The Perceived Benefits of an Arts Project for Health and Wellbeing of Older Offenders

Men's mental health and the arts: perceived benefits and dynamics of engagement

Arts engagement is gaining recognition as a non-clinical approach to promote mental health and well-being. However, the perceived utility of the arts to promote mental health among men with low socioeconomic status (SES) and how to best engage them is underexplored. This study explores the lived experiences of men with low SES who engage with the arts in Northern Ireland (n = 41). Data collected via focus groups (n = 5) and interviews (n = 11) were analysed using reflexive thematic analysis to inductively derive four themes. Theme 1 highlights how the arts facilitated friendship, a collective identity, peer support and a reason to socialize. Themes 2 and 3 explore how the arts enhanced self-esteem and emotional regulation by developing a routine, purpose, sense of mastery, a sense of catharsis through immersion in a soothing endeavour and an alternative outlet for self-expression. Theme 4 covers strategies that facilitate male engagement in the arts such as using a familiar space, delivering to an existing male group, framing the programme around male interests not health or creativity, building on existing strengths and capacities, enabling ownership, using tangible action-orientated activities, and being non-authoritative and flexible with delivery. This is one of the first studies to highlight the gendered dimensions in which men with low SES engage with and experience mental health benefits through arts engagement. This study points towards relevant theories to further understand the pathways between the arts and improved mental health among men which can inform development of tailored arts programmes for men.

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.

Restorative Practice in the Criminal Justice System: Examining a Restorative Reasoning Programme in a Women’s Prison

This paper is an analysis of a six-week Restorative Reasoning Programme that took place with 13 women in a UK women’s prison. It is an exploratory evaluation based on an adapted version of the QUALIPREV scheme. This two-stage evaluation examines both the processes of the programme, in terms of how well it ran, as well as the outcomes of the programme, in terms of how effective it was in supporting the women to address problem behaviours. Data comprise interviews with the two programme designers and facilitators and with two Prison staff responsible for activities and training; the programme materials used during the scheme; session evaluation forms; and post-programme self-completion reflections from the women engaged in the programme. Overall, the scheme had a range of positive impacts for the women: many expressed a change in attitude, including being more open for discourse and discussion around the harm they may have caused, being more willing to consider the repair needed in their personal relationships, and in some cases seeking subsequent referrals for further restorative work.

Defining an age cut-off for older offenders: a systematic review of literature

PURPOSE

In the literature, 65 years is commonly used as the age to designate an older person in the community. When studying older prisoners, there is much variation. The purpose of this paper is to investigate how researchers define older offenders and for what reasons.

DESIGN/METHODOLOGY/APPROACH

The authors reviewed articles on health and well-being of older offenders to assess terminology used to describe this age group, the chosen age cut-offs distinguishing younger offenders from older offenders, the arguments provided to support this choice as well as the empirical base cited in this context.

FINDINGS

The findings show that the age cut-off of 50 years and the term "older" were most frequently used by researchers in the field. The authors find eight main arguments given to underscore the use of specific age cut-offs delineating older offenders. They outline the reasoning provided for each argument and evaluate it for its use to define older offenders.

ORIGINALITY/VALUE

With this review, it is hoped to stimulate the much-needed discussion advancing towards a uniform definition of the older offender. Such a uniform definition would make future research more comparable and ensure that there is no ambiguity when researchers state that the study population is "older offenders".

The acceptability, effectiveness and gender responsiveness of participatory arts interventions in promoting mental health and Wellbeing: a systematic review

Background:This mixed methods review synthesizes the evidence of acceptability, effectiveness and gender-responsiveness of participatory arts interventions (PAIs) in promoting mental health and wellbeing among adults. Methods: The search was restricted to empirical studies of PAIs that reported on outcomes relating to common mental health problems and wellbeing among adults aged ≥18 years old. The mixed methods appraisal tool was used for quality appraisal. A narrative synthesis was conducted. Results:Thirty-two studies were included (1,058 participants). Typical PAI features are discussed. The evidence for effectiveness is limited by methodological issues. PAIs are perceived to benefit mental health via improved connectedness; emotional regulation; meaning-making & re-defining identity; and personal growth & empowerment. Conclusion: The review highlights the dearth of studies focused on men. Research standards to establish the evidence of effectiveness and the need to expand the evidence of acceptability beyond the "perceived effectiveness" domain are discussed.

