As the corrections population grows, correctional systems will be required to safely care for inmates with a range of specialized needs including prisoners with serious physical or mental illnesses and disabilities, aging prisoners, and those with a variety of sexual and gender identities.

All of these individuals require physical and mental health care, protection from abusive staff and inmates, and attention to their civil rights. Not only do their needs typically go unmet in the majority of facilities, but their special status also makes them more vulnerable to the harsh conditions and cultures in prisons and jails. The prisoners who fall into several of these special categories simultaneously face even greater challenges. The stress of prison tends to worsen conditions such as chronic disease, mental illness, Alzheimer’s, and victimization.

Caring for these individuals puts added burdens on already stretched correctional systems. The costs of man- aging these special populations are much higher than those for more mainstream correctional residents. Providing appropriate care often requires an empathetic or compassionate culture among staff and other inmates, which is currently rare in prisons and jails, and to some extent in probation and parole. But, the corrections sys- tem has little choice in these matters; federal and state laws governing persons with disabilities, a range of civil rights laws, and a growing number of court decisions have held that the Eighth and Fourteenth Amendments require a clear standard for handling these special inmate populations.

As poor as care inside of prisons may be, many inmates have had little to no care in the community. For the poorest inmates, being released from prison hardly solves their problems. Appropriate treatment of the elderly in prison is also elusive, inside or outside. Especially if an elderly person has served an extremely long sentence, he or she is likely to have few resources or even family members outside of prison who can tend to their medical or death expenses.

A number of advocacy groups are trying to address the legal, ethical, and practical considerations in dealing with special populations behind bars.

• To grasp the nature and depth of the problem of handling people with special needs in the corrections system.
• To understand the trend toward incarcerating the mentally ill.
• To have a sense of the rates of mental illness among the incarcerated population.
• To be aware of the issues around aging, physical illness, and death among prisoners.
• To grasp some of the challenges for staff and administrators with segregated vulnerable prisoners.
• To gain a sense of the problems faced by LGBTQ individuals in highly gender-segregated institutions.
• To be able to discuss the dilemma of prisoners receiving health care that they may not have received
• in their own community and that may rival what staff can afford.
• Understand how custody can be an opportunity to address prisoner vulnerability before release to the community.