The mental health consequences of dealing with self-inflicted death in custody

The Total Worker Health® (TWH) approach: a systematic review of its application in different occupational settings

BACKGROUND

The National Institute for Occupational Safety and Health (NIOSH), in 2011, developed the "Total Worker Health®" (TWH) as a holistic approach to protect and promote the workers' safety, health, and well-being. After over ten years from the TWH development, the aim of the present systematic review is to provide a comprehensive overview of the worldwide TWH initiatives.

METHODS

PubMed, Scopus and ISI Web of Science were searched for TWH studies published up to the 31st of July 2023, and 43 investigations could be included. The review was registered on the International prospective register of systematic reviews PROSPERO with the reference number CRD42023416972.

RESULTS

Issues that emerged as relevant for the TWH operationalization were the awareness about the TWH approach and fundamentals, the leadership commitment, and a participatory engagement of the workforce: these aspects all contributed to acceptable and effective setting oriented TWH plans, specifically tailored on the peculiarities of the workplace, including small enterprises and multiemployer worksites. Evaluation and continual improvement were reported as fundamental for the successful implementation of TWH initiatives. Limited resources for safety and health initiatives, in terms of time, people, and funds, together with difficulties in the identification of safety and health priorities and a poor participatory culture were recognized as obstacles to the TWH application. Training resulted the core component of the TWH leadership and workforce preparedness, with beneficial results in terms of safety culture and adoption of preventive measures.

CONCLUSIONS

Although interesting aspects emerged from our review, future longitudinal investigations should confirm the effectiveness, easy integration, and long-term sustainability of TWH models in different workplaces, in order to effectively support safe and health-enhancing works able to improve innovation and productivity.

Prison and forensic mental health staff after suicides in their care. A narrative review of international and German national evidence

There is a growing body of international research investigating the impact of patient suicide on mental health professionals. The experience of losing a patient to suicide can have a significant and, in some cases, long-lasting (negative) impact on mental health professionals. However, the nature and extent of the impact on prison staff or forensic mental health professionals in particular is less clear. This narrative review summarises both quantitative and qualitative studies and key findings in this area, focusing on the above professions. A literature search was conducted using PsychInfo and Google Scholar, covering the period from 2000 onwards. The vast majority of findings relate to mental health professionals in general. We were unable to identify any published reports on the responses of forensic psychiatric staff. The majority of identified studies in the prison context are qualitative. Studies from German-speaking countries are particularly scarce in both the prison and mental health contexts. We conclude that there is a profound lack of knowledge about the impact of client/patient suicide on the subgroups of (German) prison and forensic psychiatric staff. Clearly, more research is needed on both the nature and extent of the impact, as well as on the specific organisational and supportive factors that help to mitigate the negative effects of suicide.

A systematic review and mixed-methods synthesis of the experiences, perceptions and attitudes of prison staff regarding adult prisoners who self-harm

BACKGROUND

Self-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety.

AIMS

To systematically review the experiences, perceptions and attitudes of staff in adult prisons regarding self-harm.

METHOD

Systematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity.

RESULTS

Two thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (n = 15) or poor (n = 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is 'manipulative' or 'attention-seeking' were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff-prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care.

CONCLUSIONS

There are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.

Impact of a Total Worker Health® Mentoring Program in a Correctional Workforce

(1) Background: Correctional Officers show signs of adverse health early in their careers. We evaluated the impact of a one-year peer health mentoring program for new officers based on a Total Worker Health® approach; (2) Methods: Cadets (n = 269) were randomly assigned to a mentored or control group. Cadets in this mixed methods design completed physical assessments, and surveys at three time points to assess demographics, health, mentoring, and workplace variables. Physical testing included several health markers. Surveys and physical data were analyzed as repeated measures. Regression analyses were used to analyze the relationship between mentoring characteristics and outcomes. A semi-structured interview of mentors was analyzed qualitatively. (3) Results: Higher mentoring frequency was associated with lower burnout. Health behaviors and outcomes declined over time in all groups, but mentees displayed slower decline for body mass index (BMI) and hypertension compared to controls. (4) Conclusions: A continuous peer health mentoring program seemed protective to new officers in reducing burnout and also declines in BMI and hypertension. Short-term physical health markers in younger officers may not be an index of psycho-social effects. A participatory design approach is recommended for a long-term health mentoring program to be both effective and sustainable.

