Unlike jails, which typically house individuals for shorter periods, prisons are designed to accommodate longer-term sentences. Within the realm of prisons, there exists a spectrum of facilities, including state-operated, federally managed, and privately operated institutions. Additionally, military prisons cater specifically to criminal offenses committed by members of the armed forces. Over time, prisons have developed diverse structures to meet the varying security needs and inmate populations they serve. This includes the classification of prisons into different security levels, such as minimum, medium, maximum, and super-maximum security, each tailored to address the unique threat levels posed by incarcerated individuals. These distinctions play a critical role in managing and maintaining security within the prison system while also ensuring the safety of both inmates and staff.

Prison Types

Prisons serve as crucial components of the criminal justice system, designed to confine individuals convicted of serious offenses for varying lengths of time. Within the prison landscape, there exist diverse types of facilities, each with its own distinct characteristics and operational frameworks. These encompass state-run institutions, federally operated facilities, and privately managed prisons, each playing a unique role in the incarceration process. Additionally, military prisons cater to the specific needs of armed forces personnel who commit criminal acts. Understanding the differences among these prison types is essential for comprehending the complexities of the corrections system and its impact on both inmates and society at large.

State Prisons

State prisons accommodate the majority of incarcerated individuals within the United States. In 2022, out of the total 1,230,143 prison inmates, 1,070,834 (87%) were housed in state prisons (Carson & Kluckow, 2023). While the oversight of each state’s prison system falls under the purview of the respective state’s executive branch, the organizational structures of these systems can vary. At the helm of each prison facility is a warden or superintendent, who assumes responsibility for its overall operations. Supporting the Warden or Superintendent are multiple Deputy Wardens or Assistant Superintendents, each tasked with overseeing specific divisions such as management, custody, programs, and industry. These divisions comprise both program personnel[/pb_glossary], responsible for implementing various rehabilitative programs, and[pb_glossary id=250]custody personnel, including correctional officers tasked with maintaining security within the facility.

Since its peak in 2009, the overall prison population has experienced a significant decline. However, between 2021 and 2022, there was a notable uptick in state prison populations, with a 2% increase observed across 42 states (Carson & Kluckow, 2023). As illustrated in Figure 9.14 below, males constituted the overwhelming majority, comprising 93% of the state prison population, while females made up only 7%. The racial and ethnic composition of the inmate population was diverse, with 36% identifying as Black, 34% as White, 26% as Hispanic, and smaller proportions identifying as Asian or Native American/Alaska Native, as demonstrated in Figure 9.14.

Among state inmates, the primary offenses leading to incarceration were violent crimes, constituting 63% of convictions (Carson, 2022), as depicted in Figure 9.14. These offenses encompassed a range of serious acts, including murder, manslaughter, assault, rape, and robbery. Property crimes and drug offenses were the next most common types of offenses, each accounting for 13% of convictions. Property crimes involve offenses such as theft, burglary, and vandalism, while drug offenses encompass drug possession, trafficking, and related offenses. Public order crimes, including DUI/DWI and weapon charges, constituted the remaining percentage of convictions.

Furthermore, a demographic breakdown of state inmates in 2021 (Carson, 2022) revealed that 93% were male and only 7% were female, as illustrated in Figure 9.14. Findings regarding the ethnic composition of state inmates showed that 36% were Black, 34% were White, 26% were Hispanic, 2% were Asian, and 2% were American Indian/Alaska Native. Additionally, 91% of the inmates were under the age of 60. Within this age range, individuals in their 30s comprised the largest proportion at 32%, followed by those in their 40s at 23%, and those aged 18-29 at 21%. These statistics provide insights into the demographic composition and nature of offenses among state prison populations, highlighting the ongoing challenges and complexities within the criminal justice system.

Federal Prisons

Federal prisons are funded by the federal government and operated by the Federal Bureau of Prisons. As of the end of 2022, federal prisons housed 159,309 individuals, constituting 13% of the total U.S. prison population (Carson & Kluckow, 2023). Inmates in federal prisons have been convicted of federal crimes and originate from diverse regions, including various states across the nation and other countries. Notably, the demographic and offense characteristics of federal prisoners often considerably differ from those in state prisons, as illustrated in Figure 9.15.

A significant proportion of federal inmates, as depicted in Figure 9.15, are incarcerated for drug crimes, accounting for 47% of convictions among the federal prison population (Carson, 2022). This statistics underscore the prevalence of drug-related offenses within the federal correctional system, highlighting the importance of addressing substance abuse and implementing effective rehabilitation programs. Public order crimes represent the next highest category at 42%, followed by violent crimes at 8%, and property crimes at 4%.

