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Musli N, Baumgartner P, Meier M, Thiel S, Rampini SK, Battegay E, Kohler M, van Rooij F, Kuratle T, Nover L, Saffarini M, Steinack C, Saxena S, Gaisl T. The Swiss Prison Study (SWIPS): Results from a registry-based study of prisoners in Switzerland from 2015 to 2020. Swiss Med Wkly 2024; 154:3351. [PMID: 39137354 DOI: 10.57187/s.3351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
AIM OF THE STUDY The purpose of the present study was to evaluate demographic characteristics of inmates in the Canton of Zurich (exposure), and investigate the changes in diseases and drug use between 2015 and 2020 (outcome). METHODS The study prospectively evaluated 51,989 inmates admitted to the Police Prison Zurich in Switzerland between 1 April 2015 and 31 August 2020 and who were systematically medically assessed. A total of 19,027 (37%) inmates had one or more health conditions, which the authors recorded according to the International Classification of Diseases-10 (ICD-10), in addition to demographic data (country of origin, sex, age, year of imprisonment), as well as details of any drugs used (type and dosage). RESULTS The 19,027 inmates with medical conditions had a mean age of 35.4±12.5 years (range 10-89) and comprised 16,489 males (87%). The inmates originated from 170 countries, including 4606 from Switzerland (24.2%), 4227 from Eastern Europe (22%) and 3432 from the Middle East & North Africa (18%). A total of 1631 inmates (9%) were enrolled in the medication-assisted treatment (MAT) programme, and 672 patients (4%) received a psychiatric evaluation. The proportions of foreign prisoners did not increase during the study period. There was a significant increase in the use of antipsychotics from year 1 to 5 (y = 0.866x; R2 = 0.902; p = 0.01) and anticonvulsants from year 1 to 4 (y = 1.27x; R2 = 0.823; p = 0.01), and a significant decrease in the use of analgesics from year 2 to 5 (y = -4.42x; R2 = 0.947; p = 0.03) and antianxiety drugs from year 1 to 4 (y = -3.31x; R2 = 0.989; p = 0.005). Inmates from Switzerland were most likely to use antianxiety drugs, while inmates from the Middle East & North Africa were most likely to use antipsychotics (OR 2.09; CI 1.88-2.34) and anticonvulsants (OR 3.52; CI 2.90-4.29), whereas inmates from Latin and North America were most likely to use herbal medicine (OR 1.50; CI 1.05-2.10). CONCLUSIONS The findings of this study could help anticipate needs of prisons as well as improve treatment of disease and assist with substance use or abuse, particularly in the context of migration.
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Affiliation(s)
- Naser Musli
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Baumgartner
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Internal Medicine, Hospital Uster, Uster, Switzerland
| | - Marc Meier
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sira Thiel
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Silvana K Rampini
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | - Carolin Steinack
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Shekhar Saxena
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Thomas Gaisl
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Alves J, Martinho G, Gonçalves M, Maia Â. Assessment of the Health Status of Women in Prison: A Comparison between Drug Users versus Non-users. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:1615-1629. [PMID: 36377114 DOI: 10.1177/0306624x221132218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study aims to analyze the history of substances use, clinical diagnoses, contacts with healthcare, and health complaints. Also, it aims to compare the health status of substance users versus non-users. Health records of 93 detained women from a prison in northern Portugal, with a mean age of 38.02 years old, were reviewed and coded using both International Classification of Primary Care-2 and International Classification of Diseases-10th. Data revealed high percentages of detainees with a history of substance use and pre-existing clinical diagnosis. During the first month of imprisonment, on average, participants had complained to a health professional 14.63 times. Substance users were younger and presented more mental health problems and health complaints. Health policies and professional practices in prison must include immediate assessment of a woman's health concerns and foster the development of efficient protocols to address those problems, especially substance use disorder treatment.
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Affiliation(s)
- Joana Alves
- School of Psychology, University of Minho, Braga, Portugal
| | | | | | - Ângela Maia
- School of Psychology, University of Minho, Braga, Portugal
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Jeker B, Shaw D, Lagnaux N, Wangmo T, Elger BS. Motivation and training needs of prison healthcare professionals: findings from a qualitative study. BMC Psychol 2023; 11:167. [PMID: 37210567 DOI: 10.1186/s40359-023-01076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 02/03/2023] [Indexed: 05/22/2023] Open
Abstract
Health care in prison is a challenging task. The conditions of imprisonment create distinct difficulties for those providing health care in this setting. These particular circumstances have led to a shortage of quality professionals, working for the health of imprisoned people. The aim of this study is to elaborate reasons for healthcare professionals to work in a prison environment. The main research question is: why do healthcare workers choose to work in prisons? Furthermore, our study identifies training needs in various fields. Interview data that comes from a national project carried out in Switzerland and three other relatively wealthy countries were analyzed using content analysis. One-on-one, semi structured interviews were designed and conducted with professionals working in prison context. A total of 105 interviews were carried out and for this work 83 of them were analyzed and coded into themes responding to the study aim. Most participants chose to work in prison either because of practical reasons, as many reported various forms of contact with the studied prison environment at a younger age, or because of intrinsic reasons, including among others, having the wish to change the system of healthcare in prisons. Even though the education of the participants varied greatly, a lack of specialist training was expressed by many health care professions as an important factor. This study points out the need for more specific training programs for healthcare workers in prison and provides suggestions to ameliorate the recruitment and education for future prison health care workers.
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Affiliation(s)
- Benjamin Jeker
- Medizinische Fakultät, University of Basel, Basel, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
- Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Augsburger A, Neri C, Bodenmann P, Gravier B, Jaquier V, Clair C. Assessing incarcerated women's physical and mental health status and needs in a Swiss prison: a cross-sectional study. HEALTH & JUSTICE 2022; 10:8. [PMID: 35194696 PMCID: PMC8864867 DOI: 10.1186/s40352-022-00171-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 02/01/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Women make up 5% of the European prison population on average. Almost invisible in prison and health research, and suffering the stigma associated with female offending, incarcerated women are often forgotten, and their specific healthcare needs remain much ignored. Combining face-to-face survey interviews and medical chart data, we aim to assess the health status, healthcare needs, and access to preventive medicine of women incarcerated in Switzerland. RESULTS Sixty incarcerated adult women participated in a cross-sectional study to assess their life and incarceration histories, physical and mental health problems, medication, and use of medical services. Eligibility criteria were (a) an incarceration of at least four weeks and (b) the ability to provide written informed consent. Exclusion criteria were psychiatric instability and insufficient language competence. Women's average age was 34.3 years old (SD = 9.8); 45.0% of them were born in Switzerland, 33.3% in Europe and 15.0% on the African continent. Overall, 61.7% of women self-reported physical or mental health problems and 13.3% indicated they were once diagnosed with a sexually transmitted infection. Further, 78.3% of women were active cigarette smokers; more than one in three women reported alcohol use problems and almost one in two women had used at least one illicit drug in the year before incarceration. Depression and perceived stress scores were above clinical cut-off points for more than half of interviewed women. When asked how they rated their health, 68.3% of women felt it had worsened since incarceration. All but four women had accessed prison medical services; however, our study does not indicate whether women's use of healthcare was indeed adequate to their needs. CONCLUSIONS This study demonstrated incarcerated women's poor health and health-risk behaviours. Structural changes and gender-responsive health promotion interventions have the potential to improve the health of incarcerated women and help them return to the community in better health.
