As an increasing number of Americans are being incarcerated in the nation's prisons, jails and correctional facilities - 1.8 million (NCJRS, 1999), the horror of sexual victimization while incarcerated continues to affect countless individuals - youth, men and women who have been confined. Mental health professionals who serve inmates (both juvenile and adult) within correctional facilities and upon release to the community are in a unique position to address this problem in a number of ways.

Although the problem of inmate sexual assault has been known and examined in the past 30 years, the body of evidence has failed to be translated into effective intervention strategies for treating inmate victims and for insuring improved correctional practices and management.  The situation is further complicated by problems faced by most correctional institutions.   While the rate of incarceration in the United States has doubled within the last decade alone, nationwide, most penal settings are 
operating well beyond their rated capacity, with problems of overcrowding, under staffing and inadequate resources being common.  As a result, inmate sexual assault, called by some to be the 'extra punishment anyone sentenced to prison can expect,' (Weiss and Friar, 1974) continues to terrorize certain inmates.

The actual extent of prison sexual assault is still unknown.  The incidence of inmate sexual victimization is quite variable and difficult to predict with accuracy (Dumond, 1992). Despite increased attention to the problem, a recent analysis of the Nebraska prison system by Struckman-Johnson et al. (1995, 1996) revealed fairly high rates of forced/coerced sexual activity in confinement (medium/maximum - 22% of male prisoners; 16% minimum).  The same study noted that the problem appeared to be aggravated in larger prison systems with more crowded inmate populations with greater ethnic diversity.   Cotton & Groth's (1984) observation appears to still retain its validity:

Available statistics, must be regarded as VERY CONSERVATIVE AT BEST, since discovery and documentation of this behavior are compromised by the nature of prison conditions, inmate codes and subculture and staff attitudes.

The problem is further complicated by the complex social/psychological milieu of the incarcerated setting.  Coerced sexual assault may take many form, on a continuum ranging from trading sex for protection ('hooking up') to brutal gang rape.  There is a general joining of social status and sexual behavior while incarcerated, which leads many inmates to be cast in a role which can be extremely humiliating. 

Contrary to popular perception, it must be understood that NO inmate is immune from sexual victimization.  This being said, certain groups of inmates appear to be more vulnerable - they include (1) young, inexperienced,  (2)physically  small/weak, (3) inmates suffering from mental illness and/or developmental disabilities, (4) middle class, not 'tough' or 'street wise', (5) not gang affiliated, (6) known to be homosexual or overtly effeminate (if male), (7) convicted of sexual crimes, (8) violated the 'code of silence' or 'rats', (9) disliked by staff/other inmates, (10) previously sexually assaulted (Donaldson, 1993; Dumond, 1992, 1995, Fagan, Wennerstrom and Miller, 1996).  The issue of race has also been identified (Cotton, 1980, 1995; Wooden & Parker (1982), especially in those settings with disproportionate racial populations and high racial tension  (Knowles, 1997).
 
The effects of sexual victimization are pervasive and devastating, with profound physical, social and psychological components.  These effects are magnified in captivity - the perpetrator(s) actions and beliefs profoundly influence the psychology of the victim (Herman, 1992), and some inmates experience a systematic, repetitive infliction of psychological trauma, physical/sexual assault, continuation of terror, helplessness, and fear.  Whatever an inmate victim chooses to do regarding the sexual assault - reporting the crime, seeking protective custody (p.c.),  protective pairing - has profound impact upon their future life while incarcerated.  In addition to the physical harm, risk of HIV+/STD, medical injuries, PTSD, depression, suicidal ideation, victims face the loss of social status in the incarcerated community, risk further labeling and stigmatization (especially if they report or choose p.c.) and may be vulnerable to further victimization (by the same offender or others).

Clinicians who respond to inmate victims should be acutely aware of the sequelae of sexual victimization, both physically and psychologically (See Cotton & Groth, 1982, 1984; Lockwood, 1978, 1980 and Scacco, 1975, 1982).  Interestingly, many mental health clinicians may be more familiar with treating sexual predators than in understanding and treating victims of sexual assault. 

