Custodial Settings Research Articles

Forensic patients’ experiences of Synthetic Cannabinoid Receptor Agonists (SCRAs) within custodial settings

ABSTRACT There has been an enormous growth in New Psychoactive Substances (NPS), sometimes erroneously referred to as ‘legal highs’, over the past 15 years. There are currently at least 800 such compounds, and we lack adequate data on all their effects and harms. Synthetic cannabinoid receptor agonists (SCRAs), often referred to by the generic name ‘spice’, are particularly notable in this regard. There has been a lack of research on forensic patients’ experiences of SCRAs, their consumption, and any adverse impact they might have. This work qualitatively explored the experience of NPS and SCRA use in 19 male patients recruited from three secure forensic services in the South of England. The majority of participants discussed experiences of using SCRAs whilst in prison as opposed to their current forensic hospital admission. Three key themes emerged which describe participants experiences of SCRA use: (i) perpetuating cycle of drug use, mental ill-health, and crime; (ii) environmental injustices and consequences; and (iii) shame and stigma associated with SCRA use. The findings provide insights into the challenges faced by forensic patients as a result of SCRA use, as well as notable opportunities. A common call was for greater psychoeducation on drug harms and treatment opportunities.

A Scientific-Practical Analysis of the Study of Penal System Employees’ Opinion in Russia on the Problem of Criminal Leaders in Custody

On the basis of sociological research conducted by the authors, the article provides a criminological analysis of the phenomenon of criminal leaders (“thieves in law”, “proprietors”, “overseers”, etc.) in custodial settings of the penal system of Russia. The authors come to the conclusion that in order to solve the problem of criminal leaders, not only legal, but also ideological tools are needed, which, unfortunately, have not yet been developed either by science or practice.

Providing health care in politically charged contexts: a qualitative study about experiences during a public collective hunger strike of asylum seekers in Germany

ABSTRACT Purpose Role expectations of physicians providing health care for hunger strikers have been discussed in the context of prisons and detention centres. Ethical guidance for physicians in these situations is codified in the Declaration of Malta. In the last years, new forms of collective, public hunger strikes of asylum seekers have occurred. We have aimed at reconstructing the experiences of health-care personnel involved in one of such cases. Methods Semi-structured interviews with nine participants (physicians and paramedics) that had been involved in a public collective hunger strike of asylum seekers in Germany were conducted. Results We identified three health-care provider groups: voluntary physicians, emergency service providers and medical consultants for the authorities. Role conflicts arising from multiple loyalty situations with obligations towards different stakeholders (e.g., strikers, employers, authorities) were perceived as the greatest challenge especially for voluntary doctor and emergency service provider participants. Such conflicts culminated in feeling instrumentalized for political goals. Conclusion The results illustrate that professional challenges in the health care during a public collective hunger strike differ in various aspects from those described in the literature on custodial settings. We recommend expanding and adapting the medico-ethical guidance.

“Is Restorative Justice Greek to Me?”: Exploring Its Applicability in Greek Youth Detention Centres

Abstract Justice systems around the world are constantly working to balance reform/rehabilitation/re-entry and punishment in response to juvenile delinquency. In recent years, there has been a strong emphasis on the notion of restorative justice as an alternative approach to criminal justice, yet there continues to be a dearth of information on the interrelation between restorative justice, religion and imprisonment, especially among youth. The present research seeks to explore the applicability and possible future implementation of restorative justice programmes for late adolescent and young adult male offenders (18–21 years old) held in the Special Detention Institutions of Greece. It also aims to identify any links between restorative justice and religion in youth custodial settings among the large migrant population hosted in these institutions. A self-administered quantitative study was distributed to achieve this aim. The data analysis provided no statistically significant relationships between the inmates’ willingness to meet with their actual/surrogate victims and ask for forgiveness/restore relationships with them. Equally insignificant was found the inmates’ eagerness to get involved in restorative mediation with their capacity to acknowledge the harm that their illegal actions inflicted on others, and to make amends.

Commentary on the harm reduction reference group of justice health and forensic mental health network and corrective services NSW, Australia.

This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW). By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee's success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group's audit were drawn by critically appraising the JHFMHN/CSNSW HRRG's Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature. The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings. Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large. Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives.

Complaints against health care professionals providing police custodial and forensic medical/health care services in England, Wales and Northern Ireland - what do we know?

