I have a quick ‘n easy solution for those pesky requests for a second mattress that plague all correctional facilities. But before I get to that, though, there are two important points to consider in any discussion about second mattresses in correctional facilities.
First, providing inmates with mattresses, like inmate clothes and toiletries, is the purview and duty of the correctional officers, not the medical staff. What this means is that when an inmate asks for a second mattress, the question being put to us is this: Is there a medical need for this patient to have a second mattress? This is critically important. The inmate would prefer to frame the question differently, something like this: “The correctional officers only issued me one mattress, but you can over-rule them and authorize me to have a second mattress. Will you do me this favor?” This is a totally different question than “Does this patient have a medical need for a second mattress.”
Secondly, having a second mattress is a status symbol inside the correctional community. When an inmate receives a benefit that other inmates do not, he gains status and prestige. Sometimes this motivation is as important for an experienced inmate as is the extra comfort of a second mattress. I believe that if a jail provided two mattresses to every inmate in the facility, there would be requests to medical for three mattresses. (Pretty soon inmate beds would rival “The Princess and the Pea!”) So when we grant inappropriate requests for second mattresses, we are conferring status on the inmate in question. And we are denying status to those who we refuse. This also, in my mind, is important to consider.
So now to the main topic of the day: What constitutes a “medical need” for a second mattress? In my opinion—there are none! Zero. Nada. There is no medical need ever for a second mattress. I challenge anyone to find a reference in any medical literature saying that second mattresses are a treatment for anything. For example, a common reason given by inmates requesting a second mattress is that they have chronic back pain. However, if you pull out any medical textbook that deals with the treatment of chronic back pain, you will not find second mattresses mentioned in any. Go ahead! Look!
I will acknowledge that there are patients who have a medical need for a hospital bed. For example, we recently had a quadriplegic in one of my jails. He didn’t need a second mattress, he needed a hospital bed. Likewise, a patient with congestive heart failure who needs to sleep with the head of the bed elevated needs a hospital bed. A second mattress will not do the trick. I can think of many examples of medical conditions that would require a hospital bed, but I can’t think of a single instance when a second mattress would be an appropriate substitute.
Once you accept this premise—that there is no medical need for a second mattress–it ceases to be a medical concern. Such requests will no longer be routed through medical. The Correctional Officers can deal with requests for a second mattress. If they want to give an inmate a second mattress out of the kindness of their hearts, they may, but it is not a medical issue. Some facilities have opted to grant second mattresses as a comfort item to, say, women in the third trimester of pregnancy. Or to the elderly. This is fine, but this is a humanitarian gesture, not a medical need.
In my experience, once the policy that no one gets a second mattress for medical reasons becomes established in a facility, the requests for a second mattress fade away almost to nothing. Also, grievances relating to second mattresses will disappear, since a common cause of grievances is perceived unfairness. If you grant second mattresses to some but not others, the ones who do not get them will feel slighted. If everyone is treated the same, i.e. no second mattresses for anyone, inmates will not feel that they have been treated unfairly.
This policy has worked well in my facilities and in a few others I have heard of (notably the Maricopa County Jail in Phoenix, where I was first turned on to this concept). I heartily recommend it.