Co-occurring mental illness and substance use disorder among Australian prisoners

Re-examining mandatory drug testing in Australian prisons

Mandatory drug testing is commonly used in Australian prisons to detect and deter drug use. In this commentary, we review the limited evidence for mandatory drug testing programs, highlight potential harms associated with their implementation and provide recommendations for drug surveillance in prisons concordant with a harm minimisation framework.

Receipt of Opioid Agonist Treatment in provincial correctional facilities in British Columbia is associated with a reduced hazard of nonfatal overdose in the month following release

BACKGROUND

In many jurisdictions, policies restrict access to Opioid Agonist Treatment (OAT) in correctional facilities. Receipt of OAT during incarceration is associated with reduced risk of fatal overdose after release but little is known about the effect on nonfatal overdose. This study aimed to examine the association between OAT use during incarceration and nonfatal overdose in the 30 days following release.

METHODS AND FINDINGS

Using linked administrative healthcare and corrections data for a random sample of 20% of residents of British Columbia, Canada we examined releases from provincial correctional facilities between January 1, 2015 -December 1, 2018, among adults (aged 18 or older at the time of release) with Opioid Use Disorder. We fit Andersen-Gill models to examine the association between receipt of OAT in custody and the hazard of nonfatal following release. We conducted secondary analyses to examine the association among people continuing treatment initiated prior to their arrest and people who initiated a new episode of OAT in custody separately. We also conducted sex-based subgroup analyses. In this study there were 4,738 releases of 1,535 people with Opioid Use Disorder. In adjusted analysis, receipt of OAT in custody was associated with a reduced hazard of nonfatal overdose (aHR 0.55, 95% CI 0.41, 0.74). This was found for prescriptions continued from community (aHR 0.49, 95%CI 0.36, 0.67) and for episodes of OAT initiated in custody (aHR 0.58, 95%CI 0.41, 0.82). The effect was greater among women than men.

CONCLUSIONS

OAT receipt during incarceration is associated with a reduced hazard of nonfatal overdose after release. Policies to expand access to OAT in correctional facilities, including initiating treatment, may help reduce harms related to nonfatal overdose in the weeks following release. Differences in the effect seen among women and men indicate a need for gender-responsive policies and programming.

Adverse childhood experiences and mental health among incarcerated women: Self-esteem as a mediating mechanism

BACKGROUND

Adverse childhood experiences (ACEs) and mental health problems are interrelated. However, less is known about this relationship in incarcerated women and how self-esteem impacts this relationship.

OBJECTIVE

To investigate the relationship between ACEs and mental health problems (traumatic stress, depression, and anxiety) in incarcerated women with opioid use disorder (OUD) and, the possible role of self-esteem as a mediator of the relationship.

PARTICIPANTS AND SETTING

Incarcerated women (N = 500) were randomly selected from eight Kentucky jails, screened for OUD, and interviewed by research staff.

METHODS

Regression analyses and mediation models were used to examine the relationship between ACEs, mental health, and self-esteem.

RESULTS

ACEs were positively correlated with present mental health problems (traumatic stress, r = 0.407, p < .001; depression, r = 0.177, p < .001; and anxiety, r = 0.213, p < .001) and negatively correlated with current self-esteem (r = -0.241, p < .001). Linear regression analyses established that ACEs and self-esteem were significantly related to all three mental health variables of interest. Additionally, self-esteem mediated the relationship between ACEs and mental health.

CONCLUSION

This study shows that incarcerated women's experiences with ACEs are significantly related to poor mental health. Self-esteem plays a critical role in this relationship.

Inequalities in care for Iranian women suffering from the comorbidity of substance use and mental illness: The need for integrated treatment

This paper addresses the comorbidity of substance use and mental illness among women in Iran and the barriers they encounter in accessing treatment. Research has demonstrated a higher prevalence of comorbidity of substance use disorders and mental illness among women than men. It has been suggested that women in Iran may face numerous barriers to appropriate care, such as stigma and discrimination associated with substance use. Integrated treatment for co-occurring disorders (CODs) has been highly beneficial and effective; however, personal and structural limitations impede this treatment approach, which explains the need to develop a situation- and culture-specific program. Needs assessment is necessary to achieve an integrated treatment, and the Iranian government should take the lead in this endeavor. However, if this seems unlikely, non-governmental organizations could be called upon to promote it.

Exploring mental health comorbidities and opioid agonist treatment coverage among people in prison: A national cohort study 2010-2019

INTRODUCTION

Despite a high prevalence of opioid use disorder (OUD) among people in prison, there is little knowledge of how many receive the recommended opioid agonist treatment (OAT) and what characterizes those who receive OAT and those who do not when it comes to mental health comorbidities. We aimed to describe people with OUD in Norwegian prisons over a ten-year period and their OAT status, and to investigate comorbidity of mental health disorders stratified by gender.

METHODS

Data from the PriSUD study, including all people (≥19 years old) imprisoned in Norway between 2010 and 2019, linked to national patient registry data, including ICD-10 codes. We calculated the prevalence (1-year and 10-year) of OUD and OAT, and mental health comorbidity stratified on OAT-status and gender.

RESULTS

Among the cohort (n=51,148), 7 282 (14.2%) were diagnosed with OUD during the period of observation. Of those, 4 689 (64.4%) received OAT. People with OUD had high levels of comorbidity, including other drug use disorders (92.4% OAT, 90.3% non-OAT), alcohol use disorder (32.1% OAT, 44.4% non-OAT) and any other mental health disorders (61.6% OAT, 68.2% non-OAT). The proportion receiving OAT among people with OUD increased markedly during the ten years of observation; from 35.7% in 2010-70.9% in 2019.

CONCLUSION

People with OUD, both receiving OAT and not, had substantially more mental health comorbidities than the non-OUD population. Understanding how the prison population changes over time especially in terms of mental health needs related to OUD, is important for correctional health service planning.

Common mental disorders and associated factors among Ethiopian prisoners: a systematic review and meta-analysis

Background

Common mental disorders are a major public health concern in the world and negatively influence people's psychological, physical, economic, and overall well-being. Since prisoners live with restricted freedom and lack regular social interaction like communication with family and friends, the prevalence of common mental disorders is frequently found to be higher among prisoners compared to the general population. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of common mental disorders and their associated factors among prisoners in Ethiopia.

Methods

The primary published studies were searched by using different databases like PubMed, Google Scholar, CINHAL, and African Journal Online. A total of eight primary articles that assessed the prevalence and associated factors of common mental disorders among Ethiopian prisoners were included in this systematic review and meta-analysis. The data were extracted using the data extraction format in a Microsoft Excel spreadsheet and exported to Stata version 14 for further analysis. The statistical heterogeneity was assessed by the I² test. Due to the presence of heterogeneity among included studies, a random effect meta-analysis model was employed. Egger's weighted regression test and funnel plots were used to check the presence of publication bias.