Interestingly, federal inmates tend to have a slightly higher average age compared to those in state prisons (Carson, 2022). The largest age cohort among federal corrections facilities is individuals aged 30-39, comprising 32% of the total inmate population. Following this, individuals aged 40-49 make up 23% of the population. The next largest age group consists of individuals aged 18-29, accounting for 21% of federal inmates. Those aged 50-59 represent 15% of the inmate population, while individuals aged 60 or older constitute 9%. These age distributions provide insights into the demographic composition of federal inmates, indicating the need for age-specific programming and healthcare services within federal correctional facilities.

Similar to state prisons, the racial and ethnic composition of federal inmates is diverse (Carson, 2022). Black inmates comprise the largest proportion at 36%, followed closely by Hispanic and White inmates, each at 30%. Additionally, Asian and American Indian/Alaska Native inmates each account for 2% of the federal prison population. Moreover, consistent with state prisons, females represent a small percentage, comprising only 7% of federal inmates, while males constitute the overwhelming majority at 93%. These inmate demographics provide valuable insights into the characteristics of individuals within the federal correctional system and underscore the need for tailored interventions and policies to address the diverse needs of incarcerated individuals at the federal level.

Prison Structures

Prison design structures are integral components of correctional facilities, strategically engineered to address security needs and facilitate the management of incarcerated populations. These structures encompass a variety of architectural layouts and features tailored to different security levels and operational requirements. As illustrated in Figure 9.16, the notable prison designs are radial, telephone-pole, courtyard, campus, and panopticon layouts. Each design structure serves specific security and operational objectives, reflecting the evolving approaches to incarceration and rehabilitation within the corrections system. Understanding these design concepts is integral to effective prison management and the promotion of safety and security within correctional facilities.

Radial Design

The radial design was a prevalent architectural approach in 19th-century prisons, with notable examples including Pennsylvania’s Eastern Penitentiary, as depicted in Figure 9.16 above. This design aimed to enhance efficiency in surveillance and control within correctional facilities. Characterized by a central control center resembling a hub, multiple cell blocks extended outward like spokes on a wheel, providing unobstructed views for officers stationed in the control center. Additionally, this layout enabled officers to isolate specific units from the rest of the facility without necessitating a lockdown of the entire penitentiary. However, despite its advantages, the radial design posed challenges such as potential congestion during inmate movement and privacy concerns among inmates. Furthermore, this design presented obstacles to the implementation of rehabilitation programs within the facility.

Telephone-Pole Design

As depicted in Figure 9.16 above, the telephone-pole design features a long central corridor intersecting all cross sections of the facility, allowing for direct observation and quick response by staff. Each cross section serves a distinct purpose, such as housing, classrooms, or industries. This layout facilitates continuous surveillance by officers patrolling the central corridor, although it requires a larger staff compared to the radial design. Despite this, officers can isolate specific sections without disrupting overall operations. Moreover, the design minimizes congestion issues, making it particularly suitable for maximum-security institutions focused on maintaining custody and order.

Courtyard Design

As shown in Figure 9.16, the courtyard design is characterized by buildings arranged around a spacious central open area, typically in a square or rectangular configuration. Unlike layouts where all inmate movement occurs indoors, the courtyard design allows inmates to traverse from one unit to another through the central courtyard. Additionally, this open space serves as an area for outdoor recreational and social activities for inmates. The design incorporates open spaces within cell blocks, fostering natural light and outdoor access for inmates while maintaining security. By providing ample access to natural light and fresh air, the courtyard design creates a more humane prison environment. Furthermore, the courtyard design offers flexibility to accommodate various security levels within the facility.

Campus Design

The campus design resembling college campuses, features decentralized facilities and shared common areas, promoting a less restrictive environment and fostering a sense of community conducive to rehabilitation within the prison environment. This design is commonly utilized in minimum-security units and juvenile detention centers, prioritizing rehabilitation and community-building. Illustrated in Figure 9.16 above, this layout comprises multiple buildings spread across a spacious area, facilitating a sense of camaraderie while maintaining security and control. Moreover, campus designs afford inmates greater freedom and fewer restrictions compared to other layouts.

Panopticon

The panopticon is a prison architectural concept developed by the 18th-century English philosopher and social theorist Jeremy Bentham (1791), heavily influenced by deterrence theory. The term "panopticon" is derived from the Greek words "pan," meaning all or everything, and "opticon," meaning observe or see. As illustrated in Figure 9.17, the design features a centralized surveillance and control tower, enabling a single officer to visually monitor all inmates. Surrounding the central tower are multiple tiers of inmate cells, each equipped with either windows or barred doors, allowing the officer in the control tower to maintain constant visual contact with the inmates while remaining unseen. The fundamental principle behind the panopticon design was that the mere perception of being under constant observation would deter inmates from engaging in misconduct. However, challenges such as construction and maintenance difficulties, psychological effects resulting from continuous surveillance, and a shift towards rehabilitation-focused approaches have led to a decline in the popularity of panopticon designs in penitentiaries.

