23 Incarceration

Incarceration within the United States has increased in alarming rates from 1980 to 2020. The rates of incarceration have more than tripled during this time and peaked in 2008 at 2.3 million people in prisons. (Pettit and Gutierrez, 2018). That is roughly 1 in 100 adults in the United States behind bars when observing the countries’ population in 2008. The United States’ rapid increase in incarcerations does not come from increased crime rates, it is primarily due to sentencing laws and policies. There are currently over 2 million people nationwide confined in federal, state, local and tribal systems. Of this staggering number of people incarcerated, over 90% of them are men (Wagner & Sawyer, 2022). The individuals that are incarcerated within the United States face a huge disadvantage compared to the rest of the population, with nearly 65% of the entire prison population has a substance use disorder (Abo et al., 2021). A majority of this population are more likely to face mental and physical health challenges, higher suicide rates, and family issues.

Incarceration refers to being confined in a jail or prison. Police officers and other law enforcement have the ability to arrest and confine individuals who are suspected of committing  crimes or violating laws. Those put in jail are usually held there until their trial date, unless they can afford bail. If someone is found to be guilty, they are sentenced to stay at a prison and serve their time. The harshness of the living conditions can vary depending on the location and seriousness of the incarceration. Regardless of where they are held, these places are not comfortable conditions for anyone. Life is very restricted within incarcerated settings, preventing very little contact with others, especially outside of the institution. This harsh lifestyle and confinement can lead to many different health disparities that can last the rest of their life.

This image depicts the large increase in the number of

incarcerations within the United States from 1920-2020

“U.S. Incarceration rate since 1925” by DvidMCEddy is licensed under CC BY-SA 4.0

Physical Health Issues

HIV is a huge issue that is commonly found within incarcerated populations. In the United States, HIV infection rates for incarcerated persons are about 6 times greater than the general population (Feral et al., 2019). Many of those infected with HIV simply do not know that they have the infection. According to the CDC, before 2007, HIV testing for inmates was only done by request, clinically indicated, or by court order. Since 2010, it has been an opt-out procedure offered to inmates. This means that doctors test all inmates for HIV unless an inmate specifically denies testing (2011). The COVID-19 pandemic has also significantly impacted those behind bars more than the general public. This SARS (Severe Acute Respiratory Syndrome) outbreak was devastating world-wide regardless of location, age, and race. However, different media sources would focus on transmission in healthcare facilities or schools but rarely covered the dangers within the prisons. In August 2020, the rate of COVID-19 infections and deaths were significantly higher than the general population (Natoli et al., 2021).

Physical activity is another aspect of health that the incarcerated population is a risk for more so than the general population. Being physically active has many benefits for physical and mental health. According to the CDC, they suggest that everyone should achieve 150 minutes of physical activity every week. It improves brain health, cognitive ability, and judgment skills for mental health. For physical health, it decreases your chances of heart disease, stroke, diabetes, and many other adverse health issues (2022). Unfortunately, incarcerated populations do not utilize the exercise yard and prison gymnasiums to their full effect leaving only about 43% of inmates who reach the weekly physical activity suggestion regardless of age or race (MacLean et al., 2022).

Mental Challenges

Mental health issues are also prevalent for men within the incarcerated population. It is estimated that 16-30% of inmates suffer major depressive disorder (Steigerwald et al., 2021). When mental health issues are observed at a broader level, it has been found that 43% of inmates suffer from some type of mental health disorder. This prevalence is much higher than the general population (9.2%) (Sirdifield et al., 2009). These mental health issues can greatly affect quality of life while incarcerated. This risk of suffering a mental health issue could eventually lead to harming others or themselves. Suicide attempts are unfortunately a common occurrence for incarcerated populations. A study examined differences in suicide attempts between those who were ever incarcerated and never incarcerated (Smith & Udo, 2022). It was found that those who  had been incarcerated were about 3 times more likely to attempt suicide compared to those who were never incarcerated. This risk was even higher for those who were incarcerated as a juvenile  (Smith & Udo, 2022).