Awareness of the nature and frequency of complaints against health care professionals working in police custodial health care services could provide opportunities to improve patient safety. To explore this freedom of information requests were sent to police services in England, Wales and Northern Ireland, to professional regulatory bodies and to the Independent Office for Police Conduct. Eighty-seven percent of police services responded but only a minority provided complete responses, with data not being held, or not being held in an easily retrievable format, being provided as reasons. The nature and frequency of complaints were similar to a previous 2017 study, suggesting a failure to learn lessons from the investigation of complaints and implement change in clinical practice. No evidence of an accessible complaints handling and recording procedure was provided across the police services surveyed. Regulatory bodies provided some information on the nature of complaints made against doctors and nurses working in police custodial settings, but that for paramedics was unable to do so. It is recommended that the communication loop between police services, those bodies providing health care and forensic medical services and regulatory bodies needs to be closed. A common reporting system or the application of established complaints handling procedures and reporting structures, which could be achieved by transferring these services to the National Health Service, may enhance patient safety in police custody.

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

BackgroundWith over 11 million people incarcerated globally, prevention and control of COVID-19 in custodial settings is a critical component of the public health response. Given the risk of rapid transmission in these settings, it is important to know what guidance existed for responding to COVID-19 in the early stages of the pandemic. We sought to identify, collate, and summarise guidance for the prevention and control of COVID-19 in custodial settings in the first six months of 2020. We conducted a systematic search of peer-reviewed and grey literature, and manually searched relevant websites to identify publications up to 30 June 2020 outlining recommendations to prevent and/or control COVID-19 in custodial settings. We inductively developed a coding framework and assessed recommendations using conventional content analysis.ResultsWe identified 201 eligible publications containing 374 unique recommendations across 19 domains including: preparedness; physical environments; case identification, screening, and management; communication; external access and visitation; psychological and emotional support; recreation, legal, and health service adaptation; decarceration; release and community reintegration; workforce logistics; surveillance and information sharing; independent monitoring; compensatory measures; lifting control measures; evaluation; and key populations/settings. We identified few conflicting recommendations.ConclusionsThe breadth of recommendations identified in this review reflects the complexity of COVID-19 response in custodial settings. Despite the availability of comprehensive guidance early in the pandemic, important gaps remain in the implementation of recommended prevention and control measures globally, and in the availability of evidence assessing their effectiveness on reducing COVID-19 disease, impact on people in custody and staff, and implementation.

Sexually transmitted infections epidemiology and risk assessment at the main correctional facility in Malta (2017-2019).

Inmates suffer from mental and physical ailments combined with substance misuse and addiction which are often underreported or disregarded by sufferers, for fear of being stigmatized. This vulnerable group has complex medical and psychosocial needs and hence gathering data is essential for a holistic approach to care. Understanding the interplay between sexually transmitted (STIs) and blood borne infections, substance misuse and mental health is essential to enable targeted interventions and outreach programmes. The aim was to analyse the occurrence of STIs, hepatitis and tuberculosis in inmates at the main custodial facility in Malta; to assess risk behaviours and vulnerabilities through an outreach programme; to offer treatment and referral and to develop recommendations for screening of prison inmates. A mixed methodology study was used which involved analysis of health data pooled from the Genitourinary Clinic (GUC) and Corradino Correctional Facility (CCF) in Malta. In the study period, 206 inmates were tested for STIs, 67.9% males, aged between 14 and 72. Only 27% were not sexually active in the 6 months prior to testing. Among those sexually active, 31% had had sex with casual partners and 43% had never used condoms for sexual intercourse. Seventy-five percent admitted to drug use. The most common STI diagnosed was HPV (16.5%), followed by syphilis (5.8%). Genital dermatoses were also frequent (9.2%). The prevalence of Hepatitis C was high (24.5%), in relation to intravenous drug use. The authors advocate for more collaboration between sexual health clinics and prisons to address educational interventions and STIs' testing. Cultural and linguistic barriers should be considered when devising national health strategies and screening recommendations in custodial settings. Adequate follow-up should extend into the community setting once inmates leave the prison to ensure a continuum of care.

61.1 COMMUNITY PARTNERSHIPS IN BUILDING CHILD ASYLUM SUPPORT

The management of children and families apprehended at the US border has caused a public health crisis. As the number of unaccompanied minors seeking asylum increases, so will the need for multidisciplinary approaches with child and adolescent psychiatrists and community and legal organizations. This presentation aims to provide the child and adolescent psychiatrist an overview of the strengths, vulnerabilities, and challenges that these youth face in immigration custody settings and a model for engagement with community activist organizations.