Prison Security Levels

Federal and state prison systems employ various security levels to address the diverse needs and risks associated with incarcerated individuals. Both risk assessments and needs assessments play crucial roles in determining the security level and program placement of new inmates, topics that will be discussed in more detail in the following chapter. Security level placement is based on a multitude of factors, including criminal history, behavior during incarceration, escape risk, gang affiliation, and history of violent behavior, among other considerations. Accurately classifying inmates into appropriate security levels enhances safety for both staff and inmates, while also improving the effectiveness of rehabilitation programs and operational efficiency.

Minimum-Security Prisons

minimum-security prisons, often referred to as "camps," house inmates considered to pose the lowest risk to public safety. These facilities are characterized by a relatively relaxed environment, with fewer security measures and more freedom of movement among inmates compared to facilities with median and maximum-security levels. Typically, the staff-to-inmate ratio is lower compared to more secure facilities, reflecting the lower risks posed by the inmates (Federal Bureau of Prisons, n.d.). Rehabilitation and reintegration services, such as education, vocational training, and work release programs, are commonly offered. Inmates must meet specific eligibility criteria to be housed in minimum-security facilities. While some low-risk inmates are placed in minimum-security prisons upon entry, others must demonstrate good behavior during incarceration, have a low risk for violence or escape, or be nearing the end of their sentence and capable of benefiting from rehabilitation programs and the gradual transition to independence.

Medium-Security Prisons

medium-security prisons are designed to accommodate inmates who pose a moderate risk to the public safety, prison staff, or other inmates.These facilities implement stricter security measures compared to minimum-security prisons but maintain a level of restriction lower than that of maximum-security facilities. In medium-security facilities, a highly structured daily routine is enforced, allocating specific times for meals, recreation, work, education, and other activities. Additionally, movement within the facility is strictly regulated to uphold order and security. Although rehabilitation and other programs remain integral components of medium-security facilities, the emphasis on security and safety is heightened compared to minimum-security facilities due to the moderate risk level. Consequently, medium-security facilities typically maintain a higher staff-to-inmate ratio than minimum security facilities to ensure effective supervision and safety measures.

Maximum-Security Prisons

maximum-security prisons, also known as closed security prisons, are highly secure facilities designed to hold inmates who pose an exceptionally high risk to public safety, correctional staff, or other inmates. These facilities feature stringent perimeter security, often characterized by imposing stone or concrete walls, guard towers, and razor wire fencing, all aimed at preventing escape and deterring any violent incidents within the premises. Inmates spend the majority of their time confined to individual secure cells, with minimal contact with the outside world. This includes restricted visitation rights, limited phone calls, and moderated postal mail privileges. Compared to lower security facilities, maximum-security prisons usually maintain a higher staff-to-inmate ratio to ensure safety and security (Federal Bureau of Prisons, n.d.). However, this strong focus on safety and security significantly curtails inmates' opportunities to access rehabilitation programs.

Supermax Prisons

While a maximum-security prison represents the highest security level in many states, several states and the federal government operate supermax prisons. Also known as administrative maximum units, these facilities were constructed to house the most notorious and dangerous criminals. The primary objective of supermax prisons is incapacitation, with inmates residing in single-cell units where they endure isolation for 23 or even 24 hours a day, substantially hindering rehabilitation program opportunities. Additionally, supermax prisons typically maintain a significantly high staff-to-inmate ratio resulting from the prioritization of security measures in these facilities (U.S. Department of Justice, 2007).

Careers in Criminal Justice: Correctional Officer

Correctional officers fulfill a multifaceted role, guarding individuals within penal institutions and during transit between various points, such as jails, courtrooms, and prisons. They may also need to restrain individuals using appropriate techniques and escort them to different locations, like courtrooms or medical facilities. Additionally, they supervise activities of individuals in custody, conduct regular counts, and document noteworthy occurrences in reports and daily logs. Furthermore, their general responsibilities encompass enforcing facility rules and regulations, maintaining order, and ensuring security by preventing disturbances, physical assaults, and inmate escapes. This involves conducting thorough inspections for contraband and signs of security breaches, as well as monitoring postal mail and inspecting visitors to prohibit the entry of illicit items

The job demands resilience and adaptability, as correctional officers typically work full-time in shifts covering all hours, including weekends and holidays, and may be required to work overtime. As one of the occupations with the highest rate of reported injuries and illnesses, correctional officers must remain alert and ready to react swiftly throughout their shifts, as they are likely to encounter stressful and potentially hazardous situations (Bureau of Labor Statistics, 2024). Additionally, they must possess strong decision-making and negotiation skills essential for maintaining order and promptly resolving conflicts, as well as adept interpersonal skills to effectively interact with individuals in custody, visitors, and fellow officers, ensuring clear communication and collaboration.

