Custodial Settings Research Articles

Prisoners’ experiences of custodial parkrun in the UK: links to rehabilitation culture and desistance

PurposeParkruns are weekly, free, community-based, 5 km runs around open spaces, with a growing body of research indicating their social, physical and psychological benefits. Thirty-one custodial establishments in England and Wales regularly offer parkruns. The purpose of this paper is to consider prisoners' experiences of parkrun in custodial settings, and these are discussed in the context of the evidence base regarding parkrun in the community and the wider literature on prison sport, desistance, and rehabilitation culture.Design/methodology/approachUsing an inductive, qualitative approach, data was collected at three English prisons, via semi-structured interviews with 24 adult male prisoners who participated in parkrun. Data was subjected to thematic analysis.FindingsIn total, five themes reflecting positive experiences associated with custodial parkrun were identified: connection with others; healthy living; a safe and predictable exercise environment; a sense of purpose; and a re-humanising experience. Factors appearing frequently in the wider parkrun research are present in the perceptions of parkrunners in custody. In addition, factors deemed important to desistance and promoting a rehabilitation culture were also found in the experiences of the sample.Practical implicationsThe work emphasises the successes of His Majesty’s Prison and Probation Service (HMPPS) and parkrun working in partnership to support custodial events. By highlighting the positive experiences of custodial parkrun on prisons and prisoners, the authors anticipate that their findings may encourage further sites to consider launching parkrun events and prompt existing sites to consider their events in line with efforts to promote desistance and a rehabilitation culture.Originality/valueTo the best of the authors’ knowledge, this is the first paper to explore custodial parkrun. The findings indicate that custodial parkrun supports HMPPS strategic goals by offering an opportunity for prisons to promote desistance.

Profiles of Risk for Self-injurious Thoughts and Behaviors Among System-Impacted Girls of Color

Suicide is a leading cause of death among youth in custodial settings. Prior research investigating risk factors for suicide among system-impacted youth fail to incorporate an intersectional framework to contextualize suicide risk among system-impacted girls of color. Profiles of risk for self-injurious thoughts and behaviors (SITBs) were investigated in a sample of 240 racially and ethnically diverse system-impacted girls (mean [SD] age= 14.5 [1.7] years, Hispanic/Latinx 49.6%, Black 37.1%). Participants completed self-report measures evaluating traditional risk factors for suicide (mental health symptoms, trauma exposure) as well as assessments of minority stress (eg, daily discrimination) and recent engagement in SITBs at baseline and 3-month follow-up. Latent profile analysis revealed 3 distinct profiles: low-risk, characterized by relatively low levels of suicide risk indicators (n= 102); high-risk internalizing, characterized by elevations in internalizing symptom indicators (n= 96); and high-risk comorbid, characterized by relatively high levels of suicide risk indicators (n= 42). Girls in the high-risk profiles reported more SITBs at baseline and 3-month follow-up than girls in the low-risk profile. Results suggest that indicators of suicide risk can be used to classify system-impacted girls into profiles that differ concurrently and prospectively on SITBs. Findings could be used to inform more accurate risk and referral assessments for system-impacted girls of color, whose SITB-related challenges may be overlooked or framed as criminal. These findings highlight the continued need for assessments evaluating multiple indicators of risk for SITBs in the juvenile legal system. System-impacted girls of color represent an understudied subset of youth at elevated risk for engagement in self-injurious thoughts and behaviors (SITBs). This study investigated profiles of risk for SITBs in a sample of 240 racially and ethnically diverse system-impacted girls of color (mean age = 14.5 years) utilizing frequently studied factors associated with SITBs, including mental health symptoms and trauma experiences along with understudied risk factors such as minority stress. The authors found that three distinct profiles of risk for SITBs: "Low-Risk," characterized by relatively low levels of suicide risk indicators (n = 102); "High-Risk Internalizing," distinguished by elevations in internalizing symptoms (n = 96); and "High-Risk Comorbid," defined by relatively high levels of internalizing and externalizing symptoms (n = 42). Participants in both high-risk groups had high levels of trauma, minority stress, and were more likely to identify as a member of a sexually minoritized group. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

A rapid global review of guidance to prevent and control COVID-19 in custodial settings

A rapid global review of guidance to prevent and control COVID-19 in custodial settings

Poststructuralism and the construction of subjectivities in forensic mental health: Opportunities for resistance.

Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva,and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system.

Health and correctional staff acceptability of depot buprenorphine in NSW prisons.

Provision of opioid agonist treatment (OAT) in custodial settings is resource-intensive and may be associated with diversion, non-medical use, and violence. A clinical trial of a new OAT, depot buprenorphine (the UNLOC-T study), provided the opportunity to obtain health and correctional staff perspectives regarding this treatment prior to widespread roll-out. Sixteen focus groups with 52 participants were conducted, including 44 health staff (nurses, nurse practitioners, doctors, and operational staff) and eight correctional staff. Key challenges to providing OAT identified as potentially being addressed by depot buprenorphine included 1) patient access, 2) OAT program capacity, 3) treatment administration procedures, 4) medication diversion and other safety issues and, 5) impact on other service delivery. The introduction of depot buprenorphine into correctional settings was considered to have the potential to increase safety for patients, improve staff / patient relations and advance patient health outcomes via expanded treatment coverage and efficiencies gained through enhanced health service delivery. Support was almost universal from both correctional and health staff participating in this study. These findings build on emerging research regarding the positive impact of more flexible OAT programs and could be used to engage support for the implementation of depot buprenorphine from staff in other secure settings.

Access to tablet injectable opioid agonist therapy in rural and smaller urban settings in British Columbia, Canada: a qualitative study

BackgroundRural and smaller urban settings in Canada are disproportionately impacted by the overdose crisis, highlighting the need for novel public health interventions within these jurisdictions. Tablet injectable opioid agonist therapy (TiOAT) programs have been implemented in select rural communities as a means to address drug-related harms. However, little is known about the accessibility of these novel programs. Therefore, we conducted this study to understand the rural context and factors that affected access of TiOAT programs.MethodsBetween October 2021 to April 2022, individual qualitative semi-structured interviews were conducted with 32 individuals enrolled in a TiOAT program at participating rural and smaller urban sites in British Columbia, Canada. Interview transcripts were coded using NVivo 12 and data were analyzed thematically.ResultsTiOAT access varied considerably. TiOAT delivery in rural settings is complicated due to geographic challenges. Participants who were homeless and staying at a nearby shelter or those in centrally-located supportive housing had minimal issues compared to those living in more affordable housing on the outskirts of town with limited transportation options. Dispensing policies that required daily-witnessed ingestion multiple times daily were challenging for most. Only one site provided evening take-home doses whereas participants at the other site could only resort to the illicit opioid supply to address withdrawal outside of program hours. Participants described the clinics as providing a positive and familial social environment compared to experiences of stigma elsewhere. Medication interruptions did occur when participants were in hospital and custodial settings, leading to withdrawal, program discontinuation, and overdose risk.ConclusionsThis study highlights the beneficial ways in which health services tailored for people who use drugs can create a stigma-free environment with an emphasis on social bonds. Other factors such as transportation access, dispensing policies, and access in rural hospitals and custodial settings produced unique challenges for rural people who use drugs. Public health authorities in rural and smaller settings should consider these factors when designing, implementing, and scaling up future substance use services, including TiOAT programs.

Strengthening Academic Medicine's Response to Humanitarian Concerns.

Strengthening Academic Medicine's Response to Humanitarian Concerns.

Through Hope and Struggle: The Impact of “Gaisce – The President's Award” on Young Adults in Irish Prisons

This article is an exploratory study of young adult incarcerees’ perspectives on the impact of “Gaisce,” a self-development program for youth in Irish custody. Drawing on 10 semistructured interviews with male participants and a review of previous studies of this cohort, the article highlights their perceptions of Gaisce's strengths and weaknesses, paving the way for further reflection on self-development programs in custodial settings. Taking place during COVID-19, the investigation provides unique insight into the experiences of young adults participating in such a program during a pandemic.

Understanding and Preventing Ideologically Justified Violence in Custodial Settings: The MICO Paradigm

Internationally, secure institutions face a range of challenges presented by detainees convicted or suspected of terrorism-related crimes and those interested or involved in groups that support ideologically justify violence (IJV). Currently, there is an apparent absence of a theoretically grounded but operationally focused paradigm (or conceptual lens) for understanding and preventing IJV within such settings. In response, this article presents such a paradigm, to inform and direct the implementation of coherent organizational policies and practices to address this issue. The paradigm, its theoretical basis, its implications for correctional policy and practice, and limitations are outlined and discussed.

