The National Survey of Psychiatric Morbidity among prisoners and the future of prison healthcare

Assessing Maladaptive Personality in the Forensic Context: Development and Validation of the Personality Inventory for DSM-5 Forensic Faceted Brief Form (PID-5-FFBF)

The current study proposes an adaptation of the PID-5 to assesses maladaptive personal traits in forensic settings. Specifically, we adapted the item set of the PID-5 Faceted Brief Form (PID-5-FBF) to the forensic context and validated the resulting PID-5 Forensic Faceted Brief Form (PID-5-FFBF) using self- and informant-reports of 199 male prisoners. Exploratory factor analyses suggested a four-factor solution comprising Antagonism, Detachment, Disinhibited Aggression, and Insecurity. Antagonism and Detachment were very similar to the domains with the same name from the five-factor solution of the PID-5. Insecurity conceptually resembled Negative Affectivity. Disinhibited Aggression represented a forensically highly relevant composition of Antagonism, Disinhibition, and Negative Affectivity. We report results for this four- and the canonical five-factor solution throughout the manuscript. The PID-5-FFBF domains showed convergent associations with the corresponding Big Five personality traits. Furthermore, the PID-5-FFBF domains were differentially correlated with indicators of psychological adjustment and forensically relevant outcomes such as institutional misbehavior and risk for reoffending. In particular, Insecurity was associated with lower levels of psychological adjustment, while Antagonism and Disinhibited Aggression were associated with higher levels of institutional misbehavior and risk for reoffending. These findings provide initial evidence for the validity and utility of the PID-5-FFBF in forensic settings.

The complexity of the therapeutic experience within the therapeutic community based on an ex-patient’s account

Purpose

The purpose of this paper is to explore the effectiveness of the therapeutic community and to look at the potential changes that some patients may experience following treatment at the therapeutic communities (TC).

Design/methodology/approach

A thematic analysis was conducted on an e-mail sent by an ex-patient of the TC. The text was reviewed multiple times and codes were generated. Based on the data found, three themes were identified. The e-mail was sent to the patient’s primary therapist, who was asked to provide an account of the e-mail. The therapist was sent six questions created by the authors of the paper; the responses were used to compare the two perspectives.

Findings

The main findings entailed the changes the patient went through after her treatment at the TC. The patient’s account described her inability to process the adversities she had been through at the time and therefore her inability to communicate them. However, the impact the service had on the patient, according to the e-mail was evident years later. The lack of a support network during treatment at the TC and evidence of one following treatment seemed to be the key factor in the patient’s improvement.

Originality/value

The authors confirm that the research presented in this paper is their original work. The authors hereby acknowledge that all material included in this piece of work, that has been published or written by another person has been referenced accordingly.

Are prison-based therapeutic communities effective? Challenges and considerations

PURPOSE

The purpose of this paper is to detail the impact and efficacy of Her Majesty's Prison and Probation Service ((HMPPS) Therapeutic Communities (TCs) (both democratic and hierarchical). This paper outlines recent developments in the TC literature, to provide readers with an up-to-date overview of the outcomes of prison-based TC treatment, while highlighting the strengths and challenges of this treatment approach. Trends within the research are discussed, and the authors draw attention to any gaps in the current knowledge.

DESIGN/METHODOLOGY/APPROACH

This paper uses a narrative literature review approach to review the most current literature around the effectiveness of prison-based TCs in HMPPS. Academic literature published predominantly from 2010 onwards is discussed because of limited literature review publications on this topic post-2010. To obtain literature, searches of relevant databases were conducted, and/or clinical leads at prison sites were contacted for relevant publications.

FINDINGS

There is a body of research which demonstrates that TCs are an effective form of treatment for people with an offending history and personality difficulties. Evidence indicates that Democratic TC treatment plays a part in reducing reoffending rates, as well as improving psychological features. Further research is needed in a number of areas, specifically with female offenders and individuals who undertake treatment in hierarchical TCs in the UK. It is also suggested that TC treatment aftercare may help to further the positive outcomes identified.

ORIGINALITY/VALUE

To the best of the authors' knowledge, there is no up-to-date review of the impact and efficacy of HMPPS TC treatment. This paper reflects on available research within the current context of TC treatment and provides an original overview of the current UK TC practice. It has value in recommending areas for further research and consideration.