Educational requirements for correctional officers typically include a high school diploma, though some agencies may require completion of a correctional academy program in addition to on-the-job training. Qualifications vary by state and agency, with minimum age requirements typically between 18 and 21. Some federal agencies may mandate a bachelor's degree or several years of relevant work experience, along with a maximum age for applicants.

As of May 2022, the median annual wage for correctional officers and jailers was $49,610, with variations based on experience and jurisdiction (Bureau of Labor Statistics, 2024). Overall, correctional officers play a vital role in upholding safety and security within the criminal justice system, necessitating a diverse skill set and unwavering dedication to their duties to ensure facility operation and the safeguarding of society.

Issues with Prison Management

Effective prison management presents a myriad of complex challenges involved in properly addressing the wide-ranging needs of a highly diverse inmate population. Neglecting the needs of these populations can lead to exacerbated health issues, an increased risk of victimization, and challenges in rehabilitation efforts. To address these issues, comprehensive policies, programs, strategies, and interventions tailored to the unique needs of each population are essential. These efforts must prioritize safety, support, and rehabilitation for all inmates while implementing proactive measures to maintain a secure and humane prison environment.

Prison Gangs

Prison gangs create a hostile and dangerous environment within correctional facilities, which can significantly disrupt facility operations and functionality. The existence of prison gangs during the 20th century is subject to debate, however, the first officially recognized U.S. prison gang was the Gypsy Jokers, established in 1950 in Washington State prisons (Orlando-Morningstar, 1997). Subsequently, other gangs such as the Mexican Mafia, originating in 1957, and Texas Syndicates, founded in 1958, began to emerge in prisons around the country. The proliferation of prison gangs by the 1970s and 1980s prompted the Criminal Justice Institute to commission a national study on prison gangs and their impact on correctional operations (Camp, 1985).

Currently, there are numerous prison gangs, each characterized by its unique culture and set of rules. Men's prison gangs typically adhere to a hierarchical structure comprising members from a single race or ethnicity (Pyrooz et al., 2011). The presence of prison gangs represents a major concern as it undermines safety and security within correctional facilities. These gangs frequently engage in various illicit activities, including violence, drug trafficking, and extortion, both within correctional facilities and beyond, thereby posing a significant threat to both staff and inmates. To mitigate conflicts between gangs, prison administrators and staff often implement measures to keep rival gangs segregated, ensuring that members of one gang are not in proximity to members of rival gangs. According to the National Drug Intelligence Center (2008), some of the largest national prison gangs include the Aryan Brotherhood, Ñeta, Sureños, and Norteños.

The Aryan Brotherhood (AB), predominantly composed of Caucasian males, is most active in the Southwest and Pacific regions (National Drug intelligence Center, 2008). The AB primarily funds its operations through the smuggling and sale of drugs, including methamphetamine, heroin, cocaine, and marijuana. Notoriously violent, the AB is also known to engage in murder-for-hire operations within correctional facilities.

Ñeta, a gang originating in Puerto Rico, has expanded its presence into correctional facilities across the U.S. (National Drug intelligence Center, 2008).As one of the largest and most violent gangs, Ñeta generates revenue through the sale and distribution of powder and crack cocaine, heroin, marijuana, as well as LSD, MDMA, and PCP. While inmates who join Ñeta while incarcerated are not obligated to maintain their membership upon release, Ñeta street gangs do exist throughout the East Coast of the United States.

The Sureños (Southerners), pictured in Figure 9.19 above, and Norteños (Northerners) are branches of the Mexican Mafia. In the mid-20th century, divisions within the Mexican Mafia led to the emergence of the Sureños (Southerners) and Norteños (Northerners). Around this time, members of the Mexican Mafia in Southern California began to perceive their Northern California counterparts as weak, the majority of whom hailed from rural, agricultural areas. Consequently, around the 1960s, these Southern members separated themselves from the Mexican Mafia, forming the Sureños faction. Soon after, the Norteños emerged as a distinct gang. Despite their common origin, the Sureños and Norteños are sworn enemies. Both gangs heavily enforce a "fight on sight" policy, requiring intensive physical altercation with any members of their rival gang upon initial encounter. This mandated aggression necessitates correctional facilities to employ heightened security measures, compelling their separation to prevent conflict. Moreover, both gangs are deeply involved in drug trafficking, including substances such as cocaine, heroin, marijuana, and methamphetamines. Unfortunately, the influence of these gangs transcends beyond correctional facilities, with operations infiltrating and negatively impacting communities along the West Coast (National Drug intelligence Center, 2008).

