Correctional Counseling

The corrections population in the United States comprises inmates in federal and state prisons, territorial prisons, local jails, Bureau of Immigration and Customs Enforcement facilities as well as military and juvenile facilities, and this population differs across a multitude of variables compared to nonincarcerated populations. Each of these variables individually and collectively creates challenges in providing counseling services. Counseling services are likely most effective when focused on basic needs that many inmates are unable to meet for themselves. Such needs are likely to include assuring a stable living environment upon release, the means to sustain this environment through steady employment, and the elimination of the destructive patterns, such as substance abuse, that led to a destabilization in meeting these basic needs. Although challenging, working with corrections populations can be among the most rewarding kinds of work for counseling professionals.

Growth of Corrections Population

The corrections population in the United States has grown annually since 1970; over 2 million people are presently incarcerated, and over 7 million are under some form of correctional supervision (probation, parole or other supervised release, or placement in community corrections programs commonly referred to as “halfway houses”). The corrections population in the United States is between 6 and 10 times greater than that of any other industrialized country in the world. Rates of incarceration for racial and ethnic minorities are particularly discouraging. For example, two thirds of all prison inmates are minorities. One in every eight Black males in their 20s is in prison or jail on any given day. Institutional populations often exceed design capacities of the physical structures and allotted staff; state prisons operate at between 1% and 14% above capacity and federal prisons operate at 34% above capacity. This growth has thinned available resources and burdened corrections professionals.

More than half of all prison and jail inmates had a history of mental illness within the last 12 months. Rates of mental illness among female inmates (state 73%; federal 61%; jail 75%) far exceeded male rates (state 55%; federal 44%; jail 63%). Mental health problems among the corrections population are largely associated with criminal history, violent offenses, and physical aggression in prison as well as homelessness and other personal instability in the year before arrest. Estimated rates of mental illness within corrections populations typically incorporate only mood, anxiety, and psychotic disorders in their analyses and exclude developmental and substance-related disorders. Often, adjustment disorders with mood or anxiety symptoms are also not reflected in these statistics, because there is an assumed period of maladjustment inherent to incarceration. Consequently, statistics provided for the rates of mental illness within corrections populations typically underestimate actual rates, as statistics are based on a discrete set of disorders.

Growth in the U.S. incarcerated population is partly explained by decreases in numbers of patients hospitalized in mental hospitals and asylums. Although progressive movements in the 1950s and 1960s attempted to deinstitutionalize mental illness and provide for more humane treatment within the community, limited viable alternatives to mental hospitals and poorly equipped community programs contributed to increased rates of incarceration for individuals with mental illness. Quite simply, prisons have become the modern-day mental asylum.

Substance abuse is also a significant problem within the corrections population. Over 80% of all inmates were incarcerated for a drug-related offense, were under the influence of a substance at the time of their offense, committed their offense to obtain money for drugs, or were abusing substances in the month prior to their arrest. These rates have also continued to grow over the last 30 years because of changes in public policy that resulted in increased resources to arrest and convict drug offenders, mandatory sentencing laws, cutbacks in parole releases, and increases in the revocation of probation or parole. Although drug treatment programs are by far the most widely offered forms of treatment in corrections settings, the percentage of inmates reporting participation in drug treatment programs dropped across the 1990s for both state and federal facilities.

Health-Related Issues

Providing for the medical needs of the corrections population has been highly politicized since the 1976 landmark U.S. Supreme Court decision in Estelle v. Gamble (429 U.S. 97). This decision prohibited corrections professionals from passivity or indifference in their treatment of inmates’ health problems. Although aggressive prevention and treatment of health problems is preferred, this task can be daunting given that the corrections population has far more medical illnesses than the average population, correctional institutions often have limited financial and medical resources to assure adequate treatment, and the typical inmate is not often health conscious. For example, the prevalence rates for communicable diseases among the corrections population far exceed those of the average population; the proportion of inmates with HIV/AIDS is 5 times greater than in the total U.S. population, the proportion with hepatitis C is 9 to 10 times higher, and the proportion with tuberculosis is between 4 times higher (for prison inmates) and 17 times higher (for jail inmates). Hepatitis B and other sexually transmit-ted diseases (i.e., syphilis, gonorrhea, chlamydia) are also present among significant proportions of the corrections population. The prevalence rates for chronic diseases are also quite high, including heart and cerebrovascular disease, cancer, diabetes, and respiratory disease. Often, because of individual and socioeconomic barriers, illnesses are either first diagnosed in a corrections setting, or the first sustained treatment to which the inmate has access is within a corrections institution. These challenges coupled with an increasing geriatric population in prisons make successful treatment more intensive and costly.

