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

[Which Treatment Setting is Suited for Forensic Inpatients Aged≥60 Years?A Systemic Literature Analysis]

In the inpatient correctional system, the question of a suitable treatment setting for older forensic inpatients (i. e. ≥60 years) arises against the background of demographic change. In this regard, the research literature was examined using four medical databases (PsycInfo, Medline, Embase, Web of Science) for relevant keywords (elderly offender/perpetrator, aged, mental disorder, forensic treatment, forensic psychiatry). Out of 744 pre-selected articles, only 5 studies made it into the final selection. The majority of the sample is composed of men with previous criminal justice experience, who may be mentally and/or physically ill. Placement and capacity problems as well as a lack of age-appropriate infrastructure are reported. Based on the study results, an empirical recommendation regarding a suitable treatment setting cannot be given.

Stigma management during reintegration of older incarcerated adults with mental health issues: A qualitative analysis

INTRODUCTION

The number of older prisoners with mental health issues released from prisons and forensic psychiatric institutions is rising. Their successful integration is important due to its implications for the public's safety and the individual's health and well-being. However, reintegration efforts are hampered due to the double stigma attached to 'mental illness' and 'incarceration history'. To alleviate the burden of such stigma, affected persons and their social networks employ stigma management strategies. This study sought to investigate the stigma management strategies of mental health professionals supporting older incarcerated adults with mental health issues in their reintegration process.

METHODS

Semi-structured interviews with 63 mental health professionals from Canada and Switzerland were carried out as part of the overall project. To address the reintegration topic, data from 18 interviews were used. Data analysis followed the thematic analysis approach.

RESULTS

Mental health professionals emphasized the double stigmatization of their patients which impaired their quest for housing. Lengthy searches for placement frequently resulted in patients' unnecessary long stays in forensic programs. Nevertheless, participants outlined that they were at times successful in finding appropriate housing for their patients due to the use of certain stigma management strategies. They stated that they, first, established initial contacts with outside institutions, second, educated them about stigmatizing labels and, third, provided ongoing collaboration with public institutions.

DISCUSSION

Incarcerated persons with mental health issues face double stigmatization that affects their reentry process. Our findings are interesting as they illustrate ways in which stigma can be reduced, and how the reentry process can be streamlined. Future research should include the perspectives of incarcerated adults with mental health issues to shed more light on the various options that they seek for successful reintegration after imprisonment.

Perceptions of collective and other unjust punishment in Swiss prisons: a qualitative exploration

PURPOSE

This paper aims to describe and analyse Swiss prisoners' and experts' views on collective punishment, the practice where a group is punished for one person's transgression.

DESIGN/METHODOLOGY/APPROACH

A series of qualitative interviews with prisoners and stakeholders are reported following thematic analysis.

FINDINGS

Despite being forbidden by the Geneva Convention and other international instruments, participants from this study expressed the view that collective punishment continues to be practiced in some form in prisons in Switzerland, violating the rights of prisoners via unjust and arbitrary decision-making, unjust rules, inequalities in prison structures and continuation of incarceration based on the behaviour of others. Families can also be both victims and vectors of collective punishment, and prolonging the detention of prisoners who would otherwise have been released because of rare high-profile cases of reoffending can also be considered a form of collective punishment.

ORIGINALITY/VALUE

These significant findings suggest that collective punishment in various forms continues to be used in Swiss prisons.

Challenges in providing ethically competent health care to incarcerated older adults with mental illness: a qualitative study exploring mental health professionals' perspectives in Canada

BACKGROUND

The population of incarcerated older adults is the fastest growing demographic in prisons. Older persons in custody have poorer health as compared with those in the community. The unmet and complex health care needs of incarcerated older adults with mental illness raise justice, safety, dignity and fairness in care as ethical concerns. As there exists research gap to better understand these concerns, the current study aimed at exploring the perspectives of mental health professionals on challenges in delivering ethically competent care to mentally ill incarcerated older adults in Canada.

METHODS

Thirty-four semi-structured interviews were conducted between August 2017 and November 2018 with prison mental health professionals in Canada who were selected using purposive and convenience sampling techniques. The audio recorded interviews were transcribed verbatim and analysed inductively to generate themes.

RESULTS

The results were distilled into three main categories and seven subcategories that related to ethical issues in the provision of health care for mentally ill incarcerated older adults. The main categories included imprisoned older persons with special care needs, lack of resources, and the peer-support program.

CONCLUSIONS

Results of this study showed that existing practices of care of mentally ill incarcerated older adults are characterised by challenges that increase their vulnerability to worse health conditions. It is imperative for local authorities, policy makers and representatives to prepare for and respond to the challenges that compromise ethically competent health care for, and healthy ageing of, mentally ill incarcerated older adults.