An inter-disciplinary approach to care, with special attention to confronting the risk of suicide and to insuring the on-going safety and well being of the inmate following the intervention.  Clinicians must be prepared to intercede with security, classification and administrative staff to effectively manage victim care.  Standard P-57 Sexual Assault of The National Commission on Correctional Health Care (1997) should be universally adopted in all correctional settings. Another exemplary, comprehensive model to emulate is PS 5324.04 Sexual Abuse/Assault Prevention and Intervention Programs (updated 12/31/97) of the Federal Bureau of Prisons [which can be accessed at http://www.bop.gov/progstat/53240104.html]. Correctional Trainers and Staff Development Officers may also wish to examine an excellent training resource 
by AIMS Multimedia (1-800-367-2467) entitled. #8856: The Correctional Officer:Recognizing and Preventing Closed-Custody Male Sexual Assaults, which also comes with a detailed training outline for use with other related materials.

The issue of HIV+ and sexually transmitted disease bears additional comment.  As noted by Hammett et al. (1999), inmates have disproportionately high rates of infectious disease, substance abuse, high-risk sexual activity and other health care problems.  Although the rate of transmission of HIV+/AIDS by coerced sexual assault against inmates is unknown, all victims of sexual assault of inmates while incarcerated face the possibility of an 'unadjudicated death sentence' (Corrections Compendium, 1995), a significant subversion of the intent of the criminal justice system. 

The issue of sexual misconduct/abuse/assault by staff on male and female inmates is also an important issue to address.  It has become Increasingly apparent that women in confinement face substantial risk of sexual assault by a small number of ruthless male correctional staff, who use terror, retaliation and repeated victimization to coerce and intimidate confined women (Human Rights Watch, 1996, 1998; Smith, 1998; Amnesty International, 1999; Coomarasswamy, 1999; Government Accounting Office, 1999).  Concerns about this issue led the National Institute of Corrections (1999) to solicit submissions for the development of 'A training curriculum for investigating allegations of staff sexual misconduct with inmates.'  Such abuses are intolerable: they are fundamental violations of incarceration, and defile the guiding principles of correctional environments ('the care, custody and control of inmates').  Mental health clinicians must be willing to entertain such complaints and act aggressively to pursue justice to protect and treat inmates so victimized.  Additionally, all correctional institutions incarcerating women should adopt the standards and practice of the Georgia Department of Correction (NBC, 1999).
 
The nature of the incarcerated setting, itself, complicates continuity and thoroughness of care for the victim. Many inmates face transfer to different institutions, often unexpectedly. It is vital that treating clinicians insure on-going care of inmate victims if and when they are transferred from one institution to another.  There should also be clear differentiation between the needs of the inmate victim who will be released within a short period of time, and those who will be incarcerated for an extended period of time. Clinicians need to plan their treatment strategies accordingly. Finally, inmate victims, upon release, whether to parole or to the community, should be provided competent, community intervention/treatment.

Mental health professionals also have an opportunity to impact correctional staff and their attitudes which, unfortunately, may exacerbate the victimization experience for inmates. Gardner (1986) identified that education and age were factors in correctional officers' attitudes about inmate victims. Eigenberg's disturbing analysis of officers employed in the Texas Department of Correction (1989) found that half of the officers surveyed engaged in victim blaming and that many were apt to define rape victims as prostitutes and believed that homosexuals 'cry rape' if they are caught during the act of intercourse.  In a later amplified analysis, Eigenberg (1994) focused on staff training as a key ingredient to pro-actively and responsibly dealing with counter-productive staff attitudes.   Staff training programs such as those operating in the Massachusetts 
Department of Correction (1995) and the Federal Bureau of Prison are important contributions to increasing the professional response toward this issue.   (See also an insightful analysis by Dallou in Corrections Today, December 1996 and Donaldson, S. (1993)  Prisoner Rape Education Program: Overview for Administrators and Staff).