Returning to normal life after confinement is a very difficult transition, especially for those who have spent extended periods of time locked up. A study was done with a sample of 100 incarcerated men who had been released to determine what causes decreases in cardiovascular health. The leading causes for this decreased cardiovascular health were found to be smoking habits, BMI, diet, and blood pressure. It was reported that 78% of the men were current smokers (Fobian et al., 2018). Tobacco use is a common cause of CVD and limiting the amount of current smokers would help lower cardiovascular health issues.

This photo gives a visual depiction of how tightly confined inmates are contributing to how easily  infections can spread

“Prison Cell Block” by Bob Jagendorf is licensed under CC BY 2.0

Racial Differences

Some racial groups are at an increased risk of being incarcerated individuals. In particular, African American males make up 6% of the total population but account for about 36% of all incarcerated individuals. Compared to white men, African American men are twice as likely to be arrested and 6 times more likely to be incarcerated (Assari et al., 2018). Another study was done on older (ages 50+) incarcerated individuals based on race and age that measured their cognitive performance. Their performance was measured by using the Montreal Cognitive Assessment (MoCA). In each category that was tested, whites scored higher than non-Hispanic blacks and Hispanics while trying to account for variability in education (Perez et al., 2021). Race is a huge factor when considering health and cognitive outcomes for the incarcerated population.

What can be done?

I believe education would provide the largest amount of support for this vulnerable population. There are some available resources in place that need to be utilized more in order to help maximize the health of inmates. The food the prisoners are given should be a focal point for improving the health of incarcerated men. The prisoners do not choose when, how, and what they eat and consequently they lose control over their own bodies (Vanhouche, 2015). Vanhouche explains how the current food systems are done to impose power over the prisoners. This is an unnecessary portrayal of power that if changed, could have heavily benefit the overall health of prisoners. I am not suggesting that the food should be provided anytime and should be incredible meals, but a policy restricting prison guards to prevent them purposely starving or feeding foul food to inmates should be put in place.

The change for HIV testing that was implemented in 2010 to test inmates unless they deny testing is a huge step in the right direction for measuring their health. However, a huge issue for HIV positive prisoners presents itself when they are released and have barriers keeping them from accessing care. Some barriers they face are mental illness, substance abuse, difficulty accessing housing, insurance, and employment (Golin et al., 2022). Conducting an intervention to focus on an individual’s readiness to continue to take care of themselves pre-release could have major impacts on their future health. The same approach could be taken for the high percentage of those with substance use disorder (SUD). They could bring in people who have suffered the adverse effects of long term tobacco use to talk to the inmates and be a living representation of what will happen if they continue their bad habits. When they are face to face with someone who has lung or laryngeal cancer who can physically exhibit terrible outcomes, it will have a much stronger effect than just simply stating “smoking is bad” or “quit smoking it is bad for you.”

The provision of mental health services should be another focus for prisoners. There are currently therapy options in place for these holding facilities, but are not nearly rigorous as they should be when it comes to help and screening. James Rose talks about his own experience working as a counselor in a jail and the networking of hospitals that should have been in place were often shut down years prior (Rose, 2022). This leads to the psychiatrists focusing on those with extreme mental illnesses and leaving many without help. Undiagnosed and untreated mental illness within a prison could easily get progressively worse very fast. If they could focus on helping inmates as they come in with aggressive screenings, they could determine how they should help each individual to prevent them from getting any worse or prevent the onset of a mental illness from the start.

References

Abo, M. G., Jason, L. A., Guerrero, M., & Salomon-Amend, M. (2021, June 7). Life after incarceration: The impact of stability on formerly imprisoned Oxford House residents. Journal of prevention & intervention in the community. Retrieved November 2, 2022, from https://pubmed.ncbi.nlm.nih.gov/34096831/

Assari, S., Miller, R. J., Taylor, R. J., Mouzon, D., Keith, V., & Chatters, L. M. (2018). Discrimination fully mediates the effects of incarceration history on depressive symptoms and psychological distress among african american men Springer Science and Business Media LLC. doi:10.1007/s40615-017-0364-y

Centers for Disease Control and Prevention. (2022, June 16). Benefits of physical activity. Centers for Disease Control and Prevention. Retrieved November 4, 2022, from https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

Centers for Disease Control and Prevention. (2011, June 24). HIV screening of male inmates during prison intake medical evaluation — Washington, 2006–2010. Centers for Disease Control and Prevention. Retrieved November 2, 2022, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6024a3.htm