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Affiliation(s)
- Aurélie Augsburger
- Centre for Primary Care and Public Health (Unisanté), Department of Training, Research and Innovation, University of Lausanne, Lausanne, Switzerland
| | - Céline Neri
- Service of Correctional Medicine and Psychiatry, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | - Patrick Bodenmann
- Centre for Primary Care and Public Health (Unisanté), Department of Vulnerabilities and Social Medicine, University of Lausanne, Lausanne, Switzerland
| | - Bruno Gravier
- Service of Correctional Medicine and Psychiatry, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | - Véronique Jaquier
- Centre for Criminological Research (CRRC), University of Neuchâtel, & School of Health Sciences Fribourg (HEdS-FR), HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel/Fribourg, Switzerland
| | - Carole Clair
- Centre for Primary Care and Public Health (Unisanté), Department of Training, Research and Innovation, University of Lausanne, Lausanne, Switzerland.
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Pageau F, Seaward H, Habermeyer E, Elger B, Wangmo T. Loneliness and social isolation among the older person in a Swiss secure institution: a qualitative study. BMC Geriatr 2022; 22:90. [PMID: 35105337 PMCID: PMC8806358 DOI: 10.1186/s12877-022-02764-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A pandemic of loneliness is hitting the aging population. As COVID19 forced us to isolate ourselves, we are in a better position to understand consequences of social distancing. The recent literature showed that older incarcerated adults are particularly at risk of health-related complications due to isolation in the prison environment, reducing their social capital. Mental and physical health can be severely affected by loneliness and social isolation, especially in prison. METHODS Our qualitative study investigates the view of older persons deprieved of their liberty on loneliness and social isolation pertaining to their mental health. We interviewed 57 older participants, including imprisoned individuals and forensic patients, following a semi-structured interview guide. During the data management and data analysis process, we excluded 7 interviews which were of poorer quality. Thereafter, we analyzed the remainders following a thematic approach. RESULTS Most interviewees experience loneliness following lack of significant human relationships in prison. Making friends appears to be a challenge for all the participants, because, for one thing, they do not find people with similar interests. Also, secure institution setting aggravates isolation due to the restrictions of movement placed such as rules concerning movement between floors, hindering intimate relationship, and separation between friends. Moreover, contact with prison personnel is limited and lack social capital (e.g. trust). CONCLUSION To our knowledge, this study is one of the first to present incarcerated persons' perspective on loneliness, social isolation and poor social capital in the Swiss prison setting. These has been reported to cause health problems both somatic and psychological. Our participants experience these deleterious factors in detention. As prisons have the possibility to become a health-promoting environment through connectedness, friendship, and trust promotion, stakeholders need to better their social capital.
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Affiliation(s)
- Félix Pageau
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland.
| | - Helene Seaward
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland
| | - Elmar Habermeyer
- Psychiatrische Universitätsklinik, Klinik für Forensische Psychiatrie, Zurich, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland.,Unit of Health Law and Humanitarian Medicine, Center for legal medicine, University of Geneva, Geneva, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland
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Gerth J, Endrass J, Weber M, Graf M, Singh JP, Rossegger A. Exploring the mental healthcare needs of Swiss pre-trial detainees: A pilot investigation of an on-site psychiatric day clinic. Front Psychiatry 2022; 13:924861. [PMID: 35928770 PMCID: PMC9345322 DOI: 10.3389/fpsyt.2022.924861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Research has established that justice-involved individuals experience significant mental health problems. However, mental healthcare in correctional settings is often not sufficiently accessible to meet the demand. Hence, to improve the availability of mental healthcare services, especially for pre-trial detainees, the first Swiss on-site psychiatric day clinic (PDC) was established in 2019. The present cross-sectional observational study aimed to evaluate the need of psychiatric care in pre-trial detention and the PDC's potential to improve it. METHODS File record data were collected from the Office of Corrections and Rehabilitation of the Canton of Zurich. Differences in primary psychiatric care consultations and psychiatric hospital admissions between pre-trial detainees and sentenced prisoners were examined. In addition, a total cohort of pre-trial detainees of the first 18 months of PDC operations was examined to identify differences between three treatment groups: (1) pre-trial detainees exclusively treated in the PDC (n = 41), (2) pre-trial detainees exclusively treated in a psychiatric hospital (n = 58), and (3) pre-trial detainees treated in both the PDC as well as a psychiatric hospital (n = 16). RESULTS In the 5 years before the PDC opened, pre-trial detainees had significantly more primary psychiatric care consultations and were admitted to psychiatric hospitals on significantly more occasions than were sentenced prisoners. In the first 18 months of the PDC, psychiatric hospital admission rates for pre-trial detainees decreased by 18.5% and pretrial detainees exclusively treated in the PDC differed significantly from other treatment groups concerning mental disorder, gender, and alleged index offense. They were more likely to be diagnosed with adjustment disorders and were less likely to be diagnosed with schizophrenia spectrum disorder. CONCLUSION The use of mental health care among pre-trial detainees is significantly more frequent than among sentenced prisoners concerning both primary care and inpatient treatment. Since establishment of the novel on-site PDC admissions to psychiatric hospitals were found to decrease. Data indicates that especially male pre-trial detainees with adjustment disorders benefitted from this innovative path forward in correctional healthcare. Further research is needed to improve the PDC's service for female pre-trial detainees.
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Affiliation(s)
- Juliane Gerth
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland
| | - Jérôme Endrass
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland.,Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
| | - Michael Weber
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland
| | - Marc Graf
- Department of Forensic Psychiatry, University of Basel, Basel, Switzerland.,Department of Forensic Psychiatry, University Psychiatric Hospitals, Basel, Switzerland
| | - Jay P Singh
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Publication Academy Inc., Reston, VA, United States
| | - Astrid Rossegger
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland.,Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
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[Suicides in the German prison system: frequency, risk factors, and prevention]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:18-24. [PMID: 34964913 PMCID: PMC8732920 DOI: 10.1007/s00103-021-03460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
Gefangene haben ein hohes Suizidrisiko und die höchsten Suizidraten sind bei Untersuchungsgefangenen zu verzeichnen. Suizid ist die häufigste singuläre Todesursache in deutschen Gefängnissen. In diesem narrativen Übersichtsbeitrag werden zunächst die Gefängnispopulation und ihre allgemeine Gesundheitsversorgung beschrieben, wobei insbesondere auf psychiatrische und Substanzkonsumstörungen eingegangen wird. Der Hauptteil widmet sich der Prävalenz, den Ursachen und Risikofaktoren von Gefängnissuizid. Maßnahmen zur Suizidprävention werden dargestellt. Der Anteil von Männern unter Gefangenen in Deutschland ist mit 94 % (2020) wie in allen Teilen der Welt sehr hoch. Die meisten Gefangenen sind jungen oder mittleren Alters. Die durchschnittlichen jährlichen Suizidraten bei Männern und Frauen in deutschen Gefängnissen entsprechen mit 105,8/100.000 bzw. 54,7/100.000 denen der meisten Länder in der Europäischen Union (Vollerhebung 2000–2011). Die Suizidraten bei männlichen deutschen Gefangenen sind in den Jahren 2000–2013 unabhängig vom Alter kontinuierlich zurückgegangen. Bei weiblichen Gefangenen stiegen sie dagegen an, wobei die Ursachen hierfür nicht bekannt sind. Es gibt Hinweise darauf, dass psychiatrische Erkrankungen nicht erkannt worden waren. Wichtige suizidpräventive Maßnahmen sind die Unterbringung in Gemeinschaft und die Vermeidung von Isolation, beispielsweise durch das Angebot von Arbeit. Zudem stehen validierte deutschsprachige Screeninginstrumente zur Verfügung, um ein Suizidrisiko frühzeitig zu erkennen. Für eine wirksame Gefängnissuizidprävention bedarf es der Identifikation von Hochrisikopersonen, des Angebots geeigneter suizidpräventiver Maßnahmen sowie der Entwicklung teambezogener Maßnahmen beim Gefängnispersonal.
