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BOP accommodates special needs offenders.

From New York to California, medical, mental health and substance abuse services, along with the needs of female, geriatric and physically challenged inmates, are absorbing increasingly larger shares of correctional capital and operational resources. Delivering these services to an older, sicker inmate population - while controlling costs - will continue to be a major challenge in the years ahead.

Since 1981, the number of people incarcerated in the United States has tripled, from 500,000 to more than 1.5 million. Over the past decade, the Federal Bureau of Prisons (BOP) has grown from 48 facilities and 42,000 inmates to 90 institutions housing more than 101,000 inmates in 1996.

"As stewards of public resources, we must ensure the public is getting the biggest and best outcome for its investment," says Dr. Kenneth Moritsugu, assistant surgeon general and medical director for the BOP. "Flexibility is the best hedge against the future. Within corrections, we do not have the luxury of major errors in planning and operations."

Medical Issues

"Three factors govern health care delivery: time, cost and quality. You can't have all three without forfeiting one or the other," notes Sharon Johnson Rion, director of International Operations with Corrections Corporation of America. "Correctional health care now includes aging, infectious diseases, mental illness and cost containment."

The proportion of federal inmates incarcerated due to drug offenses has increased dramatically, from 29 percent to 61 percent since 1991. Although many of these offenders are under age 35, the number of inmates over age 50 is increasing rapidly. Trends indicate longer sentences, larger correctional systems and more inmates, including more women, geriatrics and those convicted of drug-related crimes. Drug-related lifestyles generate intravenous drug use, high-risk sexual activity and poor nutrition, resulting in disease when inmates are in prison.

Primary care is provided at all BOP institutions. Each institution has a health care unit, much like a primary care physician's office, staffed with a team of health care providers. When an inmate requires hospitalization, the BOP uses a local community hospital for acute care. The inmate returns to the institution to convalesce in a cell or in an observation bed. When health and custody considerations permit, an ailing inmate is transferred to one of several federal medical centers (FMC) located across the country.

The BOP has obtained two relatively new facilities as a result of the "rightsizing" of the military: FMC Carswell, the former Air Force Wing Hospital in Fort Worth, Texas, and the new FMC Fort Devens, west of Boston. As the northeast regional medical center, the Fort Devens facility also will include a new 150-bed prison psychiatric hospital and minimum and medium security level housing.

Keys to Effective Design

Designing for maximum flexibility is the best way to achieve a balance between changing inmate needs and facilities. Corrections experts agree that users should participate in the planning and design process through a team approach, ensuring that both medical needs and security mandates are met. Involving more individuals with diverse perspectives, including architects, administrators, security staff and health care providers, in planning teams will yield a better project.

Experts in the correctional and health arenas agree that design plays a major role in effective operations. "Prison health units should resemble a medical facility within the secure perimeter to enhance patient and staff morale," observes Dr. B. Jaye Anno of Consultants in Correctional Care.

Health units should have convenient emergency vehicle access, dedicated phone and computer lines, and air conditioning, which often is considered a medical necessity.

"Using reliable data and involving health professionals in the planning process are the keys to effective health unit design," advises Dr. Anno. "Designers should listen to alternative views which may be less traditional but equally as valid."

Separation and Classification

"There is no consensus on what portion of the inmate population should be separated from the general population for medical or mental health reasons," says Bobbie Huskey, president of Chicago-based Huskey & Associates and past president of the American Correctional Association. In Illinois, one-third of the special needs population over age 50 requires special housing.

Nationally, there has been a marked decline in the separation of inmates with acquired immunodeficiency syndrome (AIDS) and asymptomatic human immunodeficiency virus (HIV) from the general population. Many professionals believe active AIDS patients can be housed in the general population until their disease becomes so debilitating that they need daily assisted living for their basic functions. Medical units, particularly in regional facilities serving a broader population, should allow flexibility for housing inmates of different classifications. In some states, there is a move away from housing medically impaired inmates in maximum security cells, the most expensive housing units to build.