Results

A total of 8 primary studies with 3,585 study participants were included in this systematic review and meta-analysis. The pooled prevalence of common mental disorders among Ethiopian prisoners was 62.29% with a 95% CI (50.94, 73.65). The subgroup analysis based on regional state revealed that the pooled prevalence of common mental disorders in Amhara, Oromia, and the other two regions (Addis Ababa and SNNPR) was 72.4, 50.23, and 54.25%, respectively. History of mental illness (AOR = 6.21, 95% CI: 3.27, 11.80), poor social support (AOR = 3.90, 95% CI: 1.45, 10.51), and traumatic life events (AOR = 3.63, 95% CI: 1.04, 12.73) were significantly associated with a common mental disorder in this review.

Conclusion

In this systematic review and meta-analysis, the pooled prevalence of common mental disorders among prisoners was high. Therefore, improving the delivery of mental health services in correctional institutions has a major contribution to the reduction of the disorder, and incarcerated people require more attention and early intervention for common mental disorders.

A prison mental health network in the RANZCP

OBJECTIVE

Consider the unique features and challenges of prison psychiatry.

CONCLUSIONS

A Prison Mental Health Network within the Royal Australian and New Zealand College of Psychiatrists would serve many useful functions including improving the quality of mental health services by promoting high clinical standards and ethical practice by psychiatrists working in prisons.

Psychiatric well-being among men leaving prison reporting a history of injecting drug use: A longitudinal analysis

BACKGROUND

Community reintegration from prison is typically stressful, with several health and social outcomes impacting psychiatric well-being during this time, often exacerbated among individuals with histories of drug use. Longitudinal data was used to assess change in psychiatric well-being over 2 years following release from prison among men who reported a recent history of injecting drug use.

METHODS

Data for this study come from the Prison and Transition Health cohort study of 400 men recruited in prison prior to release and followed up over three time points. Psychiatric well-being was assessed using the 12-item General Health Questionnaire. We calculated change in individual General Health Questionnaire scores between interviews and identified covariates associated with General Health Questionnaire score using linear mixed-effects regression.

RESULTS

Data from 690 follow-up interviews among 326 participants were included in analyses. There was considerable variation in individuals' General Health Questionnaire scores. Moving accommodation frequently and frequent illicit drug injections were associated with an increase in General Health Questionnaire score (i.e. decline in psychiatric well-being). Two or more prior adult imprisonment episodes, social supports and past month primary healthcare attendance were associated with a decrease in General Health Questionnaire score.

CONCLUSION

Our findings identify health, social and structural influences on psychiatric well-being after release from prison that can inform re-entry programmes to support community reintegration.

Criminal Justice Involvement after Release from Prison following Exposure to Community Mental Health Services among People Who Use Illicit Drugs and Have Mental Illness: a Systematic Review

Illicit drug use and mental illness are common among people in prison and are associated with higher rates of reoffending and reimprisonment. We conducted a systematic review, searching MEDLINE, Embase, and PsycINFO to January 10, 2022, for studies reporting criminal justice involvement following exposure to community mental health services among people released from jail or prison who use illicit drugs and have mental illness. Our search identified 6954 studies; 13 were eligible for inclusion in this review. Studies were separated into three broad categories based on community mental health service type. Eleven of 13 studies reported a reduction in criminal justice involvement among participants exposed to community mental health services compared to a comparison group. Findings indicate a need to expand and improve integration and referral mechanisms linking people to community mental health services after jail or prison release, alongside a need for tailored programs for individuals with complex illicit drug use and mental health morbidities.

A six-session group-based pilot intervention for alcohol and other drug use in hospitalised mentally ill young offenders

OBJECTIVE

This study aims to evaluate a group-based intervention for alcohol and other drug (AOD) use offered to incarcerated youth hospitalised with mental illness.

METHODS

A six-session group-based intervention for AOD use was offered to young offenders with mental illness, hospitalised in the Adolescent Unit of the Forensic Hospital, Sydney, between June 2015 and May 2017. Pre- and post-intervention measures were collected using the Brief Psychiatric Rating Scale (BPRS), Treatment Entry Questionnaire, Drug-Related Locus of Control (DRLOC) and Drug-Taking Confidence Questionnaire, short version.

RESULTS

Pre- and post-intervention measures were compared utilising paired t-tests. Following the intervention, there was a significant reduction in the severity of psychiatric symptoms rated using the BPRS and a significant difference in DRLOC measures, reflecting increased internal locus of control.

CONCLUSIONS

Improved internal drivers for reducing AOD use and improvement in symptoms of mental illness suggest similar interventions may be beneficial and may not impact recovery even during episodes of acute illness.

A comparison of older and younger offenders with delusional jealousy

We sought to determine whether or not there were differences in medical, criminological and legal factors between older and younger offenders with diagnoses of delusional jealousy by undertaking a retrospective case-file search of Australian legal databases. Our results demonstrate that older offenders were more likely to have comorbid dementia whereas younger offenders were more likely to have comorbid substance use and chronic psychotic conditions. A history of domestic violence frequently predated the index offence but we were unable to determine if this was due to psychosis or a pre-existing tendency for violence. Despite a common diagnosis, the older offenders were more likely to be made forensic patients rather than sentenced prisoners when compared with the younger offenders. Consequently, different factors might mediate the pathway to violence in older and younger people suffering from delusional jealousy and could be additional targets for clinical intervention.

The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis

BACKGROUND

Comorbid mental illnesses and substance use disorders are associated with adverse criminal, social, and health outcomes. Yet, their burden is not reliably known among prison populations. We therefore aimed to estimate the prevalence of comorbid serious mental illnesses and substance use disorders (dual disorders) among people in prison worldwide.

METHODS

In this systematic review and meta-analysis, we searched 15 electronic databases (ASSIA, CAB Abstracts, Criminal Justice Database, Embase, Global Health, Global Index Medicus, IBSS, MEDLINE, NCJRS, PAIS Index, PsycINFO, Russian Science Citation Index, Scielo, Social Services Abstracts, and Web of Science) and the grey literature (Open Grey and ProQuest Dissertations & Theses Global) for studies reporting the prevalence of serious mental illnesses and substance use disorders in prison populations published between Jan 1, 1980, and Sept 25, 2021, and contacted the authors of relevant studies. Empirical studies among unselected adult prison populations that applied representative sampling strategies and validated diagnostic instruments, and either reported the prevalence of dual disorders or had authors who could provide prevalence data in correspondence, were included. Two reviewers (GB and SDL) independently extracted data from the eligible studies; both current (up to 1 year) and lifetime prevalence were extracted, if available. We sought summary estimates. Our primary outcomes were comorbid non-affective psychosis with substance use disorders and comorbid major depression with substance use disorders. We conducted a random-effects meta-analysis, explored between-sample heterogeneity with meta-regression, and calculated odds ratios (ORs) to assess bidirectional relationships between mental and substance use disorders. Risk of bias was assessed by use of a standard tool. The study protocol was registered with PROSPERO, CRD42020207301.

FINDINGS

Of 11 346 records screened, we identified 34 studies reporting the prevalence of dual disorders among individuals in prison and received unpublished prevalence data for 16 studies, totalling 50 eligible studies and 24 915 people. The mean quality score of included studies was 7·8 (SD 1·2). We found that 3·5% (95% CI 2·2-5·0) had current non-affective psychosis with any comorbid substance use disorder, representing 443 (49·2%) of 900 people with non-affective psychosis, and 9·1% (5·6-13·3) had current major depression and comorbid substance use disorders, representing 1105 (51·6%) of 2143 people with major depression. Between-sample heterogeneity was high (I2>80%). People in prison with current non-affective psychosis were significantly more likely to have substance use disorders compared with those without (OR 1·7, 95% CI 1·4-2·2). People with major depression had higher odds of substance use disorders than those without (1·6, 1·3-2·0).

