Understanding incarcerated populations

AORN Journal, March, 2002 by Cheryl L. Cooke

In the United States approximately 1.3 to 1.8 million people are incarcerated in state or federal prisons or local jails at any given time. (1) Approximately 682 people per 100,000 are incarcerated, and during the 1990s, the growth rate was approximately 6% annually. (2) It was estimated that the United States would have two million people incarcerated by the end of 2001. (3) Approximately 6.3 million people, or 3.1% of the country's adult population, are under some form of correctional control, either through probation or incarceration in a state or federal prison or a local jail. (4)

Nurses may come in contact with people who are under some form of correctional control in many health care settings (eg, hospitals, outpatient settings, corrections systems, clinics). Nurses must educate themselves about this patient population to provide safe, effective health care to these patients.

DEFINITION OF TERMS

In conversations about incarceration, the terms jail and prison often are confused. Jails and prisons, however, are different types of facilities. Jails house people who are awaiting the disposition of their case or transfer to another facility and those who have been convicted and will be incarcerated for less than one year. Jails often are located in urban settings within the city limits, and they provide housing for people of varying custody levels. For example, when incarcerated, jail inmates are held in one facility regardless of their crime or perceived degree of dangerousness. They may be housed in different sections of the facility for security reasons, with those inmates perceived to be more dangerous than others being closely supervised. Jails provide many types of health care services (eg, sick call, ongoing treatment for chronic illnesses, limited prenatal care). Jails usually are located in close proximity to major trauma centers because of their urban settings.

Prisons, however, provide housing for people who have been convicted and sentenced to serve 366 days or more. Prisons usually are located in remote regions and may house prisoners of various custody levels. In prison, custody level is determined at a reception center, and inmates are sent to the appropriate facility based on their need for supervision or perceived degree of dangerousness. Prisons are federal, state, or privately run facilities. (5)

CHARACTERISTICS OF PATIENTS WHO ARE INCARCERATED

Of those people currently incarcerated, approximately 90% are male. Between 54% and 59% of all jail and prison inmates have a high school diploma. An estimated 4% to 8% of individuals who are incarcerated are not US citizens. More than one-third of jail inmates have some sort of physical or mental disability. (6)

Individuals may be in custody or under correctional control in a variety of ways (eg, in prison or jail, on probation, performing community service, participating in a drug diversion program). Others may be incarcerated in long-term mental health facilities as a result of their crime. Estimates are that between 10% and 25% of all people who are incarcerated at any one time are diagnosed as mentally ill. (7)

Women make up an ever-increasing portion of the prison population. In 1998, approximately 3.2 million women were arrested, accounting for approximately 22% of all arrests that year. During that same year, approximately 1% of all women in the United States were under some form of correctional control. In 1996, women in jail comprised between 5% and 10% of the jail population. They most frequently are incarcerated for nonviolent, drug-related offenses. Approximately 50% of women in jail report experiencing physical or sexual abuse before incarceration; 27% report being raped. (8) Between 1997 and 1999, more than 1,300 babies were born to mothers in custody in US prisons or jails. (9)

Incarceration and the war on drugs. The war on drugs consists of a series of economic and regulatory policies that have resulted in an influx of people into jails and prisons with subsequent billions of dollars spent supporting the criminal justice system in the United States. The "prison industrial complex," a term coined by Angela Davis, PhD, addresses how these policy initiatives are approached in the same manner as the military was built during the 1950s and 1960s. (10)

The total number of people sentenced in the United States between 1985 and 1995 increased 84%. Of this increase, 52% is attributable to sentences related to drug crimes. During this 10-year period, there was a 331% increase in drug sentences, with the number of people sentenced for drug-related crimes increasing from 24,200 to 104,400. (11) The war on drugs has resulted in an incarceration rate of more than 70% for nonviolent offenders, many of which may be amenable to treatment instead of nonrehabilitative confinement.

Recent data on crime and drug use show that 51% of all convicted inmates state they were under the influence of illegal drugs or alcohol at the time of their offense. Eighty-three percent of state prisoners admit to using drugs at some point in the past, and 57% say that they used drugs within one month of committing the offense for which they are incarcerated. Of those incarcerated, more than one-third of state prisoners admit that they committed their current offense while under the influence of drugs. (12) Mentally ill offenders report the highest rates of drug use at the time of incarceration, with 60% to 65% of prison and jail inmates with mental illness reporting illegal drug use. (13) Drug use is a factor in the lives of people before incarceration and may be an instrumental reason why crimes such as theft, larceny, and forgery are committed.