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Merkt H, Haesen S, Eytan A, Habermeyer E, Aebi MF, Elger B, Wangmo T. Forensic mental health professionals' perceptions of their dual loyalty conflict: findings from a qualitative study. BMC Med Ethics 2021; 22:123. [PMID: 34530830 PMCID: PMC8444425 DOI: 10.1186/s12910-021-00688-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient's well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs' decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. METHODS 31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach. RESULTS We first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. CONCLUSIONS Even though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.
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Affiliation(s)
- Helene Merkt
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland.
| | - Sophie Haesen
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland
| | - Ariel Eytan
- Service des mesures institutionnelles, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Elmar Habermeyer
- Psychiatrische Universitätsklinik Zürich, Klinik für Forensische Psychiatrie, Zürich, Switzerland
| | - Marcelo F Aebi
- School of Criminal Sciences, University of Lausanne, Lausanne, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University Basel, Basel, Switzerland
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Seaward H, Wangmo T, Vogel T, Graf M, Egli-Alge M, Liebrenz M, Elger BS. What characterizes a good mental health professional in court-mandated treatment settings?: Findings from a qualitative study with older patients and mental health care professionals. BMC Psychol 2021; 9:121. [PMID: 34404482 PMCID: PMC8371872 DOI: 10.1186/s40359-021-00624-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Therapist-related activities and characteristics such as empathy and genuineness are factors that significantly contribute to psychotherapy outcome. As they play a role in psychotherapy more generally, it can be expected that they are equally important in the treatment of court-mandated patients more specifically. At the same time, these treatment settings come with specific challenges-e.g. due to coercion and control-and it could thus be that some therapist-related characteristics might have a different empathy on the therapy. This interview study sought to investigate service providers' and users' perspectives on therapist-related characteristics in the context of detention. METHODS We conducted a qualitative interview study with 41 older incarcerated persons mandated to treatment, and 63 mental health professionals (MHP). The data analysis followed thematic analysis. RESULTS Patients and experts both emphasized the importance of treating patients with respect by taking a humanistic approach, that is, condemn the deeds but embrace the person and display genuine interest in supporting patients with any issue or concern that is of relevance to them. Furthermore, interviewees underscored that the coerciveness of the therapy context required to incorporate patients' wishes into treatment planning, recognize and respond to the patients' needs, and allow some choice within the given framework. Such inclusive attitude was deemed critical to engage and motivate patients to participate in treatment. In addition, it was emphasized that feedback and advice by the therapists need to be concrete, detailed and applied to each person's current situation. Lastly, patients questioned MHP's qualification when they did not progress in therapy. DISCUSSION Our findings indicate that some therapist-related activities and characteristics are of particular importance in court-mandated settings. These include genuine interest in the patient, a respectful and positive attitude, as well as the capacity to target sensitive issues in a directive but non-confrontational manner. Further research needs to identify specific expressions and behaviors that are linked to the aforementioned characteristics in the forensic context. Our study therefore contributes to much-needed empirical research on clinician and patient perspectives on therapist characteristics and activities in the treatment of court-mandated patients.
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Affiliation(s)
- Helene Seaward
- Institute for Biomedical Ethics, University Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Tobias Vogel
- Psychiatric Hospital of the University of Basel, Forensic Psychiatric Hospital, Basel, Switzerland
| | - Marc Graf
- Psychiatric Hospital of the University of Basel, Forensic Psychiatric Hospital, Basel, Switzerland
| | | | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Center for Legal Medicine (CURML), Medical Faculty, University of Geneva, Geneva, Switzerland
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Diendéré EA, Traoré K, Bernatas JJ, Idogo O, Dao AK, Traoré GK, Napon/Zongo PD, Ouédraogo/Dioma S, Bognounou R, Diallo I, Ouédraogo/Sondo AK, Niamba PA. Prison health priorities in Burkina Faso: a cross-sectional study in the two largest detention environments in Burkina Faso. Int J Prison Health 2021; 18:97-113. [PMID: 34392661 DOI: 10.1108/ijph-04-2021-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to study the factors associated with the occurrence of diseases and beriberi among prisoners incarcerated in the two largest Remand and Correctional Facilities (RCF). DESIGN/METHODOLOGY/APPROACH This was a cross-sectional descriptive and analytical study carried out from April 20 to May 19, 2017, in the RCFs of Ouagadougou and Bobo-Dioulasso. All prisoners who consulted and those referred to the health center by the health-care team were included in the study. Complaints and diagnosed diseases information were collected using the second version of the International Classification of Primary Care (ICPC-2). The authors used a logistic regression model to perform univariate and multivariate analyses. FINDINGS Of the 1,004 prisoners from the two RCFs included in the study (32.6%), 966 (96%) were male. The median age was 31.6 years. The distribution of diseases diagnosed using the ICPC-2 showed a predominance of gastrointestinal tract, skin and respiratory tract diseases among 206 (19.3%), 188 (17.6%) and 184 (17.2%) prisoners, respectively. A total of 302 prisoners (30.1%) had clinical beriberi, and 80 prisoners (8%) were underweight. Being incarcerated for more than nine months was independently associated with a high risk of digestive and respiratory diseases as well as beriberi. RESEARCH LIMITATIONS/IMPLICATIONS This study highlighted higher frequencies of digestive, skin and respiratory complaints and diseases in the two largest detention centers in Burkina Faso. These diseases are variously related to age, penal status and length of incarceration. In addition, underweight and thiamin vitamin deficiency responsible for beriberi are more frequent in adult prisoners, those not attending school, convicted prisoners and those with a length of stay in detention of more than nine months. These concrete results should help define a strategy and priority actions needed to reduce morbidity in prisons. PRACTICAL IMPLICATIONS The actions should include the intervention of specialists in the field of common diseases in prisons, the improvement of individual hygiene conditions and environment, the improvement of the quality and quantity of the food ration, a strategy to reduce prison overcrowding. Other actions must be planned to allow specific groups such as women and minors to have access to health care that is adapted to them. Beyond the central concern of promoting the rights of prisoners and humanizing prisons, actions to improve the health of prisoners are part of an overall public health approach with its socio-economic and environmental implications. SOCIAL IMPLICATIONS There is a need for a strong commitment from the State to develop a prison health policy that prioritizes the prevention of communicable and non-communicable diseases that are particularly prevalent in this context, without forgetting mental health and nutrition. This requires a collaboration of stakeholders based on better intersectorial communication, the implementation of a monitoring and evaluation system for the health of prisoners, an enhancement of the status of health-care providers working in prisons and an increase in the funding allocated to the health of prisoners with the mobilization of the necessary funds. ORIGINALITY/VALUE This study uses a primary health care classification to assess the health of inmates in a prison in Africa. It contributes to the weak evidence around prison health surveillance and health profiling of prisoners in Africa.