INTERPRETATION

Around half of the prison population with non-affective psychosis or major depression have a comorbid substance use disorder. Consideration should be given to screening for dual disorders and implementing integrated and scalable treatments.

FUNDING

Economic and Social Research Council, Agencia Nacional de Investigación y Desarrollo (Chile), and the Wellcome Trust.

The health of detainees and the role of primary care: Position paper of the European Forum for Primary Care

This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees' encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement.

Detained Persons Incarcerated for the First Time and Needing Acute Psychiatric Care: Sociodemographic and Clinical Characteristics

Among detained persons, those incarcerated for the first time (FTI: first time incarceration) are known to present long-standing psychological vulnerability but also suffer significant deterioration of their mental health during the first year following imprisonment. Whether the patterns of psychiatric morbidity differ in FTI cases compared to cases with repeated and long term incarceration (RLTI) is still a matter of debate. We examined the sociodemographic and clinical differences between a subgroup of FTI vs. one of RLTI in a series of 139 randomly selected detained persons admitted to an acute psychiatric ward located in the central prison of Geneva, Switzerland. Fisher exact, unpaired Student t and Mann-Whitney U tests were used to explore sociodemographic (age, gender, marital status, religion, knowledge of French, education) and clinical (psychiatric outpatient care, suicidal behavior, psychiatric diagnosis) differences between the two groups. Subsequently, univariate and multiple logistic regression models were used to detect the variables associated with FTI. The proportion of women was significantly higher in the FTI compared to the RLTI group. FTI cases were also more frequently separated or divorced, with less frequent religious affiliation. 16.9% of FTI cases but only 1.3% of RLTI cases had a clinical diagnosis of depression. In multiple regression models, female sex and lower religious affiliation rate were associated with FTI status. Among diagnostic categories, depression was strongly related to FTI status both in univariate and multivariable models. Importantly, this was not the case for adjustment disorders, previous history of psychiatric care and suicidal behavior. Our observations support the assumption that FTI cases with lower affective support, less religious investment and without psychiatric care prior to imprisonment are particularly vulnerable to depressive illness.

Smoking Beyond Prison Bans: The Impact of Prison Tobacco Bans on Smoking Among Prison Entrants

This study aims to determine whether previous exposure to a total prison smoking ban is associated with a reduction in daily smoking postrelease and to identify the factors associated with daily tobacco use. Demographics, incarceration history, and substance use data were collected from the 2016 National Prisoner Entrants' Blood Borne Virus Survey for 389 Australian prison entrants. Predictors of daily smoking among those exposed to a smoking ban were illicit drug use and Indigenous status. No significant association was found between current daily smoking and recent exposure to a prison smoking ban, suggesting that the majority of Australian prisoners exposed to a tobacco ban while incarcerated will return to smoking once released. Complementary and culturally specific interventions supporting abstinence postrelease should be considered.

The needs and experiences of mothers while in prison and post-release: a rapid review and thematic synthesis

BACKGROUND

Women in prison are a vulnerable group, often with a history of abuse, out-of-home care, mental health problems and unemployment. Many are mothers when they become involved in the criminal justice system and their gender and parenting related needs are often not considered. The aim of this rapid review was to thematically synthesize the existing research on the needs and experiences of mothers while in, and following release from, prison in Australia.

METHODS

We conducted a rapid systematic search of electronic databases, search engines, the websites of key agencies, and contacted key agencies and researchers.

RESULTS

Twenty-two publications from 12 studies met the inclusion criteria and were thematically synthesized in relation to the mothers, their children, family and community, and systems and services which mothers had contact with. We found that mothers in prison have a history of disadvantage which is perpetuated by the trauma of imprisonment. Release from prison is a particularly challenging time for mothers. In relation to their children, the included studies showed that the imprisonment of mothers impacts their maternal identity and role and disrupts the mother-child relationship. Specific strategies are needed to maintain the mother-child relationship, and to ensure the needs and rights of the child are met. In relation to family and community, we found that although family and social support is an important need of women in prison, such support may not be available. Moreover, the stigma associated with having been in prison is a significant barrier to transitions into the community, including finding employment and housing. In relation to systems and services, although limited services exist to support women in prison and on release, these often do not consider the parenting role. Evaluations of parenting programs in prison found them to be acceptable and beneficial to participants but barriers to access limit the number of women who can participate.

CONCLUSION

Mothers have gender- and parenting-specific needs which should be considered in planning for corrective services in Australia. Any service redesign must place the woman and her children at the centre of the service.

The Prison and Transition Health (PATH) cohort study: Prevalence of health, social, and crime characteristics after release from prison for men reporting a history of injecting drug use in Victoria, Australia

BACKGROUND

People who inject drugs are overrepresented in prison and have diverse and complex health needs. However, outcomes after release from prison are poorly understood, limiting effective interventions supporting community reintegration. We describe the prevalence of socio-demographics, physical and mental health, alcohol and other drug use, and crime characteristics of men with histories of injecting drug use after their release from prison in Victoria, Australia.

METHODS

Data come from the Prison and Transition Health (PATH) prospective cohort study. Interviews were undertaken approximately three, 12, and 24 months after release from their index prison episode and were completed in the community, or in prison for those reimprisoned during the study. We present cross-sectional descriptive statistics for each follow-up wave of the PATH study.

RESULTS

Among 400 men recruited into PATH, 85 % (n = 336) completed at least one follow-up interview; 162 (42 %) completed all three interviews. Participants reported social disadvantage and health inequity, including high rates of unemployment, homelessness, and physical and mental health morbidities at each follow-up time point. Rapid return to illicit substance use was common, as was overdose (ranging 9 %-13 %), receptive syringe sharing (ranging 20 %-29 %), involvement in crime-related activities (ranging 49 %-58 %), and reimprisonment (ranging 22 %-50 %) over the duration of follow-up.

CONCLUSION

Men in this study experienced substantial health and social challenges across a 24-month prospective follow-up period. Improved understanding of characteristics and experiences of this group after release from prison can inform more coordinated and continued care between prison and the community.

Mental and physical health problems before and after detention: A matched cohort study

Background

Individuals with poor health are largely overrepresented in prison populations. However, it remains unclear whether their poor health status already exists prior to their detention or reflects an effect of detention. We examined the health of detainees in the year before and after their detention and compared this with the health of matched non-detainees.

Methods

In this matched cohort study, we linked national data on all persons detained in the Netherlands in 2014/2015 to electronic health records (EHR's) of a representative sample of general practitioners in the Netherlands. Participants include 952 detained persons and 4760 matched non-detained persons (matched on age, sex and general practice). Prevalence rates of health problems in the year before and after detention and odds ratios with 95% confidence intervals were calculated. Rates for a variety of physical and mental health problems are presented.