Please visit the U.S. Department of Justice’s page on National-Level Street, Prison, and Outlaw Motorcycle Gang Profiles for more information on national and regional prison gangs, such as the Black Guerrilla Family and Texas Syndicate.

Pseudo-Families

Inmate culture within women prison facilities differs significantly from that of male prisons. One notable distinction is the reduced emphasis on race within women’s prisons compared to men’s facilities, where racial dynamics play a lesser role in social interactions among female inmates (Owen, 1998). Instead of forming large, violent gangs like their male counterparts, female inmates often establish pseudo-families, also known as prison-based kinship networks (Belknap, 2007). These pseudo-families typically consist of two inmates assuming parental roles, which tend to be occupied by elder inmates with more extensive prison experience (Dillavou et al., 2022). It’s important to note that the relationships between the parental figures within pseudo-families are not romantic or sexual in nature (Belknap, 2007). In addition to parental figures, pseudo-families also encompass inmates who adopt a more childlike role, often assumed by younger individuals with limited experience with the prison system. The prevalence and nature of pseudo-families are subjects of ongoing debate, with discussions revolving around whether they serve as consensual support structures to cope with familial loss during incarceration or if they emerge as non-consensual arrangements driven by coercion and the need for protection (Dillavou et al., 2022).

Vulnerable Inmate Populations

Within correctional facilities, certain inmate populations face elevated levels of risk and vulnerability, necessitating increased attention and support. These vulnerable groups comprise a diverse range of individuals, including the elderly, individuals with mental illness, those with disabilities, and transgender inmates, among others. Each of these populations encounters unique challenges and risks while incarcerated, ranging from heightened susceptibility to victimization, such as physical assault, sexual abuse, and mental health issues, including suicide. Moverover, they can experience limited access to essential healthcare and support services, particularly in correctional facilities with limited resources.

Addressing the safety and well-being of these individuals poses significant challenges for prison administrators and staff, requiring them to navigate complex issues related to security, healthcare, and social support. Effectively meeting the unique needs of vulnerable inmate populations necessitates comprehensive policies that prioritizes safety, well-being, and access to appropriate resources and services, along with specialized training for staff. However, doing so while upholding inmates' rights and dignity requires careful consideration of logistical and ethical concerns. Balancing security imperatives with the provision of compassionate care and support remains an ongoing challenge in ensuring the fair treatment and protection of all inmates within correctional environments. Furthermore, fostering a culture of respect, inclusivity, and support is crucial for creating a safe and humane environment for all inmates, regardless of their vulnerabilities

Elderly Inmates

Recent data from the Census Bureau indicates a notable rise in the median age of the U.S. population, reaching 38.9 years—an increase of three and a half years over the past 23 years (Zeng, 2022). Concurrently, the aging trend is even more pronounced within our prison systems, with older adults constituting a growing segment of those arrested and incarcerated annually. This demographic shift in the prison population is attributed to a series of detrimental policy choices spanning approximately the last fifty years, encompassing policing, sentencing, and reentry strategies (Widra, 2023). Moreover, while correctional facilities pose health risks for individuals of all ages, the dangers faced by older adults in these environments are particularly acute, potentially leading to severe consequences, including fatalities.

Older adults, defined as individuals aged 55 and above, are increasingly becoming entangled in various stages of the criminal justice system, including arrests, pretrial detention, and incarceration (Widra, 2023). In the year 2000, only 3% of all adult arrests involved individuals aged 55 or older; however, by 2021, this demographic accounted for 8% of all adult arrests. Recent data on local jails in the United States, covering the period from 2020 to 2021—a time marked by the COVID-19 pandemic, which posed significant risks for older adults—reveals a notable trend. During this period, the proportion of the jail population aged 55 and older expanded by 24%, surpassing the average increase of 15% observed across all other age groups (Zeng, 2022).

Meanwhile, the representation of older individuals within the prison population has surged over the past three decades. Between 1991 and 2021, the percentage of individuals aged 55 or older in state and federal prisons nationwide skyrocketed from 3.4% (Harlow, 1994) to a staggering 15.3% (Zeng, 2022). This trend is even more pronounced when considering individuals serving life sentences: as of 2020, 30% of those serving life sentences were at least 55 years old, with over 61,400 older adults facing the prospect of spending the remainder of their lives behind bars.

