Running head: POPULATION AT RISK

Population at Risk
Emily Mortensen
Ferris State University

POPULATION AT RISK

Population at Risk
When a puzzle box has first been opened, at first glance, a persons reaction may be
woeful. This individual may react negatively to the disarray, and consider giving up the
challenge of solving the problem before they even begin. As they go through the process of
completing the puzzle, they find the beauty in the process, how each piece works with the others
in order to form a complete image. The world is full of puzzles, or pieces coming together to
complete the whole. One puzzle in this world is a persons health. A persons health is made up
of numerous items, including their genetic makeup, and how they care for themselves, among
many other items. One item that has a large influence somebodys health is the population that
they belong to. The population somebody is associated with can determine their risk for health
disparities. A population that is commonly associated with this increased risk is incarcerated
women.
Throughout history, America has been presented as a patriarchal society, with
more attention given to the male citizens. This discrepancy is strongly presented in the criminal
justice system. The system that is in place today has been created for men, ignoring the special
needs of women who have found themselves in a home behind bars (Braithwaite, Treadwell, &
Arriola, 2005).
Historically, women in prison have not been presented ideal living conditions. Before the
first all-female prisons were created, these women were placed in a unit of the mens prisons.
These prisons treated their female inhabitants poorly, with punishment of solitary confinement
over utilized, and these women were regularly victims of physical or sexual abuse by the male
inmates and the male guards. In 1825, a pregnant woman named Rachel Welch passed away
because she was beaten while imprisoned by a male guard. After this event, changes were made
to the housing situations of imprisoned women, and the first all-female facility, The Mount
Pleasant Prison Annex, was opened in 1839. This facility was imperfect, while it did have a

POPULATION AT RISK

female warden, it was on the grounds of Sing Sing, an all-male institution, and both facilities
were under male control. These administrators were unaware of what exactly incarcerated
women required. Even with these attempts to eliminate the abuse of these women, the women at
this new facility still fell victim to high levels of abuse and corporal punishment (Mallicoat,
2014).
In the United States today, there are over 205,000 women imprisoned, a number that
increased by an alarming 646% between the tears of 1980 and 2010 (Sentencing Project, 2012).
In the year 2013, there were 14,169 women in federal prisons, and Michigan jails housed 2,059
female inmates (Carson, 2014). Black or Hispanic women are at a greater risk for becoming
imprisoned than Caucasian women. While the likelihood for imprisonment for white women in
2001 was one in 118, for Hispanic women, the likelihood was one in 45, and for black women,
the number rose to one out of every 19 women (Sentencing Project, 2012).
Stereotypes that are often presented with female inmates include that they are irrational,
emotional, and hard to control. These biases cause these individuals to be brushed off, and not
taken seriously. The separation that prisoners experience from society is another source of bias.
Since these individuals are seen as separate from other United States citizens, and they have
committed crimes, they are seen as less than human. Individuals are more willing to treat others
poorly when they see themselves as more than the other person, as presented in the Stanford
prison experiment, where participants were randomly assigned the role of either prisoner or
guard. The guards began to treat the prisoners cruelly and became extremely controlling of them,
even though when they walked into the study, these individuals were all equals (Haney, 2007).
In the United States criminal justice system, incarcerated women receive substandard
health care in comparison to males, which has a damaging effect on these women. A NCCD
study in 1996 interviewed 151 female inmates, which found that 61% of these women required
treatment for a physical problem, and 455 required treatment for their mental health. As

