Overincarceration of Indigenous people: a health crisis

Programs supporting incarcerated and previously incarcerated indigenous peoples: a scoping review protocol

The overincarceration of Indigenous peoples and its impacts on individual and community health is a growing concern across Canada and the United States. Federally run Healing Lodges in Canada are an example of support services for incarcerated and previously incarcerated Indigenous peoples to reintegrate into community and support their healing journey. However, there is a need to synthesise research which investigates these programmes. We report a protocol for a scoping review that is guided by the following research question: What is known about culturally informed programmes and services available to incarcerated and previously incarcerated Indigenous peoples in Canada and the US? This scoping review will follow guidelines published by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. This review will only identify programmes that are guided by Indigenous ways of being and knowing in order to best serve Indigenous communities and our community partners. The results of this review will support the development of programmes that are necessary for understanding and addressing the diverse needs of incarcerated and previously incarcerated Indigenous peoples.

"These Issues Aren't Separate": The Relationship Among Being Indigenous, Motherhood, and the Criminal Justice System

In using an approach encompassing intersectionality and interconnectedness, we highlight how the experiences of Indigenous mothers and mother figures in contact with the law are a result of various historical and contemporary events. We highlight a need for a wholistic approach to eliminate the overrepresentation of Indigenous Peoples, including parents, in the criminal justice system. There is a lack of research and discussion on Indigenous women and their experience with the justice system and by using an Indigenous lens, we can explore the establishment of culturally safe resources and care wherein gender inclusivity is prioritized. Our team of researchers and advocates intends for this article to contribute and spark dialogue on Indigenous Peoples, particularly mothers and mother figures and their interactions with the justice system. Although this article mainly focuses on federal programs and policies in Canada, insights on the barriers to care can be applied into policy and practice across multiple settler states.

Determinants of SARS-CoV-2 vaccine willingness among people incarcerated in 3 Canadian federal prisons: a cross-sectional study

BACKGROUND

Maximizing uptake of SARS-CoV-2 vaccines among people in prison is essential in mitigating future outbreaks. We aimed to determine factors associated with willingness to receive SARS-CoV-2 vaccination before vaccine availability.

METHODS

We chose 3 Canadian federal prisons based on their low uptake of influenza vaccines in 2019-2020. Participants completed a self-administered questionnaire on knowledge, attitude and beliefs toward vaccines. The primary outcome was participant willingness to receive a SARS-CoV-2 vaccine, measured using a 5-point Likert scale to the question, "If a safe and effective COVID-19 vaccine becomes available in prison, how likely are you to get vaccinated?" We calculated the association of independent variables (age, ethnicity, chronic health conditions, 2019-2020 influenza vaccine uptake and prison security level), identified a priori, with vaccine willingness using logistic regression and crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

We recruited 240 participants from Mar. 31 to Apr. 19, 2021 (median age 46 years; 19.2% female, 25.8% Indigenous). Of these, 178 (74.2%) were very willing to receive a SARS-CoV-2 vaccine. Participants who received the 2019-2020 influenza vaccine (adjusted OR 5.20, 95% CI 2.43-12.00) had higher odds of vaccine willingness than those who did not; those who self-identified as Indigenous (adjusted OR 0.27, 95% CI 0.11-0.60) and in medium- or maximum-security prisons (adjusted OR 0.36, 95% CI 0.12-0.92) had lower odds of vaccine willingness than those who identified as white or those in minimum-security prisons, respectively.

INTERPRETATION

Most participants were very willing to receive vaccination against SARS-CoV-2 before vaccine roll-out. Vaccine promotion campaigns should target groups with low vaccine willingness (i.e., those who have declined influenza vaccine, identify as Indigenous or reside in high-security prisons).

Barriers and facilitators to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons: A qualitative study

INTRODUCTION

Canadian correctional institutions have been prioritized for COVID-19 vaccination given the multiple outbreaks that have occurred since the start of the pandemic. Given historically low vaccine uptake, we aimed to explore barriers and facilitators to COVID-19 vaccination acceptability among people incarcerated in federal prisons.

METHODS

Three federal prisons in Quebec, Ontario, and British Columbia (Canada) were chosen based on previously low influenza vaccine uptake among those incarcerated. Using a qualitative design, semi-structured interviews were conducted with a diverse sample (gender, age, and ethnicity) of incarcerated people. An inductive-deductive analysis of audio-recorded interview transcripts was conducted to identify and categorize barriers and facilitators within the Theoretical Domains Framework (TDF).

RESULTS

From March 22-29, 2021, a total of 15 participants (n = 5 per site; n = 5 women; median age = 43 years) were interviewed, including five First Nations people and six people from other minority groups. Eleven (73%) expressed a desire to receive a COVID-19 vaccine, including two who previously refused influenza vaccination. We identified five thematic barriers across three TDF domains: social influences (receiving strict recommendations, believing in conspiracies to harm), beliefs about consequences (believing that infection control measures will not be fully lifted, concerns with vaccine-related side effects), and knowledge (lack of vaccine-specific information), and eight thematic facilitators across five TDF domains: environmental context and resources (perceiving correctional employees as sources of outbreaks, perceiving challenges to prevention measures), social influences (receiving recommendations from trusted individuals), beliefs about consequences (seeking individual and collective protection, believing in a collective "return to normal", believing in individual privileges), knowledge (reassurance about vaccine outcomes), and emotions (having experienced COVID-19-related stress).