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Affiliation(s)
- Eric Arnaud Diendéré
- Eric Arnaud Diendéré is based at the Department of Internal Medicine, Bogodogo Teaching Hospital, and Medical association "SOS Médecins - Burkina Faso", Ouagadougou, Burkina Faso
| | - Karim Traoré
- Karim Traoré is based at General Directorate of the Prison Security Guard/Ministry of Justice/Burkina Faso, Ouagadougou, Burkina Faso
| | - Jean-Jacques Bernatas
- Jean-Jacques Bernatas is based at Expertise France, Public Health Department, Paris, France
| | - Ouedan Idogo
- Ouedan Idogo, Abdoul Kader Dao and Go Karim Traoré are all based at Medical association "SOS Médecins - Burkina Faso", Ouagadougou, Burkina Faso
| | - Abdoul Kader Dao
- P. Delphine Napon/Zongo is based at the Department of Internal Medicine, Bogodogo Teaching Hospital, and Association "Assaut Hépatites", Ouagadougou, Burkina Faso
| | - Go Karim Traoré
- Solange Ouedraogo/Dioma is based at Health Office of Expertise France, Ouagadougou, Burkina Faso
| | - P Delphine Napon/Zongo
- René Bognounou is based at Internal Medicine Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Solange Ouédraogo/Dioma
- Ismaël Diallo, Apoline Kongnimissom Ouédraogo/Sondo and Pascal Antoine Niamba are all based at Health Sciences Training and Research Unit, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - René Bognounou
- Internal Medicine Department, Yalgado OuédraogoTeaching Hospital, Ouagadougou, Burkina Faso
| | - Ismael Diallo
- Health Sciences Training and Research Unit, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | | | - Pascal Antoine Niamba
- Health Sciences Training and Research Unit, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
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Wangmo T, Seaward H, Pageau F, Hiersemenzel LP, Elger BS. Forensic-Psychiatric Risk Evaluations: Perspectives of Forensic Psychiatric Experts and Older Incarcerated Persons From Switzerland. Front Psychiatry 2021; 12:643096. [PMID: 34194344 PMCID: PMC8236506 DOI: 10.3389/fpsyt.2021.643096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/17/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Forensic-psychiatric risk assessments of persons in prisons aim to provide treatment for their mental health disorders to prevent risk of recidivism. Based on the outcomes of such evaluations, it is decided, for instance, whether the person can be released or be assigned to further treatment with or without privileges. A negative evaluation would mean that the assessed person must remain in prison or in a forensic institution until his or her mental health has improved to live safely in the community. This paper highlights the process of forensic-psychiatric evaluations and the challenges faced by the two parties directly involved in this process in Switzerland. Methods: Data for this manuscript are gathered using semi-structured one-to-one interviews. The study participants included a purposive sample of 41 older incarcerated persons under measures (i.e., mandated by court order to psychotherapeutic and psychiatric treatment), and 23 expert participants working in Swiss prisons or forensic institutions. We analyzed data using thematic analysis. Results: Study findings within four themes are reported. First we describe the standards and procedures that expert participants use to carry out adequate risk assessments and conditions under which they refuse to perform such assessments. Thereafter, we present expert participants' concerns associated with predictive risk assessments and highlight the need to be cautious in drawing conclusion from them. We then reveal older incarcerated participants' reports on the inconsistencies with the forensic expertise and their belief that these reports tend to be negative toward them. The final theme concerns older participants' experiences of how these evaluations negatively impact their lives and their perspectives of a different future. Conclusion: The study findings about forensic-psychiatric risk assessments point to the need for a clearer communication on how these evaluations take place and how decisions are taken based on them. As incarceration under measures denotes the necessity to continue therapy and reduce dangerousness, it is important that accused person understands his or her real progress, feel that the decisions are objective and justified, and are aware of the progress needed to achieve the goal of eventual release. Such clarity will not only be valuable for those under measures, but also the justice system.
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Affiliation(s)
- Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Helene Seaward
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Felix Pageau
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Bernice S. Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Grammatikopoulou MG, Lampropoulou MΑ, Milapidou M, Goulis DG. At the heart of the matter: Cardiovascular health challenges among incarcerated women. Maturitas 2021; 149:16-25. [PMID: 34134886 DOI: 10.1016/j.maturitas.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 12/17/2022]
Abstract
Many factors appear to contribute to an increased risk for cardiovascular disease (CVD) among incarcerated women. Imprisonment is associated with a bodyweight gain and an increased prevalence of overweight and obesity. Inadequate physical activity and unhealthy nutrition further contribute to this positive energy balance. Classical CVD risk factors are common, including hypertension, diabetes mellitus, metabolic syndrome, and smoking. Moreover, imprisonment is associated with an increased incidence of mental health issues, such as depression and anxiety, with coping mechanisms, including substance abuse, being frequently adopted. Specific attitudes in the correctional environment, including hunger strikes, bullying, abuse and solitary confinement, are effectors of cardiovascular and mental ill-health. Furthermore, the plethora of psychological stressors induces an accelerated aging process, paired with CVD risk. Communicable diseases, mainly human immunodeficiency virus, opportunistic infections and inadequate sunlight exposure increase cardiovascular dysregulation. Health care needs associated with the female sex are not always met, adding to the frustration and compromised well-being. All these factors act independently and cumulatively, increasing CVD risk among incarcerated women.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Maria Α Lampropoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Spycher J, Dusheiko M, Beaupère P, Gravier B, Moschetti K. Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time. HEALTH & JUSTICE 2021; 9:11. [PMID: 33987749 PMCID: PMC8120814 DOI: 10.1186/s40352-021-00136-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events. RESULTS In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care. CONCLUSIONS The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners' penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.
