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Commission: U.S. prisons, jails in need of reform: problems include violence, safety, lack of mental health care.

CORRECTIONAL facilities in the United States fail to provide proper safety, health care and living conditions for inmates and lack adequate funding and oversight, according to a new report that calls for major reforms.

Released June 2 in conjunction with a Senate hearing in Washington, D.C., "Confronting Confinement" documents conditions in the nation's 5,000 prisons and jails. The report, prepared by the Commission on Safety and Abuse in America's Prisons, calls for reforms such as violence prevention, independent oversight agencies in each state and worker training.

The 20-member commission reached its conclusions following prison site visits, public hearings, interviews with corrections officers and a research review.

"These reforms are not just for the prisoners but for public safety and the greater communities," said commission member Gary D. Maynard, director of the Iowa Department of Corrections and president-elect of the American Correctional Association, who spoke at the Senate hearing. "The prison system is supposed to exist to keep the public safe."

Among the most serious problems in the nation's correctional facilities are those involving medical care. According to the report, prisons often have only two or three doctors available to serve thousands of inmates. Some states allow physicians who are under-qualified, or who possess restricted licenses or scars on their medical records, to work in prisons or jails, the report said. Legislators often pressure prison administrators to require co-payments for medical care, which discourages many sick prisoners from seeking help, the commission found. The report recommended abolishing mandatory co-payments for prisoners and also extending Medicare and Medicaid to those who are eligible.

Violence in prisons, particularly physical and sexual abuse, is also a widespread problem in prisons. Data cited in the report showed more than 34,000 reported assaults among prisoners in 2000 and almost 18,000 assaults against staff.

"No criminal, no matter how terrible the crime, deserves being beaten or raped ... in the hands of the government," said commission member Pat Nolan, president of the Prison Fellowship's Justice Fellowship and a member of the National Prison Rape Elimination Commission, during the Senate hearing.

To reduce violence, prisons should increase worker productivity, reduce crowding, utilize more surveillance technology and strengthen bonds between prisoners and their families, the report recommended.

The commission also found that at least 350,000 inmates have a serious mental illness and most do not receive proper treatment. According to the report, only 1.6 percent of inmates nationwide were receiving 24-hour mental health care in 2000.

Many more mentally ill prisoners are likely going unnoticed. Although the American Correctional Association requires a brief mental health assessment upon entrance to prison, such screenings are often limited to a history of prior treatment, the report said.

"Prisons and jails have become America's de facto psychiatric wards," Maynard said.

The report recommended more extensive initial screening for mental illness. It cited a successful program in Montgomery County, Md., in which incoming prisoners were asked a series of questions regarding their mental health. Prisoners who say "yes" to a single question indicating a mental health concern are referred to an assessment and triage program. Mental health professionals then arrange for treatment during and after confinement.

The report also recommended that segregation of mentally ill and dangerous prisoners be used only as a last resort, as many "end up locked in their cells 23 hours a day ... with little opportunity to be productive and prepare for release." The report noted that there was a 40 percent growth in the number of prisoners housed in segregation, often in completely isolated spaces that were constantly bright or dim, between 1995 and 2000.

APHA member Corey Weinstein, MD, CCHP, a San Francisco-based medical consultant for prisoners, said that prisons present an "amazing public health opportunity" for administrators to educate and treat large numbers of people.

Each year, more than 1.5 million people are released from jails and prisons carrying diseases such as HIV/ AIDS and hepatitis C.

One solution, according to Weinstein--who was a contributor to APHA's 2005 book "Standards for Health Services in Correctional Institutions"--is to follow the example set by some prisons in Europe that recognize their public health role. In France, for example, prisons offer needle exchange programs and opiate substitution therapy to inmates.

"We see addiction as a moral crime, they see it as a disease," Weinstein said. "They're right."

To make a real difference inside prisons and jails, Congress must fund a uniform national system of reporting data on health and safety inside prisons, the commission report said.

"Without accurate numbers, we can't hold prison administrators accountable and successful institutions aren't recognized," Nolan said.

The report is online at <www.prisoncommission. org/report>.
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Author:Cowdrey, Leah
Publication:The Nation's Health
Geographic Code:1USA
Date:Aug 1, 2006
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