There are no panaceas for such a complex and difficult phenomenon as inmate sexual assault while incarcerated.  Mental health practitioners will be increasingly involved in dealing with this issue and in forging more responsive treatment strategies for individual victims themselves and in helping institutions respond more affirmatively.  We are in a pivotal role to shape the training efforts of correctional staff and to improve and enhance the classification system for identifying at-risk inmates. Administrators, government officials and security staff will look for and expect clinicians to give them insight into this often misunderstood and ill-managed problem.  Our inaction in this vital arena portends dire consequences for corrections and American society itself.
 
*This article was first published in the American Psychological Association's Division 18 Newsletter. To reach Dumond, you can email him at RWDumond@aol.com

References

Amnesty International. (1999). Not Part of My Sentence: Violations of the 
Human Rights of Women In Custody.  New York: Amnesty International USA. [may 
be accessed on the Amnesty International website at 
http://www.amnesty-usa.org/rightsforall/women/index.html].

Bureau of Prisons. (1997). PS 5324.04 Sexual Abuse/Assault Prevention and 
Intervention Programs.  <http://www.bop.gov/progstat/53240104.html> (15 Aug. 
1999). 

Coomaraswamy, R. (1999). Report on the Mission of the United States of 
America on the Issue of Violence Against Women in State and Federal Prisons. 
{E/CN.4/1999/68/Add.2} Geneva, Switzerland: United Nations High Commissioner. 
 [may be accessed on the U.N.Nations High Commissioner for Human Rights, 
Geneva, Switzerland website http://www.unhchr.ch/Huridocda/Huridoca.nsf/TestFrame/7560a6237c67bb118025674c
004406e9?Opendocument].

Corrections Compendium. (1995).  'Breaking the Silence on Prison Rape and 
AIDS'.  Corrections Compendium, XX, (July), 14.

Cotton, D.J. & Groth, A.N. (1982).  'Inmate rape: prevention and 
intervention'.  Journal of Prison and Jail Health, 2 (1), 47 - 57

Cotton, D.J. & Groth, A.N. (1984).  'Sexual assault in correctional 
institutions: prevention and intervention'.  In I.R. Stuart, Ed. (1984). 
Victims of Sexual Aggression: Treatment of Children, Women and Men.  New 
York: Van Nostrand Reinhold.

Dallou, M. (1996). 'Fighting prison rape: How to make your facility safer,' 
Corrections Today, 58 (7), 100-106. 

Donaldson, S. (1993).  Prisoner Rape Education Program: Overview for 
Administrators and Staff.  Brandon: VT: The Safer Society Press.

Dumond, R.W. (1992).  'The sexual assault of male inmates in incarcerated 
settings'.  International Journal of the Sociology of Law, 20 (2), 135 - 157.

Dumond, R.W. (1995). 'Ignominious Victims: Effective Treatment of Male Sexual 
Assault Victims in Incarcerated Settings', [with Marie King, Ph.D. & Karen 
Brouhard, LICSW],  Chair, Symposium at the 102nds Annual Conference of the 
American Psychological Association, New York City, New York, August 15, 1995

Eigenberg, H.M. (1989).  'Male rape: An empirical examination of correctional 
officer's attitudes toward rape in prison'. The Prison Journal, 68 (1), 39 - 
56.

Eigenberg, H.M. (1994).  'Male rape in prisons: Examining the relationship 
between correctional officers' attitudes toward male rape and their 
willingness to respond to acts of rape'.  In M.C. Braswell, R.H. Montgomery, 
Jr. & L.X. Lombardo (Eds.) Prison Violence in America, 2nd Edition. 
Cincinnati: Henderson.

Fagan, T.J.; Wennerstrom, D; and Miller, J. (1996). 'Sexual assault of male 
inmates: Prevention, identification and intervention.' Journal of 
Correctional Health Care, 3 (1): 49-66.
 
Gardner, J.J. (1986).  'Attitudes about rape among inmates and correctional 
officers'.  Dissertation Abstracts International, 47, 12(1), June, 4515-A.

Hammett, T.M., Harmon, P & Maruschak, L.M. (1999). '1996-1997 Update: 
HIV/AIDS, STDs and TB in correctional facilities.'  Issues and Practices. 
Washington, D.C.: United States Department of Justice. 
<http://www.ncjrs.org/txtfiles1/176344.txt> (25 Aug. 1999).