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Affiliation(s)
- Jacques Spycher
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Pascale Beaupère
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Service of Correctional Medicine and Psychiatry (SMPP), University hospital of Lausanne (CHUV), Lausanne, Switzerland
| | | | - Karine Moschetti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Technology Assessment Unit (UET), University hospital of Lausanne (CHUV), Lausanne, Switzerland
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14
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Merkt H, Wangmo T, Pageau F, Liebrenz M, Devaud Cornaz C, Elger B. Court-Mandated Patients' Perspectives on the Psychotherapist's Dual Loyalty Conflict - Between Ally and Enemy. Front Psychol 2021; 11:592638. [PMID: 33488459 PMCID: PMC7815763 DOI: 10.3389/fpsyg.2020.592638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/01/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. METHODS This qualitative interview study investigates patients' perceptions of their therapists' dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. RESULTS We first present the patients' perceptions of their treating psychotherapist's dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants' reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: (1) respecting the patient's pace and perceived coercion; (2) patient health needs to be first priority; (3) clarity in roles and responsibilities; and (4) the art of communication - between transparency and unchecked information sharing. DISCUSSION Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists' characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist' characteristics promoting a trustful relationship in correctional settings.
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Affiliation(s)
- Helene Merkt
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Félix Pageau
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Corinne Devaud Cornaz
- Unité Thérapeutique, Centre de Psychiatrie Forensique, Réseau Fribourgeois de Santé Mentale, Fribourg, Switzerland
| | - Bernice Elger
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Pageau F, Cornaz CD, Gothuey I, Seaward H, Wangmo T, Elger BS. Prison Unhealthy Lifestyle and Poor Mental Health of Older Persons-A Qualitative Study. Front Psychiatry 2021; 12:690291. [PMID: 34867505 PMCID: PMC8639530 DOI: 10.3389/fpsyt.2021.690291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Mental healthcare and lifestyle habits in prison, especially for older individuals, has been shown to be suboptimal. Most psychiatric conditions left untreated worsen food choices, physical inactivity, and substance abuse. In turn, bad habits lead to poorer mental health. Methods: To comprehensively illustrate this downward spiraling, we completed a thorough analysis of data obtained through semi-structured qualitative interviews. There were 50 interviews of aging incarcerated people included in this article. They were analyzed following a classical six-stepped thematic analysis. Results: According to our participants, sports are not well-adapted to aging individuals, nor to people with medical conditions. Prison is even more unadapted for those who both are aging and have medical conditions. Also, food served is less than optimal. According to our interviews, the older imprisoned individual often does not have access to food adapted to his or her medical conditions. Sport is maladapted for older incarcerated individuals and mostly tailored for younger ones. Finally, boredom and lack of responsibility hinder change toward a better lifestyle for older adults in prison. Conclusion: Our paper shows why prison environmental modifications are needed to help older adults with their lifestyle habits. It also exposes an original way to see the relationship between mental health and lifestyle habits.
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Affiliation(s)
- Félix Pageau
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Corinne Devaud Cornaz
- Unit of Health Law and Humanitarian Medicine, Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Isabelle Gothuey
- Unit of Health Law and Humanitarian Medicine, Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Helene Seaward
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Unit of Health Law and Humanitarian Medicine, Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Solares C, Dobrosavljevic M, Larsson H, Cortese S, Andershed H. The mental and physical health of older offenders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 118:440-450. [PMID: 32783970 DOI: 10.1016/j.neubiorev.2020.07.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
A systematic review with meta-analysis was performed to: 1) estimate the prevalence of both mental and physical health problems in older offenders; 2) calculate relative risks for the health conditions in relation to non-offender older adults and; 3) explore the potential confounding role of several variables. We searched five databases up to August 2019. Studies involving offenders older than 50 years old were included. Fifty-five publications met criteria. The pooled prevalence for 18 mental and 28 physical health problems was calculated. In comparison with non-offender older adults, older offenders showed significantly higher risk for Hypertension (RR = 1.16, CI = 1.1, 1.2), Cardiovascular Diseases (RR = 1.24, CI = 1.09, 1.41), Respiratory diseases (RR = 1.75, CI = 1.29, 2.35), and Arthritis (RR = 1.19, CI = 1.12, 1.25). Heterogeneity was significant for all meta-analyses and partially explained by the confounding effect of country, the diagnosis assessment method, and the sample characteristics. Future research should include comparison groups of non-offender older adults and use longitudinal study designs to identify risk factors that can be targeted in preventive programmes.
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Affiliation(s)
- Carmen Solares
- School of Law, Psychology and Social Work, Örebro University, Fakultetsgatan 1, SE-701 82, Örebro, Sweden.
| | - Maja Dobrosavljevic
- School of Medical Sciences, Örebro University, Södra Grev Rosengatan 30, SE-703 62, Örebro, Sweden.
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Södra Grev Rosengatan 30, SE-703 62, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Life and Environmental Sciences, University of Southampton, SO17 1BJ, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, SO16 6YD, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, NG7 2UH, UK; New York University Child Study Center, New York, NY, 10016, USA.
| | - Henrik Andershed
- School of Law, Psychology and Social Work, Örebro University, Fakultetsgatan 1, SE-701 82, Örebro, Sweden.
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Huang Y, Wu R, Wu J, Yang Q, Zheng S, Wu K. Psychological resilience, self-acceptance, perceived social support and their associations with mental health of incarcerated offenders in China. Asian J Psychiatr 2020; 52:102166. [PMID: 32447270 DOI: 10.1016/j.ajp.2020.102166] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We aimed to analyze the mental health status of incarcerated offenders in the detention centers and related factors; and introduce psychological resilience, self-acceptance and perceived social support for further analyses, to explore the relationships between them and mental health in these special populations. METHODS Incarcerated offenders in two detention centers of Guangdong province were recruited. General demographic questionnaire, Self-acceptance Questionnaire (SAQ), Perceived Social Support Scale (PSSS), Connor and Davidson Resilience Scale (CD-RISC) and General Health Questionnaire (GHQ-20) were addressed to the participants for investigation. Pearson correlation analysis, multiple linear regression and Structural Equation Modeling (SEM) were used to identify the associations and related factors. RESULTS Scores for GHQ-20, CD-RISC, SAQ and PSSS were 7.72 ± 4.49, 57.85 ± 17.30, 40.94 ± 5.40 and 42.99 ± 9.90, respectively. Some socio-demographic factors influenced significantly to the mental health status. After adjusting for socio-demographic factors, the scores of self-acceptance (B = -0.23, P < 0.001), perceived social support (B = -0.10, P < 0.001) and psychological resilience (B = -0.06, P < 0.001) were negatively associated with scores of mental health. Further SEM analyses suggested self-acceptance and resilience had not only mediating effects respectively, but also multiple mediating effects between perceived social support and mental health (r = -0.11, P < 0.01; r = -0.12, P < 0.01; r = -0.04, P < 0.01). CONCLUSION The levels of mental health, psychological resilience, self-acceptance and perceived social support among incarcerated offenders are generally low, and influenced by socio-demographic factors. In addition, self-acceptance, perceived social support and resilience are protective factors for mental health status of offenders; and self-acceptance and resilience mediate the association between perceived social support and mental health.