The emergence of custodial health nursing as a specialty whose time has come: An Australian experience.

Nurses provide healthcare in prisons worldwide. Working within security restraints, in environments not designed for nursing care, custodial health nurses (CHNs) use specialist nursing skills and knowledge to do essential work. Rapid increases in prisoner age, infirmity and ill-health of prisoners mandate their access to these nurses. To raise awareness of the CHNs struggle for specialty status within the nursing profession, public health frameworks and prisons. Publicly available information is organised and analysed through the author's lens of 20 years working in the Australian prison system as a general nurse and nurse practitioner. CHNs efforts towards becoming a specialty within nursing, public health and prisons are ongoing. Overcoming barriers and maximising facilitators to effective CHN practice would be indicators of successful incorporation of nursing models that assist prisoner patients. Prison healthcare contexts are unique regarding prisoner health and funding that impacts the CHNs resourcing, their scope of practice and acceptance of nursing in prison systems and the broader healthcare sectors. Greater visibility of the CHNs will help promote policy reforms regarding nursing services within a changing prisoner demographic. Changes to educational and professional support for CHNs are needed. Policy restrictions on funding for CHN models in Australia fall short of international standards for prison healthcare; however, political and organisational commitment in this area will be necessary to attain community-equivalent healthcare standards across the custodial setting. Professional structures, competencies and specialty policy frameworks are required to promote CHNs as advocates for prisoners needing care and their professional development. CHNs at the forefront of policy development and review will benefit all stakeholders in custodial health.

Navigating pregnancy and early motherhood in prison: a thematic analysis of mothers’ experiences

BackgroundMaternal imprisonment negatively impacts mothers and their children and is likely to have lifelong and intergenerational sequelae. In many jurisdictions nationally and internationally, young children (usually those less than 5 years) can reside with their mothers in prison. However, there is considerable debate regarding the impact of prison environments on incarcerated mothers and their children who are born, and/or raised in prison. Research to date on the pregnancy and mothering experiences of imprisoned mothers and their preferences for care arrangements for their babies and young children is limited.MethodsThis study was part of the Transforming Corrections to Transform Lives project, in which workshops were conducted with imprisoned mothers to understand their needs while in custody and post-release, and the kind of supports and system changes that are required to meet those needs. Incarcerated mothers (n = 75) participated in seven workshops conducted across four Queensland prisons. Themes were generated through reflexive thematic analysis.ResultsThree themes characterised mothers’ experiences of being pregnant and undertaking a mothering role of a young child while in prison. First, for most mothers, imprisonment adds vulnerability and isolation during pregnancy and childbirth. Second, although mothers felt that residing together with their children in prison motivated them to change for a better future, they were concerned about the potential negative impact of the prison environment on the child’s development. Lastly, most mothers voiced losing autonomy and agency to practice motherhood independently within custodial settings. Mothers expressed a need for the correctional system to be adapted, so it is better equipped to address the unique and additional needs of mothers with young children.ConclusionMothers’ experiences indicated that the correctional system and policies, which were predominantly designed for men, do not adequately address the varied and complex needs of pregnant women, mothers, and their young children. Imprisonment of pregnant women and mothers with young children should be the last resort, and they should be provided with holistic, individually tailored support, most preferably in community settings, to address their multiple intersecting needs.

Identifying and responding to young people with cognitive disability and neurodiversity in Australian and Aotearoa New Zealand youth justice systems

Many young people in the criminal justice systems of both Australia and Aotearoa New Zealand will have cognitive disabilities and neurodiversity, and substantial challenges arise in efforts to provide services that will adequately meet their needs. This is despite the introduction of funding models based on an assessment of individual needs (rather than block funding to organisations). In this narrative scoping review, we argue that justice agencies will need to partner with specialist disability support services if they are to meet the needs of those in both custodial and community settings. This requires knowledge of the nature and prevalence of disability in the youth justice population, awareness of available service responses and the development of skills to engage young people in services and programmes that will support rehabilitation and community inclusion.