Herman, J.L. (1992).  'Complex PTSD: A syndrome in survivors of prolonged and 
repeated trauma'.  Journal of Traumatic Stress, 5 (3), 377 - 389.

Human Rights Watch. (1996). All Too Familiar: Sexual Abuse of Women in U.S. 
State Prisons. New York: Human Rights Watch.

Human Rights Watch. (1998). Nowhere to Hide: Retaliation Against Women in 
Michigan State Prisons. New York: Human Rights Watch. [Summary can be 
accessed on the Human Rights Watch website at 
http://www.hrw.org/hrw/reports98/women/Mich.htm].

Knowles, G.J. (1996). Male Sexual Assault: A Search for Causation and 
Prevention. San Diego, CA: Cambridge Scientific Abstracts/Sociological Abstracts
[Accension No. 96532302]

Lockwood, D. (1978).  Sexual Aggression Among Male Prisoners.  Ann Arbor, MI: 
University Microfilms International.

Lockwood, D. (1980).  Prison Sexual Violence.  New York: Elsevia/Thomond 
Books.

Lockwood, D. (1994).  'Issues in prison sexual violence'. In M.C. Braswell, 
R.H. Montgomery, Jr. & L.X. Lombardo (Eds.) Prison Violence in America, 2nd 
Edition.  Cincinnati: Henderson.

National Broadcasting Company. (1999). Women Behind Bars: Geraldo Rivera 
Reports.  www.ojp.usdoj.gov/bjs/correct.htmDocumentary aired on Friday, September 11, 1999 at 10:00PM (EST).

National Commission on Correctional Health Care. (1997).  Standards for 
Health Services in Prisons. Chicago: National Commission on Correctional 
Health Care.

Scacco, A.M. (1975).  Rape in Prison.  Springfield, IL: Charles C. Thomas.

Scacco, A.M. (Ed.). (1982).  Male Rape: a Casebook of Sexual Aggression.  New 
York: AMS Press, Inc.

Smith, B. (1998). An End to Silence: Women Prisoner's Handbook on Identifying 
and Addressing Sexual Misconduct.  Washington, D.C.: National Women's Law 
Center. [may be 

Struckman-Johnson, C.J., Struckman-Johnson, D.L., Rucker, L., Bumby, K., & 
Donaldson, S. (1995).  'A Survey of Inmate and Staff Perspectives on Prisoner 
Sexual Assault'.  Paper presented at the Annual Meeting of the Midwestern 
Psychological Association in Chicago,  May 4, 1995.
 
Struckman-Johnson, C.J., Struckman-Johnson, D.L., Rucker, L., Bumby, K., & 
Donaldson, S. (1996) 'Sexual coercion reported by men and women in prison.' 
The Journal of Sex Research, 33, (1), 67-76.

Toch, H. (1992).  Mosaic of Despair: human breakdowns in prison. (Revised 
Edition).   Washington, D.C.:  American Psychological Association.

United States Department of Justice. (1999). 'Summary Findings for 
correctional populations.'   <http:www.ojp.usdoj.gov/bjs/correct.htm> (29 
Aug. 1999).

United States Department of Justice. (1999).  National Institute of 
Corrections Solicitation For a Cooperative Agreement on the Development of a 
Training Curriculum for Investigating Allegations of Staff Sexual Misconduct 
with Inmates. Washington: D.C.: United States Department of Justice. [may be 
accessed at the NCIC webstite at 
http://www.nicic.org/inst/coop-miscondcurr99.htm].

United States General Accounting Office. (1999). Women in Prison: Sexual 
Misconduct by Correctional Staff.  United States General Accounting Office 
Report to the Honorable Eleanor Holms Norton (GAO/GGD-99-104) [may be 
accessed on the GAO website at http://www.gao.gov/new.items/gg99104.pdf].

Weiss, C. & Friar, D.J. (1974).  Terror in the Prisons: Homosexual Rape and 
Why Society Condones It.  Indianapolis: Bobbs-Merrill.

Wooden, WS & Parker, J. (1982).  Men Behind Bars: Sexual Exploitation in 
Prison. New York: Plenum Press.