Criminal Justice Setting: Federal Corrections
Role: Social Worker providing Case Management Services
Of the 114 federal prisons existing today, 27 are for females. The average age of the female inmate is 28. 66% of female inmates are white. 18% of female inmates are not citizens of the United States. 28% of female inmates are Latino, and 29% are black. Women in prison serve an average of 78 months. There are currently 13,033 female inmates in federal prison and they include 6.7 % of the federal prison population. Most of these women in federal prison are poor, single mothers who are undereducated and unskilled.
Every day, women in prison suffer unnecessarily because of the lack of access to sufficient medical and mental health care. Chronic illnesses are left untreated, emergencies are disregarded and patients with serious mental health issues do not receive appropriate care. Sometime, this lack of proper medical care becomes a death sentence. A considerable amount of women inmates has experience abuse, both sexual and physical, and have depression, anxiety, self-harm tendencies, and likely have a dual diagnosis.
Women who become incarcerated have a high rate of substance abuse and addiction. Women inmates have a great likelihood of having experienced trauma at some point in life. Women inmates have a high likelihood of having pre-existing medical conditions including gynecological issues. A large percentage of women inmates have children. Inmate poor health is typically attributed to poor nutrition, substance abuse, lack of health care or inadequate health care, and poverty. Women inmates are at a higher risk for cancer due to behavior prior to incarceration including behavior that is high risk and failure to maintain preventative health care. Pregnancy upon incarcerations is an issue and child placement. There are also mental health vulnerabilities.
Criminogenic risk factors are factors that are used to determine the treatment level for the prisoner. For female offenders, these may include poverty, psychopathology issues, educational issues, parental or family issues, personality, and antisocial attitudes . Criminogenic needs are the focus of treatment for the prisoner and include antisocial attitudes and peers who are antisocial, substance abuse and employment. Substance use in women has a strong correlation to reoffending. The ability to obtain employment to support herself and her children and the ability to find stable, safe housing are significant needs.
Criminal Justice Setting
The first federal prison for females was created in 1927 in Alderson, West Virginia. Ever since its creation, there have been struggles in the ability to provide adequate care for women inmates. Initially, women were not a very large portion of the total number of persons incarcerated. Women were often housed with men and faced considerable abuse and abhorrent conditions. This did not change until the 1980’s. This was due to a lawsuit entitled Todaro v. Ward, which found the state institutional health care treatment of women unconstitutional in New York. Following this case, standards were created for prison medical care by the American Medical Association.
Correctional facilities have more health services than they did in the past. Most testing and treatment, however, occurs during admission. Federal Correctional Facilities do have a policy for routine exams, but the quality of care various throughout institutions. Many physicians caring for inmates are not trained adequately to complete the type of work presented in prisons. The most significant health presentations are tuberculosis, sexually transmitted diseases, HIV and AIDS and gynecology. Thus, there are gaps in illnesses commonly presented at female institutions including asthma and heart conditions as well as problems relating to drug and alcohol abuse.
When women arrive to prison, they often have spent the majority of their lives without medical care. Thus, they spend a considerable amount of time attempting to reach a healthy standard. Prison medical care is often reported as understaffed with professionals, and those who occupy positions often have little care or concern for the actual needs of the inmate patient.
As the female inmate population has increased, the concern for proper health care for women in prions should become a priority. Women present to prison with a variety of specific health issues relating to risky behavior prior to incarceration. There are also risks in prison for infectious diseases. There are child bearing and gynecological issues. Mental health is another factor significant in the treatment of female inmates. Women inmates face significant mental health issues as a large number of them have experience physical, sexual or emotional abuse at some point in their life. Thus, there is a need for therapy for the female inmate.
As psychiatric hospitals have been dismantled, prisons have become the institution for those suffering from a mental illness. Women inmates are a high percentage of these individuals. It is crucial that women inmates be correctly diagnosed and treatment for their mental illness in order to reintegrate back into society. Often times, these women have a dual diagnosis; that is substance abuse disorder and a mental health disorder. Estimates have reported that as many as 52% of women inmates have mental health issues. In the treatment of these women, it is important not only to provide appropriate pharmaceutical care but also therapy and counseling.