The perils associated with aging in prison are profound. While prisons are inherently detrimental environments for individuals of any age, the risks are particularly heightened for older adults. Extensive research indicates that incarceration itself hastens the aging process, leading to an increased prevalence of chronic and life-threatening illnesses at an earlier stage of life than would typically occur outside of prison (Kaiksow et al., 2023). Research indicates that incarcerated individuals often exhibit geriatric conditions typically found in non-inmates who are 15 years older (Greene et al., 2018). This encompasses elevated rates of cognitive impairment, dementia, Alzheimer's disease, urinary incontinence, and mobility issues, among others (Kaiksow et al., 2023). The decline in both physical and mental capabilities can lead to various forms of harm, including injury, assault, sexual violence, and even death.

Furthermore, physiological indicators of aging manifest in individuals at younger ages than anticipated. Additionally, a conservative estimate suggests that over 44,000 individuals aged 45 and above experience solitary confinement in state prisons annually, enduring conditions that not only curtail lifespans but also detrimentally impact physical, mental, and emotional well-being (Couloute, 2017). Years of inadequate resources, limited accessibility, and understaffing in prison healthcare exacerbate the situation, resulting in each year spent behind bars equating to a loss of two years in life expectancy for individuals (Widra, 2023). Moreover, the scarcity of healthcare resources within prisons not only compromises the health of older individuals but also proves to be inefficacious and excessively costly.

State and federal governments are allocating increasingly larger sums of money toward healthcare for their expanding populations of older adults. While most studies examining the substantial expenses associated with incarcerating older individuals date back at least a decade, their findings consistently reveal significant financial burdens (Widra, 2023). For instance, the medical care and extra precautions necessary to protect an aging population in jails and prisons costs the prisons two to three times the amount compared non-elderly prisoners (Chettiar et al., 2012). In 2013, the federal Bureau of Prisons (BOP) dedicated 19% of its total budget—equating to $881 million—to incarcerate older adults (Office of the Inspector General, 2016). During this period, the BOP identified a striking trend: a remarkable 25% surge within just one year in this specific demographic, distinguishing it as the fastest-growing group within the inmate population. This stands in stark contrast to the 1% decline observed in the remainder of incarcerated individuals. This significant transformation signals a notable change in the composition of those behind bars, emphasizing the urgency for focused analysis and interventions to address this evolving landscape.

Mentally Ill Inmates

When mental health institutions closed in the latter part of the twentieth century, instead of developing much-needed alternative resources or community-based facilities, patients were discharged into society. As Wagner (2000) notes, "Many of the people released from the closed state hospitals are the same people who are now incarcerated in the state prisons" (para. 12). In the absence of adequate community-based mental health services, individuals with mental illnesses often become ensnared in the criminal justice system due to factors such as homelessness, substance abuse, or the inability to access mental health care support services. This trend of closing mental health institutions and expanding correctional facilities persisted into the 21st century. For instance, in 1999, 500 psychiatric hospital beds were eliminated in New York State, while $360 million in state funds were allocated for the construction of two supermax prisons equipped with psychiatric wings (Wagner, 2020).

Therefore, the situation faced by individuals with serious mental illnesses today closely resembles that of individuals with serious mental illnesses in the 1840s—a shortage of psychiatric beds and an abundance of jail and prison cells (Torrey et al., 2010). Consequently, incarceration institutions have effectively become mental health facilities, housing significant numbers of individuals with mental health problems, despite lacking "the capacity to adequately meet the needs of those in their care" (Sawyer, 2017, para. 2). Today, the sizable population of mentally ill prison inmates presents a complex and challenging issue that intersects with various aspects of public health, criminal justice, and human rights.

Correctional facilities are inherently ill-suited for individuals with serious mental illness (Torrey et al., 2010). The complex needs of these individuals extend far beyond the scope of incarceration facilities, and they often lack the essential resources and trained personnel to deliver adequate mental health care (Sawyer, 2017). The confluence of limited resources, overcrowding, and a dearth of specialized staff exacerbates the already deficient mental health services within correctional facilities. As a result, rather than receiving essential treatment in appropriate clinical settings—which are scarce, inadequately funded, or altogether absent—many inmates with mental illness are left untreated.

Research indicates that a substantial proportion of the prison population grapples with mental health disorders, with rates significantly surpassing those observed in the general population (Sawyer, 2017). This underscores the troubling reality that, instead of receiving adequate treatment and care, a considerable number of individuals suffering from mental illness in the U.S. are funneled into the criminal justice system, where they frequently go undiagnosed and untreated.

Housing large populations of mentally ill inmates within incarceration facilities presents several challenges (Torrey et al., 2010). One primary issue is accurately identifying mentally ill inmates. However, due to various factors such as insufficient resources, stigma, and inadequate screening processes and training, many mentally ill inmates may not receive the proper diagnosis and treatment they need. Findings from the 2011-2012 National Inmate Survey (Bronson & Berzofsky, 2017) revealed that "only about a third of those reporting serious psychological distress were currently receiving treatment" (Sawyer, 2017, para. 2). Consequently, many inmates with mental illnesses receive minimal or limited treatment, leading to exacerbated symptoms and heightened suffering.