Findings

Detainees and matched controls differed statistically significant in their pre-detention health status. Compared with controls, male detainees were more likely to report psychological (odds ratio [OR] 3·64 [95% CI 3·11–4·26]), social (1·96 [1·46–2·64]), neurological (1·34 [1·02–1·76]), digestive (1·23 [1·02–1·49]), genital system-related (1·36 [1·07–1·72]), and unspecified health problems (1·32 [1·10–1·59]) in the year before their detention. For example, 43·7% of detainees and 17·6% of controls reported psychological problems in this pre-detention year. To some extent these pre-detention health differences were related to socioeconomic differences. Nevertheless, after taking these characteristics into account, a number of pre-detention health differences between detainees and controls remained statistically significant. No statistically significant changes in prevalence rates from pre- to post-detention and no differences in the levels of change across detainees and controls were observed. For female detainees a similar pattern was found.

Interpretation

People who experience detention have high and complex health needs both pre- and post-detention. While this study did not show a health deteriorating effect of detention, it also did not show a health improving effect. This latter finding may indicate a missed opportunity for health care services to address detainees’ health, especially since persons entering detention have elevated health problems. Knowledge on detainees’ specific health problems may help health care providers in prisons and in the community to adequately address the health care needs of this vulnerable group.

Funding

None.

Incarceration among adults living with psychosis in Indigenous populations in Cape York and the Torres Strait

OBJECTIVE

The relationship between psychosis and contact with the criminal justice system for Indigenous people living in rural and remote areas is not well understood. In this study, the authors examine patterns of incarceration among Indigenous people living with psychosis in Cape York and the Torres Strait over two decades.

METHODS

Data were collated from a clinical database of complete psychiatric records from 1992 to 2015, extracted for all Indigenous patients with a psychotic disorder from the Remote Area Mental Health Service, and linked to the Queensland Corrections Service database. Descriptive statistics were calculated to compare characteristics between those incarcerated and those not incarcerated during the study period and to quantify patterns of incarceration including types of offences, time spent in custody and frequency of incarceration. Multivariate Cox regression analysis was used to assess associations between reported variables and 'first incarceration'.

RESULTS

Forty-five percent of Aboriginal patients (n = 116) were incarcerated compared with 31% of Torres Strait Islanders (n = 41) (p = 0.008), and the proportion of males incarcerated (51%, n = 141) was approximately twice that of females (24%, n = 35; p = 0.001). A cluster of first incarcerations were observed in close time proximity to diagnosis of psychosis. Individuals who had a history of both alcohol and cannabis use had approximately two times higher risk of being incarcerated following positive diagnosis compared to those without a history of substance use (hazard ratio = 1.85; 95% confidence interval: [1.08, 3.17]; p = 0.028). Males accounted for approximately 85% (n = 328) of sentences. The most common most serious offence was causing physical harm to others (assault - n = 122, 31%).

CONCLUSION

Our study found that for Aboriginal and Torres Strait Islander people with a psychotic disorder in North Queensland, criminal justice responses with resultant incarceration occurs frequently. Access to appropriate mental health services and diversion options for Indigenous Australians with psychosis should be a key public health and justice priority.

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.

Mental Health, Psychological Distress, and Coping in Australian Cross-Cultural Prison Populations

The rates of mental illness are significantly higher in prison populations compared to the general community; however, little research has examined the rates of mental illness for cross-cultural groups of prisoners in Australia. This omission is concerning given the increasingly diverse nature of the Australian prison population. To address this gap in knowledge, the present study aimed to identify rates of key mental health factors and associated psychological processes in a cohort of 191 men from culturally and linguistically diverse, Indigenous Australian and English-speaking backgrounds who were incarcerated at a maximum-security prison in Victoria, Australia. We also explored differences in both psychological distress levels and predictors of psychological distress. Although no significant mental health differences were identified cross-culturally, the results revealed that several mental health factors predicted psychological distress for all prisoners, F(11, 147) = 33.23, p < .001, R² = .71. The experiences of anxiety and sleep disturbance-related symptoms, β = .34; depressive symptoms, β = .19; posttraumatic stress disorder symptoms, β = .25; and the use of psychological processes, such as avoidance coping, β = .16; and engagement in cognitive fusion, β = .15, all predicted psychological distress. The use of positive thinking as a coping strategy was found to predict a reduced level of psychological distress for prisoners, β = -.13. The findings indicated that the mental health profiles of cross-cultural groups of prisoners are similar in nature, suggesting that justice involvement may be a more useful predictor than cultural differences concerning psychological health.

Mental disorders and risk of suicide attempt in prisoners

BACKGROUND

Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process-the transition from ideation to action-would provide valuable information for clinical risk assessment in this high-risk population.

METHODS

Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247).

RESULTS

One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide at some point (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73-4.13) and suicide attempt (OR range 1.82-4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR 1.65, 95% CI 1.10-2.48), alcohol dependence (OR 1.89, 95% CI 1.26-2.85), and posttraumatic stress disorder (OR 2.09, 95% CI 1.37-3.17) distinguished attempters from ideators.

CONCLUSION

Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.

The mental health of culturally and linguistically diverse offenders - what do we know?

OBJECTIVE

A key challenge facing justice health service providers is addressing and treating the high rates of mental illness among offenders. It is well documented that rates of mental illness are substantially higher within prison populations compared to the general population. As such, the need to provide ongoing treatment to prisoners experiencing mental health issues is of fundamental importance. Prisoners experiencing mental health disorders are more likely to have poorer social outcomes on release, including a greater likelihood of recidivism and poorer health outcomes. The growing numbers of justice-involved individuals from culturally and linguistically diverse (CALD) backgrounds signal the need for justice systems to adapt to the changing demographic.

CONCLUSIONS

In this commentary, we argue that greater efforts to explore the nature and prevalence of mental illness among CALD groups in custody, where such concerns are often intertwined with additional complex personal, environmental and historical criminogenic risk factors, are desperately needed to improve system responses and reduce recidivism.

Is mental illness associated with placement into solitary confinement in correctional settings? A systematic review and meta-analysis

The aim of this meta-analysis was to examine the association between any mental health problem and the risk of being placed into solitary confinement in correctional settings. PubMed, PsycINFO, Web of Science and Google Scholar were searched from each database's inception date to November 2019. All publications assessing both mental health problems and placement into solitary confinement in a sample of adult inmates in correctional settings were included. The meta-analysis was performed using random-effects models. Heterogeneity among study point estimates was assessed with Q statistics and quantified with I² index. Publication bias was assessed with funnel plots. Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed throughout. After screening 2777 potential studies, 11 studies were included amounting to a total of 163 414 inmates. Included studies comprised of a mix of mental disorders rather than a specific diagnosis per se. The odds ratio (OR) from the pooled studies was 1.62 (confidence interval (CI) = 1.21-2.15). The observed relationship remained unchanged regardless of the removal of outliers (OR = 1.63, CI = 1.47-1.80) and regardless of the adjustment of confounders (OR = 1.58, CI = 1.32-1.88). The present study shows a moderate association between any mental health problem and placement into solitary confinement within a considerable sample of inmates. As more individuals suffering from mental illness enter the correctional system, it is essential that correction officials create new safe interventions to manage these inmates and offer them proper mental health care to limit the use of solitary confinement, which may have deleterious effects.