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Affiliation(s)
- Yuanni Huang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong Province, China; Shenzhen Pingle Orthopedics Hospital (Shenzhen Pingshan Hospital of Traditional Chinese Medicine), Shenzhen, 518122, Guangdong Province, China
| | - Ruibin Wu
- Chaozhou People's Hospital, Chaozhou, 521000, Guangdong Province, China
| | - Junkai Wu
- Chaozhou Detention Center, Chaozhou, 521011, Guangdong Province, China
| | - Qingwen Yang
- Xingning Detention Center, Xingning, 514526, Guangdong Province, China
| | - Shukai Zheng
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Kusheng Wu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
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Opitz-Welke A, Lehmann M, Seidel P, Konrad N. Medicine in the Penal System. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:808-814. [PMID: 30642429 DOI: 10.3238/arztebl.2018.0808] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 02/12/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infectious diseases, substance dependencies, and dental diseases are the most important health problems affecting incarcerated persons. In Germany, for example, prisoners are 48 to 69 times more likely to be infected with the hepatitis C virus (HCV) than the general population, and 7 to 12 times more likely to be infected with the human immunodeficiency virus (HIV). The prevalence of mental illnesses is also markedly higher in the incarcerated than in the general population. METHODS This review is based on pertinent publications retrieved by a selective search in two databases (PubMed and Google Scholar) for any of the terms "health care," "primary health care," "mental health care"; "infectious disease," "opioid maintenance treatment," and "severe mental disorder" in conjunction with "prison," "jail," "detention," and "incarceration." RESULTS Among prisoners in German prisons, approximately 20% consume heroin, 20-50% suffer from alcohol dependency and abuse, and 70-85% smoke. The prevalence of tuberculosis in German prisons in 2002 was 0.1%. The provision of needles to incarcerated persons has a preventive effect on infection with hepatitis C, hepatitis B, and HIV, yet programs of this type have been discontinued in most penal facilities. In a systematic review, psychotic disorders were found in 3.6% (95% confidence interval [CI]: [3.1; 4.2]) of male inmates and 3.9% [95% CI: 2.7; 5.0] of female inmates. 25% of incarcerated persons suffer from attention-deficit-hyperac- tivity disorder. Persons recently released from prison have an above average mortality, largely due to drug intoxication. CONCLUSION An analysis of medical prescribing data reveals deficiencies in the provision of HCV treatment to all affected persons and in the provision of substitution treatment to persons with opiate dependency. In view of the known risks associated with imprisonment, greater emphasis should be placed on the provision of treatment for infectious diseases, substance dependencies, and mental illness, both in prison and in outpatient care after release.
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Affiliation(s)
- Annette Opitz-Welke
- Prison Hospital Berlin, JVA Plötzensee, Berlin; Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin
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19
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Opitz-Welke A, Konrad N, Welke J, Bennefeld-Kersten K, Gauger U, Voulgaris A. Suicide in Older Prisoners in Germany. Front Psychiatry 2019; 10:154. [PMID: 30984041 PMCID: PMC6449439 DOI: 10.3389/fpsyt.2019.00154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/01/2019] [Indexed: 01/15/2023] Open
Abstract
As in many countries, the numbers of older prisoners are rising in Germany, but scientific information on this group is scarce. For the current study, a survey was used that included all prison suicides in Germany between the years of 2000 and 2013. Suicide rates of the elderly prisoners exceeded the suicide rates of the general population and the same age group. We observed a continuous decrease in the suicide rate of elderly prisoners. When compared to the younger suicide victims in prison, significantly more elderly suicide victims were: female, of German nationality, remand prisoners, or serving a life sentence. In Germany, elderly prisoners are a vulnerable subpopulation of the prison population. Higher suicide rates than in the same age group in the general population indicate unmet needs regarding mental disorders and their specific treatment.
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Affiliation(s)
- Annette Opitz-Welke
- Justizvollzugskrankenhaus in der JVA Plötzensee, Berlin, Germany.,Institut fúr Forensische Psychiatrie der Charité Berlin, Berlin, Germany
| | - Norbert Konrad
- Institut fúr Forensische Psychiatrie der Charité Berlin, Berlin, Germany
| | | | | | - Ulrich Gauger
- Institut fúr Forensische Psychiatrie der Charité Berlin, Berlin, Germany
| | - Alexander Voulgaris
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
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García SJ, Borges DTM, Blanes L, Ferreira LM. Avaliação clínica e epidemiológica do paciente com feridas em uma unidade prisional do Estado de São Paulo. AVANCES EN ENFERMERÍA 2019. [DOI: 10.15446/av.enferm.v37n1.72054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: o objetivo do estudo é realizar levantamento de dados clínicos e epidemiológicos dos pacientes com feridas em uma unidade do sistema prisional no estado de São Paulo.Metodologia: estudo retrospectivo e descritivo onde foram coletados dados dos prontuários de uma unidade prisional anotados em livros de registros e prontuários de saúde entrejaneiro de 2015 e janeiro de 2016.Resultados: foram analisados 52 prontuários de pacientes com feridas. Todos os pacientes eram do sexo masculino, sendo 51,92 % brancos e 53,85 % possuíam entre 30-39 anos.Foram encontradas lesões de 10 etiologias diferentes, sendo as queimaduras as mais frequentes (22,95 %), seguidas de lesões por pressão (21,31 %). A doença mais constante nos pacientes em tratamento de feridas foi lesão medular.Conclusão: os pacientes com feridas no sistema prisional eram em sua maior parte brancos, do sexo masculino, com idade média de 37,21 anos, sendo mais frequentes as queimadurase as lesões por pressão.
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Haesen S, Merkt H, Imber A, Elger B, Wangmo T. Substance use and other mental health disorders among older prisoners. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:20-31. [PMID: 30616851 DOI: 10.1016/j.ijlp.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
The goal of this study is to explore the status quo of mental health and substance use problems among older prisoners. Our review presents the prevalence as well as co-occurrence of substance use and other mental health disorders in older prisoners. We conducted a systematic review of literature following the PRISMA statement. The search was carried out in four databases and supplemented with manual screenings of bibliographies from all retrieved articles. Publications were included if they met specific inclusion criteria. A total of 17 articles were included and in half of them, older offenders were the main study population. Older inmates have higher prevalence of mental health disorders than younger prisoners and are more likely to use alcohol. Several studies mentioned an association between substance use and other mental health disorders. Access to treatment was a concern with several studies providing recommendations to improve this. Most studies were done on older male prisoners, confirming that older female prisoners constitute a subgroup of a subgroup which is even more vulnerable and under-researched. It is important to carry out more research on both older male and female prisoners to ensure optimal delivery of appropriate mental health care for older prisoners and to prepare for a currently younger population that will age with different and distinct mental health problems and substance use patterns.