POPULATION AT RISK

compared to men, these women required more medical assistance for their health problems, but
had lesser access to the care that they needed (Acoca, 1998).
If medical care did become available, it was implemented poorly, with inadequate
supervision and follow-up to the care to ensure that it worked effectively. With this flaw in the
system, prisoners with chronic diseases began to deteriorate and lose quality of life faster than
they would have if they had received adequate care. The prisoners receiving mental health
medications became overmedicated and suffered the effects of these chemical restraints (Acoca,
1998).
In this population of incarcerated women, their health concerns are an issue that needs to
be addressed, and the care of these issues needs to be improved greatly. These women are at an
increased risk for HIV infection, along with other sexually transmitted infections, infectious and
communicable diseases, mental health disorders, and reproductive health problems. One
explanation for why these inmates receive such poor health care is because their doctors do not
take their health concerns seriously. It has been found that male doctors . . . often attribute
womens complaints to psychosomatic causes (Acoca, 1998, par.8). It is because of this bias
that health care providers are not giving these patients the medical attention that they need, and
many illnesses are going undiagnosed or untreated among these women.
One of the most prevalent health issues that incarcerated women face is substance abuse.
In the 1996 NCCD study, over 80% of the interviewed women had reported a history of regular
drug or alcohol use, and 71% reported that they had used it regularly within a month of their
arrest. This problem is addressed poorly in correctional facilities, with two-thirds of women
stating that the treatment they require for their substance abuse was not available to them (Acoca,
1998).
Villagr Lanza, Fernndez Garca, Rodguez Lemelas, & Gonzlez-Menndez conducted
a randomized controlled study to compare different treatment methods for substance abuse

POPULATION AT RISK

disorder. There were 50 incarcerated women participating in the trial. They had to meet the
diagnostic criteria for substance abuse disorder and were required to be serving a sentence of
greater than six months in length (see Appendix A for participants characteristics). The two
treatment methods that were utilized in this treatment were acceptance and commitment therapy
(ACT) and cognitive behavioral therapy (CBT), and there was a control group present as well
(2014).
The patients that were involved in the CBT treatment worked to identify the thoughts that
were causing the patients to desire the drugs, and worked to alter their behavior to limit these
situations, or their reactions to them. The ACT treatment worked to help the patients to respond
in a better way to previously avoided events. It was proven that for long-term success of
treatment, ACT proved to be more effective than CBT in reducing drug use (43.8% versus
26.7%, respectively) and improving mental health (26.4% versus 19.4%, respectively) of
incarcerated women (Villagr Lanza, Fernndez Garca, Rodguez Lemelas, & GonzlezMenndez, 2014).
For nursing purposes, there are different therapeutic strategies that could be implemented
to aid the prisons in improving the care of incarcerated women who are dependent on substances.
The first strategy is to establish a trusting relationship between the patient and the caregiver. This
strategy helps the patient to feel more accepted, and they are more willing to comply with the
care plan when they have that relationship with their caregiver. Accompanying the trusting
relationship with the staff, it is essential that these clients also form trusting relationships with
their peers. This helps the clients to feel that they have support, and they will be more willing to
open up when they are among peers that they trust (Finfgeld-Connett & Johnson, 2011).
Individualized care is another technique that helps clients to find success in substance
treatment programs. Practitioners who have developed their critical thinking and problem solving
skills will be required in order to make decisions in treatment. When an individual is seeking

POPULATION AT RISK

treatment for an ailment, they are more willing to comply with the regimen if they feel that they
have not received a highly individualized plan that fits all of their needs and their exact situation
(Finfgeld-Connett & Johnson, 2011).
Separation from the general population of the prison is another technique that can help
the patients to find more success in their treatment programs. In the general environment of the
prison, women are told to be extremely independent. This technique is effective in keeping the
prisoners out of more trouble, but it is detrimental to the success at halting the use of an addictive
substance. This technique helps the patients to follow through on their individualized treatment
plans, and gives them ample opportunity to form relationships with their care providers and their
peers. The environment in these treatment programs is one of caring and support, and with this,
the clients are likely to remain successful in cessation of substance dependence upon completion
of the program (Finfgeld-Connett & Johnson, 2011).
A policy that affects the lives and care of all prisoners is the prisoners rights law. This
law outlines the rights that an inmate has while behind bars. One segment of the prisoners rights
law relates directly to medical and mental health care. This segment states that they are entitled
to care for these problems, but the treatments are only required to be adequate, as opposed to the
best available care or standard treatment available to the general population (HG Legal
Resources, 2015).
This policy has a negative effect on the population of incarcerated women, as well as
incarcerated men. The fact that these individuals are only receiving substandard treatment for
their medical ailments shows that they are not able to effectively fight these diseases, and
morbidity will be more prevalent in these communities. If an individual with diabetes is
incarcerated, she will be more likely to remain uncontrolled. With her uncontrolled diabetes, this
individual will have a heightened risk at contracting the complications of cardiovascular disease,
neuropathy, kidney, eye, food, damage, hearing impairment, skin conditions, and Alzheimers