Exposure to Traumatic Events and Development of Psychotic Symptoms in a Prison Population: A Network Analysis Approach

Previous studies consistently observed an association between exposure to traumatic events and psychotic symptoms. However, little is known about the differential impact of distinct traumatic events and the role of general symptoms in mediating this relationship. Thus, our study aimed to explore the differential association of several traumatic events to the psychotic symptoms in a sample of prisoners and whether this association is mediated by general symptoms. The total sample from the Survey of Psychiatric Morbidity Among Prisoners in England and Wales (N = 3039; 75.4% male) was used. Participants completed a list of traumatic events experienced before reclusion, the Psychosis Screening Questionnaire, Clinical Review Schedule-Revised. Network analysis was used to estimate the network of interactions between traumatic events and general and psychotic symptoms. Shortest paths analysis was performed to identify the different development trajectories. Results suggested that memory problems, compulsions, and irritability might be key mediating symptoms for most traumatic events. However, sexual abuse showed alternative mediators that might be specific of this traumatic event. Finally, the traumatic events, suffered from violence at work, separation/divorce and been homeless showed direct associations with specific psychotic symptoms.

A cross-sectional prevalence survey of psychotropic medication prescribing patterns in prisons in England

Background

The prevalence of mental illness is significantly higher among prisoners than among people in the wider community. Psychotropic prescribing in prisons is a complex and controversial area, where prescribers balance individual health needs against security and safety risks. However, there are no current data on prescribing patterns in prisons or how these compare with those in the wider community.

Aims

The study aimed to determine the prevalence, appropriateness and acceptability of psychotropic prescribing in prisons. The objectives were to determine rates of prescribing for psychotropic medications, compared with those in the wider community; the appropriateness of psychotropic prescribing in prisons; and the perceived satisfaction and acceptability of prescribing decisions to patients and general practitioners (GPs).

Method

Eleven prisons, housing 6052 men and 785 women, participated in a cross-sectional survey of psychotropic prescribing. On census days, data were extracted from clinical records for all patients in receipt of hypnotics, anxiolytics, antipsychotics, antimanics, antidepressants and central nervous system stimulants. The Clinical Practice Research Datalink supplied an equivalent data set for a random sample of 30,602 patients prescribed psychotropic medicines in the community. To determine the acceptability of prescribing decisions, patients attending GP consultations at three prisons were surveyed (n = 156). Pre- and post-consultation questionnaires were administered, covering expectations and satisfaction with outcomes, including prescribing decisions. Doctors (n = 6) completed post-consultation questionnaires to explore their perspectives on consultations.

Results

Overall, 17% of men and 48% of women in prison were prescribed at least one psychotropic medicine. After adjusting for age differences, psychotropic prescribing rates were four times higher among men [prevalence ratio (PR) 4.02, 95% confidence interval (CI) 3.75 to 4.30] and six times higher among women (PR 5.95, 95% CI 5.36 to 6.61) than among community patients. There were significant preferences for certain antidepressant and antipsychotic drugs in prison, compared with in the community. In 65.3% of cases, indications for psychotropic drugs were recorded and upheld in theBritish National Formulary. Antipsychotic prescriptions were less likely than other psychotropics to be supported by a valid indication in the patient notes (PR 0.75, 95% CI 0.67 to 0.83). In the acceptability study, patients who identified mental health as their primary problem were more likely than individuals who identified other types of health problems to want to start, stop and/or change their medication (PR 1.46, 95% CI 1.23 to 1.74), and to report dissatisfaction following the consultation (PR 1.76, 95% CI 1.01 to 3.08). Doctors were more likely to issue prescriptions when they thought that the patient wanted a prescription (PR 4.2, 95% CI 2.41 to 7.28), they perceived pressure to prescribe (PR 1.66, 95% CI 1.26 to 2.19), and/or the problem related to mental health (PR 1.67, 95% CI 1.27 to 2.20).

Conclusions

Psychotropic medicines were prescribed more frequently in prisons than in the community. Without current and robust data on comparative rates of mental illness, it is not possible to fully assess the appropriateness of psychotropic prescribing. Nonetheless, psychotropic medicines were prescribed for a wider range of clinical indications than currently recommended, with discernible differences in drug choice. Complex health and security concerns exist within prisons. Further research is necessary to determine the effect of psychotropic prescribing on physical health, and to determine the optimum balance between medicines and alternative treatments in prisons.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Attention-deficit/hyperactivity disorder in young French male prisoners

While forensic studies have reported higher than community rates of mental disorders in imprisoned populations, few studies have focused on attention-deficit/hyperactivity disorder (ADHD) in these subjects. The aim of this study was to investigate ADHD prevalence among young French male prisoners. A specific diagnostic interview (Conners' Adult ADHD Diagnostic Interview for DSM-IV, CAADID) was used. Correlations between ADHD, subsyndromal ADHD, and criminal features were investigated. 11% of young male prisoners among 93 male subjects aged 18-35 years met the criteria for actual ADHD, and 17% met those for childhood ADHD. Considering ADHD and subsyndromal ADHD, prevalence was about 43% in adulthood. ADHD and subsyndromal ADHD in adulthood were significantly associated with a higher number of imprisonments and a younger age at first arrest. It could be advisable to better identify subjects with ADHD symptoms among prison populations.

