Health Care Policies Addressing Transgender Inmates in Prison Systems in the United States

Abstract

Inmates with gender identity disorders (GID) pose special challenges to policy makers in U.S. prison systems. Transgender persons are likely overrepresented in prisons; a reasonable estimate is that at least 750 transgender prisoners were in custody in 2007. Using the Freedom of Information Act, requests were mailed to each state, the District of Columbia, and the Federal Bureau of Prisons in 2007. The requests were for copies of policies, directives, memos, or other documents concerning placement and health care access of transgender inmates. By April 2008, 46 responses were received; 6 states did not reply. Information was qualitatively analyzed and summarized. There was substantial disparity in transgender health care for inmates with GID or related conditions. Most systems allowed for diagnostic evaluations. There was wide variability in access to cross-sex hormones, with some allowing for continuation of treatment and others allowing for both continuation and de novo initiation of treatment. There was uniformity in denial of surgical treatments for GID.

Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women’s healthcare experiences in sex-segregated jails and prisons

“…Due to many participants strong desire to affirm their gender, it is possible that participants more readily recalled negative healthcare experiences than positive encounters, thus the data may be subjects to recall bias. Nonetheless, our findings extend prior quantitative research documenting structural and interpersonal barriers to care among incarcerated transgender individuals (e.g., Brown, 2009; Lydon, 2015). Additionally, the findings reported here only represent the perspective of transgender women who sought healthcare while incarcerated, and do not account for the perspectives of providers in these settings.…”

“…According to a 2009 study (Brown and McDuffie, 2009), the vast majority of jurisdictions have policies that allow transgender individuals to continue hormone therapy provided that they are able to provide sufficient documentation (i.e., medical records) proving that they were prescribed hormones by a physician prior to incarceration. Correctional healthcare providers report that the policies requiring documentation of prior use of hormones are in place to reduce healthcare expenditures and prevent inmates from exploiting their access to free healthcare by acquiring medications that were not deemed medically necessary prior to incarceration (Clark and Hughto White, 2016).…”

Working with transgendered sex offenders: prison staff experiences

“…Indeed, being seen by experts regarding gender identity concerns is an important issue for transgender offenders (Chaplin et al, 2014) and this may be an important bridge to gap between prison authorities and transgender offenders, particularly as lack of support can leave them potentially vulnerable to self-harm and suicide (Coleman et al, 2012). Despite the US research demonstrating these needs, reviews of the legal efforts highlight an ongoing struggle for transgender individuals to secure basic human rights (Simopoulos and Khin, 2014); Brown and McDuffie, 2009). …”

“…with clothes, hair, make up) and health considerations (Brown, 2007). There is also an increased need for medical and psychiatric specialist care, as well as gender identity specialists (Brown and McDuffie, 2009). Indeed, being seen by experts regarding gender identity concerns is an important issue for transgender offenders (Chaplin et al, 2014) and this may be an important bridge to gap between prison authorities and transgender offenders, particularly as lack of support can leave them potentially vulnerable to self-harm and suicide (Coleman et al, 2012).…”

Narratives of Transgender People Detained in Prison: The Role Played by the Utterances “Not” (as a Feeling of Hetero- and Auto-rejection) and “Exist” (as a Feeling of Hetero- and Auto-acceptance) for the Construction of a Discursive Self. A Suggestion of Goals and Strategies for Psychological Counseling

“…As shown by several studies focused on this topic (Brown and McDuffie, 2009; Chianura et al, 2010; Brown, 2014), transgender people in prison request special needs, whether compared to other typologies of prisoners. Transgender inmates, indeed, are generally more exposed to processes of violence and exclusion, and such a harsh existential condition exacerbates even more within highly institutionalized contexts, such as prisons.…”