict those who are likely to be violent or most offended in future. Consequently, in 1996, actuarial models were recommended to replace the clinical approaches rather than supplementing them because of their accuracy in predicting behavior. The significance contribution of this finding is combining various tests to determine the particular risk of a particular group and not necessarily to determine the accurate ones in predicting the behavior of the mentally ill in future (Levin 2015).
There is a pressing need for the management of the mental health illness to balance treatment and control of the current situation. Research that was conducted in 2007 point out that, there is no strategy available that can automatically identify the offender, risk, treatment procedures or the control levels. If such methods can be developed, then the clinicians and the prison administrators that regard effectiveness in treatment and risk management will have practical strategies for the mentally ill prisoners.
Regarding the inmates, the clinicians may demand the diagnostic health information of the patients while the prison administration may require any information that is likely to be necessary for the management of the jail. Since 1940, it is understood that there is no easy strategy to deal with the problem. In a research in 2006, the issue of dealing with the mentally ill people was characterized by the pressure between mental health and the security of the prison as an institution (Landsberg 2002).
Observations have been made that, there is no balancing equation between the treatment need of the prisoners and the supply of the resources necessary for treatment and this has affected the way the prison administration has been handling the patients in jails. Research that was done by Faiver in 1998 illustrated that department of corrections needs to be careful when punishing the mentally ill inmates especially when they act beyond control since they are not able to think clearly, and the patients are not sure of the rules that they should not break. Also, according to Lovell's article, it is easy to evaluate how psychopathology hinders a mentally ill person to comprehend and follow rule that are set by an institution. Victimization being at the top of the list, there are several issues that hinder the treatment of the mentally ill prisoners (Landsberg 2002).
Mentally ill inmates are not only the offenders in prison but their deeds also lead other inmates to aggressiveness. It has been observed that mentally ill inmates are likely to cause a commotion in the jail settings, which lead other inmates to unplanned behaviors that may ruin the peace of others in the institution. Research show that mentally ill prisoners are likely to do wrong repeatedly than the other inmates. Also, the mentally ill prisoners were liable to be in prison for a longer time than the others because they were likely to repeat their offenses more frequently sometimes even before they could complete their imprisonment terms (Hassan, Rahman, King, Senior and Shaw 2012).
In advancing the knowledge of the issue of assessing, prevention, control, treatment and management of the mental illness among the inmates, research has to be frequently done. In some prisons, inmates have specializes areas in which they stay separately without having other people around. These areas can be used to monitor the behavior of the mentally ill prisoners so that the assessment may be accurate to tell the severity of the illness. One would trigger their minds to see how they respond and their aggressiveness. In gaining more knowledge on this issue, it would be necessary also to follow closely with other prison institution on the similarities of the conditions of the inmates. Identifying the disorders of the patients and looking at the relationship between them would be necessary to determine the trend of the illness. It would be of help too to follow up with other countries and compare the data they have with their assessment criteria to determine the situation (Hassan, Rahman, King, Senior and Shaw 2012).
It would also be necessary to ensure that there are policies formulated with the help of clinicians and health practitioners that would be implemented by all institutions. The system would ensure that accurate data is provided that give accurate figures of the mentally ill inmates and the level of their problem. Also, the background information of their illness would be given along with their diagnostic information that will help determine the number of patients that need treatment. It would also be necessary to prohibit the release of prisoners back to the community when they are not adequately treated or not given the necessary service. If some inmates are released before recovering, this will provide inaccurate data, if the research covered only those in prison (Frances 2011).
The methodology that would be effective in advancing knowledge would be creating a web portal and inviting the managers of different institutions to edit the files. Here, they could post their data on mental health and give their opinion on better methods to reduce the cases as well as any newly discovered strategies, which would keep the researcher updated on the temporary issues that emerge with time concerning the problem (Frances 2011).
The unit of analysis would be medication. According to the United States Bureau of Justice Statistics research that was done in 2000, 73% of the prisons in the United States administered psychotropic drugs to their patients in the institutions, while 114,400 patients all over the world were given the drugs when in prison. Administering drugs for treatment is the best option that would be used because all other methods such as psychiatric intervention would consume a lot of time and money. Use of one institution as the sample would be favorable to ensure fast and efficient feedback. In the analysis, using computer aided personal interview would be necessary, which would give real comments and information that would not be distorted because every individual would give the information according to his or her experience with the prisoners (Frances 2011).
The study would be designed to apply to the clinicians and prison administrators for credible information. Any other person who does not fall in these two categories may not take part. The best sources of funding would be the government, through the ministry of health, the health practitioners’ bodies and associations, the psychiatric associations, the therapeutic Association and other health stakeholders. Writing an appeal of invitation would help in presenting the need at hand (Frances 2011).