Substance Abuse Counseling

Although the rates of inmate participation in drug treatment programs have decreased, such programs remain a staple of psychological and rehabilitative services in correctional settings. Evidence suggests that participation in such treatment programs decreases both recidivism and continued drug use upon release. For example, the Federal Bureau of Prisons found that inmates who completed the Drug Abuse Program (DAP) were 73% less likely to be rearrested in the first year after release than untreated inmates. Additionally, a comparison of urinalyses showed that DAP inmates were 44% less likely to continue using substances after release than inmates who did not complete DAP. Research on state facilities has shown similar reductions in recidivism of around 50%. The most effective of these programs are those that combine treatment during incarceration with community aftercare upon release.

Vocational and Academic Counseling

Some degree of vocational or academic development while incarcerated remains the most consistent factor predicting rates of recidivism. In other words, inmates who participate in vocational programming, a specific occupational apprenticeship, or an academic advancement program are less likely to reoffend upon release. According to Moore, one study conducted by the Florida Department of Corrections (DOC) concluded that inmates who earned a GED were 8.7% less likely to recidivate than those inmates without a GED. Inmates who obtained a GED and improved their scores on the Test of Adult Basic Education to the ninth grade level or higher were 25% less likely to recidivate. Inmates who completed a vocational development program were 14.6% less likely to recidivate than those who did not complete any vocational programs. The impact of vocational and academic programs in reducing recidivism is not exclusive to Florida, as similar results are seen in other state and federal institutions.

Aside from the direct benefit to the inmate and his or her family for remaining free from further incarceration, there is a direct benefit to correctional institutions and their taxpayers. The reduction in recidivism rates for inmates who obtained a GED in the Florida study translated into approximately 100 inmates not returning to prison. The reduction in recidivism rates for inmates who completed a vocational program translated into approximately 169 inmates not returning to prison. The Florida DOC estimated that the amount saved by not having to reincarcerate the 100 inmates with a GED was approximately $1.9 million; the savings for the 169 inmates who participated in vocational programs was $3.2 million.

Release and Reintegration

Approximately 97% of the U.S. incarcerated population will be released to the community. Release is extremely challenging for inmates as is evidenced in dramatically increased rates of suicide and accidental death by either overdose or homicide immediately upon release. Consequently, nearly all counseling with corrections populations should focus on release preparation.

References:

  1. Binswanger, I. A., Sterns, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., et al. (2007). Release from prison—a high risk of death for former inmates. New England Journal of Medicine, 356, 157-165.
  2. Bureau of Justice Statistics. (2006). National corrections populations. Washington, DC: Department of Justice.
  3. Harrison, P. M., & Beck, A. J. (2006). Prisoners in 2005: Bureau of Justice Statistics bulletin. Washington, DC: Department of Justice.
  4. James, D. J., & Glaze, L. E. (2006). Mental health problems of prison and jail inmates: Bureau of Justice Statistics special report. Washington, DC: Department of Justice.
  5. Mauer, M. (1999). The race to incarcerate. New York: New Press.
  6. National Commission on Correctional Health Care. (2002, May). The health status of soon-to-be-released inmates: A report to Congress. Chicago: Author.
  7. Pratt, D., Piper, M., Appleby, L., Webb, R., & Shaw, J. (2006). Suicide in recently released prisoners: A population-based cohort study. The Lancet, 368, 119-123.

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