Taxpayers spend about $70 billion a year on jails, prisons and other correctional facilities in the U.S. and currently there are 2.2 million inmates in our correctional system. When we look at each type of facility individually, we find that healthcare issues often vary by facility type but there are also common themes – a lot depends on the stage of the inmate’s incarceration.
There are about 6,500 correctional facilities in the U.S. About 50 percent of these facilities are city and county jails and the remainder are state and federal prisons as well as 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 one to 15,000 beds. When someone is arrested, the first place they go is the local jail. Inmates in these facilities are generally convicted of non-violent misdemeanor charges and they don’t stay in the facility 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. About 85 percent of inmates have drug and alcohol addictions. Suicide is also a much higher risk in a jail setting and 40 percent of inmates have mental health issues. There is also 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.
Penitentiaries and Prisons
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 there are 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 percent 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 the inmates are much younger and therefore don’t have a long history of unhealthy behaviors.
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 members of society.