There should be recommendations on policy, requiring all institutions that play any significant role in the mental health illness to implement the policies set. Also, creating awareness to the public of the existing policies and practices in line with the mental illness would help achieve the goal to reduce the risk. It would be in order inviting all the bodies involved in the mental health to collaborate in the study so that they can also give insights that may play a great role. The finding of the survey would be paramount in defining the situation of the mentally ill inmates so that the necessary steps would be taken to better the situation. The data from the study would be presented to all the stakeholders, including the clinicians, psychiatrists, and the criminal justice association through their websites for evaluation. The data could also be presented on the web portal with a clear description of how the study was done, what the findings were, and the data analysis. Their website could be accessed by the relevant people that may be in need of the data (Fagan and Ax, 2011).
In conclusion, a significant percentage of the mentally ill persons need immediate treatment. These inmates are at risk because of the seriousness of their problem as many health practitioners, psychiatrists and prison administrators are struggling to correct the situation. Research has shown that the situation is getting worse as prisons are still receiving prisoners who are in severe conditions. However, the facilities and the resources seem to be limited, and there are no new strategies that have been discovered yet to take care of the worsening situation. Out of this situation, this paper reviewed some of the significant ways to manage and control the predicament (Enos 2015).
Enos, G. (2015). Leaders sound alarm on abundance of jail inmates with mental illness. Mental Health Weekly, 25(19), 1-3.
Fagan, T. & Ax, R. (2011). Correctional mental health (1st ed.). Los Angeles: Sage.
Faiver, K. (1998). Health care management issues in corrections (1st ed.). Lanham, MD: American Correctional Assc.
Frances, R. (2011). General Medical Problems of Incarcerated Persons With Severe and Persistent Mental Illness: A Population-Based Study. Yearbook Of Psychiatry And Applied Mental Health, 2011, 132-133.
Hassan, L., Rahman, M., King, C., Senior, J., & Shaw, J. (2012). Level of Mental Health Intervention and Clinical Need Among Inmates With Mental Illness in Five English Jails. Psychiatric Services, 63(12), 1218-1224.
Landsberg, G. (2002). Serving mentally ill offenders (1st ed.). New York: Springer.
Levin, A. (2015). Report Slams U.S. Prisons for Use of Force Against Inmates With Mental Illness. Psychiatric News, 50(17), 1-1.
Moran, M. (2014). Mental Illness Highly Prevalent Among Incarcerated Women. Psychiatric News, 49(5), 1-1.
OSTERWEIL, N. (2012). Serious Mental Illness Prevalent Among Inmates. Clinical Psychiatry News, 40(1), 1-22.
Prison staff raise concerns over handling inmates with mental illness. (2002). Mental Health Practice, 5(8), 3-3.
Steadman, H., Osher, F., Robbins, P., Case, B., & Samuels, S. (2009). Prevalence of Serious Mental Illness Among Jail Inmates. Psychiatric Services, 60(6).
Thompson, A. (2009). Caring for Prison Inmates the Hospice Way. Illness, Crisis, & Loss, 17(4), 363-378.
Health care is a scarce good and, therefore, everything should be done to ensure that health care is offered to all individuals without discrimination. Health care in the justice system is one of the main concerns in the sector. In the justice system, the focus is on law offenders, correctional facilities and the offering of heath care to the individuals in these institutions. Health care in correctional facilities has been an arising issue that has caused various discussions in different platforms.
The effectiveness of health care in correctional facilities has been questionable, leading to reforms to try to ensure that there is a change. The environments of correction facilities are known to be setting where infectious diseases are highly concentrated. Infectious diseases are highly concentrated in jails compared to prison settings. Therefore, individuals who stay for too long before being transferred to prisons end up having contracted the illnesses.
Research proves that individuals in prisons have a higher possibility to contract illnesses compared to the general public. Such data has caused research to be carried out on factors, which increase the chances of prison inhabitants are at a higher risk of contracting illnesses. One reason associated with the high number of infectious diseases in prison is due to lack of concern for the health of inmates. In some prisons, the number of inmates is higher than the required capacity and; therefore, this increases the chances of transmission of highly infectious diseases. However, the inmates are not only the one at risk of contracting the infectious diseases in the prisons. Workers who are employed in prisons are also prone to the infections due to their area of work (Møller, 2007). However, research proves that there are methods that can be used to control the infections. It is essential to establish that the health of inmates and workers in correctional facilities is kept safe since health care is a universal basic need.