Direct‐acting antiviral therapy for chronic hepatitis C among incarcerated people who inject drugs

AbstractHepatitis C virus (HCV) infection is an important public health problem, causing significant morbidity and mortality worldwide. The prevalence of HCV infections is especially high among people who inject drugs (PWID). The efficacy of direct‐acting antiviral (DAA) therapy was evaluated herein. During 2019‐2021, a total of 321 cases who received a full course of DAA therapy and completed a 12‐week follow‐up observation were studied. The most frequent genotype (GT) was GT6 (34.9%), followed by GT1a (23.4%), GT1b (14.6%), GT2 (12.1%), and GT3 (11.8%). Increase was observed in GT6 (from 29.8% in 2019 to 44.9% in 2021) and GT3 (from 9.9% in 2019 to 16.3% in 2021) over the study years. GT2 was more likely found in patients >50 years old, while GT3 was more in younger patients (both P < .05). GT3 was also more frequently associated with moderate scores of fibrosis‐4 index (FIB‐4) (1.45 ≤ FIB‐4 ≤ 3.25, 13/38 vs 49/283; P < .05). High viral loads (>1 500 000 IU/mL) were found in 65.7% of the patients, including 21.5% showing a very high level (>6 000 000 IU/mL). Compared to other genotypes, viral loads were significantly higher in GT6 (P < .005) and lower in GT1b (P < .01). The end of treatment virologic response rate and the sustained virologic response rate at 12 weeks (SVR12) post‐treatment were both 100%. Two recurrent infections with GT6 and GT2 were noted at 16‐month and 3‐month, respectively, after achieving SVR12. The present report provides a solid evidence for the effectiveness of DAA therapy in the treatment of hepatitis C among incarcerated PWID. We believe that appropriate DAA therapy, when incorporated with active universal screening, can achieve micro‐elimination of chronic hepatitis C in incarcerated persons. Hence, the strategies should be applied to all custodial settings, especially for PWID, as an important step to eliminate hepatitis C by 2025, a goal set by the Taiwan government.

Optimising community health services in Australia for populations affected by stigmatised infections: What do service users want?

Stigma in health services undermines diagnosis, treatment and successful health outcomes for all communities, but especially for those affected by blood-borne viruses and sexually transmitted infections (STIs). This study sought to examine experiences in accessing and receiving health services, including what characteristics promoted better health, safety and well-being for people with blood-borne viruses or STIss. It conducted 46 in-depth interviews with people who inject drugs, gay men and other men who have sex with men, sex workers, people in custodial settings, culturally and linguistically diverse people, Indigenous Australians and young people in one Australian urban community setting. Findings reveal that stigma persists in the provision of healthcare services, and that previous experiences of discrimination or fear of mistreatment may result in a reluctance to continue to access services. On-going staff training and education are important to ensure healthcare environments are welcoming and inclusive. Specialised services and services that employed peers were seen as favourable. Attending different services for different health needs created particular access challenges and undermined participant ability to engage in more holistic healthcare. The fragmented structure of health services was thus seen as a barrier to accessing health services, and stronger collaboration between health services is recommended.

Re-examining the dual harm profile: an assessment using US prison population-level data

ABSTRACT Dual harm behaviour has recently gained scholarly attention. Dual harm centres on a subset of people who display violent and self-harming behaviour. This study re-examines the differential profile characteristics identified in Europe for those who dual harm, using international data featuring a population study of a state prison system in the south-eastern United States. Three years of data produced 43,489 institutional events, from a custodial population of 22,918. Logistic regression analysis indicates that those who dual harm in custody had an overall rate of infraction 40–70% higher than those who engage solely in violence or self-harm, and five times higher than those without physical harm infractions. Dual harm was associated with higher rates of non-harm incidents (e.g. property damage and disorder), younger age, lower educational achievements on admission and less educational development during imprisonment, greater self-reported mental health need although not substance abuse, and fewer intimate relationships. Dual harm was related to more lethal acts of self-harm such as ligature or ingestion. This is the first study that applies the dual harm profile to prison data within the US. This study supports dual harm as a highly relevant construct within international custodial settings and offers policy implications for this population.

