Prison mental health services: results of a national survey of standards, resources, administrative structure, and litigation

The formation of adequate mental health systems within prisons has accelerated as a result of successful class action lawsuits. Our recent national survey questioned all state correctional departments about the existence of standards in each system, compliance with such standards, prevalence of class action lawsuits involving the issue of providing adequate mental health services for inmates, issues related to consent decrees, available mental health resources within the correctional system, and the administrative structure of the mental health system. Our purpose was to identify those factors correlated with certified class action lawsuits involving issues related to mental health services. Twenty-one states were involved in such litigation. Only the presence of psychiatric hospitals operated by the department of corrections correlated with the presence of certified class action lawsuits involving mental health services. Prison systems larger than 15,000 inmates were at higher risk for such litigation. Smaller systems having psychiatric hospitals run by the state mental health agency appeared to be at less risk for such litigation.     

The sources and consequences of corrections officers' stress: A South Korean example

Corrections officers play crucial roles in the functioning of correctional institutions. They create and maintain the social and security milieu within prisons and often have direct impact on the behavior of inmates through their daily contact with inmates. Studies showed, however, that the correctional work environment was fraught with stress. Many studies found that corrections officers experienced excessive stress, which manifested in physical illnesses, burnout, family problems, or their inability to perform their duties—compromising institutional safety and creating further stress for other staff. These studies were instrumental in instituting improvements in the correctional work environment; however, most were conducted in Western societies. To extend the knowledge of corrections officers' work environments, this study examined correctional work among officers in South Korea. Specifically, stress-related issues outlined in previous studies were examined here to assess their relevance and applicability in the South Korean society. Implications for policy and future endeavors are discussed.     

Aggressive behavior and measurement of psychopathy in female inmates of German prisons--a preliminary study

Studies concerning inmate psychopathy (as measured by Psychopathy-Checklist-Revised, PCL-R; Hare, 1991) have predominantly been concerned with male inmates. This study was the first to look into psychopathy using the PCL-R with the whole required procedure in German prisons with female inmates. The aims of the present study were to gain data about the prevalence of psychopathy in this sample and to examine potential relations between the types and motive of aggression, prosocial behavior and scores on the PCL-R. Sixty female inmates were examined. We obtained a prevalence rate of psychopathy of 17% (N=10, with a cut-off score of 25). Considering a wide range of subtypes of aggressive behaviors, we found that physical proactive, and relational reactive aggression as well as age predicted high scores of psychopathy. However, prosocial or helping behavior was not associated with psychopathy. Implications for diagnostic issues in forensics concerning female prisoners are discussed.     

Risk factors for potential occupational exposure to HIV: A study of correctional officers

This study examined social determinants that explain correctional officer exposure to blood/bodily fluids. Seasoned officers in five prisons were selected at random to complete an anonymous mail survey regarding situations which may have placed them at risk for exposure to HIV while at work. Institutional variables more strongly predicted officer chances of occupational exposure in a corrections setting than did perceptual and individual level variables, particularly the custody level of inmates supervised, length of time in the corrections career, and being in a position of rank. Years of experience increased the number of exposures to blood and bodily fluid, and increased officer apprehensiveness concerning uses of force with seropositive inmates. Knowledge about HIV and the frequency of use of personal protective equipment was not related to the likelihood of encounters with blood or bodily fluids.     

White-collar offenders and the jail experience: a comparative analysis

The incarceration experiences of white-collar offenders have received relatively little attention among criminological researchers, and the research that has been conducted has focused on offenders’ experiences in prisons rather than jails. The purpose of this study was to fill this gap by examining approximately 6500 inmates incarcerated in local jails, comparing those classified as white-collar offenders to violent and other non-violent offenders. The differences between offender types based on demographics, psychological adjustment (i.e., mental health issues since arrival to jail), and behavioral adjustment (i.e., institutional misconduct) are examined to see whether white-collar inmates have more difficulty than others adjusting to the jail environment (consistent with the special sensitivity hypothesis). Findings suggest that white-collar jail inmates do not appear to experience symptoms indicative of poor psychological or behavioral adjustment to the jail environment. Implications for policy and future research are discussed.     

Muslims in prison: a case study from Ohio state prisons

The present study explores core issues related to the understudied population of Muslim inmates. Mail questionnaires were sent to the full-time chaplains employed by religious services in thirty Ohio state male prisons. The survey examines: (1) characteristics of Muslim inmates, (2) patterns of identification with Islam, (3) religious behavior inside the prisons, and (4) relations between conversion to Islam and crime committed. Our findings indicate that while the vast majority of Muslim inmates are African-American, they are otherwise similar to the incarcerated population in terms of age, education, and marital status. Most of the Muslims in our sample converted while incarcerated. The devotion of Muslim prisoners in the sample tends to be high as demonstrated by adherence to central religious practices. Finally, we found no relationship between crime and conversion to Islam inside prison. Although our data must be understood as tentative, it offers a basis for further investigation of this population of inmates.     

HIV-infected prisoners: what mental health services are constitutionally mandated?

