Sexual victimization survey carries clinical implications

The Federal Prison Rape Elimination Act of 2003 requires an annual survey of prisoners to collect data regarding episodes of sexual abuse and victimization between and against inmates. The 2013 report from the Department of Justice was released in May and covered data from the preceding year. I spent some time wading through the 108-page report and wanted to present some of my “take-away” points for correctional clinicians.

First, some background regarding how the survey was conducted. Both public and privately run facilities were selected based upon a randomized, stratified list of all jails, prisons, military, and immigration facilities as well as correctional facilities in Native American jurisdictions. In all, 225 prisons and 358 jails reported data.

Within each facility, a random sampling of prisoners were selected to participate, and the survey was designed to capture a representative sample based on gender and age. Inmates as young as 16 years of age were surveyed, making this the first report of sexual victimization of juveniles held in adult facilities. More than 92,000 inmates were surveyed. Each inmate was asked questions regarding any incident of sexual contact, activity or abuse within the past 12 months as well as the frequency of the abuse.

The survey was administered anonymously and confidentially, so no data were available to confirm accuracy of the inmate report or the outcome of a given incident if it was reported.

Respondents were asked about incidents of inmate-upon-inmate sexual contact as well as staff-upon-inmate events. The activity was classified as either consensual or abusive when committed by an inmate; when committed by staff the activity was classified as either “willing” or “unwilling.”

In addition to information about the sexual activity, respondents were asked to provide information about previous psychiatric contacts. They were asked whether they had ever been told they had a mental disorder, had been kept overnight in a psychiatric unit or facility, had been treated with medication or participated in counseling. All respondents also were asked to complete an epidemiologic screening instrument known as the K6, which is a brief measure of psychological symptoms. They were then classified as being “seriously psychologically distressed” (SPD) based upon the K6 cutoff score.

Overall, 4% of jail and prison inmates reported one or more incidents of sexual victimization by another inmate or by staff. Among prison inmates, 2% reported the incident involved another inmate, while 2.4% involved staff. Both inmates and staff perpetrated assaults on 0.4% of prisoners. Rates were similar but slightly lower for jail detainees.

Victim characteristics differed based upon the perpetrator of the abuse. Victims of inmate abuse tended to be female, white, never-married, and college educated. Victims of staff abuse tended to be male, black, and in the 20- to 24-year age group.

Age generally was not a factor in inmate victimization in that juveniles held in adult facilities had no different rate of victimization than adults. However, risk of abuse generally appeared to decrease after the age of 55.

Physical stature, as measured by the calculated body mass index (BMI), was related to sexual victimization in jail, where underweight and morbidly obese inmates both had nearly double the rate of inmate-on-inmate victimization. Conversely, among prisoners, overweight or obese inmates were less likely to be victimized by their peers.

Inmates held for violent sex offenses had higher rates of inmate-on-inmate victimization than inmates held for other offenses.

Sexual orientation was significantly correlated with victimization for both adults and juveniles. Non-heterosexual inmates were among those with the highest rates of victimization. In prison, 12.2% were victimized by peers and 5.4% by staff. Non-heterosexual juveniles were similarly at risk, particularly those charged with violent sex offenses. Most juveniles were victimized more than once and fewer than one in six reported the incident to staff, family or another outsider.

Peer victimization rates were two to four times higher among inmates with a history of medication use or counseling. Inmates classified as having “serious psychological distress” (SPD) had significantly higher rates of both inmate and staff inflicted victimization, however they also were more likely to report the abuse. A non-heterosexual orientation also was associated with high rates of victimization for SPD prisoners.

Given this information, correctional clinicians can be cognizant of risk factors for sexual victimization among jail and prison inmates. Gay or bisexual prisoners, prisoners charged with violent sex offenses, and those exhibiting high levels of psychological distress might warrant additional questions regarding victimization during previous incarceration or current problems in the facility. Protective custody might be considered, but should not be mandated by policy given that this might reduce access to rehabilitation programs or services. Inmates at risk also can be educated about reporting mechanisms and available counseling services should the need arise.