Chosen Forensic Social Work
The evaluation of the healthcare needs of women incarcerated in federal prison, and the support and treatment of this client population. In order to properly treat the federal female inmate, it will be necessary to address each individual on a case by case basis. The needs of one inmate will be quite different from the needs of others. The initial health assessment should be included in the case management file in order for the case manager to ensure that the inmate is having all medical issues addressed. This may also include a required report by the medical staff to the case manager regarding treatments that have been followed up on .
Discussion
An initial assessment of the inmate upon entry into the prison facility will be the most significant step in beginning the evaluation of the client. The goal of healthcare is “to diagnose, comfort, and cure”; the goal of a prison is to “confine, punish, and rehabilitate” “. These two goals collide and aggravated because correctional facilities are “inherently coercive institutions that for security reasons must exercise nearly total control over their residents’ lives and the activities within their confines” .
A case manager will be responsible for developing the inmate’s treatment plan including health issues. The case manager will monitor the progress of the treatment and document the progress. The unique needs of the inmate will be considered. This can occur with a strengths-based case management. This would be an appropriate means to respond to the individual needs of the prisoner. Incorporating an evidence based program for mental health care would also be appropriate. This would include conducting assessments that can accurately identify the inmate’s issues.
A social and traditional healthcare approach that includes addresses risk factors, that acknowledges the inmate’s history of lack of healthcare, that understands the multidimensional aspects of criminal behavior and that incorporates trauma-informed programs while at the same time addressing healthcare issues would be the program to implement. The outcome of these interventions would include overall better care of the women inmates. It will also allow the female inmate to become more informed about her own medical care issues while taking into account diversity. It will promote efficiency and provide the inmate with a better transition from prison.
Simply because a woman enters federal prison, does not mean she should be denied decent health care. This includes health care for any serious physical ailments they enter prison with as well as any mental health issues the inmate faces. Improving the health of women in prison may also have an effect of improving their basic human rights. Addressing health issues may improve the safety of women in prison, improve the general health of the entire population of the prison, decrease the cost of health care for women in prison and provide the women who ultimately leave the institution with adequate physical and mental health to succeed in the free world.
Social Justice
Incarceration deprives a woman of her basic right to freedom and liberty. With this deprivation, a woman should be afforded other basic rights in prison, including the right to proper health care. The woman inmate is fundamentally entitled to minimum care. Minimum care would include the addressing of health issues and mental health issues that were present upon entry into prison.
Without addressing health issues in prison, the public health would be affected and this is another issue of social justice. Women who are incarcerated are typically socially and economically deprived and suffer health conditions as a consequence. Without proper care in prison, these health conditions will deteriorate and placing such individuals back into society is a public health risk. Thus, the proper healthcare of even one-woman inmate, is beneficial to the public.
References
Anderson, T. L. (2016). Issues in the Availability of Health Care for Women Prisoners. Retrieved from http://www.udel.edu/soc/tammya/pdfs/Issues%20in%20the%20Availability%20of%20Healthcare%20for%20Women%20in%20Prison.pdf
Dubler, N. (2014, March 10). Ethical Dilemmas in Prison and Jail Health Care. Retrieved from Health Affiars: http://healthaffairs.org/blog/2014/03/10/ethical-dilemmas-in-prison-and-jail-health-care/
Hollin, C., & Palmer, E. J. (2006, September). Criminogenic need and women offenders: A critique of the literature. Legal and Criminological Psychology, 11(2).
Inmate Gender. (2016, March 26). Retrieved from Federal Bureau of Prisons: https://www.bop.gov/about/statistics/statistics_inmate_gender.jsp
Matejkowski, J., Johnson, T., & Severson, M. E. (2014, February). Prison Social Work. Retrieved from Encyclopedia of Social Work: http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-1002
Problems and Unmet Needs In The Contemporary Women's Prison. (2016). Retrieved from The Composition of Women's Prisons: http://law.jrank.org/pages/1805/Prisons-Prisons-Women-Problems-unmet-needs-in-contemporary-women-s-prison.html
Sipes, L. A. (2012, February). Statistics on Women Offenders. Retrieved from Corrections.com: http://www.corrections.com/news/article/30166-statistics-on-women-offenders
White, K. (2008). Women in Federal Prison: Pathways In, Programs Out. William & Mary Journal of Women and the Law, 14(305).
