Running head: INCARCERATED MEN: A VULNERABLE POPULATION

Incarcerated Men: A Vulnerable Population

Staci K. Simonelli
Ferris State University

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Vulnerable Population
A vulnerable population is a specific group of people at risk for certain health conditions,
biases, disadvantages, and harmful situations (Chin, 2005). These populations can be determined
by factors such as sex, age, race, religion, and socioeconomic status. Incarcerated men are a
great example of an extremely vulnerable population. These men constantly face an uphill
battle. They are faced with certain risks other populations might not encounter. Independence is
no longer a luxury they have. They are now completely reliant on the state and the prison
workers for every need they have. Some of these men have nothing to lose because they carry
life-sentences. This can create violence among prisoners. Those who are incarcerated come
from different backgrounds, cultures, and ethnicities. Combining all these different types of
culture and personalities can create altercations among prisoners, even those not looking for
trouble. Also, having a large number of people in close quarters with each other is a sure way to
have diseases spread. The combination of these factors make this population particularly
vulnerable.
History
Eastern State Penitentiary was the first prison built in the United States in Philadelphia,
Pennsylvania in 1829 (Thibaut, 1982). This new prison system was based on the hope that the
convicted criminals would have the time and solitude to think about their behavior and hopefully
become genuinely sorry for what they had done (Thibaut, 1982). This prison was the gateway
for the penitentiary systems we have today. The Eastern State Penitentiary created this new
vulnerable population we must not forget about in todays society.

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Misconceptions of Population
Incarcerated men have numerous challenges. Common biases and misconceptions exist
against this population. They are thought to be mainly African-American, violent, rapists,
gangsters, murderers, gay, sociopaths, and a waste of space. One mistake can put someone in
prison. There have been cases where prisoners have been wrongly accused of the crime they
committed. Ergo, all incarcerated men cannot be placed into one stereotype. These stereotypes
can be mentally and emotionally damaging for these men, especially upon release. When they
are placed back into society, these stereotypes prevent them from getting jobs, maintaining
relationships with friends and family, and being a productive member of society. These
misconceptions can damage their newly regained life and freedom, and make the world a
miserable place to be.
These biases can also affect the delivery of health care. Becoming an unbiased human
being is a difficult concept. Is it really possible to be unbiased? These misconceptions may be in
our subconscious or may be readily apparent. The problem is when healthcare workers let these
stereotypes affect the way they treat their patients. If an inmate comes into the emergency room
with complaints of severe abdominal pain, it is the responsibility of the health care team to treat
that inmate like any other patient. Some people may think the inmate is just trying to get out of
prison and might be faking an illness. Shutting down certain biases we have may be argued
impossible, but controlling them is the key.
Demographics
Similar demographics exist among the nation, state, and county of Muskegon. Patterns
show that African-Americans and Hispanics have a greater presence in prison systems than
Caucasians. Sakala (2014) writes, Nationally, according to the U.S. Census, Blacks are

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incarcerated five times more than Whites are, and Hispanics are nearly twice as likely to be
incarcerated as Whites. Nationally, male prisoners increased by 1,800 in 2010 (Sakala, 2014).
According to Appendix A, 40% of the United States incarcerated population is black (Sakala,
2014). In 2013, 41,700 males were contained in Michigans penitentiaries (Carson, 2014).
Muskegon Correctional Facility contained 677 male prisoners in 2009 with their average age
being 41 years (Caruso, 2009). Out of the 677 men, 326 of those men were white (Caruso,
2009). With an increasing number of prisoners, this vulnerable population continues to grow.
Understanding the demographics and trends of this population can help identify the people at
risk.
Health Concerns
Mental disorders can be a huge problem in this population. A study was done on 800
incarcerated men (Beaurepaire, et al., 2006). Multiple psychiatrists interviewed this random
sample of men, and determined whether they fit into a diagnosis for a mental disorder. It was
estimated that over 50% of these men fell into diagnoses such as schizophrenia (3.8%), major
depressive disorder (24%), generalized anxiety (12%), and drug dependence (10.8%)
(Beaurepaire et al., 2006). Some men struggle with disorders while in prison, and others when
they are released. Since these men did something wrong in order to end up in prison, many
people do not care to help them. This is a huge reason why this population is at such a high risk.
They are left behind and do not have resources to receive the help they need. Post-traumatic
stress disorder is a problem for many released inmates (Schnittker, Uggen, Shannon, & Mcelrath,
2015).
Prevalent Disease