 —Annette Hanson, M.D.

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

The Federal Prison Rape Elimination Act of 2003 requires an annual survey of prisoners to collect data regarding episodes of sexual abuse and victimization between and against inmates. The 2013 report from the Department of Justice was released in May and covered data from the preceding year. I spent some time wading through the 108-page report and wanted to present some of my “take-away” points for correctional clinicians.

First, some background regarding how the survey was conducted. Both public and privately run facilities were selected based upon a randomized, stratified list of all jails, prisons, military, and immigration facilities as well as correctional facilities in Native American jurisdictions. In all, 225 prisons and 358 jails reported data.

Within each facility, a random sampling of prisoners were selected to participate, and the survey was designed to capture a representative sample based on gender and age. Inmates as young as 16 years of age were surveyed, making this the first report of sexual victimization of juveniles held in adult facilities. More than 92,000 inmates were surveyed. Each inmate was asked questions regarding any incident of sexual contact, activity or abuse within the past 12 months as well as the frequency of the abuse.

The survey was administered anonymously and confidentially, so no data were available to confirm accuracy of the inmate report or the outcome of a given incident if it was reported.

Respondents were asked about incidents of inmate-upon-inmate sexual contact as well as staff-upon-inmate events. The activity was classified as either consensual or abusive when committed by an inmate; when committed by staff the activity was classified as either “willing” or “unwilling.”

In addition to information about the sexual activity, respondents were asked to provide information about previous psychiatric contacts. They were asked whether they had ever been told they had a mental disorder, had been kept overnight in a psychiatric unit or facility, had been treated with medication or participated in counseling. All respondents also were asked to complete an epidemiologic screening instrument known as the K6, which is a brief measure of psychological symptoms. They were then classified as being “seriously psychologically distressed” (SPD) based upon the K6 cutoff score.

Overall, 4% of jail and prison inmates reported one or more incidents of sexual victimization by another inmate or by staff. Among prison inmates, 2% reported the incident involved another inmate, while 2.4% involved staff. Both inmates and staff perpetrated assaults on 0.4% of prisoners. Rates were similar but slightly lower for jail detainees.

Victim characteristics differed based upon the perpetrator of the abuse. Victims of inmate abuse tended to be female, white, never-married, and college educated. Victims of staff abuse tended to be male, black, and in the 20- to 24-year age group.

Age generally was not a factor in inmate victimization in that juveniles held in adult facilities had no different rate of victimization than adults. However, risk of abuse generally appeared to decrease after the age of 55.

Physical stature, as measured by the calculated body mass index (BMI), was related to sexual victimization in jail, where underweight and morbidly obese inmates both had nearly double the rate of inmate-on-inmate victimization. Conversely, among prisoners, overweight or obese inmates were less likely to be victimized by their peers.

Inmates held for violent sex offenses had higher rates of inmate-on-inmate victimization than inmates held for other offenses.

Sexual orientation was significantly correlated with victimization for both adults and juveniles. Non-heterosexual inmates were among those with the highest rates of victimization. In prison, 12.2% were victimized by peers and 5.4% by staff. Non-heterosexual juveniles were similarly at risk, particularly those charged with violent sex offenses. Most juveniles were victimized more than once and fewer than one in six reported the incident to staff, family or another outsider.

Peer victimization rates were two to four times higher among inmates with a history of medication use or counseling. Inmates classified as having “serious psychological distress” (SPD) had significantly higher rates of both inmate and staff inflicted victimization, however they also were more likely to report the abuse. A non-heterosexual orientation also was associated with high rates of victimization for SPD prisoners.

Given this information, correctional clinicians can be cognizant of risk factors for sexual victimization among jail and prison inmates. Gay or bisexual prisoners, prisoners charged with violent sex offenses, and those exhibiting high levels of psychological distress might warrant additional questions regarding victimization during previous incarceration or current problems in the facility. Protective custody might be considered, but should not be mandated by policy given that this might reduce access to rehabilitation programs or services. Inmates at risk also can be educated about reporting mechanisms and available counseling services should the need arise.

 —Annette Hanson, M.D.

