Taxpayers spend about $70B a year on corrections in the US and currently there are 2.2M inmates in our correctional system. Exactly what are the different types of correctional facilities and what are their issues?
There are about 6,500 correctional facilities in the US. About 50% of these facilities are county and city jails and the rest are state and federal prisons and state run juvenile facilities. The big difference between these facilities, as it relates to medical care, is the management structure of the facility and the type of inmate you find on the inside.
County and City Jails
These facilities are run by the local county or city and can range in size from 1 bed to 15,000 beds. When someone is arrested, the first place they go is the jail. Inmates in these facilities are generally convicted of non-violent misdemeanor charges and they don’t stay for more than a year. Jails also house inmates that are recent arrests that have not posted bail and inmates that are being held over for trial. The average stay for most jail facilities is less than 30 days. For these reasons, jails have to be very good at medically screening their inmates when they come in to their facility. Drug and alcohol withdrawal is a serious issue. 85% of inmates have drug and alcohol addictions. Suicide is also a much higher risk than normal in a jail setting and 40% of inmates have mental health issues. You also have a much higher incident rate of Hepatitis C, HIV and other communicable diseases. Jails have boot camps, work release programs and other services to try to address substance abuse and meet educational needs of inmates.
Penitentiary and Prison
Penitentiaries and prisons are run by state governments and the Federal Bureau of Prisons to house inmates convicted of crimes. On average, prisons are much larger facilities than jails and an inmate is in prison for an average of 6 years. While you have a lot of the same issues in the prison setting, there are some major differences. Withdrawal is generally not an issue in prison because by the time an inmate makes it to the prison setting they have been in the system for at least several months. Because of the length of stay, there is a lot more chronic disease management for issues such as diabetes or cancer. As an example, some states have set up facilities that house all inmates in the state correctional system with cancer. There are also state prison facilities that are 100% geriatric. Like jails, communicable disease and mental health are also big issues in the prison setting.
Juvenile facilities are under state supervision and as their name suggests, inmates in these facilities are under 18. They house both long and short term stays and typically they have less than 50 beds. There are similar healthcare issues in the juvenile setting, but they are not as acute because of the youth of the inmates.
So what does this mean for the medical providers in these facilities? Studies have shown that the biological age of inmates as a whole is significantly higher than their actual age because of poor health practices and high risk behavior. This places a high priority on the medical provider to give inmates high quality healthcare to help them return to their communities in a condition to be more productive society members.