Posttraumatic Stress Disorder Symptoms and Criminal Behavior in U.S. Army Populations: The Mediating Role of Psychopathy and Suicidal Ideation

Whereas past research has demonstrated the relationship between posttraumatic stress disorder (PTSD) and criminal behavior, the present study examines the underlying mechanisms driving this association. The primary objective was to determine the role of psychopathy and suicidal ideation as mediating factors in the relationship between military PTSD symptoms and criminal behavior (defined as incarceration status). A correlational study using archival data from the U.S. Disciplinary Barracks (USDB) and a control population of U.S. Army soldiers was conducted. The USDB provided data from 310 incarcerated male U.S. Army soldiers. Data were also collected from 310 nonincarcerated, male U.S. Army soldiers in the greater Fort Rucker, Alabama area. Data validity checks eliminated some cases, thus yielding a final dataset of 246 USDB and 252 control participants. The results suggested partial mediation, in that PTSD symptoms had a direct effect on incarceration status, and significant indirect effects through suicidal ideation and psychopathy while controlling for intelligence and warmth. In furnishing evidence of how psychopathy and suicidal ideation mediate the relationship between PTSD and incarceration status in military personnel, this research highlights specific internalization and externalization mechanisms that may increase the tendencies of people with greater PTSD symptoms to engage in criminal behaviors. By adding to the small amount of prior research on why PTSD sometimes leads people to engage in criminal behaviors, our research provides specific, observable symptoms that clinicians may use to identify, treat, and possibly ameliorate facets of PTSD that can lead affected people to engage in criminal behaviors.

PTSD and re-offending risk: the mediating role of worry and a negative perception of other people's support

BACKGROUND

Studies of posttraumatic stress disorder (PTSD) are mainly focused on victims of trauma. Very few studies explored the links between PTSD symptoms and re-offending risk in perpetrators of violence.

OBJECTIVE

The aim of the study was to assess the effect of PTSD symptoms on re-offending risk in prisoner populations with a focus on indirect effects of worry and a negative perception of other people's support on the relationship between PTSD and re-offending risk.

METHODS

75 prisoners (25 females, mean age: 44.36 years; 50 males, mean age: 34.7 years) were assessed for exposure to child abuse and neglect, PTSD symptoms, worry, a negative perception of other people's support and re-offending risk. Mediation analyses tested the indirect effects of worry and a negative perception of other people's support on the relationship between PTSD and re-offending risk.

RESULTS

72% participants presented PTSD symptoms and 30.7% were at risk of re-offending. Mediation analyses supported the hypothesis of a mediation pathway from PTSD to worry and a negative perception of other people's support to an increased risk of re-offending.

CONCLUSIONS

The results indicate that prisoners report high rates of PTSD symptoms; furthermore, they highlight an important relationship between PTSD and re-offending risk. Findings suggest that future research should test further the indirect effects of negative cognitive and emotional states on the relationship of PTSD and re-offending risk and explore more in depth the role of PTSD to assess and treat prisoners.

Law enforcement preferences for PTSD treatment and crisis management alternatives

Evidence-based treatments (EBT) for posttraumatic stress disorder (PTSD) remain underutilized. Analog research, however, indicates that patients may be more amenable to receiving EBT for PTSD than utilization rates suggest. This study sought to extend previous studies by investigating PTSD treatment preferences among law enforcement individuals (i.e., active duty officers, cadets, criminal justice students). We asked 379 participants, with varying trauma histories, to read a police traumatic event and imagine they had developed PTSD. Participants rated the credibility of six treatment options which they might encounter in a treatment setting, and chose their most and least preferred treatments. Next, they evaluated a widely used debriefing intervention aimed at preventing PTSD. Almost 90% of participants chose exposure or Cognitive Processing Therapy as their first or second most preferred treatment, and they rated these interventions as significantly more credible than the other four treatment options. The sample showed ambivalence regarding the perceived efficacy of debriefing but found the rationale credible. This study supports previous analog research indicating that patients may be more interested in EBT than indicated by utilization rates, and suggests that law enforcement departments should consider offering EBT to officers who develop PTSD.