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Transnational trends in prescription drug misuse among women: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:56-73. [DOI: 10.1016/j.drugpo.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 09/14/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022]
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Krammer S, Eisenbarth H, Fallegger C, Liebrenz M, Klecha D. Sociodemographic Information, Aversive and Traumatic Events, Offence-Related Characteristics, and Mental Health of Delinquent Women in Forensic-Psychiatric Care in Switzerland. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:3815-3833. [PMID: 29284379 DOI: 10.1177/0306624x17749638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The present study describes a much understudied group-namely, female prisoners under forensic-psychiatric care in the German-speaking part of Switzerland-to improve understanding of their risks and their needs. Data were derived from internal databases of a Forensic-Psychiatric Service. Data were collected in the form of their sociodemographic characteristics, prevalence of aversive and traumatic events, type of offence committed, and mental health conditions. Based on a full-sample approach, a total of 1,571 files were analysed. Results reveal that two thirds of the participants were not in a stable relationship, more than half did not complete a school degree, and three quarters were without stable employment prior to their incarceration. Two thirds were mothers and about one third did not grow up with their parents. Almost half grew up with an alcohol abusing parent, about half experienced violence and/or neglect in childhood, and about a quarter of the cases sexual abuse. About 95% had a mental health diagnosis according to International Classification of Diseases-Version 10 (ICD-10), and the most prevalent mental and behavioural disorder was due to psychoactive substance abuse. The most frequent offence type was drug-related crimes. Women convicted for drug-related crimes were more likely to have an ICD-10 F1 disorder compared with those convicted for other crimes. Conversely, women with violent offences were less likely to suffer from ICD-10 F1 disorder than those who had committed nonviolent offences. Findings have implications for practitioners and policy makers, and contribute to the cycle of violence theory discussion. In conclusion, future research areas are suggested.
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Affiliation(s)
- Sandy Krammer
- 1 Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Switzerland
| | | | - Carole Fallegger
- 1 Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Switzerland
| | - Michael Liebrenz
- 1 Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Switzerland
| | - Dorothee Klecha
- 1 Department of Forensic Psychiatry, Institute of Legal Medicine, University of Bern, Switzerland
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Pizzicato LN, Drake R, Domer-Shank R, Johnson CC, Viner KM. Beyond the walls: Risk factors for overdose mortality following release from the Philadelphia Department of Prisons. Drug Alcohol Depend 2018; 189:108-115. [PMID: 29908410 DOI: 10.1016/j.drugalcdep.2018.04.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND High overdose mortality after release from state prison systems is well documented; however, little is known about overdose mortality following release from local criminal justice systems (CJS). The purpose of this study was to assess overdose mortality following release from a local CJS in Philadelphia, PA. METHODS We conducted a retrospective cohort study of individuals released to the community from a local CJS between 2010 and 2016. Incarceration records were linked to overdose fatality data from the Medical Examiner's Office and death certificate records. All-cause, overdose, and non-overdose mortality were examined. RESULTS Of the 82,780 individuals released between 2010 and 2016, 2,522 (3%) died from any cause, of which 837 (33%) succumbed to overdose. Individuals released from incarceration had higher risk of overdose death compared to the non-incarcerated population (Standardized Mortality Ratio [SMR]: 5.29, 95% CI 4.93-5.65), and risk was greatest during the first two weeks following release (SMR: 36.91, 95% CI: 29.92-43.90). Among released individuals, black, non-Hispanic individuals (Hazard Rate [HR]: 0.17, 95% CI: 0.14-0.19) and Hispanic individuals (HR: 0.41, 95% CI: 0.34-0.50) were at lower risk for overdose than white, non-Hispanic individuals. Individuals released with a serious mental illness (SMI) were at higher risk of overdose (HR: 1.54, 95% CI: 1.27-1.87) than those without a SMI. DISCUSSION Previously incarcerated individuals are at high risk of overdose death following release from a local CJS, especially in the earliest weeks following release. Prevention measures including behavioral health treatment and referral and take-home naloxone may reduce overdose mortality after release.
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Affiliation(s)
- Lia N Pizzicato
- Philadelphia Department of Public Health, Opioid Surveillance, Epidemiology, and Prevention Program, 1101 Market St., Suite 1320, Philadelphia, PA 19107, USA; CSTE Applied Epidemiology Fellowship, 2872 Woodcock Blvd., Suite 250, Atlanta, GA 30341, USA.
| | - Rebecca Drake
- Philadelphia Department of Public Health, Medical Examiner's Office, 321 University Ave., Philadelphia, PA 19104, USA
| | - Reed Domer-Shank
- Philadelphia Department of Prisons, 7901 State Rd., Philadelphia, PA 19136, USA
| | - Caroline C Johnson
- Philadelphia Department of Public Health, Office of the Health Commissioner, 1101 Market St., Suite 1320, Philadelphia, PA 19107, USA
| | - Kendra M Viner
- Philadelphia Department of Public Health, Opioid Surveillance, Epidemiology, and Prevention Program, 1101 Market St., Suite 1320, Philadelphia, PA 19107, USA
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Annaheim B, Bretschneider W, Handtke V, Belardi A, Elger BS. Prescription of pain medication in prisons: A comparative analysis of younger and older male prisoners. Pharmacoepidemiol Drug Saf 2018; 27:987-994. [PMID: 29926998 DOI: 10.1002/pds.4573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/20/2018] [Accepted: 05/09/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE In prison populations, treating pain is particularly challenging, especially for the growing number of older prisoners. The objective was to find out about prevalence, frequency, and types of pain medications prescribed to older prisoners (≥50 years) in comparison with younger prisoners (<50 years). METHODS Data were collected in Switzerland as part of a study on ageing prisoners' health. Fifteen prisons (out of 26 of the total eligible population) agreed to take part, and data from medical records of 190 older and 190 younger male prisoners were analysed. Descriptive statistics on pain medication prescriptions (excluding drugs used in opioid dependence) were carried out and differences between the 2 age groups tested for statistical significance. RESULTS More than half of younger and older prisoners were prescribed pain medication during the past 180 days, while 10% of younger and 15% of older prisoners were prescribed pain medication on a daily basis. Nonsteroidal anti-inflammatory drugs and "other analgesics and antipyretics" were most frequently prescribed. Significantly (P < .05), more younger than older prisoners were prescribed NSAIDs and drugs to treat muscle skeletal pain. Tramadol was the opioid most often prescribed. CONCLUSIONS This is the first empirical study investigating prescriptions of pain medication in Swiss prisoners on a national level. It shows that nonopioid pain medication is an important part of health care provision inside prison, while there are only few prescriptions of strong opioids. Research is needed to investigate whether the standard set by the principle of equivalence is met regarding treatment of pain in prison.
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Affiliation(s)
- Beatrice Annaheim
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Violet Handtke
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Angelo Belardi
- Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Center for Legal Medicine (CURML), University of Geneva, Geneva, Switzerland
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Haesen S, Wangmo T, Elger BS. Identity as an older prisoner: findings from a qualitative study in Switzerland. Eur J Ageing 2018; 15:199-210. [PMID: 29867304 PMCID: PMC5971027 DOI: 10.1007/s10433-017-0443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The increasing numbers of aging prisoners raise the issue of how they maintain their personal identity and self-esteem in light of long-standing detention. This study sought to answer this question since identity and self-esteem could influence mental and physical health. We conducted a secondary analysis of 35 qualitative interviews that were carried out with older inmates aged 51-75 years (mean age: 61 years) living in 12 Swiss prisons. We identified three main themes that characterized their identity: personal characterization of identity, occupational identity, and social identity. These main themes were divided into sub-themes such as familial network, retirement rights or subjective social position. Personal characterization of identity mostly happened through being part of a network of family and/or friends that supported them during imprisonment and where the prisoner could return to after release. Individual activities and behavior also played an important role for prisoners in defining themselves. Occupational identity was drawn from work that had been carried out either before or during imprisonment although in some cases the obligation to work in prison even after reaching retirement age was seen as a constraint. Social identity came from a role of mentor or counselor for younger inmates, and in a few cases older prisoners compared themselves to other inmates and perceived themselves as being in a higher social position. Identity was often expressed as a mix between positive and negative traits. Building on those elements during incarceration can contribute to better mental health of the individual prisoner which in turn influences the chances for successful rehabilitation.