Farel, C. E., Golin, C. E., Ochtera, R. D., Rosen, D. L., Margolis, M., Powell, W., et al. (2019). Underutilization of HIV testing among men with incarceration histories. AIDS and Behavior, 23(4), 883-892. doi:10.1007/s10461-018-02381-9

Golin, C. E., Knight, K., Carda-Auten, J., Gould, M., Groves, J., L White, B., Bradley-Bull, S., Amola, K., Fray, N., Rosen, D. L., Mugavaro, M. J., Pence, B. W., Flynn, P. M., & Wohl, D. (2016, September 6). Individuals motivated to participate in adherence, care and treatment (impact): Development of a multi-component intervention to help HIV-infected recently incarcerated individuals link and adhere to HIV CARE. BMC public health. Retrieved November 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011897/

Karnik, N., Soller, M., Redlich, A., Silverman, M., Kraemer, H., Ph.D., H. C. K., Haapanen, R., & Steiner, H. (2009, June 1). Prevalence of and gender differences in psychiatric disorders among juvenile delinquents incarcerated for nine months. Psychiatric Services. Retrieved December 7, 2022, from https://ps.psychiatryonline.org/doi/full/10.1176/ps.2009.60.6.838

MacLean, A., Maycock, M., Hunt, K., Mailer, C., Mason, K., & Gray, C. M. (2022, April 18). Fit for life: The development and optimization of an intervention delivered through prison gymnasia to support incarcerated men in making positive lifestyle changes. BMC public health. Retrieved November 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9017016/

Mendel, R. A. (2011). No place for kids the case for reducing juvenile incarceration. Distributed by ERIC Clearinghouse. Retrieved December 2022, from https://folio.iupui.edu/bitstream/handle/10244/1035/JJ_NoPlaceForKids_Full.pdf.

Natoli, L. J., Vu, K. L., Sukhija-Cohen, A. C., Engeran-Cordova, W., Maldonado, G., Galvin, S., Arroyo, W., & Davis, C. (2021, September 17). Incarceration and covid-19: Recommendations to curb covid-19 disease transmission in prison facilities and surrounding communities. International journal of environmental research and public health. Retrieved November 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471417/

Perez, A., Manning, K. J., Powell, W., & Barry, L. C. (2021, October). Cognitive impairment in older incarcerated males: Education and race considerations. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. Retrieved November 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448974/

Pettit, B., & Gutierrez, C. (2018). Mass incarceration and racial inequality. American journal of economics and sociology. Retrieved November 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9540942/

Pyle, N., Flower, A., Fall, A., & Williams, J. (2016). Individual-level risk factors of incarcerated youth – sage journals. SAGE Journals. Retrieved December 7, 2022, from https://journals.sagepub.com/doi/10.1177/0741932515593383

Rose, J. (2022, July 18). Counseling in jail. Counseling Today. Retrieved November 4, 2022, from https://ct.counseling.org/2020/03/counseling-in-jail/

Sirdifield, C., Gojkovic, D., Brooker, C., & Ferriter, M. (2009). A systematic review of research on the epidemiology of mental health disorders in prison populations: A summary of findings. The Journal of Forensic Psychiatry & Psychology, 20(sup1), S78-S101. doi:10.1080/14789940802594445

Steigerwald, V. L., Rozek, D. C., & Paulson, D. (2021). Depressive symptoms in older adults with and without a history of incarceration: A matched pairs comparison Informa UK Limited. doi:10.1080/13607863.2021.1984392

Vanhouche, A.-S. (2015, April 16). Acceptance or refusal of convenience food in present-day prison. Appetite. Retrieved December 1, 2022, from https://reader.elsevier.com/reader/sd/pii/S0195666315001932?token=18ED08101B59C97D525DE9F155767C1DDEA1290520F73871CD632CED5BA82340803CD120C017B6F4A9DC0AF0545133A5&originRegion=us-east-1&originCreation=20221202005158

Wagner, W. S. and P. (2022, March 14). Mass incarceration: The whole pie 2022. Prison Policy Initiative. Retrieved October 7, 2022, from https://www.prisonpolicy.org/reports/pie2022.html#datasection