Correctional Health in the United States: Key Issues

The overlapping epidemics of infectious diseases, mental illness and addiction have become increasingly more prevalent among inmates than they are in the general population. In many cases, the diseases of addiction and mental illness are the root cause of incarceration in the first place. In spite of this, inmates have traditionally been marginalized or given sub-par medical care by the U.S. healthcare system both while imprisoned and after they are released.


We present here an overview of the epidemics of infectious diseases, mental illness and addiction in the U.S. Correctional System.


HIV/AIDS Facts:

  • Overall it is estimated that between 23 and 31 percent of people living with HIV/AIDS in the United States pass through the U.S. correctional system each year (Hammett, Harmon et al. 2002).
  • Several studies suggest that between one third and one half of these persons are not aware of their HIV status (Sabin, Frey et al. 2001; Altice, Marinovich et al. 2005).
  • At the end of 2005 correctional authorities reported that a total of 20,888 state inmates (1.8 per cent) and 1,592 federal inmates (1.0 per cent) were diagnosed with HIV infection or had confirmed AIDS (Maruschak 2007).
  • This represents a prevalence of HIV that is five times higher in U.S. state and federal prisons than in the general population (Spaulding, Stephenson et al. 2002).
  • In total, African Americans accounted for 53 per cent of known prison HIV/AIDS cases and Hispanic/Latinos accounted for 25 per cent of known prison HIV/AIDS cases in 2004 (Maruschak 2007; Sabol, Minton et al. 2007).

Hepatitis and Tuberculosis Facts:

  • According to a national study, 29-43 per cent of all those infected with hepatitis C virus passed through the U.S. correctional system in 1997 (Hammett, Harmon et al. 2002).
  • Similarly, an estimated 40 per cent of all those infected with tuberculosis passed through the U.S. correctional system in 1997 (Hammett, Harmon et al. 2002).

Drug/Alcohol Dependence Facts:

  • The total economic cost of heroin addiction in the United States was estimated to be $21 billion in 1996 (Mark and Woody 2001).
  • An estimated 60-83 per cent of all people in correctional facilities have used drugs at some point in their lives (Walter 2001).
  • According to the 2004 Survey of Inmates in State and Federal Correctional Facilities, 53 per cent of all State prisoners and 45 per cent of all Federal prisoners met the DSM-IV criteria for drug dependence (Mumola and Karberg 2006).
  • Fifty-six percent of state inmates and 50 per cent of federal inmates reported drug use in the month prior to incarceration (Mumola and Karberg 2006).
  • Among state prisoners who were dependent on drugs or alcohol, 53 per cent had at least three prior sentences to probation or incarceration (Mumola and Karberg 2006).

Mental Health Facts:

  • Based on self-reported histories of mental health treatment or DSM-IV criteria for mental disorders, it was estimated that at midyear 2005 more than half of all prison and jail inmates had a mental health problem.
  • Approximately 50 per cent of prison and jail inmates reported symptoms that met the criteria for mania, 25 per cent reported symptoms of major depression, and 20 per cent reported symptoms that met the criteria of a psychotic disorder (James and Glaze 2006).
  • Only 1 in 3 state prisoners and 1 in 6 jail inmates with a mental health problem received treatment since admission (James and Glaze 2006).
  • Three quarters of prison and local jail inmates who had a mental health problem also met the criteria for substance dependence (James and Glaze 2006).

REFERENCES

  1. Altice, F. L., A. Marinovich, et al. (2005). "Correlates of HIV infection among incarcerated women: implications for improving detection of HIV infection." J Urban Health 82(2): 312-26.
  2. Hammett, T. M., M. P. Harmon, et al. (2002). "The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997." Am J Public Health 92(11): 1789-94.
  3. James, D. J. and L. E. Glaze (2006). "Mental Health Problems of Prison and Jail Inmates." U.S. Department of Justice Document NCJ 213600.
  4. Mark, T. L., G. E. Woody, et al. (2001). "The economic costs of heroin addiction in the United States." Drug Alcohol Depend 61(2): 195-206.
  5. Maruschak, L. M. (2007). "HIV in Prisons, 2005." U.S. Department of Justice Document NCJ 218915.
  6. Mumola, C. J. and J. C. Karberg (2006). "Drug Use and Dependence, State and Federal Prisons, 2004." U.S. Department of Justice Document NCJ 213530.
  7. Sabin, K. M., R. L. Frey, Jr., et al. (2001). "Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992-1998." J Urban Health 78(2): 241-55.
  8. Sabol, W. J., T. D. Minton, et al. (2007). "Prison and Jail Inmates at Midyear, 2006." U.S. Department of Justice Document NCJ 217675.
  9. Spaulding, A., B. Stephenson, et al. (2002). "Human immunodeficiency virus in correctional facilities: a review." Clin Infect Dis 35(3): 305-12.
  10. Walter, J. P. (2001). Drug Policy Clearinghouse Fact Sheet: Drug Treatment in the Criminal Justice System. Washington, D.C., Office of National Drug Control Policy.