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.

The Unhappy Mental Health Triad: Comorbid Severe Mental Illnesses, Personality Disorders, and Substance Use Disorders in Prison Populations

BACKGROUND

Information on the comorbidity of mental health problems in prison populations is scarce. The aim of the present study was to assess the prevalence of comorbidities at intake to prison between three diagnostic groups: severe mental illnesses (SMIs), personality disorders (PDs), and substance use disorders (SUDs). The co-occurrence of those disorders in prison populations may require the integration of differential treatment approaches and novel treatment trials.

METHODS

A consecutive sample of N = 427 (229 male and 198 female) individuals committed to imprisonment in Santiago de Chile was assessed with the Mini Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV (module for borderline personality disorders) on arrival at prison. Diagnoses were a priori grouped as SMI including psychosis, bipolar disorder and major depression, PD including borderline and antisocial PD and SUD including alcohol and drug abuse or dependence. Sex stratified multivariate binary logistic regression analyses were conducted to assess sociodemographic, criminal and treatment characteristics of individuals with at least one diagnosis from each of the three diagnostic groups.

RESULTS

The triad of SMI, PD, and SUD was present in n = 138 (32.3%; 95% IC: 28.0-36.9) study participants, n = 105 (45.9%; 95% CI: 39.4-52.4) of the men and n = 33 (16.7%; 95% CI: 12.1-22.6) of the women. Among those with the disorder triad, n = 129 (30.2%; 95% CI: 26.0-34.8) had major depression, PD and SUD; n = 54 (12.6%; 95% CI: 9.8-16.2) had psychosis, PD and SUD. The disorder triad was more common in men (OR = 4.86; 95% IC: 2.63-8.95), younger age (OR = 0.94; 95% CI: 0.91-0.97), and participants with lower educational levels (OR = 1.69; 95% CI: 1.01-2.82). The disorder triad was significantly associated with previous incarcerations (OR 2.60; 95% CI: 1.55-4.34) and histories of psychiatric hospitalizations (OR 2.82; 95% CI: 1.27-6.28).

DISCUSSION

The complex triad of disorders from different diagnostic groups is common in prison populations, especially among young men. Successful treatment interventions may have the potential to break a cycle of repeat institutionalization in prisons and psychiatric institutions.

First diagnosis of psychosis in the prison: results from a data-linkage study

BACKGROUND

Psychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed.

AIMS

Determine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison.

METHOD

This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006-2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison.

RESULTS

Of the 38 489 diagnosed with psychosis for the first time, 1.7% (n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79-2.89), Aboriginality (OR = 1.81, 95% CI 1.49-2.19), older age (OR = 1.70, 95% CI 1.37-2.11 for 25-34 years and OR = 1.63, 95% CI 1.29-2.06 for 35-44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42-5.69). Eight out of ten were diagnosed within 3 months of reception.

CONCLUSIONS

Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release.

DECLARATION OF INTEREST

None.

Interventions for drug-using offenders with co-occurring mental health problems

BACKGROUND

This review represents one from a family of three reviews focusing on interventions for drug-using offenders. Many people under the care of the criminal justice system have co-occurring mental health problems and drug misuse problems; it is important to identify the most effective treatments for this vulnerable population.

OBJECTIVES

To assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems in reducing criminal activity or drug use, or both.This review addresses the following questions.• Does any treatment for drug-using offenders with co-occurring mental health problems reduce drug use?• Does any treatment for drug-using offenders with co-occurring mental health problems reduce criminal activity?• Does the treatment setting (court, community, prison/secure establishment) affect intervention outcome(s)?• Does the type of treatment affect treatment outcome(s)?

SEARCH METHODS

We searched 12 databases up to February 2019 and checked the reference lists of included studies. We contacted experts in the field for further information.

SELECTION CRITERIA

We included randomised controlled trials designed to prevent relapse of drug use and/or criminal activity among drug-using offenders with co-occurring mental health problems.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures as expected by Cochrane .

MAIN RESULTS

We included 13 studies with a total of 2606 participants. Interventions were delivered in prison (eight studies; 61%), in court (two studies; 15%), in the community (two studies; 15%), or at a medium secure hospital (one study; 8%). Main sources of bias were unclear risk of selection bias and high risk of detection bias.Four studies compared a therapeutic community intervention versus (1) treatment as usual (two studies; 266 participants), providing moderate-certainty evidence that participants who received the intervention were less likely to be involved in subsequent criminal activity (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.53 to 0.84) or returned to prison (RR 0.40, 95% CI 0.24 to 0.67); (2) a cognitive-behavioural therapy (one study; 314 participants), reporting no significant reduction in self-reported drug use (RR 0.78, 95% CI 0.46 to 1.32), re-arrest for any type of crime (RR 0.69, 95% CI 0.44 to 1.09), criminal activity (RR 0.74, 95% CI 0.52 to 1.05), or drug-related crime (RR 0.87, 95% CI 0.56 to 1.36), yielding low-certainty evidence; and (3) a waiting list control (one study; 478 participants), showing a significant reduction in return to prison for those people engaging in the therapeutic community (RR 0.60, 95% CI 0.46 to 0.79), providing moderate-certainty evidence.One study (235 participants) compared a mental health treatment court with an assertive case management model versus treatment as usual, showing no significant reduction at 12 months' follow-up on an Addictive Severity Index (ASI) self-report of drug use (mean difference (MD) 0.00, 95% CI -0.03 to 0.03), conviction for a new crime (RR 1.05, 95% CI 0.90 to 1.22), or re-incarceration to jail (RR 0.79, 95% CI 0.62 to 1.01), providing low-certainty evidence.Four studies compared motivational interviewing/mindfulness and cognitive skills with relaxation therapy (one study), a waiting list control (one study), or treatment as usual (two studies). In comparison to relaxation training, one study reported narrative information on marijuana use at three-month follow-up assessment. Researchers reported a main effect < .007 with participants in the motivational interviewing group, showing fewer problems than participants in the relaxation training group, with moderate-certainty evidence. In comparison to a waiting list control, one study reported no significant reduction in self-reported drug use based on the ASI (MD -0.04, 95% CI -0.37 to 0.29) and on abstinence from drug use (RR 2.89, 95% CI 0.73 to 11.43), presenting low-certainty evidence at six months (31 participants). In comparison to treatment as usual, two studies (with 40 participants) found no significant reduction in frequency of marijuana use at three months post release (MD -1.05, 95% CI -2.39 to 0.29) nor time to first arrest (MD 0.87, 95% CI -0.12 to 1.86), along with a small reduction in frequency of re-arrest (MD -0.66, 95% CI -1.31 to -0.01) up to 36 months, yielding low-certainty evidence; the other study with 80 participants found no significant reduction in positive drug screens at 12 months (MD -0.7, 95% CI -3.5 to 2.1), providing very low-certainty evidence.Two studies reported on the use of multi-systemic therapy involving juveniles and families versus treatment as usual and adolescent substance abuse therapy. In comparing treatment as usual, researchers found no significant reduction up to seven months in drug dependence on the Drug Use Disorders Identification Test (DUDIT) score (MD -0.22, 95% CI -2.51 to 2.07) nor in arrests (RR 0.97, 95% CI 0.70 to 1.36), providing low-certainty evidence (156 participants). In comparison to an adolescent substance abuse therapy, one study (112 participants) found significant reduction in re-arrests up to 24 months (MD 0.24, 95% CI 0.76 to 0.28), based on low-certainty evidence.One study (38 participants) reported on the use of interpersonal psychotherapy in comparison to a psychoeducational intervention. Investigators found no significant reduction in self-reported drug use at three months (RR 0.67, 95% CI 0.30 to 1.50), providing very low-certainty evidence. The final study (29 participants) compared legal defence service and wrap-around social work services versus legal defence service only and found no significant reductions in the number of new offences committed at 12 months (RR 0.64, 95% CI 0.07 to 6.01), yielding very low-certainty evidence.

