Correctional Nurse . Net

Lorry Schoenly, PhD, RN, CCHP

Are Women Inmates Special? WHO/UN Checklist

You’ve just been told that your all-male prison will be converted to a women’s prison next month. Will that make a difference? You bet! Be prepared for some changes! Sure, women have lots of the same conditions as men and your chronic care clinics will still include diabetes, hypertension and cardiac disease. Of course, the obvious changes will be put in place: pelvic exams and mamographies will now be a routine part of health care delivery. But what else is in store?

The World Health Organization and the United Nations teamed up to publish a checklist to help European prisons focus on the special needs of women. The Action Guidance and Checklists document includes lists for decision makers, senior prison officials and prison health care staff. The recent publication of this document reminded me of the gender issues that are specific to the patient population we care for in correctional nursing.

Women make up only 10% of those incarcerated in the US and the numbers are increasing nearly twice as fast as men. One in every 100 black women are incarcerated as compared with 1 in 297 Hispanic and 1 in 355 white women. The typical incarcerated woman is in her early to mid thirties with a fragmented family history. Sixty percent have a history of physical or sexual abuse. There is significant history of substance abuse – in fact a high percentage are behind bars on drug charges.

Women inmates are greater users of health services than male inmates. In addition, working in a female facility requires more sensitivity and intuition – and definitely more patience. Significant substance abuse issues, poverty,  and multiple psychosocial issues including mental illness, trauma & abuse can mean it is harder for female offenders to trust the healthcare team.

All of these gender-specific issues means a need for greater health care staffing – something not always considered when looking at male vs female inmate health care. What has your experience been in caring for female inmates? Do you agree that things are very different? Tell us your story……

 

October 8, 2011 Posted by | Women | , , , , , , , , , , | 2 Comments

Inmate Health Perspective with Author Piper Kerman

Correctional Nursing Today on BlogTalkRadio

Piper Kerman, author of the memoir “Orange is the New Black” discusses her book and experiences in a federal prison, focusing on the healthcare perspective. Discussion includes:

  • Women’s Health Care Issues
  • Drug and Alcohol Rehab
  • Discharge Planning

July 18, 2010 Posted by | Correctional Nursing Today, Women | , , , , , , , , , , , , , , , | Leave a Comment

Women’s Health in Prison

Girl in Prison Alice Cope

Girl in Prison By Alice Cope

The number of women in prison is much less than men, however, the rate of growth of female prisoners is nearly double that of males in the US. From 1995 to 2002 the female inmate population grew by 42% and is the fastest growing prison population. Currently 7% of the US prison population and 12% of the jail population is female. Gender issues must be considered in correctional healthcare. Women inmates have increase need for healthcare.

Trauma Informed Care

As many as 57% of women inmates have been physically or sexually abused at some point in their lives.  This trauma contributes to increase in depression, stress & anxiety disorders, learning problems, behavioral disorders, and substance abuse according to NCCHC. The trauma-informed approach recognizes trauma as a central issue in the health of the majority of women inmates.  Sensitivity and acknowledgement of a traumatic history can lead to interventions promoting recovery.

Mental Health

Trauma and abuse coupled with drug and alcohol abuse lead to increase mental illness. 36% of women inmates are treated for some form of mental illness compared to 24% of men. Correctional nurse working in women’s prisons  experience first-hand the increased medication administration, esp. psychotropics, for female inmates.  Women inmates are more willing to seek out counseling and psychiatric services, although many facilities are under staffed in these area.

Pregnancy and Reproductive Health

Incarcerated women tend to have complicated and high risk pregnancies due to their past medical histories, lack of prenatal care, and drug/alcohol use.  Reproductive health is jeopardized by increased sexually transmitted diseases, pelvic inflammatory disease, and poor hygiene. Inadequate attention to female-specific screenings such as breast exams and Pap smears can lead to undetected cancers. 

Impact of Prison on Health

A study in the UK found that imprisonment was largely detrimental to women’s health for a number of reasons. The shock of imprisonment coupled with separation from family and children affected health, as did poor health habits such as lack of exercise, poor dietary choices and close proximity to smokers.

What other female-specific health conditions have you seen in corrections?

October 28, 2009 Posted by | Inmate Issues, Women | , , , , , , , , , , , , , | 2 Comments

Shackling Inmates in Labor? What’s Up with That?

botmaster-shackles336Shackling laboring inmates has been an issue for some time in corrections and is getting press due to coverage in New York. Last week they became the sixth state to ban the use of shackles during labor except is special situations. The ACLU and other prison watch groups have been actively pursuing a change in this corrections practice. It is one of many ethical dilemmas correctional nurses become involved with. Unlike in hospitals, healthcare is secondary to security and safety in the running of the correctional facility. The Department of Corrections and custody officers can have a very different perspective on any given situation from the healthcare providers. A ‘Command and Control’ attitude can be quite challenging to deal with.

Shackles are for Outside the Walls

Some clarification is necessary to the uninitiated. The news articles make it appear that the women are INSIDE the prison giving birth and being shackled. Unless referring to the few prison hospitals around the country, what is really happening is that the women have been transported to the hospital to give birth. They are therefore outside the security perimeter of the prison and there are standard precautions in place to decrease the chance of escape and to reduce the need for a large number of officers to attend them. Those standard precautions include handcuffs and shackles.

Standard Security Procedure

Now those of us who have given birth know that it is highly unlikely that a women in true labor is going to have the wherewithal to evade an officer in the L&D Unit and escape into the community. However, inmates have been known to be very creative in their escape plans. No corrections officer wants to be the one on duty when an escape takes place. Therefore,the custody officer is going to use standard procedures (IE shackles) unless special directives are issued – thus the need for specific policy to be in place regarding the laboring inmate in the community.

Advocating for Change

I’m not really an advocate for legislation for everything so the idea of getting legislation about this in all 50 states seems a bit much to me. However, the Federal Bureau of Prisons and 5 other states so far have specific policy or legislation allowing the laboring inmate to be free of shackles. The visibility of the New York situation may speed the adoption throughout the country – that is a good thing. The Rebecca Project for Human Rights has also taken up the call and been instrumental in facilitating the New York State legislation. A listing of specific state by state information was recently posted by the Crime Reporter.

September 2, 2009 Posted by | Ethical Issues, Women | Leave a Comment