Case Study on Promising Practices in Corrections

The cost of healthcare among inmates has been steadily rising. In 2018 the spending per prisoner ranged from $19,796 in California to $2, 178 in Arkansas (Joynt & Bishop, 2018).  Two of the factors that have been identified as driving up costs in the Corrections Department is the old age of inmates as well as inmates with mental illness. This essay highlights how these factors contribute to rising healthcare costs in Prisons as well as promising programs that have been initiated to counter them.

The population of older adults in prisons has risen by 280 percent between 1999 and 2016 (McKillop & Boucher, 2018). It is anticipated that older inmates will constitute a third of the entire penitentiary population in 2050. The Federal Department of Prisons (BOP) noted that between 2003 and 2013, the number of older adults aged 55 and above admitted into prisons grew by 82 percent while that of the younger inmates declined (McKillop & Boucher, 2018). With a rising aging population of older inmates, so does the cost of healthcare.  In 2013, BOP spent about 19 percent of the budget, $881 million, on older inmates (McKillop & Boucher, 2018).

Older inmates are responsible for increased health spending because medical needs increase with age. Skarupski et al. (2018), who examined how old age among inmates contributed to high healthcare costs in prisons, found that older inmates had been burdened by chronic illnesses, comorbidity, and difficult mobility. The author noted that older inmates had a higher record of diabetes, hypertension, arthritis, kidney failure, and heart conditions. Moreover, the Bureau of Justice Statistics reported that between 40-60 percent of inmates aged 50 years and above had some form of cognitive impairment or mental illness (Joynt & Bishop, 2018). Older inmates also perceive prison staff as being indifferent to instances of injury and illness, which heightens their anxiety about death.

The number of inmates suffering from mental illness has also been on the rise and accounts for a significant percentage of prison healthcare spending. In 2010, it was reported that one-third of prisoners had mental illness while one-quarter suffered mental illness alongside substance use disorder. Mental illness patients cost more than other prisons for a number of reasons, such as staffing needs. In Florida State, the cost of housing a mentally ill inmate was $130 a day compared to $80 a day for a regular inmate (Joynt & Bishop, 2018). In a 2002 report, it cost Texas State between $30,000 and $50,000 to treat a mentally ill inmate compared to $20,000 for a regular inmate (Joynt & Bishop, 2018).  

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Nursing Homes

One of the promising programs that aim at reducing the cost of treating elderly inmates involves partnering with nursing homes to send parolees. Several states have requested private nursing homes to care for the older inmates under the “medical parole” program through a contract (Vestal, 2014). Moreover, this program allows inmates to receive medical attention outside the prison while remaining in state custody. California has been sending elderly inmates to nursing homes since 2010, while Connecticut launched its first nursing home in 2013 (Vestal, 2014).

Since not most people would accept a prisoner (though elderly) being placed next to their elderly relatives, Connecticut adopted a different approach altogether. The state requested contractors to offer a nursing home facility that could handle a continuous flow of older inmates and patients from state prison who required medical treatment. Other states which have proposed similar arrangements include Michigan, Kentucky, and Wisconsin (Vestal, 2014). Outside facilities allow a state to save money through Medicare and Medicaid.

Most elderly and disabled prisoners qualify for Medicaid on condition that they receive the care outside prison. Moreover, the states can then apply for reimbursements via those health programs for inmates who received health services in those facilities. Disabled and elderly inmates receiving federally-subsidized long-term care outside nursing homes can potentially help states save millions of dollars in healthcare costs.

This program is faced by opposition from the general population who are reluctant to accept them. Some of these inmates serve lengthy sentences for the crime of murder and rape. Sex offenders can also be hard to place in nursing homes. Moreover, some of them may exhibit behavioral problem, which may be more pronounced due to mental illnesses. However, to overcome this obstacle, prisons can assess those eligible for medical parole and denying those with recent disciplinary action.

Reducing Re-Incarceration

Several promising programs have been introduced in US prisons that aim at tackling the rising cost of treating mental illness in prisons. One of the programs is the Re-entry Intensive Care Coordination Teams (RICCT), which is an initiative of the Oklahoma Department of Mental Health and Substance Abuse Services (Arkansas Public Policy Panel, 2015). The program is aimed at helping mentally ill inmates with other disorders to transition from the penal system into treatment.

Other services they offer include community-based programs, vocational programs, housing, and medical care. By providing these services, RICCT aims at accomplishing its major goal of reducing the rate of re-incarceration (Arkansas Public Policy Panel, 2015). Inmates who are mentally ill have a higher likelihood of being re-incarcerated, which means their treatment has to continue or restart. By decreasing the number of people with mental health issues in prison, the cost of healthcare by the correction department can be lowered.

In a similar pilot program, Changing Lives and Changing Outcomes, by the Texas Tech University in Lubbock, the project aims at helping learning inmates to avoid behaviors that may lead to re-incarceration after they are released. The program addresses anti-social thinking and behavior patterns among prisoners diagnosed with mental illness.

The program not only helps the inmates deal with mental illness but also teaches them life skills on how to challenge antisocial thought patterns and cultivate healthy relationships with others. Morgan, Kroner, and Mills (2017), who investigated the impact of a re-incarceration limiting program, found that participants decreased reactive criminal thinking, hostility, anxiety, and psychotism as well as depression. This shows that programs focused on reducing re-incarceration reduce mentally ill inmates being rearrested and thereby reducing healthcare spending in prisons.

The paper finds that contacting nursing homes and initiating programs aimed at reducing re-incarceration can have a positive impact on reducing healthcare spending by prisons. The groups that are targeted by these programs are the mentally ill and the elderly inmates. The nursing home program must overcome the challenge of opposition from the general population if it is to be successful. This paper finds these programs promising and recommends they be adopted on a national scale. This way states, as well as the federal government, can save billions of dollars.

References

Arkansas Public Policy Panel. (2015). A Brief Cost Analysis of Arkansas Mental Health and Prison Reform. https://static1.squarespace.com/static/55afb880e4b039b081c51cbc/t/55ba30fae4b0b0462f40a157/1438265594437/Mental+Health+Report.pdf

Joynt, M. E. H., & Bishop, A. (2018). Assessing the Healthcare Needs of Graying Prisoners. Routledge Handbook on Offenders with Special Needs.

McKillop, M., & Boucher, A. (2018, February 20). Aging Prison Populations Drive Up Costs. The Pew Charitable Trusts | The Pew Charitable Trusts. https://www.pewtrusts.org/en/research-and-analysis/articles/2018/02/20/aging-prison-populations-drive-up-costs

Morgan, R. D., Kroner, D. G., & Mills, J. F. (2017). Evidence Base for Changing Lives and Changing Outcomes (CLCO). A Treatment Manual for Justice-Involved Persons with Mental Illness, 1-1. https://doi.org/10.4324/9781315204994-1

Skarupski, K. A., Gross, A., Schrack, J. A., Deal, J. A., & Eber, G. B. (2018). The Health of America’s Aging Prison Population. Epidemiologic Reviews, 40(1), 157-165. https://doi.org/10.1093/epirev/mxx020

Vestal, C. (2014, August 12). For Aging Inmates, Care Outside Prison Walls. The Pew Charitable Trusts | The Pew Charitable Trusts. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2014/08/12/for-aging-inmates-care-outside-prison-walls