According to Joseph Bick, the main reason behind the establishment of jails and prisons is to ensure that the public safety is assured at the maximum level. Jails and prisons were not setup to reduce the transmission levels of infections or deliver health care effectively. The author emphasizes that the factors that increase the levels of transmission of infections in prisons are delays in medical checks and treatment, lack of infection-control advise and crowding. Other factors include rationed access to clean water, soap and laundry, and prohibitions against the use of sterile-needles and condoms which are harm reduction mechanisms. The transfer of inmates to another facility from their former residence, which happens abruptly also makes the control of healthcare hard. Inmates are not exposed to constant health check-ups, lack of measures to recognize a disease outbreak, and lack of disease eradication mechanisms (Bick, 2007).
Joseph Bick also emphasizes on the lack of enough technology in correctional facilities that can handle the outbreak of a disease or treat inmates. Sharing of clinical information between different correctional facilities also reduces the effectiveness of health care for inmates. The issue of mental illness and its high prevalence rates in correctional facilities complicates the management of contagious diseases. Correctional facilities are reluctant to seek help from outside agencies in matters of health care. Therefore, health care provision in the facilities continues to be poor since the correctional facilities do not have the expertise or ability to offer efficient health care. Hygiene is another issue that is neglected in the correctional facilities, and hygiene goes hand in hand with health (Bick, 2007). Therefore, if high levels of hygiene are established, the levels of some contagious disease will reduce. Another health care issue that is arising in correctional facilities is the high prevalence of sexually transmitted infections.
The second article has a title, ‘The Health and Health Care of US Prisoners: Results of a Nationwide Survey.’ The article analyzes the access to health care among inmates in the US and the prevalence of mental and chronic mental illness. The research methods used to know the findings of the research are the 2004 Survey of Inhabitants of the Federal and State correctional facilities and the 2002 Survey of inhabitants of local jails. The data from the research showed an increase in the number of prison inhabitants in the United States having quadrupled over the past twenty-five years. As of now, “the United States incarcerates more individuals per capita, than any other nation in the world” (Wilper, n.d., 2009).
Out of a hundred thousand individuals, the imprisonment rate in the United States is 750, compared to a country like India, which has thirty individuals imprisoned out of a hundred thousand people. The US population of inmates is 2.3 million, which adds up to around one percent of the adult population in the country. With such a large number of inmates, the provision of health care is a challenge to the facilities despite the inmates having a constitutional right to health care. The research provided information that a high population of the inmates has chronic conditions, especially viral infections. Another key concern is that mental illness and substance abuse is very common among inmates.
The article also looks into the effectiveness of health care provision to the inmates and treatments that sick inmates face.
The four common sexually transmitted diseases found in a prison setting are gonorrhea, genital herpes, chlamydia, and syphilis. Though HIV is also common in the correctional facilities, its prevalence is not as high as the four diseases stated above. Sexually transmitted diseases treatment is ignored in most prisons and those with urgent medical conditions are mostly the one who receives the attention. Therefore, there is disregard for chronic illnesses and sexually transmitted illnesses. These actions result in the spread of the chronic and sexually transmitted is very high. For example, in Pennsylvania, the percentage of incarcerated women with syphilis is 10.0 out of a hundred thousand (Brown, 2003). Compared to the number of the non-incarcerated population in the same region, which is 0.8, the prevalence of the disease in prison is extremely high.
The setting of correctional facilities is also to blame for the prevalence of diseases and spread of some behaviors like drug and substance abuse. According to Theodore Hammett, many administrators of correctional facilities despite them denying any involvement are the reason behind illicit drug use and sexual activities in their facilities. If the administrators were effective, then some of these habits would not happen under their watch (Hammett, 2006).
However, instead, the administrators are involved in the illicit drug trade since they earn profits from allowing the smuggling and sale of drugs in the prisons. Therefore, the blame should not entirely be on the health sector for the failure of health care in the correctional facilities. Provisions should be made to ensure that inmates are assured of their health during their term in prison since it is their right. Therefore, measures like health insurance should be activated for inmates to assure them of health care while in correctional facilities.
A fact that is not considered is that when the inmates are released, they might end up infecting the public without their consent. Therefore, it is important to treat the inmates while still serving their terms rather than risk the lives of other individuals when the inmates are released. The protection of the inmates from infections does not necessarily have to comprise complex processes. For a start, the inmates need to be taught on the importance of hygiene and its benefits. Infection-control methods also need to be highlighted to the inmates to enable them protect themselves in situations where they can (Møller, 2007). Such small hygienic practices can be very effective in reducing the number of infections that inmates suffer.
