[Congressional Record Volume 148, Number 19 (Thursday, February 28, 2002)]
[Extensions of Remarks]
[Pages E232-E233]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            BILL TO ESTABLISH OFFICE OF CORRECTIONAL HEALTH

                                 ______
                                 

                          HON. TED STRICKLAND

                                of ohio

                    in the house of representatives

                      Thursday, February 28, 2002

  Mr. STRICKLAND. Mr. Speaker, I would encourage my colleagues to 
support HR 2422, legislation I have introduced that would establish an 
Office of Correctional Health within the Department of Health and Human 
Services.
  According to the Department of Justice (DOJ), the United States is 
second only to Russia among industrialized nations in incarceration 
rates with nearly 2 million people in jail or prison. The fuel that 
feeds this prison population explosion is comprised of several 
components. Mandatory minimum and ``three-strikes'' sentencing laws 
have resulted in longer sentences and more frequent incarcerations. A 
look at the changing demographics in American prisons and jails sheds 
light on the challenges correctional facilities face at the beginning 
of the 21st century.
  Substance abuse poses a significant health care challenge for 
correctional facilities. According to DOJ, 57 percent of state 
prisoners and 45 percent of federal prisoners surveyed in 1997 said 
they had used drugs in the month before their offense. A whopping 83 
percent of state prisoners and 73 percent of federal prisoners had used 
drugs at some time in the past. It is estimated that about three-
quarters of all inmates can be characterized as being involved in 
alcohol or drug abuse in the time leading to their arrest.
  According to an article in the Washington Post entitled, ``Mentally 
Ill Need Care, Find Prison'', it is estimated that the number of 
inmates with serious mental illnesses in American prisons and jails is 
nearly 5 times the number of mentally ill in state mental hospitals. So 
many of these inmates with mental health needs also have a co-occurring 
substance abuse problem. This high incarceration rate of the mentally 
ill, many of whom have substance abuse problems, poses an enormous 
challenge to the correctional health care system. In the first 
comprehensive report on mental illness in correctional facilities, the 
Bureau of Justice Statistics (BJS) found that 7 percent of federal 
inmates and 16 percent of those in state prisons or local jails or on 
probation said they either had a mental condition or had stayed over 
night in a mental hospital unit or treatment program. The highest rate 
of mental illness was among white females in state prisons at 29 
percent. For white females age 24 or younger this level rose to almost 
40 percent. When compared to other inmates, mentally ill inmates and 
probationers reported higher rates of prior physical and sexual abuse. 
According to BJS, nearly 6 in 10 mentally ill offenders reported they 
were under the influence of alcohol and drugs at the time of their 
current offense.
  The increased incarceration rate of women also presents new health 
care challenges to correctional facilities. According to BJS, in 1998 
an estimated 950,000 women were under custody, care or control of 
correctional agencies. Nearly 6 in 10 women in state prisons had 
experienced physical or sexual abuse in the past. This statistic, 
coupled with the reality that 7 in 10 women under correctional sanction 
have minor children, points to the acute need for counseling services. 
Women inmates utilize health care, including sexually transmitted 
diseases, and the possibility of pregnancy either upon entry into the 
corrections system or during, women's special health care needs must be 
addressed in a comprehensive fashion.
  The health care needs of inmates have expanded as the incarcerated 
population has aged. As inmates grow old in prison they succumb to the 
same ailments which afflict the elderly in the outside world--diabetes, 
heart disease and stroke. These geriatric health care needs represent 
another challenge to correctional agencies in providing adequate care.
  In 1996, the Centers for Disease Control and Prevention's National 
Center for HIV, STD, and TB Prevention formed an ad hoc working group, 
the Cross Centers Correctional Work Group made up of health 
professionals from across CDC. The purpose of the group is to focus 
attention on the complex health needs of incarcerated men, women, and 
youth in the United States. I commend the work of this group and the 
fine efforts of CDC in addressing the very complex health issues 
associated with correctional facilities.
  According to CDC, the prevalence of infectious disease is high among 
inmates. For AIDS, the prevalence is five times that of the general 
population. Further, inmates coming into correctional facilities are 
increasingly at risk for HIV infection through risk behaviors such as 
needle sharing and unprotected sex. Tuberculosis is another important 
public health issue in prisons and jails according to CDC. TB infection 
rates are substantially higher among inmates; estimates are anywhere 
from four to 17 times higher because conditions associated with TB 
(poverty, drug use, HIV infection, etc.) are more common in the 
incarcerated population than the general US population. According to 
CDC, even as we have decreased the number of TB cases overall, it has 
become a much more focused disease, with outbreaks of TB in 
correctional facilities starting to count as a major factor in its 
spread. For Hepatitis C, the prevalence among inmates is nine times 
higher than that of the general population.
  Jails, where inmates are held awaiting trial or serve short sentences 
of two years or less, represent the ``front lines'' of correctional 
health care. Many inmates lacked good access to health care services 
before their incarceration and are therefore more likely to come to 
jails and prisons with chronic illnesses and infectious diseases. Rates 
of infectious disease are known to be higher among inmates than in the 
general population. This high incidence of infectious disease among 
inmates threatens the health and lives of thousands of dedicated 
corrections officers and staff members who work in prisons and jails 
across America.

[[Page E233]]

  Most inmates are released after they've served their time; without 
treatment, these infected inmates threaten the public health of the 
community upon release. Every year there are approximately 12 million 
inmates released into the community. We need to recognize the real 
opportunity for treatment and prevention services in treating the high-
risk corrections population as well as the clear public health 
implications for the community at large.
  All of these alarming statistics contribute to the need for the 
establishment of an Office of Correctional Health within HHS. Such an 
office would coordinate all correctional health programs within HHS; 
provide technical support to State and local correctional agencies on 
correctional health; cooperate with other Federal agencies carrying out 
correctional health programs to ensure coordination; provide outreach 
to State directors of correctional health and providers; and facilitate 
the exchange of information regarding correctional health activities.
  Mr. Speaker, with a growing diverse and medically complex population 
in America's prisons and jails, we must ensure that inmates are 
provided the health care they need, that staff members operate in a 
safe working environment, and as a result, that public safety is 
enhanced.

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