Exploration of older prisoner’s social needs, who attended one of two prison initiatives for older people: an inductive phenomenological study

Purpose

The purpose of this study was to explore the social needs and experiences of older prisoners who were attending one of two social initiatives in a prison in England.

Design/methodology/approach

This paper is based on an interpretative phenomenological study, conducted in a prison in the South West of England. Older prisoners attending an initiative implemented for those over 55, a purposive activity or a social task group, participated in focus groups, which were audio recorded and thematically analysed.

Findings

Two overarching themes were identified. Firstly, the need to feel safe: prisoners felt attending an initiative provided them with a safe haven away from noisy and boisterous younger prisoners, who they perceived as different from them and who received preferential treatment. Secondly, being provided with a purpose: prisoners felt they belonged among their peers, which motivated them to attend and support group activities.

Research limitations/implications

This study was completed in one prison. However, both initiatives supported the social needs of older prisoners and enabled them to leave their cells, although they felt unsafe when not attending an initiative.

Originality/value

There remains a need to support the process of integrating younger and older prisoners, by the provision of both integrated and separate initiatives, with the aim of developing cross-generational and bi-directional peer support.

A systematic review of interventions for older adults living in jails and prisons

Objectives: The population of older adults in prison is the fastest growing demographic. Older inmates are more likely to have chronic medical conditions and cognitive decline, but these conditions occur earlier and may be more complex for older inmates. Specialized interventions to manage the unique health and mental health needs of older inmates are important to improve health and reduce burden on criminal justice systems. The aim of this research is to conduct a systematic review of empirically-tested interventions to improve the health or mental health of older adults living in jail or prison.Method: We conducted a systematic review of the literature to answer two research questions: (1) what interventions designed to improve the health or mental health of older adults living in jail or prison have been empirically tested? and (2) what are the effects of the interventions on inmates' physical or mental health?Results: Twenty-four articles were identified; seven met inclusion criteria. Several manuscripts discussed the same intervention, so the review identified five unique interventions for incarcerated older adults. The interventions are discussed including their main findings and limitations.Conclusion: Results support the need for research on interventions for incarcerated older adults. Intervention during incarceration can have a great impact on older adults' health and mental health during incarceration and upon reentry to the community. Directions for future research suggest the need for collaboration between practitioners and researchers in order to increase knowledge of what types of intervention work for older inmates living in jails and prisons.

Rugby as a rehabilitation program in a United Kingdom Male Young Offenders' Institution: key findings and implications from mixed methods research

There is a growing body of research on the effectiveness of rehabilitation programs in a Young Offenders' Institution (YOI). The aim of the present study is to investigate the effectiveness of rugby training as a rehabilitation intervention in a YOI in the United Kingdom. Young adult males (n=46) currently serving sentences at the YOI were split into two groups, intervention (n=25; mean age, 19.64±0.81 years) and no intervention (n=21; mean age, 19.76±0.89). Participants completed the Criminal Attitudes and Associates (MCAA) instrument at three different time cycles and then pre/post for intervention group. Additionally, qualitative interviews (one to one and focus groups) were carried out with the intervention and no intervention groups during the same cycles of the study. The results of questionnaire analysis showed no significant difference in MCAA measures taken before and after rugby intervention. Interestingly, the intervention group showed more procriminal attitudes on their responses compared to the no intervention group. Finally, analysis of the 3 cycles of data collected showed that the time of the year the questionnaire was completed has a significant impact on the responses given. In contrast, the qualitative interviews showed a very positive change of attitude towards rehabilitation from the intervention group after rugby training. The implications of the results in relation to studies aimed at evaluation of the intervention programs in YOI are discussed.

Optimising opioid substitution therapy in the prison environment

PURPOSE

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

DESIGN/METHODOLOGY/APPROACH

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

FINDINGS

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

ORIGINALITY/VALUE

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.