‘. . . staff here are just dropped in the deep end’: The Impact of Roles on Communication and Supervisor Support in Youth Custody

Staff experience in youth custody are often categorised by strains, which are affected by communication and support. This research explores the association between staff roles, within a Secure Training Centre in the England, and the levels of communication and support. It enhances our understanding of the challenges faced by staff members working with young people in custodial settings and how levels of communication and support are dictated by staff roles. Through questionnaires ( N = 74) and interviews ( N = 15) with staff, statistically significant relationship between staff role and levels of communication and support was identified. Through triangulation, this article illustrates the effectiveness of the job demands–resources model in understanding staff experiences with communication and supervisory support in youth custody. It has wide-ranging implications by providing sociologists with an effective model for understanding job satisfaction and stress and by providing policy-makers and organisations delivering custodial services an understanding of the communication and support required to reduce stress and turnover.

Self-harm and suicide attempts among incarcerated lesbian, gay and bisexual people in Australia.

Guided by minority stress theory, we explored the association between sexual identity, justice system involvement, self-harm and suicide attempts, among a cohort of incarcerated adults in Australia. A sample of 2698 adults incarcerated in Queensland and Western Australia were surveyed between 1 August 2008 and 12 August 2016 about their current psychological distress, mental health diagnoses, contact with mental health services, and lifetime and recent self-harm and suicide attempts. We used multivariable logistic regression to explore the relationship between sexual orientation, prior criminal justice system involvement, mental health and demographic factors. Five percent of the sample identified as gay, lesbian or bisexual, with 37% of lesbian, gay, bisexual and other same-sex attracted individuals reporting that they had self-harmed (vs 14% of heterosexual peers; χ2 = 52.4; p < 0.001) and 49% reporting a history of at least one suicide attempt (vs 23%; χ2 = 49.2; p < 0.001). Lesbian, gay, bisexual and other same-sex attracted people were 2.1 times (95% confidence interval: [1.4, 3.3]) and 1.8 times (95% confidence interval: [1.2, 2.8]) more likely to report a history of self-harm and suicide attempt, respectively, than non-lesbian, gay, bisexual and other same-sex attracted respondents. Intersectionality theory suggests that people who are navigating two or more marginalised identities often experience a compounding of internal and external stressors. Consistent with that theory, lesbian, gay, bisexual and other same-sex attracted people who experience incarceration may be at particularly high risk of self-harm and suicidal behaviour. Custodial settings should both improve cultural competency for frontline staff working with lesbian, gay, bisexual and other same-sex attracted individuals and improve access to mental health services during incarceration.

Screening for mental disorders in police custody settings

SUMMARYMental disorders are overrepresented in the criminal justice system, and this applies equally to police custody. These environments are complex and often pressured, and the acuity of the situation, combined with underlying mental disorders, comorbid medical problems and substance misuse, can lead to behavioural disturbance and increased psychiatric risk. Police custody may also present an opportunity to identify and signpost people with mental disorders and vulnerabilities who are ordinarily hard to reach by standard health services. This article considers the purposes of mental health screening of detainees in police custody. It gives an overview of research into screening for a range of psychiatric disorders and vulnerabilities (including substance misuse and traumatic brain injury) and summarises data on deaths in and immediately following release from custody. Given the inadequacy of statutory screening procedures in some jurisdictions, the authors offer a pragmatic evidence-based protocol to guide screening for mental disorders in custody detainees.

Covid-19 restrictions in a custodial forensic setting

Covid-19 restrictions in a custodial forensic setting

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system: A global systematic review.

SummaryBackgroundPeople who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.MethodsWe searched Embase, PsycINFO, MEDLINE, and grey literature databases for articles published between 1 January 2000 and 1 June 2021. The protocol was registered with PROSPERO (CRD42020185989).FindingsThirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.InterpretationMore high-quality evidence from criminal justice settings other than adult prisons, particularly from low- and middle-income countries, should be considered a priority for future research.FundingThis work was funded by the Australian government's National Suicide Prevention Taskforce. RB is supported by a National Health and Medical Research Council (NHMRC) Emerging Leader Investigator Grant (EL2; GNT2008073). MW is supported by a NHMRC Postgraduate Scholarship (GNT1151103). SF was funded by the NIHR HTA Programme (HTA Project:16/159/09).