Mental health services in Nigerian prisons: Lessons from a four-year review and the literature

Absconsion in forensic psychiatric services: a systematic review of literature

While serious concerns are often raised when patients abscond or leave unauthorized from psychiatric services, there is limited knowledge about absconsion in forensic psychiatric services. Following the preferred reporting items for systematic reviews and meta-analyses guideline, we searched Medline/PubMed, PsycINFO, EMBASE, CINAHL, Scopus, and Web of Science through May 2020 for eligible reports on absconsion in forensic patients with no language limits. The search string combined terms for absconsion, forensic patients, and psychiatry in various permutations. This was supplemented by snowball searching for additional studies. Of the 565 articles screened, 25 eligible studies, including two interventional, seven cross-sectional, and 16 case-controlled studies spanning five decades were included. Absconsion and re-absconsion rates ranged from 0.2% to 54.4% and 15% to 71%, respectively, albeit higher rates trended with less secure psychiatric units. Previous absconsion, aggression, substance use, high Historical Clinical Risk Management-20 score, anti-sociality, psychiatric symptoms, sexual offending, and poor treatment adherence were the factors reported with a degree of predictive value for absconsion. However, the construct of absconsion was heterogeneous in the included studies and the quality of evidence on the predictors of absconsion was limited. Serious risky behaviors including re-offending, violence, self-harm, suicide, rape, and manslaughter were perpetrated by patients during unauthorized leave. Nevertheless, the rates of re-offending were generally low in the included studies (highest recidivism rate = 0.11). There is need for standardized assessment and documentation of absconsion to improve risk analysis and management. Furthermore, it is necessary to develop a structured guideline for defining absconsion, and to create a protocol that operationalizes all absconsion-related behaviors/events to promote reliable assessment and comparative analysis in future studies.

Implementation of risk assessment tools in psychiatric services

Violence remains a major risk management concern in psychiatric services with implications on the safety and well-being of patients, staff, and the public. Serious physical and psychological consequences of violence involving property damage, bodily injuries, and threat to life have been reported in mental health services. Risk assessment tools are important safeguard measures; however, research on clinical implementation is presently limited. Structured professional judgment (SPJ) risk management tools that incorporate professional discretion with analytical understanding of evidence-based risk factors are widely accepted for risk assessment. However, clinical utility is suboptimal due to several barriers, including those related to the tool, the clinical setting, and resistance from health professionals. To better understand the challenges militating against optimal implementation of risk assessment tools, we reviewed and presented some lessons from the implementation of clinical practice guidelines on a general scale and our experience implementing an SPJ tool called Hamilton Anatomy of Risk Management across a variety of psychiatric services. In summary, the clinical utility of risk assessment tools improves if the tool is psychometrically sound, concise, consensus rated, time efficient, and practical for planning risk management. User feedbacks on the tool utility are also important to sustain implementation.

Alcohol use disorder among prisoners in Debre Berhan prison, Ethiopia: a cross-sectional study

BACKGROUND

Several studies reported that history of alcohol use among prisoners is higher than the prevalence in the general population. Criminality is found to be associated with alcohol use disorder (AUD) in previous studies. In Ethiopia, there is limited information on the prevalence and associated factors of AUD among prisoners. Therefore, this study aimed to assess the prevalence and associated factors of AUD among prisoners of Debre Berhan Prison.

METHODS

A cross-sectional survey was conducted to assess history of AUD among prisoners at Debre Berhan Prison, before imprisonment. We selected 347 prisoners with a systematic sampling technique and interviewed using Alcohol Use Disorder Identification Test (AUDIT) to screen for AUD in May 2017. Data entry was done using Epi-Data version 3.1 software, and bivariate and multivariate analyses were done using Stata version 13 software. Crude and adjusted odds ratios, with 95% confidence intervals and p-values are reported.

RESULTS

About six out of ten prisoners (59.1%) had AUD before imprisonment. Factors associated with increased odds of AUD were perception that the current offence is related to using substances (AOR = 4.2; 95% CI = 2.3, 7.8), and family history of substance use (AOR = 8.7; 95% CI = 1.7, 44.9). Being married had lower odds of AUD compared to the unmarried (AOR = 0.5; 95% CI = 0.2, 0.9).

CONCLUSION

We found that the prevalence of AUD 1 year before imprisonment in this population is high. AUD is found to be associated with a family history of substance use and perception that the current offence is related to using a substance. We recommend community-based study with different kind of study designs to see the relationship between AUD and crime for planning interventions.

Prison mental healthcare: recent developments and future challenges

PURPOSE OF REVIEW

In prisons, resources for psychiatric care are limited, but the population is at high risk for mental disorders. This article aims to review recent findings and developments and to focus on the changing needs of prisoners and consequences for treatment.

RECENT FINDINGS

The evidence for high general prevalence rates of mental disorders in prison populations can be considered as robust worldwide. Recent meta-analyses focused on specific prevalence rates and found that complex disorders, such as attention deficit hyperactivity disorder and posttraumatic stress disorder, are also more common in prison populations. Interest is growing in studying subgroups with special needs, for example, women and older prisoners. Furthermore, a large amount of research deals with suicide and self-harm, especially risk factors and assessments. Promising results have been obtained for treatment outcome in substance use disorders. Psychological therapies, however, have not yet been proven to have sustaining effects.

SUMMARY

Considering the growing amount of research on prison inmates' mental health issues and heterogeneous needs, future studies should aim to consolidate previous findings and develop special diagnostic and therapeutic standards for mental healthcare in prisons that consider ethical aspects and human and financial resources.

The impact of urbanization on mental health service provision: a Brazil, Russia, India, China, South Africa and Africa focus

PURPOSE OF REVIEW

Asia and Africa are experiencing rapid urbanization and rural growth. This review focuses on the impact of urbanization on preventive and treatment mental health service provision with attention to the Brazil, Russia, India, China, and South Africa economic bloc and sub-Saharan Africa.

RECENT FINDINGS

A search of the PubMed, Academic Search Ultimate, and Global Health databases, and use of Google Scholar yielded relevant health, environmental, and urban planning research articles from sub-Saharan Africa and Brazil, India, China, and South Africa. Preventive services are ineffective in addressing violence exposure, substance use, poor quality housing, and spatial segregation, with differing trajectories in the various countries. Similarly, the impact of urbanization on social capital and green infrastructure is variable. Although Brazil appears to have a well-developed mental health system, it is unable to meet the care demand. Integrated country-wide and district-based analyses in China indicate planning is underway.

SUMMARY

In general, existing mental and general health services in low and middle-income countries are grossly inadequate in terms of prevention, coverage, and quality to withstand population transitions lying ahead. People with mental disability, as a vulnerable and stigmatized subpopulation, are at high risk of neglect as urbanization progresses, particularly in India and sub-Saharan Africa.