AUTHORS' CONCLUSIONS

Therapeutic community interventions and mental health treatment courts may help people to reduce subsequent drug use and/or criminal activity. For other interventions such as interpersonal psychotherapy, multi-systemic therapy, legal defence wrap-around services, and motivational interviewing, the evidence is more uncertain. Studies showed a high degree of variation, warranting a degree of caution in interpreting the magnitude of effect and the direction of benefit for treatment outcomes.

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

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.

Comorbidity Patterns Among Patients With Opioid Use Disorder and Problem Gambling: ADHD Status Predicts Class Membership

Objective: Psychiatric comorbidities are highly prevalent among individuals affected by substance use disorders and those with non-substance-related addictive disorders such as gambling disorder. More recently, the frequent co-occurrence of substance use disorders and attention-deficit hyperactivity disorder (ADHD) has received particular attention. The aim of our study was to identify patterns of psychiatric comorbidity and to examine associations between patient group and ADHD status with class membership. Methods: Participants were patients with opioid use disorder enrolled in opioid maintenance treatment (OMT), either recruited from the community (n = 142; M age = 35.8 years; 38.7% female) or prison (n = 133; M age = 35.7 years; 21.8% female), and patients undergoing treatment for problem gambling (PrG; n = 80; M age = 43.1 years; 20% female). To enable direct comparisons, the following instruments were applied: Mini International Neuropsychiatric Interview, Adult ADHD self-report scale, Wender Utah Rating Scale, and European Addiction Severity Index. We used a latent class analysis (LCA) to identify psychiatric comorbidity patterns and a multinomial logistic regression to examine associations between patient group, ADHD status, age, and gender with class membership. Results: The LCA resulted in a three-class solution: (1) a class of individuals with a relatively low probability of current psychiatric comorbidities, except for a high probability of substance use disorders; (2) a class with markedly increased probabilities of current and recurrent psychiatric comorbidities, especially for major depression; and (3) a class with very low probabilities of psychiatric comorbidities, except for moderate probabilities of substance use disorders and antisocial personality disorder. Both OMT patients recruited from the community and those in prison were less likely than PrG patients to be assigned to the most burdened class with respect to psychiatric comorbidity (class 2). Further, both individuals with ADHD in childhood and those with adult ADHD were more likely members of class 2. Conclusions: PrG patients seem to be at an even higher risk for psychiatric comorbidities compared to OMT patients. Raising awareness among practitioners for the high prevalence of psychiatric comorbidities among patients with gambling disorder and individuals with ADHD is crucial to initiate adequate treatment and to improve response.

Outcome of serious violent offenders with psychotic illness and cognitive disorder dealt with by the New South Wales criminal justice system

BACKGROUND

The few studies of the recidivism by people with psychotic illness and cognitive disorder who are convicted of serious violent offences and sentenced by the courts.

METHOD

Re-imprisonment data were obtained for 661 individuals convicted of serious non-lethal violent offences in the District Courts of New South Wales in the years 2006 and 2007. Rates of re-imprisonment of offenders known to psychotic illness or cognitive disorder (intellectual disability or acquired brain injury) was compared to those not known to have those conditions. A survival analysis was performed controlling for the effects of male sex, having a report by a mental health professional at the initial sentencing and receiving a custodial sentence for the initial offence.

RESULTS

There was no significant difference in the overall likelihood of further imprisonment between those with psychotic disorder (53.7%), those with cognitive disorder (50.7%) or among those with neither condition (45.2%; χ² = 2.22, p = 0.33). A Kaplan-Meier analysis found that people with a psychotic disorder were returned to custody earlier than those not known to have psychosis ( p = 0.002). People with psychosis spent a non-significantly greater time in custody (mean 477 days) than those with a cognitive disorder (mean 334 days) or among those with neither condition (mean 348 days) (Mann-Whitney Z-score = 1.5, η² = 0.003, p value = 0.13). For the entire sample of 661 offenders, those who received non-custodial sentences for their initial offences had a lower likelihood of spending any time in custody in the follow-up period.

CONCLUSION

The likelihood of returning to custody of sentenced violent offenders with psychotic illness or cognitive disorder is higher than that of released forensic patients in New South Wales followed up for a similar period. The results suggest an opportunity to improve the outcome of offenders with psychosis by better treatment and rehabilitation.

Approved and Off-Label Use of Prescribed Psychotropic Medications among Federal Canadian Inmates

OBJECTIVE

To examine psychotropic medication prescription practices in federal Canadian penitentiaries.

METHOD

468 files were drawn from a purposive sample of thirteen Canadian federal institutions representing the five regions, different security levels, and male and female designated facilities. Information on the names of all psychotropic medications prescribed, indications for use, dosage, frequency, and route of administration was retrieved. Designation of approved or off-label use of medications was determined by consulting: (1) the Health Canada (2016) Drug Product Database, (2) the Canadian Compendium of Pharmaceuticals and Specialties 2016, and (3) the American Hospital Formulary Service Drug Information 2016. Prescription rates were examined by gender, Indigenous ancestry, drug class, institutional infractions, and current offence.

RESULTS

36.2% of prescriptions for psychotropic medication were coded as 'off-label'. Anxiolytic/hypnotics drugs were the psychotropic drugs most commonly used for off-label purposes. There were no differences in the prevalence of approved versus off-label prescriptions based on Indigenous ancestry or gender, and no pattern of elevated off-label prescription practices for offenders involved in institutional misconducts or those sentenced for the most serious crimes.

CONCLUSIONS

The rates of prescribing 'off-label' psychotropic medication are not elevated relative to other correctional settings or to rates cited in Canadian surveys conducted in the community.

“I Lost Me Visits”

Utilizing Bacchi’s poststructuralist approach, “What’s the problem represented to be?,” we critically examine how the “problem” of drug use in prison is represented within a key initiative—the Identified Drug User program (IDUP)—of prison drug policy in one Australian jurisdiction. We use two data sources for our analysis: interview transcripts of recently incarcerated young men (aged 19–24) with histories of injecting drug use and selected prison drug policy and program documents. We examine how the “problem” of drug use in prison is problematized within the IDUP and question commonly accepted ways of thinking that underpin the program. We explore the discursive and subjectification effects of problem representations which produce young men as “rational” and “choosing” and, at the same time, as “untrustworthy” and “deserving of punishment.” We highlight how these effects have consequences for young men’s connections to family while incarcerated which can work against the very issues the IDUP is trying to address. We make two claims in particular: that the IDUP produces harmful effects for young men and their families and that the harmful effects produced are, paradoxically, those the IDUP aims to avoid. Our analysis offers insights into how drug use in prison could be thought about differently, including suggestions that might reduce at least some of its adverse effects.