State and federal correctional facilities currently have approximately 23,000 inmates who are infected with human immunodeficiency virus (HIV). These inmates suffer from the same mental health disorders as uninfected inmates but are additionally subject to mental health problems uniquely related to their HIV infection. Many prison systems are struggling to provide minimal mental health care to uninfected inmates. How will prisoners address the additional mental health needs of the staggering number of inmates being diagnosed with AIDS and HIV? This article describes the type of mental health services that are constitutionally mandated and discusses whether and how prisons will have to respond to the distinct mental health issues related to HIV infection.     

Where the Margins Meet: A Demographic Assessment of Transgender Inmates in Men’s Prisons

Drawing on official data and original interview data on 315 transgender inmates in California prisons for men, this research provides the first empirical portrayal of a prison population in California that is unique by virtue of being both transgender and incarcerated. Situated at the nexus of intersecting marginalities, transgender inmates fare far worse on standard demographic and health measures than their non‐transgender counterparts in the US population, the California population, the US prison population, and the California prison population. With the possible exceptions of partnership status and educational attainment, these factors combine to reveal that transgender inmates are marginalized in heretofore undocumented ways. At a time in which an evidence‐based approach to corrections is increasingly embraced by corrections officials in the US, this article provides the first systematic profile of transgender prisoners. It reveals they can be regarded as a special population that, from a policy point of view, raises what Minow calls “the dilemma of difference”.     

Socrates behind bars: a report on an experimental course on justice and philosophy

This paper describes a particular educational experience: a course that took place in prison involving law students and inmates. One of the co-authors was the leading instructor in the course, whereas the other played an active role during its design and implementation. Social prejudices and taboos on crime, criminals and prisons offer a simplistic, biased and altogether negative image of penal institutions and those involved in them. This picture pervades society in general, and the legal professions in particular. The course described in this paper is aimed at bridging the gap between inmates and future lawyers by bringing them together into the same classroom to think and reflect collectively. The method used was the Socratic dialogue, in which the professor acted as a “spiritual midwife” encouraging dialogue and debate around fundamental issues such as truth, fear, happiness, respect, responsibility, justice, and so on. During each session, participants explored these concepts in depth, and had the opportunity to gain a better understanding of the other’s point of view. The ultimate aim was that upon completing this course both groups could have a better understanding of each other’s realities. This paper is based on the personal accounts of the participants in the course, including professors and students (both law students and inmates). The methodology is qualitative and phenomenological, and its value lies in the singularity of the experience. Drawing on the theory of justice of Amartya Sen, we identify this course as a non-transcendentalist and non-institutionalist approach to justice, exploring the role that emotions play in it. In the conclusions we express our belief that by thinking together and trusting each other students and inmates can open themselves to a logic of cooperation that connects both with a broader sense of justice and the enhancement of democracy.     

GROWTH AND QUALITY OF U.S. PRIVATE PRISONS: EVIDENCE FROM A NATIONAL SURVEY*

Research Summary: Private prisons incarcerate 5.3% of the sentenced, adult population in the United States. The present study presents selected results from a 1999 survey of administrators who monitored private prisons in the United States (or U.S. territories). Among the findings of interest, the private sector experienced significant problems with staff turnover, escapes, and drug use. Where possible, private prison operations were compared with those of the Federal Bureau of Prisons. Policy Implications: Given the issues raised here with public safety, public sector agencies contracting for private prisons need to develop incentives or other means to ensure that private sector operators retain experienced custody staff.     

The erosion of authority and the perceived legitimacy of inmate social protest: A study of prison guards

The level of control exercised by guards over inmates, it has been argued, has decreased recently as a result of therapeutic, legal, and bureaucratic changes in American prisons. Feeling that inmates too often and too easily circumvent their authority, and that greater inmate rights pose a serious threat to their ability to maintain order, guards tend to discredit inmate complaints and to deny inmates the right to lawful social protest. Questionaire data are analyzed to examine (1) the extent and degree to which guards perceive as legitimate the various means by which inmates may protest unfair treatment by staff and (2) the relationship of this perceived legitimacy of inmate social protest to a variety of factors that prior research has isolated as important in understanding prison guards as an occupational group.     

Administrative Justice in the Penitentiary: A Report on Inmate Grievance Procedures

The majority of prisons today have an internal grievance mechanism that gives inmates an opportunity to air complaints and seek solutions to individual and institution-wide problems. This study reports on the way the mechanism functions at two Illinois state prisons—one minimum security and one maximum security. The main findings are: (1) that the mechanism is heavily and repetitively used by only a portion of the inmate population, (2) that the grievances filed range widely in type as well as in merit, although it is clear that there is much frivolous activity, (3) that inmates win only a small percentage of their cases, either at the first-instance level or on appeal, and (4) that among both line prison staff (at least at one of the prisons) and inmates there is considerable dissatisfaction with the process, although a minority of prisoners and the higher echelon prison administrators can be counted on for more favorable assessments. The article goes on to compare these findings with the generally articulated objectives of the grievance process and concludes with a series of suggestions that have been made for improving its workings.     