The challenges associated with the high population of jail and prison inmates with serious mental illness are extensive. As noted by Torrey et al. (2010), "Because of their impaired thinking, many inmates with serious mental illness are major management problems…and difficult to deal with" (p. 12). Untreated mentally ill inmates frequently engage in disruptive behavior, escalating the risk of conflicts and violence within correctional facilities. When they are unable to adhere to facility rules, they are often subjected to punishment, including placement in solitary confinement or segregated housing units, resulting in up to 23 to 24 hours of isolation in their cell (Wagner, 2020). A 2010 audit of three Wisconsin state prisons revealed that 55 to 76% of inmates in segregation were mentally ill (Torrey et al., 2010). Prolonged isolation often exacerbates their conditions and can lead to further deterioration of mental health, an increased risk of self-harm, and even suicide. Despite growing awareness of the harmful effects of solitary confinement, particularly among mentally ill inmates, it remains a widespread practice in many prisons.

Moreover, inmates with serious mental illness tend to experience longer prison stays and have a higher likelihood of returning after release, thereby increasing costs. According to Torrey et al. (2010), "The main reason mentally ill inmates stay longer is that many find it difficult to understand and follow jail and prison rules" (p. 12), leading to a higher probability of violating facility regulations. As the county and state corrections systems operate independently from, and often lack coordination with, the mental health system, the majority of mentally ill individuals leaving jails and prisons often receive minimal to no psychiatric follow-up care, contributing to a higher recidivism rate among mentally ill ex-offenders. Research conducted in Los Angeles County Jail revealed that 90% of mentally ill inmates were repeat offenders, with 31% having experienced incarceration ten times or more (Torrey et al., 2010). In addition to longer incarceration stays and high recidivism rates, mentally ill inmates necessitate more staff, expensive psychiatric examinations and medications, and an increased number of lawsuits, all of which exponentially raise incarceration costs for these offenders.

In addition to the multitude of widespread challenges, mentally ill inmates face heightened vulnerability to violence and abuse within prisons, often being targeted by other inmates or subjected to mistreatment by prison staff (Torrey et al., 2010; Wagner, 2020). Furthermore, inmates suffering from mental illness are at a higher risk of suicide. A study conducted in Washington State in 2002 revealed that 77% of inmates who attempted suicide had a mental illness, compared to 15% among the general jail population (Torrey et al., 2010).

The treatment of mentally ill inmates raises critical legal and ethical considerations. Depriving inmates of adequate mental health care may constitute a violation of their constitutional rights, including the Eighth Amendment’s prohibition against cruel and unusual punishment (U.S. Const. amend. VIII). Furthermore, neglecting to address the underlying mental health issues of offenders undermines fundamental principles of justice and rehabilitation. Failing to adequately attend to the mental health needs of inmates not only infringes upon their rights but also perpetuates cycles of suffering and recidivism.

The imperative for alternative approaches to addressing the needs of mentally ill offenders is gradually gaining recognition. Overcoming these challenges requires a fundamental transition toward a more humane and rehabilitative approach to criminal justice. This transition entails substantial investments in mental health services, diversion programs, mental health courts, and specialized treatment facilities that provide comprehensive treatment and support services. By diminishing reliance on incarceration as the primary solution, these programs aim to facilitate rehabilitation and societal reintegration. Prioritizing these initiatives can contribute to a justice system that not only addresses the complexities of mental illness but also fosters healthier communities and more effective long-term outcomes.

Transgender Inmates

Protecting transgender inmates while simultaneously ensuring their equal access to programs has posed a significant challenge for prison administrators. Historically, transgender individuals deemed to be at risk were often segregated during incarceration (Ortlip-Sommers, 2020), which has been found to exacerbate psychological issues and hamper access to rehabilitation programs. Conversely, housing transgender inmates incongruously with the general population often results in ostracization, harassment, and elevated rates of violence, particularly in men’s prisons.

