As they add to a comparatively small but growing body of research, correctional health doctors and epidemiologists in Connecticut have started selecting 250 inmates to participate in a study on depression and suicidal thoughts among aging prisoners—the nation’s fastest-growing prison population.
For 30 months, the team will monitor physical agility, wellness and illness among aged-50-and-over inmates who volunteer as study participants. Researchers will focus on possible links between those medical areas and inmates’ cognitive skills, memory, mental clarity and overall mental health.
The University of Connecticut Health Center’s Center on Aging researchers are part of a relative handful of scientists who have been analyzing the particular needs of the nation’s growing cohort of aging inmates, and pushing for standardized care to replace what largely are varying, state-by-state rules governing inmates’ mental health and other medical care.
“The people who become elderly during incarceration face real stresses,” said Dr. Robert Trestman, a psychiatrist and neurobiologist and executive director of UConn Health’s correctional managed health care program.
“They’ve typically lost the vast majority of their social network,” Trestman, one of the researchers, told The Crime Report.
“Their biological age is typically much higher than their chronological age; they typically look a decade older. They are at greater risk for chronic impairment, for depression and for a sense of hopelessness or a sense of suicidal thinking. And this is not an area where there has been much study at all.”
“The number of older prisoners is skyrocketing,” said epidemiologist Lisa Barry, lead author of the upcoming study and a smaller, initial study of whether older inmates’ physical decline fuels depression and suicidal thoughts, published in the International Journal of Geriatric Psychiatry’s September 2016 issue.
“To get funding [for this kind of research], you have to make a good case, clinically and logically, about why this is important …
“Correctional institutions are looking for ways to deal with this burgeoning population. Of the more serious mental illnesses, depression impacts older persons more. That’s true in prison and in the community.”
As an outgrowth of the previous study—for which psychiatrist Trestman is a co-author—the National Institute of Mental Health is funding what will be a five-year project involving the 250 inmates. In June 2016, a social worker and public health practitioner were hired to help chart the physical, cognitive and mental capacity of study participants, male and female inmates from all ten of Connecticut’s prisons.
Physicians and other clinicians from UConn’s health center, where Barry also teaches psychiatry, are the sole providers of medical and mental health care in Connecticut’s prisons, jails and halfway houses.
For its part, the research published in September 2016 reached several early conclusions that must be further tested before they can be fully validated.
Running from September 2012 through June 2015, the previous study concluded that, among 110 male and 57 female inmates aged 50 to 83; 56 percent were white, 28 percent were black, 9 percent were Latino and 6 percent were some other race:
- 7 percent of studied inmates were physically unable to meet the daily rigors, researchers wrote, of “dropping to the floor for alarms, climbing on/off the top bunk, hearing orders, walking while wearing handcuffs, standing in line for medications, and walking to chow.”
- 25 percent of them were depressed; that compares to up to eight percent of persons their age who, according to the federal Centers for Disease Control and Prevention, are not incarcerated.
- Those who had trouble seeing and who had chronic physical diseases were more likely to be depressed and to have contemplated suicide.
- Women, more than men, contemplated suicide.
“When it comes to mental health and physical functioning, one often impacts the other,” researcher Barry said.
The new, five-year study will include in-depth interviews of inmates; assessments of their medical records and history; trace their ongoing mental and other medical needs. As one example, how well can an aging inmate repeatedly sit in and get up from a chair without needing to using arm rests or another person’s help?
Heightened Risk of Mental Illness for Elderly
Aging Americans, in general, may be at heightened risks for mental illness. The Centers for Disease Control and Prevention estimates that 20 percent of people 50 years and older have anxiety, bi-polar disorder, depression, severe cognitive impairment and other psychiatric or psychosocial disabilities.
The risks likely are higher among the incarcerated, said Dr. Brie Williams, a University of California at San Francisco School of Medicine primary care and geriatrics physician with incarcerated patients. Williams has been a co-collaborator with Connecticut’s researchers on prior studies and policy papers and at public forums on correctional health.
“We’ve been looking at how various social and physical factors may compound mental health challenges of older [inmates] in ways that are distinct from younger ones,” said Williams, also founding director of the University of California Criminal Justice & Health Consortium.
“Older people in jail can have depression, cognitive impairment, a history of trauma and abuse. And on top of that, they may fear of being victimized because they are older, frailer. For example, we’ve much concern that if [inmates] cannot hear [prison guards’] instructions they may be written up for violating a rule.”
Added Williams, who also has focused on traumatic brain injury and post-traumatic stress disorder among inmates: “If you’re demented and depressed and hearing impaired and trying to understand and follow directions of a judge who might be handling your probation hearing, you’re up against a lot.”
Among other outcomes, researchers on the mental health of older inmates said they hope to help prisons and jails develop interventions on issues ranging from the kinds of cells where older inmates are assigned to helping inmates travel to dining halls and other prison locations in a timely, less-arduous way. Such interventions might lessen the mental ills some of them suffer.
Katti Gray is a contributing editor for The Crime Report. She welcomes your comments.