POPULATION AT RISK

disease (Mayo Clinic, 2015). These individuals are more likely to die at a younger age due to the
ineffective treatment that they are receiving.
The population of incarcerated women is one that is at risk for a number of problems.
They are subjected to abuse, and are at a greater risk for HIV and other sexually transmitted
diseases, communicable and infectious disease, mental health disorders, reproductive health
problems, and substance abuse. These women are not entitled to receive proper care for any
illnesses that they have, and have increased morbidity because of that. The fact that these women
are incarcerated is one piece to the puzzle of their individual health, and each woman is a piece
to the puzzle of a highly flawed system for providing care to these women. Significant changes
will be required for the United States justice system to ensure that these women receive the care
that they need in order to live long and healthy lives.

POPULATION AT RISK

References
Acoca, L. (1998). Defusing the time bomb: Understanding and meeting the growing health care
needs of incarcerated women in America. Crime and Delinquency, 44(1), p. 49.
Braithwaite, R. L., Treadwell, H. M., and Arriola, K. R. J. (2005). Health disparities and
incarcerated women: A population ignored. American Journal of Public Health, 95(10),
p. 1679-1681. doi: 10.2105/AJPH.2005.065375
Carson, E. A. (2014). Prisoners in 2013. Retrieved from http://www.bjs.gov/
Finfgeld-Connett, D., and Johnson, E. D. (2011). Therapeutic substance abuse treatment for
incarcerated women. Clinical Nursing Research, 20(4) p. 462-481. doi:
10.1177/1054773811415844
Haney, C. (2007). Stanford Prison Experiment. In Y. Jewkes & J. Bennett (Eds.), Dictionary of
prisons and punishment. Devon, United Kingdom: Willan Publishing.
HG Legal Resources (2015). Prisoners Rights Law. Retrieved from http://www.hg.org/prisonerrights-law.html
Mallicoat, S. L. (2014) Women and crime: A text/reader (2nd ed.). United States: SAGE
Publications
Mayo Clinic (2015). Type 2 diabetes. Retrieved from http://www.mayoclinic.org/
Sentencing Project, The (2012). Incarcerated women. Retrieved from
http://www.sentencingproject.org/doc/publications/cc_Incarcerated_Women_Factsheet_D
ec2012final.pdf
Villagr Lanza, P., Fernndez Garca, P., Rodguez Lemelas, F. & Gonzlez-Menndez, A.
(2014). Acceptance and commitment therapy versus cognitive behavioral therapy in the
treatment of substance use disorder with incarcerated women. Journal of Clinical
Psychology, 70 (7), p. 644-657. doi: 10.1002/jclp.22060

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9
Appendix A

M(SD)
M
M(SD)
SD)
(6.4)
33.1
(5.8)
(mos.)
50
(33.1)
38.7
59.1
(37.7)
of
(9.4)
drug
16.7
abuse
(5.7)
19.9
14.8
(2.2)
(yrs.)
7.9
(6.1)
11.3
12.6
(9.2)
(6.5)
variable
n(%)
n(%)
Marital
n(%)
13
(72.2%)
7(20.1)
(53.8%)
1
(7.7%)
4
(22.2%)
Widow
Criminal
1status
typology
(5.3%)
public
health
(50%)
(30.8%)
(27.8%)
44
(44.4%)
9
(50%)
(61.5%)
persons
(22.2%)
(5.6%)
(7.7%)
Main
substance
9
(50%)
8
(61.5%)
5
(38.5%)
(27.8%)
5
Alcohol
31
(16.7%)
1
(5.6%)
(5.3%)
SD
deviation;
=
standard
CBT
=(8
behavioral
cognitiveacceptance
ACT
and
=
therapy;
CG
=9
control
group.
condition
CBT
ACT
CG
Characteristics
Table
15

(Villagr Lanza, Fernndez Garca, Rodguez Lemelas, & Gonzlez-Menndez, 2014).