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Moschetti K, Zabrodina V, Wangmo T, Holly A, Wasserfallen JB, Elger BS, Gravier B. The determinants of individual health care expenditures in prison: evidence from Switzerland. BMC Health Serv Res 2018; 18:160. [PMID: 29514629 PMCID: PMC5842659 DOI: 10.1186/s12913-018-2962-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prison health systems are subject to increasing pressures given the specific health needs of a growing and aging prison population. Identifying the drivers of medical spending among incarcerated individuals is therefore key for health care governance in prisons. This study assesses the determinants of individual health care expenditures within the prisons of the canton of Vaud, a large region of Switzerland. METHODS We use a unique dataset linking demographic and prison stay characteristics as well as objective measures of morbidity to detailed medical invoice data. We adopt a multivariate regression approach to model total, somatic and psychiatric outpatient health care expenditures. RESULTS We find that chronic infectious, musculoskeletal and skin diseases are strong predictors of total and somatic costs. Schizophrenia, neurotic and personality disorders as well as the abuse of illicit drugs and pharmaceuticals drive total and psychiatric costs. Furthermore, cumulating psychiatric and somatic comorbidities has an incremental effect on costs. CONCLUSION By identifying the characteristics associated with health care expenditures in prison, this study constitutes a key step towards a more efficient use of medical resources in prison.
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Affiliation(s)
- Karine Moschetti
- Institute of Social and Preventive Medicine, University of Lausanne and University Hospital of Lausanne (CHUV), Route de la Corniche 10, 1010 Lausanne, Switzerland
- Technology Assessment Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Véra Zabrodina
- Institute of Social and Preventive Medicine, University of Lausanne and University Hospital of Lausanne (CHUV), Route de la Corniche 10, 1010 Lausanne, Switzerland
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Alberto Holly
- Institute of Health Economics and Management, HEC Lausanne, University of Lausanne, Lausanne, Switzerland
| | | | - Bernice S. Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Centre of Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Bruno Gravier
- Service of Correctional Medicine and Psychiatry, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Wangmo T, Hauri S, Meyer AH, Elger BS. Patterns of older and younger prisoners' primary healthcare utilization in Switzerland. Int J Prison Health 2017; 12:173-84. [PMID: 27548019 DOI: 10.1108/ijph-03-2016-0006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to identify primary health concerns prompting older and younger prisoners in Switzerland to consult a nurse or a general practitioner (GP) within the prison healthcare setting, and explores if these reasons for visits differ by age group (49 years and younger vs 50 years and older). The authors used 50 years and older as the benchmark for older prisoners in light of literature indicating accelerated aging among prisoners. Design/methodology/approach Retrospective information from medical records of 406 prisoners were collected for a period of six months. This study analyzed the reasons for which prisoners visited the nurses and GPs available to them through the prison healthcare service. These reasons were coded using the International Classification of Primary Care-version 2. Data were analyzed descriptively and four generalized linear models were built to examine whether there was an age group difference in reasons for visiting nurses and GPs. Findings The health reasons for visiting nurses and GPs by 380 male prisoners from 13 Swiss prisons are presented. In the six month period, a total of 3,309 reasons for visiting nurses and 1,648 reasons for visiting GPs were recorded. Prisoner participants' most common reasons for both visits were for general and unspecified complaints and musculoskeletal problems. Older prisoners sought significantly more consultations for cardiovascular and endocrine problems than younger prisoners. Research limitations/implications Nurses play an important role in addressing healthcare demands of prisoners and coordinating care in Swiss prisons. In light of age-related healthcare demands, continuing education and training of both nurses and GPs to adequately and efficiently address the needs of this prisoner group is critical. Allowing prisoners to carry out some care activities for minor self-manageable complaints will reduce the demand for healthcare. Originality/value This study presents unique data on healthcare concerns for which prisoners visit prison nurses and GPs. It highlights the varied needs of older prisoners as well as how these needs are addressed based on the availability of the primary healthcare provider within the prison.
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Affiliation(s)
- Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel , Basel, Switzerland
| | - Sirin Hauri
- Faculty of Medicine, University of Basel , Basel, Switzerland
| | - Andrea H Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel , Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel , Basel, Switzerland
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Moschetti K, Zabrodina V, Stadelmann P, Wangmo T, Holly A, Wasserfallen JB, Elger BS, Gravier B. Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland. PLoS One 2017; 12:e0187255. [PMID: 29084290 PMCID: PMC5662217 DOI: 10.1371/journal.pone.0187255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 10/16/2017] [Indexed: 11/19/2022] Open
Abstract
Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP), nursing or psychiatric healthcare utilization (HCU) within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors), diagnosed chronic somatic and psychiatric disorders (needs factors), as well as prison stay characteristics (contextual factors). For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population.
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Affiliation(s)
- Karine Moschetti
- Institute of Social and Preventive Medicine, University of Lausanne and University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Technology Assessment Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- * E-mail:
| | - Véra Zabrodina
- Institute of Social and Preventive Medicine, University of Lausanne and University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Pierre Stadelmann
- Institute of Social and Preventive Medicine, University of Lausanne and University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Institute of Health Economics and Management, HEC Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Alberto Holly
- Institute of Health Economics and Management, HEC Lausanne, University of Lausanne, Lausanne, Switzerland
| | | | - Bernice S. Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Centre of Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Bruno Gravier
- Service of Correctional Medicine and Psychiatry, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Can routine data from prisoners’ files be used to estimate prevalence rates of illicit drug use among prisoners? Int J Public Health 2017; 63:33-40. [DOI: 10.1007/s00038-017-1030-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022] Open
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Sánchez FC, Fearn N, Vaughn MG. Prevalence and correlates of in-prison substance use among incarcerated women in Spain. J Ethn Subst Abuse 2017; 17:356-374. [DOI: 10.1080/15332640.2016.1255579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Alves J, Costa Maia Â. Self-Reports of Health before and during Imprisonment in Female Inmates. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2017. [DOI: 10.1159/000481967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The health of female inmates has been described as more vulnerable than that of detained male and the overall female population. The purpose of this study is to describe health behaviors, history of diseases, health complaints, and health status of 232 incarcerated women. The women reported risk behaviors and unexpected health surveillance before their imprisonment. In prison, their tobacco use increased, drug consumption decreased and high rates of diseases, use of medicines, health complaints, and poor health status were found. The women’s perceptions of their current health, compared with the time period before prison, revealed different types of impact, with one-third reporting health improvements. These data suggest that women prisoners’ health and the prison’s impact on their health must be better studied in order to enhance the health intervention programs during imprisonment.
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