Sociodemographic, Clinical, and Therapeutic Aspects of Penitentiary Psychiatric Consultation: Toward Integration Into the General Mental Health Services

Indifferent minds, broken system: a critical examination of mental health care provision for Spain's incarcerated population with serious mental illnesses

Background

Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI).

Objective

To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment.

Methods

Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision.

Results

In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings.

Conclusions

Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.

Catechol-O-methyltransferase activity in individuals with substance use disorders: a case control study

BACKGROUND

Impulsivity and substance use disorders (SUD) have been both associated with changes in dopaminergic processes. In this study, we intended to evaluate the dopaminergic function in imprisoned SUD offenders through the determination of s-COMT activity.

METHODS

The study included 46 male individuals from a Portuguese penal institution. The participants were assessed through a battery of standardised instruments: Psychopathy Checklist-Revised (PCL-R), Barratt Impulsivity Scale Version 11 (BIS-11), and the European version of the Addiction Severity Index (EuropASI). In addition, s-COMT erythrocyte activity was evaluated.

RESULTS

Overall, 73.9% (n = 34) of the individuals had Antisocial personality disorder (ASPD) and 58.7% (n = 27) presented SUD. We evidenced, for the first time, that, in individuals with SUD, s-COMT activity was correlated with the severity of drug dependence (EuropASI) (p = 0.009), and with BIS-11 factors self-control (p < 0.0001) and non-planning (p = 0.002).

CONCLUSIONS

This study opens new perspectives regarding the pharmacological intervention on substance dependence through the interference on dopamine pathways.

The Prevalence of Generalised Anxiety Disorder Among Prisoners of the Penitentiary Institution in North-Eastern Poland

Introduction: Generalised anxiety disorder (GAD) is one of the most common mental disorders. The psychosocial factors that may lead to generalised anxiety disorders include stress, traumatic events, conscious and unconscious internal conflicts, and low social and economic status. Imprisonment and forced isolation may favour the development of depression or anxiety disorders in inmates. Thus, this study aimed to analyse the prevalence of generalised anxiety disorder (GAD) in the population of inmates detained in one of the largest penitentiary units in north-eastern Poland. Materials and Methods: The data comes from 2017 and includes information on 635 male inmates incarcerated at the Czerwony Bór Prison. The information comes from the health records of individual inmates, kept by the prison outpatient clinician, and documented consultations with doctors of units outside the prison. The classification of generalised anxiety disorders (F41.1) was made in accordance with the 10th Revision of the International Statistical Classification of Diseases and Health Problems and the clinical diagnosis made by a psychiatrist. The Mann-Whitney test was used to compare quantitative data without normal distribution, chi-squared test or Fisher exact test for comparing qualitative data. A one-dimensional and multi-dimensional logistic regression model was used to examine the impact of the prison type on the prevalence of generalised anxiety disorder. Results: Generalised anxiety disorder was observed among 44 prisoners (6.9%), most often in the age range 30-39 years and among men younger than 30 years, respectively 40.9 and 31.8% of all diagnosed. The average age of patients was 34.6 years. The least number of prisoners with GAD was in the age group 50-59 (2.3%). Nearly 66% of patients were prisoners detained in a closed type prison; the chance of generalised anxiety disorder was three times higher than among the prisoners in a half-open and open type facility. Generalised anxiety disorder was diagnosed significantly more often with those currently serving a prison sentence than those before incarceration. Conclusions: In Polish conditions, the importance of the problem associated with GAD is evidenced by a significant increase in its prevalence in the prison environment and a three times higher chance of developing generalised anxiety disorder among prisoners in a closed type institution, which calls for highly organised psychiatric care and increased availability of psychological assistance for prisoners.

Promoting adherence to psychopharmacological treatment among prisoners with mental health problems: Follow-up of a randomized controlled trial

This study presents follow-up results regarding a treatment adherence programme (TAP) for prisoners, the initial effectiveness of which we previously evaluated in a randomized controlled trial. Here we used an experimental design with two randomized groups and assessment at four time points: baseline (pre-intervention), at 3 months (post-intervention), and at 6 and 9 months after baseline. Participants were 151 prisoners with mental health problems (M_age = 41.85, SD = 10.31) who were randomly assigned to either the TAP or treatment as usual (TAU). Prisoners who completed the TAP showed a greater improvement in treatment adherence at 3 and 9 months, compared with those who received TAU. There were no significant differences between the groups in subjective well-being under medication. The availability of an easy-to-apply, universal programme that is able to promote treatment adherence in the prison context could make a positive contribution to the general health of inmates.

Influence of prisoners' mental health on the relational climate of prisons

Introduction:

Entry into prison involves adapting to a prison culture that is sometimes altered by the effect of imprisonment. Prisons are overcrowded and hold large numbers of inmates suffering from mental disorders and difficulties of adaptation, who affect the delicate equilibrium of the prison environment and can worsen the relational climate.

Material and method:

Several bibliographical databases on the influence of the mental health of adult inmates on the prison relationship climate and existing interventions in this regard that have been published in the last 15 years were reviewed. This data was complemented by other information obtained from the online bibliographic indexes of the Ministry of the Interior.

Results:

There is little literature on the influence of mental health on the relational climate of prisons and existing interventions. However, what literature there is does respond to a current prison reality where inmates with mental health problems have an increased risk of victimization and also a greater predisposition to penitentiary misconduct that causes violations of rules and the consequent application of disciplinary sanctions that lead to segregation.

Discussion:

The dysfunctional behaviour of such inmates, as well as the stigmatized treatment they receive, negatively impact the prison social climate, generating pathological relational styles and distorting the prison environment. This creates a need for an adequate number of programs and interventions of sufficient quality to prevent and mitigate their consequences.

Influence of the use of atypical antipsychotics in metabolic syndrome

OBJECTIVES

To describe the possible relationship between the use of antipsychotic drugs and the presence of metabolic syndrome. Other objectives are to list the main side effects of antipsychotic treatment, and to determine if there is any pharmacological treatment that can contribute towards counteracting metabolic syndrome.

MATERIAL AND METHOD

A narrative bibliographic review was carried out of the following databases: PubMed, Cochrane, CINAHL, IBECS, LILACS and HealthCare. Preference in the selection process was given to clinical trials and systematic review articles or review articles and some articles that were considered relevant because of their content. The time period was limited to between January 2014 and November 2019. The languages were English and Spanish. Repeated articles and those that were not related to the objectives were rejected. The search criteria were: "antipsychotic AND metabolic syndrome"; "schizophrenia AND metabolic syndrome"; "bipolar disorder AND metabolic syndrome"; "metabolic syndrome AND suicide NOT disorder"; "metabolic syndrome AND prisons"; "metabolic syndrome AND prolactin".

RESULTS

24 articles were selected out of the 510 that were consulted. The relationship between atypical antipsychotics and metabolic syndrome was evident. Other anticholinergic, antidopaminergic effects, extrapyramidal syndromes, neuroleptic malignant syndrome, hypotension, arrhythmias, sedation, hypovitaminosis D, increased prolactin, sexual dysfunction, sleep disturbances, etc. are also highlighted. Pharmacological associations with other drugs were also found.

DISCUSSION

There is a relationship between the use of atypical antipsychotics and weight gain, lipid disorders, glucose and high blood pressure. There are some associated drugs that decrease some symptoms (ranitidine, topiramate, metformin, melatonin, modafinil). Patients taking this type of medication should be monitored and encouraged to lead healthy lifestyles.