I am a student nurse at a non-profit US jail that is run by the department of corrections, which has a contract with Public Health to provide the jail health. There are about 800 inmates, but the capacity is at least 1200. This would be described as one of the "nicer" jails because due to a previous lawsuit at a sister-institution this facility is held to higher standards than the minimum.
Lows of jail health: (1) you probably won't see a nurse anywhere else chewing tobacco on the job; (2) you are often limited on the services you may provide--only acute problems are usually addressed--no toe fungi, acl repairs, only emergent hernia repairs; (3) strict guidelines on who gets treated for psychiatric issues--if a client has been shown to be non-compliant for 45 days then they won't reinstate the medication, unless the inmate becomes extremely unstable ("suicidal or eating out of the toilet")--otherwise they just need to lay low and deal with it; (4) jail health been referred to as similar to veterinary medicine by some health professionals because you have to read the client's body and intentions--manipulations and mind-games for secondary gains (simple examples are to get an extra blanket, their personal shoes, or a pillow, which usually is not provided--remember, although jail is for those inmates with sentences less than 1 year (prison is for 1 year+) everyone goes to jail first, even if you shot the mayor; (5) scarey correctional officers--I heard one nonchelantly explain to an inmate that if they were caught "pocketing" a medication they'd be reported, then thrown in the hole, kicked off their medications, then "totally fucked up everytime I see you."
Highs of jail health: (1) as a nurse you are given the opportunity to spend large amounts of time (regularly up to 30+ minutes if you efficiently complete other tasks, there aren't any medical emergencies, and you coordinate care with the schedule of the correctional officers) to spend with clients they may rarely-never have the opportunity to speak with the provider outside of jail); (2) for the most part, clients seem to be very receptive to suggestions for improving health, and how to avoid returning to previous substance abuse habits; (3) jail may benefit those that have substance abuse problems or with histories of domestic violence (however, from one journal article I read, inmates with other crimes do NOT report any benefit to their life (4) there does appear to be a decent methadone program for heroine addicts, but it's run by an outside agency, so I don't get much exposure to the process.
Tomorrow I will accompany the psych ARNP in the clinic in the morning. Hopefully this will help clarfy the extent and manifestations of illness within the jail, how I may treat and improve my care as a nurse, what needs are not addressed, and upon discharge what support inmates (i/ms) receive or would be helpful.
However, right now I will estimate that 60 of the 80 medications that I distribute are considered psych medications. Judging by this prevalence of psych meds, one might surmise that
some of the complaints that inmates (i/ms) submit requests for:
Common issues after probing during interviews: nearly all i/m report recent and diverse history of substance abuse (not talking about marijuana)--apparently the most newly abused drug is Oxycontin ("oxys") which people often snort or smoke, and often leads to behavior problems and even more expensive habits such as heroine.
