Reforming solitary confinement: the development, implementation, and processes of a restrictive housing step down reentry program in Oregon

Prior incarceration, restrictive housing, and posttraumatic stress disorder symptoms in a community sample of persons who use drugs

BACKGROUND

Criminalization of drugs in the United States (US) has extensive consequences for people who use drugs (PWUD). Incarceration and substance use overlap with 65% of the US prison population meeting substance use disorder (SUD) criteria. Exposure to the criminal-legal system negatively impacts the health of PWUD. PTSD is commonly comorbid with SUDs, and exposure to restrictive housing (RH) during incarceration may worsen mental health. Because PWUD are disproportionately incarcerated, experiences occurring during incarceration, such as RH, may contribute to the development or exacerbation of PTSD and SUDs. This study of PWUD investigated prior criminal-legal system exposure and its association with PTSD symptoms in community-dwelling PWUD.

METHODS

This cross-sectional study recruited PWUD from syringe service programs (SSP). Inclusion criteria were: age 18+, current or past opioid use disorder, and SSP enrollment. Data collected included: sociodemographics; incarceration, substance use, SUD treatment history, and PTSD assessments (Life Events Checklist for DSM-5 and the PTSD Checklist for DSM-5). Bivariate testing and multivariate logistic regression analyses, with probable PTSD as the dependent variable and a three-level variable for criminal legal history as the independent variable, were conducted to determine whether incarceration and RH were associated with probable PTSD.

RESULTS

Of 139 participants, 78% had an incarceration history with 57% of these having a history of RH. 57% of participants screened positive for probable PTSD, and physical assault was the most common traumatic exposure. Any history of incarceration was not associated with probable PTSD diagnosis; however, in multivariate testing, adjusting for age, sex, and substance use, a history of RH (adjusted odds ratio [aOR]: 3.76, 95% CI 1.27-11.11) was significantly associated with probable PTSD.

CONCLUSIONS

RH and PTSD were both exceptionally common in a sample of SSP participants. RH can be detrimental to physical and mental health. Clinicians and policy makers may not consider incarceration as a traumatic experience for PWUD; however, our data suggest that among highly marginalized PWUD, prior exposure to incarceration and RH may add an additional burden to their daily struggles, namely PTSD.

Solitary confinement and the well-being of people in prison

BACKGROUND

Solitary confinement and mental well-being has been researched extensively, with a significant increase in studies over the last ten years. These recent studies produce mixed evidence for whether placement in solitary confinement is associated with psychological distress. We advance our understanding of these relationships in two critical ways. First, we conduct both between- and within-person analyses within the same data to better understand the relationship of solitary confinement and mental well-being relative to the well-being of people in less restrictive prison settings. Second, we ask the men in our sample questions about their personality style, coping strategies, and interactions with staff, which allows us to explore how individual characteristics and prison experiences matter, alongside isolation, in understanding mental well-being.

METHODS

We gather data from interviews at three time points with 122 men in solitary confinement and 204 men in other conditions of confinement in Arizona from 2017 to 2019. We merge these interview data with administrative data on study sample and population sample to include critical measures such as mental health score, risk level, and visitation status. Our interviews contain a Global Severity Index (GSI), created from 90 self-reported psychopathological symptoms experienced, that we use to assess well-being. We estimate cross-classified multilevel models to assess between-person differences and within-person change in well-being over time.

RESULTS

There was a small relationship between solitary confinement and worsening well-bring (longitudinal, within-person) and a small relationship between solitary confinement and worse well-being (cross-sectional, between-person), with this between-person association reduced significantly upon inclusion of additional individual characteristics and prison experiences.

CONCLUSIONS

Our results suggest that the incarceration experience, including conditions of confinement, is associated with mental well-being in different ways for different people. We believe that collective confinement and well-being could receive the same scholarly attention and public concern as solitary confinement.

Health in Prison: Does Penitentiary Medicine in Italy Still Exist?

Despite the detailed legislative developments that have occurred within the context of prison medicine in Italy, problems of a management nature continue to affect prisoner health and management, which in turn impact the prison system’s ability to offer prisoners a real opportunity for rehabilitation. Certain behavioral aspects reported in prisons may alter and negatively impact the normal doctor-patient relationship, including elements that hinder the therapeutic alliance and impede proper clinical risk prevention and management. However, practical steps may be taken in connection with the analysis of flows and healthcare services that may enable prison administrations to bring about a true, modern restructure of the prison system.