The main research question is; how many sick inmates are in a correctional facility and what illnesses they have been diagnosed with? Second, how often are inmates checked randomly for any illnesses? Third, of the diagnosed patients, how many are still undergoing treatment or medication? For the diagnosed patients, how often do they receive check-ups and how many patients have recovered fully from their illnesses. How many patients in the facility have chronic illnesses? How many inmates have mental illnesses? How many inmates have chronic illnesses? Is there a facility in the correctional facilities under research that the inmates can get treatment, or special care is outstanding situations? Does the correctional facility have medicine to cater for abrupt occurrence of diseases among the inmates.
In the issue of health care in correctional facilities, there are factors that are constant in all the articles that are the cause of the deterioration of health care in these institutions. The first factor is the reluctance of the administration of the correctional facilities to offer the inmates constant and effective health care. In correctional facilities, there is a lack of technology and manpower to handle cases of ill health or the break out of a disease. Research also proves that the administration of correctional facilities is responsible for the prevalence of sexual activities and substance abuse. Substance abuse leads to sexual activities in correctional facilities, which lead to the transmission of sexually transmitted diseases (Hammett, 2006). However, it is sad that all these activities happen under the watch of the administrators of the facilities. Therefore, there should be strict rules in the behavior of inmates in prison and limit their freedom to avoid such behaviors.
Definition of variables
In the research study, there are two types of variables; independent variables and dependent variables. Independent variables refer to the factors in the research study that are not changed by the other variables being measured. Dependent variables, on the other hand, are a variable that is dependent on other factors. The dependent variables in the research study include the number of sick patients, the number of medical personnel in the correctional facilities and the technology available to deal with sick patients. The independent variables in the research study include the number of inmates in the facility. The policies in the correctional facilities also add up as an independent variable. However, there are differences in the policies in the correctional facilities because of the difference in locations. However, the facilities have some similarities in policies, which are common in all the facilities.
Definition of population
The population of prisons is diverse, and the research study views correctional facilities with both male and female inhabitants. The research study provides data showing that female inmates are at a higher risk of contracting sexually transmitted infections. All the data used in the research study shows that indeed the population in correctional facilities suffers a problem when it comes to health. The research study looks into federal, and state correctional facilities in order to find out if there is any difference in the two correctional facilities levels. The research study also involved workers in the correctional facilities to try and provide information relating to the issue.
Sampling method and rational
Various methods are used to sample the inmates to obtain the required data. One of the methods used to sample the data include is to compare the number of sick inmates to the total population of the inmates. This helps create a percentage of the inmates who are sick compared to the total number of inmates. The research study uses data from different correctional facilities in different states in order to establish if there are similarities or differences. The illnesses researched on in the study include, sexually transmitted diseases and chronic illnesses. The illnesses are syphilis, gonorrhea, HIV, Hepatitis B, tuberculosis, chlamydia, genital herpes and influenza.
Sampling method and statistical power issues
According to the data provided by the research study, it is true to say that there is a clear connection between low health care and correctional facilities. The data collected from various correction facilities show that inmates are at a higher risk of contracting contagious illnesses compared to the public. For example, number of incarcerated women in Alabama who have syphilis out of a population of a hundred thousand individuals is 9.3. However, for the non-incarcerated population in the same state, only 5.8 out of the population of a hundred thousand have the disease. The data provided in the research study also shows there is a clear relation between health care and hygiene levels in correctional facilities.
In conclusion, it is true that the health care levels in correctional facilities are relatively low. Most correctional facilities neglect the provision of health care to inmates and those attended to are the one who have emergencies. The rest have to deal with their problems without receiving any medical help, which is very sad. It is important to ensure that inmates receive health care service just like any other citizens (Brown, 2003). Just because they are locked up for their crimes against the law, does not mean that they should be denied the right to proper access to health care. Reforms should be enforced to ensure that health care provision in correctional facilities is one of the top priorities.
Bick, J. (n.d.). (2007) Healthcare Epidemiology: Infection Control In Jails And Prisons. Clinical Infectious Diseases, 1047-1055.
Brown, K. (2003). Managing Sexually Transmitted Diseases in Jails. The Body: The Complete HIV/AIDS Resource, September, 2003.
Hammett, T. (n.d.). (2006) HIV/AIDS And Other Infectious Diseases Among Correctional Inmates: Transmission, Burden, And An Appropriate Response. American Journal of Public Health, 2006, June; 96(6): 974-978.
Møller, L., & World Health Organization. (2007). Health in prisons: A WHO guide to the essentials in prison health. Copenhagen: World Health Organization.
Wilper, A., Woolhandler, S., Boyd, J., Lasser, K., McCormick, D., Bor, D., & Himmelstein, D. (n.d.). (2009). The Health And Health Care Of US Prisoners: Results Of A Nationwide Survey. American Journal of Public Health. 2009, April; 99 (4): 666-672.
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