A recurring narrative among incarcerated transgender individuals involves experiencing harassment and disrespect from correctional staff, medical personnel, and other service providers. According to a 2009 survey conducted by the Hearts on a Wire Collective, which focused on incarcerated trans and gender-variant individuals in Pennsylvania, respondents detailed instances of ignorance and mistreatment (Emmer et al., 2011). As illustrated in Figure 9.21, the survey revealed that 64% of respondents encountered medical staff who lacked understanding of their health needs as transgender or gender-variant individuals. Moreover, 80% reported experiencing verbal harassment from staff, with 30% subjected to physical or sexual assault by staff members. Shockingly, 30% of respondents also disclosed that staff either encouraged or allowed cisgender incarcerated individuals to harass or assault them. Furthermore, of those who filed grievances due to harassment, half reported that no action was taken, and 60% experienced retaliation for filing complaints. Additionally, 17% of respondents were prohibited from practicing their religion based on their gender or perceived gender (Oberholtzer, 2017). These findings from Pennsylvania resonate with broader patterns observed in a survey by the National Center for Transgender Equality conducted in 2015, which reported that 20% of transgender individuals incarcerated within the last year experienced physical or sexual assault from correctional staff (James et al., 2015).

The 21st century marked significant progress in safeguarding the rights and well-being of transgender inmates, with many state policies tracing their origins back to the Prison Rape Elimination Act (PREA) of 2003. PREA was a sweeping reform aimed at recognizing and mitigating the pervasive sexual abuse occurring in prisons and jails across the country. Although PREA was not specifically tailored for LGBTQ+ inmates, it incorporated provisions intended to safeguard all inmates, irrespective of their sexual orientation or gender identity.

In 2009, the National Prison Rape Elimination Commission identified transgender individuals as particularly vulnerable to assault and violence during incarceration (see U.S. Code on Prison Rape Elimination). Subsequently, in 2012, the DOJ commenced funding initiatives for state, local governments, and tribes aimed at fostering a "zero tolerance" culture in prisons, jails, and other correctional facilities. During this same year, the commission established national standards for preventing sexual assault in prisons in 2012 (National PREA Resource Center, n.d.), incorporating several guidelines specifically targeting transgender concerns as indicated in the list below.

PREA Guidelines (as cited in Oberholtzer, 2017):

• Individuals must be screened upon intake for risk factors for experiencing abuse, including whether they identify as trans.
• When an individual identifies as trans, the facility must assess them on a case-by-case basis to decide housing (i.e. whether they belong in a men’s or women’s facility), and an individual’s views regarding their own safety must be seriously considered in housing decisions.
• Trans people cannot be placed in segregated housing or solitary confinement for their own protection without their consent, or unless it is the only available option.
• Trans people must be given the opportunity to shower separately.
• Correctional staff may not physically search trans people to determine their genital status; all examinations must be conducted by a medical professional as part of a broader medical exam.
• Facilities must train correctional staff in how to search and communicate with trans people respectfully.
• When reviewing an incident of rape or sexual assault, staff must review whether the incident was motivated by various factors including gender identity and/or transgender status.

Despite the strides made in policy changes within jails and prisons over the past 25 years, significant challenges remain for LGBTQ+ individuals in correctional facilities. While there has been some acknowledgment of the unique needs of LGBTQ+ inmates, evidenced by the implementation of nondiscrimination policies and the creation of specific housing units, the persistent issues of harassment, discrimination, and violence underscore the ongoing struggle faced by this population. It is imperative that efforts to address these challenges continue, with a focus on promoting inclusivity, providing comprehensive training for staff, and ensuring access to supportive services for LGBTQ+ individuals within the criminal justice system. Only through sustained commitment and advocacy can meaningful progress be made toward creating safer and more equitable environments for LGBTQ+ individuals in correctional settings.

Attributions

1. Figure 9.14: Race/Ethnicity, Sex, Crime Type, and Age Demographics of U.S. State Prison Inmates by Wesley B. Maier and Kadence C. Maier, for WA Open ProfTech, © SBCTC, CC BY 4.0
2. Figure 9.15: Race/Ethnicity, Sex, Crime Type, and Age Demographics of U.S.Federal Prison Inmates by Wesley B. Maier and Kadence C. Maier, for WA Open ProfTech, © SBCTC, CC BY 4.0
3. Figure 9.16: Prison Outline Designs by Kadence C. Maier, for WA Open ProfTech, © SBCTC, CC BY 4.0
4. Figure 9.17: Capture by Emelyne Brown is released under CC BY 2.0
5. Figure 9.18: Correctional Officers by CoreCivic is released under CC BY-ND 2.0
6. Figure 9.19: Surenos tattoo by U.S. Department of Homeland Security in the Public Domain; This image or file is a work of a United States Department of Homeland Security employee, taken or made as part of that person's official duties. As a work of the U.S. federal government, the image is in the public domain in the United States.
7. Figure 9.20: HMP-Littlehey-8862.jpg by PrisonImage is released under CC BY-SA 4.0
8. Figure 9.21: Study Findings of Transgender Prison Experience by Kadence C. Maier, for WA Open ProfTech, © SBCTC, CC BY 4.0