Mental disorders in prisons

Cessation of dangerousness status: an analysis of 224 reports from the Instituto de Perícias Heitor Carrilho, Rio de Janeiro, Brazil

Objectives:

To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision.

Methods:

The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis.

Results:

The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress.

Conclusions:

In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment.

Access to primary care in adults in a provincial correctional facility in Ontario

Background

Little is known about access to primary care either prior to or following incarceration in Canada. International data demonstrate that the health of people in prisons and jails is poor, and access to primary care in the community may be inadequate for incarcerated persons. We aimed to describe the primary care experience of adults in custody in a provincial correctional facility in Ontario in the 12 months prior to admission.

Methods

We conducted a written survey, and invited all persons in the institution to participate, excluding those in segregation.

Results

One hundred and twenty-five persons participated, 16.8 % of whom were women. The median age was 33. In the 12 months prior to admission to custody, 32.2 % (95 % CI 23.5–40.8 %) of respondents did not have a family doctor or other primary care provider and 48.2 % (95 % CI 38.8–57.6 %) had unmet health needs. Participants reported a mean of 2.1 (SD = 2.8) emergency department visits in the 12 months prior to admission.

Conclusions

Study participants report a lack of access to primary care, a high mean number of emergency department visits, and high unmet health care needs in the 12 months prior to incarceration. Time in custody may present an opportunity for connecting this population with primary care and improving health.

Severe mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis

BACKGROUND

High levels of psychiatric morbidity in prisoners have been documented in many countries, but it is not known whether rates of mental illness have been increasing over time or whether the prevalence differs between low-middle-income countries compared with high-income ones.

AIMS

To systematically review prevalence studies for psychotic illness and major depression in prisoners, provide summary estimates and investigate sources of heterogeneity between studies using meta-regression.

METHOD

Studies from 1966 to 2010 were identified using ten bibliographic indexes and reference lists. Inclusion criteria were unselected prison samples and that clinical examination or semi-structured instruments were used to make DSM or ICD diagnoses of the relevant disorders.

RESULTS

We identified 109 samples including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models, and we found a pooled prevalence of psychosis of 3.6% (95% CI 3.1-4.2) in male prisoners and 3.9% (95% CI 2.7-5.0) in female prisoners. There were high levels of heterogeneity, some of which was explained by studies in low-middle-income countries reporting higher prevalences of psychosis (5.5%, 95% CI 4.2-6.8; P = 0.035 on meta-regression). The pooled prevalence of major depression was 10.2% (95% CI 8.8-11.7) in male prisoners and 14.1% (95% CI 10.2-18.1) in female prisoners. The prevalence of these disorders did not appear to be increasing over time, apart from depression in the USA (P = 0.008).

CONCLUSIONS

High levels of psychiatric morbidity are consistently reported in prisoners from many countries over four decades. Further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and examine trends over time within nations with large prison populations.

Mental health of young offenders in Switzerland: Recognizing psychiatric symptoms during detention

We reviewed the medical records of the 118 adolescent detainees which had at least one consultation by a psychiatrist at the prison health facility during 2007. General practitioners used the International Classification of Primary Care (ICPC-2) for recording health problems. Psychiatrists used the International Classification of Diseases (ICD-10) for making psychiatric diagnoses. The concordance between the mental health assessment done by general practitioners using the ICPC-2 and the diagnoses proposed by psychiatrists was globally satisfying. The five most frequent ICD categories (conduct disorder, drug abuse, alcohol abuse, personality disorder, adjustment disorder) encompassed the most frequently reported ICPC-2 psychological symptoms. Several associations between psychological symptoms and socio-demographic characteristics were observed. Apart from providing a description of the mental health of adolescent detainees in one of Switzerland's largest detention centre for minors, results suggest that general practitioners can adequately identify frequent mental disorders in such contexts.

Temperament, insecure attachment, impulsivity, and sexuality in women in jail

BACKGROUND

Women constitute only a small proportion of inmates, but several studies have shown that they have higher rates of psychiatric disturbance than incarcerated men and community samples. Mental health treatment is necessary to prevent severe illness and suicide in these women.

METHODS

The convenience sample consisted of 40 female detainees and 40 controls who were administered self-report questionnaires to assess temperament (TEMPS-A), insecure attachment (ECR), impulsivity (BIS-11), and sexual behavior (SESAMO).

RESULTS

The incarcerated women had higher levels of affective temperament (except for hyperthymia), avoidance, anxiety, impulsivity, and psychosexual issues than the female community sample.

CONCLUSIONS

Many interrelated emotional and affective disturbances affect the physical and psychological well-being of women in jail, and it is possible that these problems may lead to suicide. Health professionals need to develop gender-specific therapeutic interventions for women in jail.