CONCLUSIONS

Lack of information and misinformation were important barriers to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons. This suggests that educational interventions, delivered by trusted health care providers, may improve COVID-19 vaccine uptake going forward.

Reasons for COVID-19 vaccine refusal among people incarcerated in Canadian federal prisons

BACKGROUND

Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons.

METHODS

Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive-deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy.

RESULTS

Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling "punished" and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers.

INTERPRETATION

Reasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.

Seroprevalence and risk factors for SARS-CoV-2 among incarcerated adult men in Quebec, Canada (2021)

Background

People in prison are at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We examined the seroprevalence of SARS-CoV-2 and associated carceral risk factors among incarcerated adult men in Quebec, Canada.

Methods

We conducted a cross-sectional seroprevalence study in 2021 across 3 provincial prisons, representing 45% of Quebec’s incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity (Roche Elecsys serology test). Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard errors. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CIs) were calculated.

Results

Between 19 January 2021 and 15 September 2021, 246 of 1100 (22%) recruited individuals tested positive across 3 prisons (range, 15%–27%). Seropositivity increased with time spent in prison since March 2020 (aPR, 2.17; 95% CI, 1.53–3.07 for “all” vs “little time”), employment during incarceration (aPR, 1.64; 95% CI, 1.28–2.11 vs not), shared meal consumption during incarceration (“with cellmates”: aPR, 1.46; 95% CI, 1.08–1.97 vs “alone”; “with sector”: aPR, 1.34; 95% CI, 1.03–1.74 vs “alone”), and incarceration post-prison outbreak (aPR, 2.32; 95% CI, 1.69–3.18 vs “pre-outbreak”).

Conclusions

The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied among prisons. Several carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration.

Incarceration of indigenous people in Brazil and resolution no. 287 of the National Council of Justice of Brazil

Abstract This article aims at analyzing Resolution No. 287 of the National Council of Justice of Brazil (CNJ), which establishes special procedures for the treatment of indigenous people who stand as accused, defendants, who are sentenced or are deprived of liberty and shows the necessary process to ensure their rights within the Brazilian Judiciary Branch. It encourages a reflection about why said Resolution’s impact on social representations within the Brazilian Judiciary Branch is nearly none. The Resolution No. 287 is a surprising step by CNJ to effectively recognize the cultural and ethnic plurality of the original peoples of Brazil, although it maintains contradictions inherent to the challenge of overcoming the assimilationist paradigm. However, beyond any new registration protocols, any reduction in incarceration rates or any training of magistrates and adaptation of their services, any change will ultimately come from the outside, as Brazilian elites abdicate privileges coming from their whiteness.

When the law influences medical practice: Potential impact of the Bouchard-Lebrun ruling on the forensic unit of the Malartic Psychiatric Hospital in Northern Quebec, Canada

The attribution of criminal responsibility in the context of substance intoxication is a matter of controversy in forensic psychiatry. In 2011, the Supreme Court of Canada ruled that Tommy Bouchard-Lebrun was guilty in the straightforward case of a crime committed while in a state of substance-induced psychosis by an individual without a history of mental disorder. However, the ruling may since have served as a precedent also for settling cases where an offence is committed while in a certain state of intoxication and where there is much more diagnostic uncertainty. The goal of our research was to study the impact of the Bouchard-Lebrun Supreme Court decision on rates of criminal responsibility judgements and toxic psychosis diagnosis in the context of such cases. Applying a time-trend ecological study design, we conducted a chart review of every patient treated at the forensic unit of the Malartic Psychiatric Hospital in northern Quebec in the short periods pre- and post-ruling. We then determined the proportion of patients judged not criminally responsible and the proportion diagnosed with substance-induced psychosis. We ran chi-squared tests on the two sets of dichotomous variables. In the period following the Bouchard-Lebrun ruling, a statistically significant decrease was observed in the proportion of individuals judged not criminally responsible, as was a statistically significant increase in the proportion of individuals diagnosed with substance-induced psychosis. The findings suggest that the Bouchard-Lebrun ruling may have had an impact on subsequent forensic psychiatry decision-making and treatment at the Malartic Hospital.

Invisible women: correctional facilities for women across Canada and proximity to maternity services

Purpose

This paper aims to describe the process to create an inventory of the facilities in Canada designated to incarcerate women and girls, health service responsibility by facility, facility proximity to hospitals with maternity services and residential programmes for mothers and children to stay together. This paper creates the inventory to support health researchers, prison rights advocates and policymakers to identify, analyse and respond to sex and gender differences in health and access to health services in prisons.

Design/methodology/approach

In spring 2019, this study conducted an environmental scan to create an inventory of every facility in Canada designated for the incarceration of girls and women, including remand/pretrial custody, immigration detention, youth facilities and for provincial and federal sentences.

Findings

There are 72 facilities in the inventory. In most, women are co-located with men. Responsibility for health varies by jurisdiction. Few sites have mother-child programmes. Distance to maternity services varies from 1 to 132 km.

Research limitations/implications

This paper did not include police lock-up, courthouse cells or involuntary psychiatric units in the inventory. Information is unavailable regarding trans and non-binary persons, a priority for future work. Access to maternity hospital services is but one critical question regarding reproductive care. Maintenance of the database is challenging.

Originality/value

Incarcerated women are an invisible population. The inventory is the first of its kind and is a useful tool to support sex and gender and health research across jurisdictions.