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

The Federal Prison Rape Elimination Act of 2003 requires an annual survey of prisoners to collect data regarding episodes of sexual abuse and victimization between and against inmates. The 2013 report from the Department of Justice was released in May and covered data from the preceding year. I spent some time wading through the 108-page report and wanted to present some of my “take-away” points for correctional clinicians.

First, some background regarding how the survey was conducted. Both public and privately run facilities were selected based upon a randomized, stratified list of all jails, prisons, military, and immigration facilities as well as correctional facilities in Native American jurisdictions. In all, 225 prisons and 358 jails reported data.

Within each facility, a random sampling of prisoners were selected to participate, and the survey was designed to capture a representative sample based on gender and age. Inmates as young as 16 years of age were surveyed, making this the first report of sexual victimization of juveniles held in adult facilities. More than 92,000 inmates were surveyed. Each inmate was asked questions regarding any incident of sexual contact, activity or abuse within the past 12 months as well as the frequency of the abuse.

The survey was administered anonymously and confidentially, so no data were available to confirm accuracy of the inmate report or the outcome of a given incident if it was reported.

Respondents were asked about incidents of inmate-upon-inmate sexual contact as well as staff-upon-inmate events. The activity was classified as either consensual or abusive when committed by an inmate; when committed by staff the activity was classified as either “willing” or “unwilling.”

In addition to information about the sexual activity, respondents were asked to provide information about previous psychiatric contacts. They were asked whether they had ever been told they had a mental disorder, had been kept overnight in a psychiatric unit or facility, had been treated with medication or participated in counseling. All respondents also were asked to complete an epidemiologic screening instrument known as the K6, which is a brief measure of psychological symptoms. They were then classified as being “seriously psychologically distressed” (SPD) based upon the K6 cutoff score.

Overall, 4% of jail and prison inmates reported one or more incidents of sexual victimization by another inmate or by staff. Among prison inmates, 2% reported the incident involved another inmate, while 2.4% involved staff. Both inmates and staff perpetrated assaults on 0.4% of prisoners. Rates were similar but slightly lower for jail detainees.

Victim characteristics differed based upon the perpetrator of the abuse. Victims of inmate abuse tended to be female, white, never-married, and college educated. Victims of staff abuse tended to be male, black, and in the 20- to 24-year age group.

Age generally was not a factor in inmate victimization in that juveniles held in adult facilities had no different rate of victimization than adults. However, risk of abuse generally appeared to decrease after the age of 55.

Physical stature, as measured by the calculated body mass index (BMI), was related to sexual victimization in jail, where underweight and morbidly obese inmates both had nearly double the rate of inmate-on-inmate victimization. Conversely, among prisoners, overweight or obese inmates were less likely to be victimized by their peers.

Inmates held for violent sex offenses had higher rates of inmate-on-inmate victimization than inmates held for other offenses.

Sexual orientation was significantly correlated with victimization for both adults and juveniles. Non-heterosexual inmates were among those with the highest rates of victimization. In prison, 12.2% were victimized by peers and 5.4% by staff. Non-heterosexual juveniles were similarly at risk, particularly those charged with violent sex offenses. Most juveniles were victimized more than once and fewer than one in six reported the incident to staff, family or another outsider.

Peer victimization rates were two to four times higher among inmates with a history of medication use or counseling. Inmates classified as having “serious psychological distress” (SPD) had significantly higher rates of both inmate and staff inflicted victimization, however they also were more likely to report the abuse. A non-heterosexual orientation also was associated with high rates of victimization for SPD prisoners.

Given this information, correctional clinicians can be cognizant of risk factors for sexual victimization among jail and prison inmates. Gay or bisexual prisoners, prisoners charged with violent sex offenses, and those exhibiting high levels of psychological distress might warrant additional questions regarding victimization during previous incarceration or current problems in the facility. Protective custody might be considered, but should not be mandated by policy given that this might reduce access to rehabilitation programs or services. Inmates at risk also can be educated about reporting mechanisms and available counseling services should the need arise.

 —Annette Hanson, M.D.

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.