In Illinois, only 11 percent of inmates needing assistance are housed in maximum security, while two-thirds of medically impaired inmates are housed in minimum security. From 1992 to 1995, the number of inmates assigned to single cells for medical reasons declined by 50 percent.

Native American Jails as Mental Health Facilities

While larger communities often have the resources, trained personnel and social infrastructure to detain inmates with psychiatric problems, remotely located Native American communities must find other solutions.

According to Christine DuClos, project director for the National Center on American Indian and Native Alaskan Mental Health Research, incarceration often is used to address alcohol abuse in Native American communities. Between 70 percent and 100 percent of most crimes are committed under the influence of alcohol. Similarly, most mentally ill inmates have not committed crimes, but because there are no adequate policies, public facilities or staff to monitor and treat those needing mental health care, these individuals are incarcerated.

Family visitation areas are important in Native American detention facilities because of the importance these cultures place on the healing process, spirituality and the role of elders and family members. These concerns vary by tribe.

Jail staff for Native American facilities rarely are trained in suicide prevention measures. Instead, many facilities hire a detention officer for this task. Within a few days, the officer is performing shift work without any formal training. Basic suicide prevention training should include identifying suicidal characteristics, warning signs and preventative steps for handling those at risk.

Women "Do Time" Differently

Women's programs often need more space and time than those for men. Prevention and intervention should consider small residential programs, along with parity and gender sensitive policies. Individual or small-group programming often is used for female inmates, with the goal of self-sufficiency.

"We must foster independence for [female] offenders by allowing them to determine when to turn on the lights and by allowing them to iron their own clothes," says Dr. Joann Morton, associate professor, College of Criminal Justice, University of South Carolina.

Standardization Not the Answer

Several years ago, C. Y. Teena Farmon, warden of the Central California Womens Facility (CCWF) in Chowchilla, was asked to open a women's prison that was built according to the standard design for a men's prison. Corrections officials did not understand the different functional, programmatic and design criteria necessary for women's facilities. Modifications were slow in coming or too costly. To spruce up the outdoor recreational area, for example, female inmates placed flower pots in the urinals.

"It is impossible to apply a standardized design from a men's facility to a women's facility and expect it to work," Farmon says. "There are too many differences, from storage, medical and privacy needs to work programs and housing. Women are less destructive of their surroundings than men."

In California, the number of women in prison is rising at a faster rate than men. At one point, the CCWF housed 4,100 women. In early 1996, it housed 3,100 inmates, while a second 2,000-bed women's facility completed nearby housed more than 2,100 women.

Larger, multilevel housing units present a lack of flexibility for housing different classifications in women's facilities. Among the inmates housed in CCWF, about one-third are classified as level one, or minimum security. However, with large housing units, level one through level four inmates are routinely housed together.

Women's needs for emergency and health services differ from men's, because of greater demand and different exams and tests. Women typically have more medical problems upon entering prison and require more follow-up tests and lab services. Pharmacies must be able to prepare and store medications for female-related diseases. Other differences for women's facilities occur in reception areas, intake processing and programming.

"We want to build self-esteem by offering programs to give inmates practical skills they can use when they get out," says Farmon. California stresses nontraditional jobs and programming for female inmates, offering 27 vocational programs, from automotive repair to masonry.

Designing for Women's Needs

"As the [female] offender population continues to grow, states will be forced to determine where to house an expanding women's population in new construction or renovated facilities," says Connie Roehrich, warden of the Minnesota Correctional Facility at Shakopee.

When the decision was made to design the new Shakopee facility during the 1980s, many planning criteria were considered. The issues addressed included facility location, size, the potential for future expansion and design solutions specifically for women's needs. These included privacy concerns, overnight visits by children, housing all security levels, mental health services and physical disability accommodations.