Prison environment and non-communicable chronic disease modifiable risk factors: length of incarceration trend analysis in Mexico City

BACKGROUND

There is a lack of evidence regarding chronic disease modifiable risk factors among prisoner populations in Latin America. The purpose of this study was to estimate the prevalence of modifiable risk factors for chronic diseases and to assess their relationship with length of incarceration.

METHODS

We analysed data from a cross sectional study in which 4241 prisoners were randomly selected to answer a questionnaire with socio-demographic and health behaviour content using an audio computer-assisted self-interview format. Physical activity (PA), low-quality diet, current smoking and alcohol or cocaine use during the last month in prison were our main outcomes. Quantile regression models and logistic regression models were performed.

RESULTS

Our final analytical sample consisted of 3774 prisoners from four Mexico City prisons. PA was estimated as 579 median metabolic equivalents-min/week, prevalence of alcohol use was 23.4%, cocaine use was 24.2% and current smoking was 53.2%. Our results suggest that, as length of incarceration increased, PA as well as alcohol and cocaine use increased, whereas the quality of diet decreased.

CONCLUSION

This study supports the hypothesis that exposure to prison environment (measured by length of incarceration) fosters modifiable risk factors for chronic diseases, particularly diet quality and cocaine use.

The associations of poor psychiatric well-being among incarcerated men with injecting drug use histories in Victoria, Australia

BACKGROUND

Dual substance dependence and psychiatric and psychological morbidities are overrepresented in prison populations and associated with reoffending. In the context of an increasing prison population in Australia, investigating the needs of vulnerable people in prison with a dual diagnosis can help inform in-prison screening and treatment and improve prison and community service integration and continuation of care. In this study we quantified psychiatric well-being in a sample of people in prison with a history of injecting drug use in Victoria, Australia, and identified factors associated with this outcome.

METHODS AND RESULTS

Data for this paper come from baseline interviews undertaken in the weeks prior to release as part of a prospective cohort study of incarcerated men who reported regular injecting drug use prior to their current sentence. Eligible participants completed a researcher-administered structured questionnaire that canvassed a range of issues. Psychiatric well-being was assessed using the 12-item General Health Questionnaire (GHQ-12) and potential correlates were included based on a review of the literature. Of the 317 men included for analyses, 139 were classified as experiencing current poor psychiatric well-being. In the multivariate model using modified logistic regression, history of suicide attempt (aOR = 1.36, 95%CI 1.03-1.78), two or more medical conditions (aOR = 1.87, 95%CI 1.30-2.67) and use of crystal methamphetamine in the week prior to their current sentence (aOR = 1.52, 95%CI 1.05-2.22) were statistically significantly associated with current poor psychiatric well-being.

CONCLUSIONS

Comprehensively addressing the health-related needs for this vulnerable population will require a multidisciplinary approach and enhancing opportunities to screen and triage people in prison for mental health and other potential co-occurring health issues will provide opportunities to better address individual health needs and reoffending risk.

Women's Health in Queensland Prisons

Internationally, best practice for prison health care recommends transferring health service provision from corrections to health authorities. Although it is expected that this change will result in improved health care, there is little evidence of evaluation. This article used qualitative interviews with health service providers to gain insight into the health needs of women's prisons in Queensland, Australia, both prior to and after the transition in health care service provision. We found that service providers identified that problems persisted regardless of service provider and that improvement required increased resources and more fundamental structural changes within prison environments.

Psychological distress among re-education through labour camp detainees in Guangxi Autonomous Region, China

BACKGROUND

There is currently no information about the prevalence of, and factors contributing to psychological distress experienced by re-education through labour camp detainees in China.

METHODS

A cross-sectional face-to-face survey was conducted in three labour camps in Guangxi, China. The questionnaire covered socio-demographic characteristics; sexually transmissible infections (STIs); drug use; psychological distress (K-10); and health service usage and access inside the labour camps. K-10 scores were categorised as ≤30 (low to moderate distress) and  >30 or more (highly distressed). Univariate and multivariate logistic regression models identified factors independently associated with high K-10 scores for men and women separately.

RESULTS

In total, 755 detainees, 576 (76%) men and 179 (24%) women, participated in the health survey. The study found 11.6% men versus 11.2% women detainees experienced high psychological distress, but no significant gender differences were observed (p> 0.05). Multivariate logistic regression showed that multiple physical health problems were significantly associated with high psychological distress among men.

CONCLUSION

Drug treatment and forensic mental health services need to be established in detention centres in China to treat more than 10% of detainees with drug use and mental health disorders.

National Prevalence of Mental Disorders among Incoming Canadian Male Offenders

OBJECTIVE

A current estimate of prevalence rates of mental disorder among Canadian federal offenders is required to facilitate treatment delivery and service planning.

METHOD

The study determined prevalence rates of major mental disorders among newly admitted male offenders entering the federal correctional system in Canada. Data were collected at each regional reception site on consecutive admissions for a 6-month period (N = 1110). Lifetime and current prevalence rates were estimated using the Structured Clinical Interview for DSM Axis I Disorders (SCID-I) and the SCID Axis II Disorders (SCID-II). Degree of impairment was estimated using the Global Assessment of Functioning (GAF) scale. Results were disaggregated by Aboriginal ancestry.

RESULTS

The national prevalence rate for any current mental disorder was 73%. The highest rates were for alcohol and substance use disorders; however, over half of participants met the lifetime criteria for a major mental disorder other than alcohol or substance use disorders or antisocial personality disorder. Thirty-eight percent met the criteria for both a current mental disorder and one of the substance use disorders. Fifty-seven percent of offenders with a current Axis I mental disorder were rated as experiencing minimal to moderate functional impairment based on the GAF, indicating that most participants do not require intensive psychiatric services.

CONCLUSIONS

These results underscore the challenge posed to Canadian federal corrections in providing the necessary mental health services to assist in the management and rehabilitation of a significant percentage of the offender population with mental health needs.

Mental health of prisoners: prevalence, adverse outcomes, and interventions

More than 10 million people are imprisoned worldwide, and the prevalence of all investigated mental disorders is higher in prisoners than in the general population. Although the extent to which prison increases the incidence of mental disorders is uncertain, considerable evidence suggests low rates of identification and treatment of psychiatric disorders. Prisoners are also at increased risk of all-cause mortality, suicide, self-harm, violence, and victimisation, and research has outlined some modifiable risk factors. Few high quality treatment trials have been done on psychiatric disorders in prisoners. Despite this lack of evidence, trial data have shown that opiate substitution treatments reduce substance misuse relapse and possibly reoffending. The mental health needs of women and older adults in prison are distinct, and national policies should be developed to meet these. In this Review, we present clinical, research, and policy recommendations to improve mental health care in prisons. National attempts to meet these recommendations should be annually surveyed.