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HIV/AIDS is one of the most concerning and deadly diseases that arises in prison. In
2010, there were 20,093 inmates with HIV/AIDS in state and federal prisons with 91% being
men (Center for Disease Control and Prevention, 2015). Many inmates have access to
healthcare while in prison, but are afraid to disclose their risky behavior. As a result, HIV/AIDS
statistics increase because many inmates do not know they have the disease.
Health care related to HIV/AIDS could be improved drastically if everyone was required
to get tested. Those who tested positive could then be placed in a designated ward. This
information would not need to be known by anyone except the healthcare provider and the
specified ward locations would not be disclosed. The prison workers also should not know in
order to avoid prisoner maltreatment due to their own biases. Maintaining prisoners
confidentiality and maintaining HIPAA is a must. If men are going to engage in sexual activity
with each other, there really would be no other way to prevent the spread of HIV/AIDS. Hiring
enough people to watch them every second would cost too much for the state budget. As long as
we continue to restrict the natural human instinct to procreate, HIV/AIDS will be a problem if
we do not make a change. Mandatory testing upon entrance to the corrections facility could
make a huge impact and drop the prevalence of this disease drastically.
Nurses can be the key in improving disease rates in prison systems. They can serve as
educators to the incarcerated men. These men are often unaware of the signs and symptoms of
diseases and do not understand the complications and how their lives may be affected by it. The
nurse can also establish a relationship with the men so they feel comfortable enough to disclose
certain medical concerns and questions. Nurses can be advocates for them which they will most
likely be in desperate need for. There are not many people advocating for prisoners, but they are
still human beings and should be treated that way. Nurses can also refer them to other services

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the prison offers. They may suggest counseling for a man who wasnt able to attend his mothers
funeral due to incarceration. Nurses could also meet with men who are getting released and
discuss with them PTSD and issues many men face after leaving prison. Providing resources on
where they can go for help and who they could talk to could potentially save their life. Nurses
can do so many things for this at risk population. Sometimes it may be administering vaccines
and immunizations, while other times it may be something as simple as being there and listening
to them. The important thing is not to forget about this vulnerable population. Nurses should
care for everyone regardless of biases.
Impact of Health Policy
The Affordable Care Act has impacted this population drastically. These people cannot
be turned away from having pre-existing medical conditions or be dropped from their insurance
plans for needing medical services (Kahn, 2015). Newly released prisoners might have the need
for counseling or other types of medical services. Medicaid is something they can obtain in
order to help pay for these needed services. Finding work after prison can be especially difficult
which means insurance and benefits are hard to come by. Medicaid is something they can rely
on to be there when they need it.
The Affordable Care Act specifically requires states to provide targeted outreach to
facilitate the enrollment of underserved and vulnerable populations in Medicaid and
CHIP. Potential points of contact with these newly eligible individuals may include
public defenders, county jails, prisons, probation, and parole, among others within the
criminal justice system. (National Health Care for the Homeless Council, 2012)

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The Affordable Care Act also has resulted in a higher number of individuals entering the
prison system with insurance to begin with. This health care policy has given this forgotten
population a chance at receiving health care.

References
Beaurepaire C, Duburc A, Falissard B, Fagnani F, Gasquet I, & Loze JY. (2006). Prevalence of
mental disorders in French prisons for men. BMC Psychiatry. 6(33), p. 1-6.
doi:10.1186/1471-244X-6-33
Carson, A. (2014). Prisoners of 2013. U.S Department of Justice. p. 4-30. Retrieved from
http://www.bjs.gov/content/pub/pdf/p13.pdf
Caruso L., P. (2009). Michigan department of corrections 2009 statistical report. Retrieved from
https://www.michigan.gov/documents/corrections/2009_MDOC_STATISTICAL_REPO
RT_319907_7.pdf
Center for Disease Control and Prevention. (2015). HIV among incarcerated populations.
Centers for Disease Control and Prevention. Retrieved from
http://www.cdc.gov/hiv/group/correctional.html
Chin, M. H. (2005). Populations at risk: A critical need for research, funding, and action. Journal
of General Internal Medicine, 20(5), 448449. http://doi.org/10.1111/j.15251497.2005.41010.x
Kahn III, C. N., Ault, T., Potetz, L., Walke, T., Hart Chambers, J., & Burch, S. (2015). Assessing
Medicare's hospital pay-for-performance programs and whether they are achieving their
goals. Health Affairs, 34(8), 1281-1288. doi:10.1377/hlthaff.2015.0158

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National Health Care for the Homeless Council, (2012). The Affordable Care Act and criminal
justice: Intersections and implications. Health reform and justice-involved populations:
Opportunities for the HCH community. Retrieved from www.nhchc.org/2012/05/healthreform-and-justice-involved-populations-opportunities-for-thehch-community/.
Sakala, L. (2014). Breaking down mass incarceration in the 2010 census: State-by-state
incarceration rates by race/ethnicity. Prison Policy Initiative. Retrieved from
http://www.prisonpolicy.org/reports/rates.html
Schnittker, J., Uggen, C., Shannon, S. K.S. and Mcelrath, S. M. (2015), The institutional effects
of incarceration: Spillovers from criminal justice to health care. Milbank Quarterly, 93:
516560. doi: 10.1111/1468-0009.12136
Thibaut, J. (1982). To pave the way to penitence: Prisoners and discipline at the Eastern State
Penitentiary 1829-1835. Pennsylvania Magazine of History and Biography, Vol. 106, No.
2, 187-222. Retrieved from http://www.jstor.org/stable/20091663?
seq=1#page_scan_tab_contents

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Appendix A

Race/Ethnicity

% of US
population

% of U.S.
incarcerated
population

National incarceration
rate
(per 100,000)

White (nonHispanic)

64%

39%

450 per 100,000

Hispanic

16%

19%

831 per 100,000

Black

13%

40%

2,306 per 100,000