The Shakopee facility was built in 1986, on 37 acres of state-owned land across the street from the original facility, which was built in the 1920s. Both facilities are located in a residential area in the city of Shakopee, a Minneapolis/St. Paul suburb.

When the only women's prison in Minnesota was built 70 years ago, there was no fence or wall constructed around the facility. The new Shakopee facility does not have perimeter fencing or walls either. The facility has been well accepted by the community. Buildings and grounds resemble a college campus more than a prison.

Inmate programming, recreation, education, medical services, food service, intake and visiting occur in a main building. Living units were designed so that inmates would have to go outdoors several times a day to the main building to eat, see the doctor, attend classes and work.

Residential buildings have peaked roofs on the exterior and natural light on the interior wherever possible. Most program spaces are located off the main interior corridor, or "The Street." This corridor has a peaked roof and skylights to let in natural light. It is finished with maintenance-free burnished block.

Living spaces reflect women's need for privacy. At Shakopee, each woman has her own room with a toilet stall that is enclosed by a swinging door. All women can use the large central day room, which is visible to control room staff. Each living unit has one on-grade wing with rooms accessible to women with disabilities.

Overnight Visits

For the many female offenders who also are mothers, being a parent is an important part of their lives. Most inmate mothers will return home to parent their children. At Shakopee, the prevailing philosophy always has encouraged strengthening ties between mother and child. For nearly 20 years, children visiting the women's prison have been able to stay overnight with their mothers. The three general population living units have trundle beds built beneath each bed for easy roll-out access. This allows great flexibility for women to live in any unit and have children stay overnight.

Female inmates are less destructive of property than male inmates. At Shakopee, there is no graffiti or property destruction of any kind. All furnishings in the living units are wood with upholstery and were made at the men's correctional facility industry program. All areas are carpeted, including hallways, classrooms, day rooms and food service areas. Carpeting absorbs much of the noise and creates an atmosphere more typical of a school setting than a prison.

"The way [female] offenders react to incarceration is significantly different than [male inmates]," Roehrich observes. "Women react much more destructively toward themselves. The best method of managing [female] offenders is with programming. Effective programs include counseling to identify self-destructive behaviors, learning cognitive thinking skills, parenting classes [and] building practical work and educational skills. Women can be housed in less secure settings and will respond to programming."

At Shakopee, the prison industries program offers training for nontraditional occupations, such as woodworking, construction, telemarketing, data entry, computerized drawings and land-use maps.

In the apartment-style housing, four women typically share a unit; eight to 10 women work off the grounds. These are the least expensive buildings to operate, says Roehrich, because they require the least staff. The facility claims a 25 percent recidivism rate; work release is considered to be 100 percent successful.

Shakopee has 10 mental health beds, with five to eight short-term crisis beds. Mental health units have greater space needs because there are more suicide threats, crisis attention and a need for quiet spaces to get away from the noise.

Aging Prison Populations

Several studies note that those 65 and older comprise the fastest growing age group in the United States. By the year 2000, 34 million Americans will be over age 65. Americans over 50 years of age will compose 33 percent of the United States population by the year 2010. In 1992, this group comprised only 26 percent of the total U.S. population.

"The public generally envisions prison inmates as physically aggressive young men," says Morton. For correctional administrators, however, the graying of America is reflected in the prison population.

Older inmates are increasing both in number and percentage of the total population in state and federal prison systems. In 1982, the Bureau of Justice Statistics reported the number of inmates age 55 and older would more than double from 1981 to 1990. In 1988, the BOP estimated the percentage of federal inmates 50 years and older would increase from 11.7 percent to 16 percent by the year 2005. This means the BOP will be housing 17,000 inmates age 50 and over by the year 2000.

Design Considerations

Most correctional facilities are not designed for older inmates. As the growing needs of the elderly population are recognized, experts claim new policies, procedures and staff training programs should be established to respond to the special needs of the older offender.

