Special Populations

1. Special Populations

2. Who is a “special needs inmate”? • These inmates have a physical or mental disability, or have lifestyles that limit his or her capacity to function in the “normal” inmate population ***Do NOT forget that an inmate that has special needs is still incarcerated FOR A REASON!

3. Mental disorders occur at high rates in all countries 450 million people worldwide suffer from mental health or behavioral disorders Many disorders are present before incarceration, but others are exacerbated by the stress of prison Prisons are bad for mental health Overcrowding Various forms of violence Lack of privacy Lack of meaningful activity Isolation from social networks Inadequate health services Stigma and discrimination by staff and other prisoners Mental Health and Prisons: The Challenge

4. For Prisoners: Improve quality of life Reduce stigma Likelihood of decreasing recidivism For Employees: Prisoners with unattended to mental health needs further complicate and negatively effect the environment and places greater demands on staff; this is reduced by addressing and treating mental health needs Mental Health and Prisons: The Benefits of Responding to Issues

5. Mental Health Disabilities • Subdivided into three categories: • Developmental Disabilities • Often referred to as “mentally retarded” • Based on IQ testing and has different levels of severity • In general, offenders on GP yards that are classified MR are mildly mentally retarded • Learning Disabilities • Mental Illness

6. At first, MR inmates may seem normal, or just “a little slow.” However, signs include: Lack of personal hygiene i.e. forgetting to shower or brush their teeth Difficulty communicating Offenders may not be understood because their thinking is not logical Unusual or inappropriate social behavior They may think things are funny when no one else does or make inappropriate remarks Lacking basic life skills i.e. not knowing how to make a collect call Remember, these are SIGNS, not conclusive proof of retardation Mental Retardation: Signs

7. Retarded people have difficulty functioning in numerous situations, especially new ones. They may seem confused and come across as defiant, though they are genuinely having difficulty learning. It is your job to BE ALERT! Take care to not misread this behavior. Remember that for the retarded inmate, this is not behavior he can control, it is a result of mental and learning deficits. Managing MR Inmates

8. COMMUNICATE! • When communicating with MR inmates: • Give specific and concrete directions • Use simple and direct language • Use small, ordered directions • Check to see steps are followed • Do not give abstract directions • "Fill this bucket with water and use the mop to wash the floor" versus "Clean this place up"

9. Protecting MR Inmates Mentally retarded offenders can be easily manipulated or abused by other inmates because they are impressionable and sometimes eager to please. It is your job to not only protect them from physical, sexual, and emotional abuse, but also make sure that other inmates don't talk them into engaging in illegal behaviors.

10. Learning Disabilities • Intelligence is average or above average, but the inmate has difficulty using and understanding language. • This includes problems with: • Listening • Speaking • Reading • Writing • Mathematics • Logical thinking

11. Helping Inmates with Learning Disabilities • Make sure they get the information they need • Give directions slowly and clearly • Demonstrate behaviors and activities (if needed) • Offer assistance; do not complete tasks for them • Protect them from others who might take advantage of them • Be understanding • Encourage independence

12. Signs may occur often or sporadically, but include: Mood Changes Behavior Changes Changes in eating or sleeping patterns These signs need to be observed for significant and prolonged changes that are unrelated to current events Most common: Schizophrenia Anxiety Disorders Paranoia Hypochondria Depression Mental Illness: Emotional Disturbances

13. Remember: • Mentally ill inmates… • Are not "bad" people, they are sick • Have real symptoms—understand their feelings are genuine • Take reinforcement from you! Stay positive and professional—it can diffuse potentially bad situations.

14. Mental Illness: Personality Disorders • Inmates with personality disorders want their OWN rules, NOT to play by others' • They are impulsive and often act without consideration of consequence • Often compulsive liars without guilt • They do not learn from experience, and are irresponsible, insisting, and entitled

15. Working with Personality Disorders • Be straightforward and factual • Be consistent with enforcing rules • Be mindful of attempts to manipulate and compromise • When in doubt, contact mental health staff

16. Refer prisoners who display mental health issues to mental health staff Provide prisoners with access to treatment and care Ensure availability of psychosocial support and medication (if necessary) Provide staff training Provide literature to prisoners on their issues Mental Health and Prisons: What Can Be Done?

17. Deaf inmates Carry a pen and paper to communicate To get their attention, tap them on the shoulder Blind inmates Familiarize this inmate with his living area When offering assistance, allow the inmate to take your arm for guidance Diabetes Diabetic coma is caused by not enough insulin in the blood stream Insulin shock is the result of too much insulin in the blood stream Both have symptoms that look similar to intoxication—know your inmates and get medical attention immediately Physical Disabilities

18. Paraplegia Accommodations are made for inmates that are wheelchair bound, but remember that they are INMATES Be respectful, but cautious Epilepsy Seizures generally last 2 to 3 minutes When encountering an inmate having a seizure: Remove all objects nearby Loosen tight clothing Turn the person on their side Call for medical assistance Physical Disabilities Continued:

19. Medical Issues and Prison

20. Medical Issues and Prison • Though not in the top 5 health care issues, cancer, diabetes, and HIV/AIDS are also issues present in the prison population. • Cancer accounts for 3.1% of health issues • Diabetes and HIV/AIDS account for less than 1% of health issues

21. Medical Issues and Prison: Issues • Inmates’ access to the medical department may be restricted to scheduled opening times, except for emergencies. • Many facilities will not allow inmates to keep their own medications, making them dependent on the healthcare staff for dosing. • Many tools necessary for managing disease are not permitted outside of the medical unit, making self-care impossible. For example, inmates with diabetes may not be able to keep glucose monitoring devices, lancets, insulin, or syringes in their possession for security reasons. • Inmates have very few options with diet choices, adding to the challenge of medically managing inmates with certain chronic conditions (e.g., diabetes and hypertension). • The correctional environment can be unhealthy in itself, with lack of cleanliness, overcrowding, poor ventilation and lack of adequate lighting producing environmental concerns. Also, smoking is a common trait among the incarcerated, with estimates as high as 67% of inmates meeting clinical criteria for alcohol or drug use disorders.

22. 7 Ways Inmate Can Receive Quality Medical Care in Corrections • Treat inmates with respect • Listen attentively—listen for cues that distinguish a normal medical call out from an emergency • Be honest • Maintain appropriate boundaries—they may be patients, but they are inmates first • For Doctors/Nurses: Avoid the defensive medicine temptation—do not order more tests or medications for an inmate than you would for any other patient • Focus on what you can do for them, not what you cannot do for them • DOCUMENT, DOCUMENT, DOCUMENT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

23. LGBTI Population in Prison • Prisoners that are lesbian, gay, bisexual, transsexual, or intrasexual are among the most vulnerable population of prisoners • Prisoners that are openly gay or that are effeminate (in male prisons) or masculine (in female prisons) are at high risk for sexual assault and abuse • Though many of these inmates are housed in Protective Custody, they are still at risk • It is especially important for staff to recognize signs of abuse and follow PREA regulations when necessary

24. Anatomical Issues with Transgendered Inmates • Though transgendered inmates may be in the process of transitioning before being incarcerated, they are gender classified by their sexual organs. If they have not undergone complete transitioning, they are still their gender of birth. • It is an important boundary issue that they be referred to as a man if not fully transitioned to a woman, and vice versa. • Referring to the inmate as the gender that they have not yet transitioned to unconsciously sets them apart from everyone and can also cause unwanted attention to them.