Prison life: television, sports, work, stress and insomnia in a remand prison

OBJECTIVE

To compare how prisoners complaining of insomnia and prisoners without sleep problems describe their daily activities, stress factors and the perceived reasons for their sleep quality in prison.

METHOD

102 randomly chosen remanded prisoners complaining of insomnia and 61 randomly chosen prisoners who did not complain of insomnia.

RESULTS

Prisoners complaining of insomnia and those reporting good sleep differed significantly in their lifestyle in prison. A significantly higher percentage of the former than of the latter reported writing letters, diaries or a book in prison, as well as doing "arts-related" activities such as painting and listening to music. A significantly higher percentage of non insomniac prisoners than of prisoners complaining of insomnia practiced sports in prison, watched television, and spent their day discussing and meeting other detainees. PSQI and GHQ scores were significantly different between insomniac and non insomniac prisoners. Insomniac prisoners complained significantly more often than non-insomniac prisoners about sleep disturbances, in the first place by roommates, but also by guards. Activities in prison and stressful events were significant factors associated with the variable "insomnia versus no insomnia" Worries about medical problems (odds ratio: 12.9), being separated or divorced (odds ratio: 8.8), having experienced stressful events during the past week (odds ratio: 8.7), "art" activity (odds ratio: 8.6), and having a GHQ score>10 (odds ratio: 7.7) had the highest odds ratios among the tested covariates. No sports in prison and some activities were also predictors of insomnia when entered separately or conditionally.

CONCLUSION

Our study provides arguments on how to alleviate insomnia in prison: changing conditions of imprisonment is of public health benefit. Increased opportunities to practice sports in prison as well as adequate care for medical problems and psychological support to reduce context related stress should be routinely offered to insomniac prisoners.

Psychiatric morbidity in murder and attempted murder crime convicts: A Turkey study

In the present, the morbidity of psychiatric disorders of homicide/attempted homicide crime convicts imprisoned in Turkey, Sivas maximum security prison was investigated. Seventy imprisoned homicide/attempted homicide crime convicts included in this study. Sociodemographic information form, structured clinical interview for DSM-IV Axis-I disorders and structured clinical interview for DSM-III-R personality disorders applied to the participants. Most commonly diagnosed disorders among those convicts were current Axis-I disorders, depressive disorders (7.1%) and anxiety disorders (5.7%). Among Axis-I disorders, the most diagnosed one was the substance use disorders (45.7%). The most diagnosed Axis-II disorder was found as to be antisocial personality disorder (48.6%). The rate of convicts who were diagnosed as having both Axis-I and Axis-II disorders was 51.4%. The most prevalently accompanying lifetime Axis-I disorders to antisocial personality disorder with respect to Axis-I, and Axis-II comorbidity was substance use disorders. As a result, it was thought that the substance use disorders and antisocial personality disorder among the homicide/attempted homicide crime convicts were the most prevalent lifetime psychiatric disorders.

Does PTSD occur in sentenced prison populations? A systematic literature review

BACKGROUND

A systematic review of the literature on mental disorder in prisoners, published in 2002, made no mention of post-traumatic stress disorder (PTSD), but indicators from other studies suggest that a history of serious and chronic trauma is common among offenders.

AIMS

To conduct a systematic review of the literature with the specific questions: does any epidemiological study of sentenced prisoners include data on prevalence of PTSD while in prison? If so, what is the prevalence in this group?

METHOD

Literature databases EMBASE, Medline, PsychInfo, PILOTS and SIGLE were searched. The Journal of Traumatic Stress was searched manually. Preliminary screening was conducted by reading abstracts of hundreds of papers. Ten exclusion criteria were then applied to the screened selection. Reference sections of all accessed papers were searched for any further studies.

RESULTS

One hundred and three potentially relevant papers were identified after preliminary screening. Four met all criteria for inclusion and suffered none of the exclusion criteria. PTSD rates ranged from 4% of the sample to 21%. Women were disproportionately affected.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

All four papers suggested that the prevalence of PTSD among sentenced prisoners is higher than that in the general population, as reported elsewhere. Overall the findings suggest a likely need for PTSD treatment services for sentenced prisoners.