According to architect Charles Silverman, AIA, vice president of DMJM, a national architectural/engineering firm, "Chronological age does not accurately describe the older offender. Genetic, socioeconomic conditions, lifestyle, mental health and access to social and medical services all contribute to the aging process."

Chronic illness, contagious diseases and sanitation must be considered when developing geriatric environments. The elderly are slower to recognize and respond to heat and cold. Mechanical systems should maintain constant temperature throughout the living space. Physical therapy, rehabilitative therapy and exercise areas ideally should be close and accessible to elderly inmates.

Because there is potential for younger inmates to victimize older inmates, industry and educational programs may have to be decentralized to reduce such opportunities. More emphasis should be placed on providing classrooms for improving life and work skills to better prepare inmates for release into the community.

Mainstreaming and Special Units

Correctional administrators should consider how and where the special needs unit fits within the overall prison system and, assuming it is not a stand-alone unit, how it shares services and programs with other correctional units. Operational flexibility is enhanced when a special needs unit for geriatric, disabled and medically ill inmates is located near the health unit.

"Most inmates with special needs, whether from age or illness, remain in the general population. We must comply with the Americans with Disabilities Act regarding accessibility and mobility requirements for visitors and staff in new facilities," says Farmon.

Medical facilities increasingly will be housing inmates on a long-term basis for chronic illnesses. California has a licensed skilled nursing facility in the women's prison that is capable of maintaining constant, direct nursing care. For many prison administrators, medical needs are a major concern, particularly when no money is available to renovate alternative housing options.

"Prisons have no business running nursing homes," Morton asserts. "We must keep people independent as long as possible and occasionally consider compassionate release and community placement for nonviolent offenders." Policy and programming issues must be resolved before or during the design process.

Recycling Vacated Public Institutions for Special Needs

Creative strategies, using existing infrastructure for special needs services and housing, are being developed across the country. With many public hospitals experiencing a glut of empty in-patient bed space, vacated state mental hospitals are being recycled for correctional use. Minnesota and New York, for example, are using vacated state mental hospitals for medium security prisons and substance abuse facilities, respectively. In 1996, South Carolina renovated a state mental hospital and created a secure juvenile facility as part of a court order to fast track a series of youth offender wilderness camps.

Other potential adaptive reuses for vacated public institutions include prison geriatric, hospice and chronic care facilities. In northeastern Pennsylvania, county jails are considering an arrangement to use empty medical beds at the nearby Veterans Administration Medical Center in Wilkes Barre.

Working together in multidisciplinary planning teams, corrections professionals will be better equipped to address the many challenges of accommodating inmates with special needs.


Johnson, M.D., Sally C., and J. David Ramseur. 1993. Federal medical center features state-of-the art treatment facility. Corrections Today. (December).

Moritsugu, K. 1990. Inmate chronological age versus physical age. Long-term confinement and the aging inmate population. Washington, D.C.: Federal Bureau of Prisons.

Morton, J. B. 1991. An analysis of prison systems response to older inmates. Columbia, S.C.: University of South Carolina, College of Criminal Justice. Unpublished study.

Morton, J. B., and J. Anderson. 1982. Elderly offenders: The forgotten minority. Corrections Today

Nadel, Barbara A. 1996. Prison design: Elusive opportunities in a big field. Architectural Record (March)

Nadel, Barbara A. 1995. Prison sightings. Planning (June).

Nadel, Barbara A. and Kevin Travis. 1994. New York State inmate health care needs pose treatment, design challenges. Corrections Today (April).

Barbara A. Nadel, AIA, is principal of Barbara Nadel Architect, a New York City firm specializing in programming, planning and design of correctional, health care and institutional facilities.
COPYRIGHT 1996 American Correctional Association, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:Treating Special Needs Offenders; Federal Bureau of Prisons
Author:Nadel, Barbara A.
Publication:Corrections Today
Article Type:Cover Story
Date:Oct 1, 1996
Previous Article:Perot/Choate.
Next Article:A tie that binds: fostering the mother-child bond in a correctional setting.

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