Carla Conroy MPHP439 April 24, 2008 Medical Conditions and Health Care in Prisons Stories are often showed on the news of convicted felons being sentenced to days, months and years in prison. What some people may not think about is that happens to these people once they become inmates if they have a medical condition. Are there services available to them to them so they may receive medical treatment while incarcerated? What options are available for follow-up care once inmates are released for prison? This chapter will explain some of the medical conditions inmates often have, with an emphasis on mental health disorders, and how many inmates have them, as well as the state of health care in prisons across the country. Inmate Population At midyear 2000, there were approximately 1.3 million inmates being held in 1,668 Federal, State and private correctional facilities across the United States. These correctional facilities are divided in to two different categories, confinement facilities and community based facilities. In confinement facilities, less than 50% of the inmates are allowed to leave the facility for any reason without a staff member. The number of these types of facilities decreased 7% between midyear 1995 and midyear 2000. However, the number of community based facilities, facilities where more than 50% of the inmates are allowed to leave the facility for any reason without a staff member, increased by 7%1. Between both facilities, the number of inmates being held rose by 28% and the number of facilities housing these inmates grew by 14% between midyear 1995 and midyear 2000. The majority of these facilities were State run facilities (78%) and these State-run facilities held 84% of all prisoners. Approximately half of the facilities were classified as minimum security facilities, a third as medium security facilities and the rest as maximum security facilities. State prisons were operating at 1% above capacity, while federal prisons were operating at 34% above capacity. The majority of prison inmates were males (93%). Almost half (46%) of prisoners were black, followed by whites (36%), Hispanics (16%), American Indians or Alaska Natives (1%) and Asian or Pacific Islanders (1%)1. Mental Health Disorders Mental health disorders are classified and their symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as DSM-IV. DSM-IV diagnoses are divided in to five categories, or axes, ranging for Axis I to Axis V. Axis I disorders are major mental disorders and include major depression, anxiety disorders, bipolar disorder, ADHD and psychotic disorders. Major Depressive Disorder: depression is characterized by periods of feeling sad or down and/or decreased interest in family, friends and surroundings. In addition, people with depression experience persistent irritability, loss of concentration, psychomotor agitation or retardation, feelings of worthlessness and/or guilt, suicidal ideation/suicide attempts and changes in sleep and appetite, both of which can either be increased or decreased. These symptoms must last at least 2 weeks at a time and cause the person some type of problems at home, at work or at school in order for them to receive a diagnosis of Carla Conroy MPHP439 April 24, 2008 Major Depression2. At midyear 2005 24% of state prison inmates had symptoms of major depressive disorder in the 12 months before they were assessed3. Bipolar Disorder (BD): Bipolar Disorder is a mood disorder where people experience periods of depression as described above, as well as periods of mood elevation, or mania. Symptoms of mania include feeling extremely good about one’s self, talking fast, louder and more often, decreased need for sleep, starting new projects or activities, impulsivity, distractibility, increased irritability, hypersexuality, racing thoughts and grandiose ideas or plans. Bipolar Disorder is broken into two major types; Bipolar I Disorder and Bipolar II Disorder. Bipolar I disorder is when a patients has manic symptoms that last a week or more and cause the person significant problems at work, home and/ or school. When someone has Bipolar II Disorder, their manic symptoms due not last as long and do not cause significant impairment2. At midyear 2005 43% of state prison inmates had symptoms mania in the 12 months before they were assessed3. Psychotic Disorders: People who have psychotic disorders experience delusions, hallucinations and/or grossly disorganized behavior consistently for at least 6 months, which cause some type of impairment at either work, home or school2. Approximately 15% of state prison inmates have experienced either delusions or hallucinations and 4% of experienced both3. Substance Use Disorders: Substance use disorders are broken down both by substance type, such as alcohol, cannabis etc. as well as specifier, either abuse or dependence. People with a substance abuse diagnosis experience some type of social, work or school problems as a result of their drinking or drugging. Dependence takes this one step further and is present when a person not only experience problems because of their substance use, but their body has become physically dependent on the substance as well2. Substance use disorders are very common in the prison population, with dependence being more prevalent than abuse. 74% of state prison inmates had a substance use disorder, with 54% of those having a dependence diagnosis. When broken down by substance 51% had an alcohol use disorder (30% of those being a dependence diagnosis) and 62% had a drug use disorder (44% of those being a dependence diagnosis) 3. Often times those with a mental health disorder also have a substance use disorder. The prison population is no exception. 42% of state prison inmates had both a mental health disorder and a substance abuse or dependence disorder3. Communicable Diseases Communicable diseases are of great concern to prison officials, given that prison inmates are in such close proximity to each other, as well as the people that work in the prisons. This section goes over a number of communicable diseases that are commonly found in prisons and their prevalence in the prison population. Viral Hepatitis: One communicable disease commonly found in correctional facilities is viral hepatitis, of which there are five types; Hepatitis A (HAV), Hepatitis B (HBV), Hepatitis C (HCV), Hepatitis D (HDV), and Hepatitis E (HEV).