A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions

This qualitative study explored prisoners’ lived experiences of substance use and mental health difficulties and aimed to examine perceived links between these two areas and how they might be associated with recovery during engagement with the Breaking Free Health and Justice (BFHJ) treatment programs. Interviews were conducted with 32 prisoners receiving treatment for substance use in North-West England. Emerging from prisoners’ interviews were themes relating to difficult life experiences from childhood into adulthood, how these experiences played a role in the emergence of their multiple and complex difficulties, their treatment experiences, and how their current involvement with the criminal justice system acted as a catalyst for positive change, including engagement with the BFHJ programs. This study identified the roles of substance use and mental health difficulties in the lives of participants, identified how their multiple and complex difficulties might be addressed, and provided insights into prisoners’ interpretations of their life experiences.

Modelling the Impact of Condom Distribution on the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System

Aims

To determine the effects of 1) a condom distribution program and 2) a condom distribution program combined with opt-out sexually transmitted infection (STI) screening on the transmission and prevalence of STIs in a prison system.

Methods

Using data from an implementation evaluation of a state-wide prison condom program and parameter estimates from available literature, a deterministic model was developed to quantify the incidence and prevalence of sexually transmitted HIV, hepatitis B, chlamydia, syphilis and gonorrhoea across 14 Victorian prisons. The model included individual prison populations (by longer (>2 years) or shorter sentence lengths) and monthly prisoner transfers. For each STI, simulations were compared: without any intervention; with a condom distribution program; and with a combined condom and opt-out STI screening at prison reception intervention program.

Results

Condoms reduced the annual incidence of syphilis by 99% (N = 66 averted cases); gonorrhoea by 98% (N = 113 cases); hepatitis B by 71% (N = 5 cases); chlamydia by 27% (N = 196 cases); and HIV by 50% (N = 2 cases every 10 years). Condom availability changed the in-prison epidemiology of gonorrhoea and syphilis from self-sustaining to levels unlikely to result in infection outbreaks; however, condoms did not reduce chlamydia prevalence below a self-sustaining level due to its high infectiousness, high prevalence and low detection rate. When combined with a screening intervention program, condoms reduced chlamydia prevalence further, but not below a self-sustaining level. The low prevalence of HIV and hepatitis B in Australian prisons meant the effects of condoms were predicted to be small.

Conclusion

Condoms are predicted to effectively reduce the incidence of STIs in prison and are predicted to control syphilis and gonorrhoea transmission, however even combined with a screening on arrival program may be insufficient to reduce chlamydia prevalence below self-sustaining levels. To control chlamydia transmission additional screening of the existing prison population would be required.

Alcohol and other drug use among Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander men entering prison in New South Wales

Introduction and aims

Prison entrants commonly have a history of problematic alcohol and other drug (AoD) use. Aboriginal and Torres Strait Islander (Indigenous) Australians are vastly overrepresented in Australian prisons with an incarceration rate 16 times that of non-Indigenous Australians. Relatively little attention has been given to the patterns of AoD use among prison entrants and we hypothesise that they may differ between Indigenous and non-Indigenous entrants. The aim of this paper is to compare the prior AoD use among Indigenous and non-Indigenous prison entrants and identify the implications for AoD treatment provision within prisons.

Design and method

Cross-sectional random sample of 200 men recently received into New South Wales (NSW) criminal justice system.

Results

During the 12 months prior to imprisonment, 106 prison entrants consumed alcohol at levels at which an intervention is recommended. Additionally during the four weeks prior to prison, 94 inmates had used illicit drugs daily. There was some overlap between these two groups; however, heroin users were less likely to consume alcohol at harmful levels. Relative to non-Indigenous entrants, Indigenous entrants prior to imprisonment used more cannabis but less amphetamine on a daily basis. There were no other significant differences between the alcohol or drug use of Indigenous and non-Indigenous prison entrants.

Discussion and conclusion

Both Indigenous and non-Indigenous men entering prison have a history of high levels of AoD use but a slightly different treatment focus may be required for Indigenous inmates.

Correlates of property crime in a cohort of recently released prisoners with a history of injecting drug use

Background

Injecting drug use (IDU) is a strong predictor of recidivism and re-incarceration in ex-prisoners. Although the links between drug use and crime are well documented, studies examining post-release criminal activity and re-incarceration risk among ex-prisoners with a history of IDU are limited. We aimed to explore factors associated with property crime among people with a history of IDU recently released from prison.

Method

Individuals with a history of IDU released from prison within the past month were recruited via targeted and snowball sampling methods from street drug markets and services for people who inject drugs (PWID) into a 6-month cohort study. A multivariate logistic regression analysis of baseline data identified adjusted associations with self-reported property crime soon after release.

Results

Interviews were conducted a median of 23 days post-release with 141 participants. Twenty-eight percent reported property crime in this period and 85 % had injected drugs since release. Twenty-three percent reported injecting at least daily. Reporting daily injecting (adjusted odds ratio (aOR) 4.36; 95 % confidence interval (CI) = 1.45–13.07), illicit benzodiazepine use (aOR = 2.59; 95 % CI = 1.02–5.67), being arrested (aOR = 6.12; 95 % CI = 1.83–20.45) and contact with mental health services (aOR = 4.27; 95 % CI = 1.45–12.60) since release were associated with property crime.

Conclusion

Criminal activity soon after release was common in this sample of PWID, underscoring the need for improved pre-release, transitional and post-release drug use dependence and prevention programmes. Addressing co-occurring mental disorder and poly-pharmaceutical misuse among those with a history of IDU in prison, and during the transition to the community, may reduce property crime in this group.

Predictors of Psychiatric Hospitalization in Ex-Prisoners With Substance Use Problems

This study analyzed predictors of psychiatric hospitalization in ex-prisoners with substance use problems ( N = 4,081) assessed with the Addiction Severity Index and followed post-release for hospitalizations with psychiatric diagnoses (including suicide attempts). Thirty-four percent were hospitalized, and in Cox regression, several substance-related variables predicted hospitalization, including use of heroin, sedatives, and polysubstance. A secondary analysis, with a psychiatric non-substance focus, excluded hospitalizations involving only substance-related disorders or only a personality disorder in addition to a substance-related disorder. With this definition, 10% were hospitalized, and significant baseline predictors were previous psychiatric hospitalization (hazard ratio [HR] = 1.83), previous suicide attempt (HR = 1.91), depression (HR = 1.33), anxiety (HR = 1.37), sedative use (HR = 1.46), and, negatively, amphetamine use (HR = 0.71). Substance-related variables may predict all-cause psychiatric hospitalizations in prisoners with substance use problems, whereas non-substance-related psychiatric hospitalization may be predicted by baseline psychiatric problems, which calls for attention to psychiatric problems in this setting.

Self-determination theory: a framework for clubhouse psychosocial rehabilitation research

The Clubhouse model is a widely used approach to psychosocial rehabilitation that has been a pioneer in supporting recovery-oriented programmes. Little consideration has been given however, to the theories that guide research of the recovery practices used by Clubhouses. In this paper, we provide a description of self-determination theory, including its philosophical background followed by explanation of its relevance to health care and Clubhouse contexts. We argue that self-determination theory provides a robust social constructionist theoretical framework that is well-suited to informing research related to psychosocial rehabilitation, recovery-oriented practices and the Clubhouse model.