The role of the psychiatrist in evaluating a prison mental health system in litigation

Federal courts during the past 14 years have recognized that many prisons in the United States have provided constitutionally inadequate medical and psychiatric services. Our recent national survey indicates that at least 20 states have had at least one part of their correctional system included in a certified class action suit that alleged insufficient mental health services for inmates. This article reviews the role of the expert psychiatric witness during the phases of litigation that involve proposed remedial plans and compliance in implementing remedial plans. Available epidemiologic data about psychiatric disorders among prison inmates, standards for correctional mental health care, and various mental health system models are briefly reviewed. A comprehensive approach to evaluating proposed remedial plans and assessing issues of compliance with accepted plans is described. Special attention is directed toward psychiatric issues unique to a correctional system.     

The impact of prison conditions on staff well-being

Prison conditions have been at the center of long-standing debates among corrections scholars. Interestingly, this debate has focused on inmates alone while paying little attention to the potential impact of prison conditions on staff. Addressing this limitation, the study draws on survey data collected from a stratified random sample of prison staff working at all federal prisons in 2007 to examine the impact of prison conditions on staff well-being (substance use, psychological symptomatology, physical duress, and sick leave use). Mixed-level models show that harsh physical conditions correspond to significant problems for staff on all outcomes measured (individual-level impacts). The data also show that prison-level aggregations of harsher conditions correspond to significant deterioration in staff physical and psychological symptomatology above and beyond individual-level effects.     

Inmate harassment and rape: an exploratory study of seven maximum- and medium-security male prisons in Israel

Prisons deprive male inmates of heterosexual relationships and thus prevent them from asserting their masculinity via "traditional" means. Accordingly, many prisoners experience extreme emotional, psychological, and physical distress, which turns several of them to intimidation, aggression, and re-establishment of their sense of dominance through homosexual activities with coerced partners. This study, based on 760 hours of phenomenological semi-structured interviews undertaken in a random sample of 1.5% of the male prisoner population in Israel, analyzes the neglected issue of homosexual rape in Israeli prisons. The study finds that (a) sexual harassment or homosexual rapes rarely take place in Israeli prisons and (b) Israeli inmates view homosexual rape in prison as disgusting and disgraceful and conceptualize it in highly negative emotional terms.     

The Gender Paradox in Prison Suicide Rates

Few studies of prison suicide have focused on suicide among female inmates, and even fewer studies have provided comparisons of rates by gender. Using national data on U.S. prisons and suicide, this study examined the “gender paradox” in prison suicide rates by comparing suicide rates of female and male inmates and U.S. residents and then examined characteristics of prisons that reported suicides. Findings indicated that rates of suicide in prison were similar for female and male inmates, but rates were higher for female inmates and lower for male inmates compared to the respective rates for female and male U.S. residents. Prisons that reported female suicides evidenced significant differences in prison conditions, including higher assault rates and mental health service utilization, compared to prisons for males and female prisons without suicide. Implications of the findings for understanding the gender paradox and for prison suicide prevention are discussed.     

The Economics of Prisons

This survey scans the English language research on prisons published since the appearance of Becker's (1968) seminal piece. After first describing the economic nature of prison and parole, issues concerning comparative institutional analysis and organizational design are discussed, including the role of private prisons. Empirical evidence on production functions for prisons, recidivism and offender rehabilitation programs is reviewed. A brief overview of policy issues and suggestions for future research concludes the survey.     

Prison staff and work stress: The role of organizational and emotional influences

Previous research has well established the influence of demographics and work environment variables on the experience of job stress for correctional officers. However, the literature examining this phenomenon for other correctional staff is just beginning to emerge. Scant attention has also been previously devoted to the potential role of emotional issues, such as emotional dissonance, work environment variables of perceived organizational fairness, and feedback regarding job performance. The present research adds to this emerging literature through use of survey data from a sample of correctional staff employed in two prisons in Kentucky. Bivariate and multivariate analyses reveal that influences on perceived work stress are primarily organizational issues, including role conflict, emotional dissonance, and task control. Contrary to popular belief, the percent of one’s work time spent in contact with inmates reduces the experience of work stress.     

Is tougher better? The impact of physical prison conditions on inmate violence

Physical conditions of prisons have been at the center of long-standing debates in correctional policy and research. Many argue prisons should be unpleasant to deter future offending and motivate prosocial change among inmates. Others believe harsh conditions inhibit effective treatment and, perhaps, make offenders worse. Little progress in these debates has emerged, primarily because few studies exist that have tested propositions coming from either camp. This study draws on survey data collected from a random sample of staff at each of the 114 federal prisons operating in 2007. Staff perceptions of noise, clutter, dilapidation, and privacy were combined to reflect physical conditions of each prison (aggregated to the prison level). Operational data measuring serious violence was used to create a count of serious assaults at each prison over the same time period referenced in the staff survey. Utilizing a Poisson framework, the data showed that poor physical conditions of prisons correspond to significantly higher rates of serious violence. Implications for theory and policy are discussed.