Strategies to maximise study retention and limit attrition bias in a prospective cohort study of men reporting a history of injecting drug use released from prison: the prison and transition health study

BackgroundThere are significant challenges associated with studies of people released from custodial settings, including loss to follow-up in the community. Interpretation of findings with consideration of differences between those followed up and those not followed up is critical in the development of evidence-informed policies and practices. We describe attrition bias in the Prison and Transition Health (PATH) prospective cohort study, and strategies employed to minimise attrition.MethodsPATH involves 400 men with a history of injecting drug use recruited from three prisons in Victoria, Australia. Four interviews were conducted: one pre-release (‘baseline’) and three interviews at approximately 3, 12, and 24 months post-release (‘follow-up’). We assessed differences in baseline characteristics between those retained and not retained in the study, reporting mean differences and 95% confidence intervals (95% CIs). ResultsMost participants (85%) completed at least one follow-up interview and 162 (42%) completed all three follow-up interviews. Retained participants were younger than those lost to follow-up (mean diff − 3.1 years, 95% CI -5.3, − 0.9). There were no other statistically significant differences observed in baseline characteristics.ConclusionThe high proportion of participants retained in the PATH cohort study via comprehensive follow-up procedures, coupled with extensive record linkage to a range of administrative datasets, is a considerable strength of the study. Our findings highlight how strategic and comprehensive follow-up procedures, frequent contact with participants and secondary contacts, and established working relationships with the relevant government departments can improve study retention and potentially minimise attrition bias.

Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder in custodial setting – a case series

ABSTRACT Background Methadone, a full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are established first-line medications for opioid maintenance therapy. Transition from methadone to sublingual buprenorphine may precipitate withdrawal and is usually performed only in patients on low dose of methadone (<30–40 mg). Transition from methadone to a novel subcutaneous buprenorphine depot (Buvidal) has not been previously described. Objectives To test the hypothesis that a rapid transition from methadone to buprenorphine depot after a single dose of buprenorphine 4 mg sublingual is safe and well tolerated. Methods Retrospective chart analysis of a case series of seven opioid users under custodial setting (prison) who were switched from methadone to buprenorphine depot (initial dose 16 mg weekly subcutaneously) after an initial test dose of buprenorphine 4 mg sublingual within 48 hours. Results Clinical data indicate that a rapid transition from methadone to depot buprenorphine is feasible (six patients within 48 hours, one within 4 days). All patients were successfully switched to buprenorphine depot and the transfer period was completed without dropouts or major medical problems. Further dose adjustments were performed in 4 of 7 patients. Conclusions Transition of opioid users from methadone to buprenorphine depot is feasible and safe via 4 mg buprenorphine sublingual. This procedure may facilitate induction of buprenorphine depot formulations in patients treated with methadone.

HIV/AIDS, hepatitis and tuberculosis-related mortality among incarcerated people: a global scoping review

PurposePeople in prison are at a higher risk of preventable mortality from infectious disease such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) than those in the community. The extent of infectious disease-related mortality within the prison setting remains unclear. The purpose of this paper was to collate available information on infectious disease-related mortality, including the number of deaths and calculate the person-time death rate.Design/methodology/approachThe authors searched databases between 1 January 2000 and 18 November 2020 for studies reporting HIV, HBV, HCV, TB and/or HIV/TB-related deaths among people in prison.FindingsThe authors identified 78 publications drawn from seven Joint United Nations Programme on HIV/AIDS’ regions encompassing 33 countries and reporting on 6,568 deaths in prison over a 20-year period. HIV/AIDS (n = 3,305) was associated with the highest number of deaths, followed by TB (n = 2,892), HCV (n = 189), HIV/TB (n = 173) and HBV (n = 9). Due to the limitations of the available published data, it was not possible to meta-analyse or in any other way synthesise the available evidence.Research limitations/implicationsTo inform targeted efforts to reduce mortality, there is a need for more, better quality data to understand infectious disease-related mortality in custodial settings. Increased investment in the prevention and management of infectious diseases in custodial settings, and in documenting infectious disease-related deaths in prison, is warranted and will yield public health benefits.Originality/valueTo the authors’ best knowledge, this is the first scoping review focussed on deaths due to these infections among people in prison internationally. The gaps identified form recommendations to improve the future collection and reporting of prison mortality data.

A qualitative exploration of young people and prison officers’ experiences of empathy within a young offenders’ institution

PurposeThis study aims to explore the ways in which young people and prison staff (Prison Officers) within a youth custodial establishment experience empathy. Previous research tends to view empathy as a stable trait and one which people can develop through individual-centred therapy. There has been little consideration of the impact of relationship factors and context in relation to empathy experience and expression. The current study aims to address this by exploring the role of the custodial context in shaping empathy, including the potential impact of relationships, environmental factors and culture.Design/methodology/approachA qualitative approach was used to enable breadth and depth in the exploration of this area. Individual, semi-structured interviews were carried out with a purposive sample of three young people and three Prison Officers. Data was analysed using inductive thematic analysis informed by the guidelines of Braun and Clarke (2006) and King and Horrocks (2010).FindingsConstructed themes included “constructions of empathy”, “recipe for empathy”, “institutional investment”, “the value of empathy” and “doing empathy”. Together, they provide detailed insight into the interplay of personal and wider contextual factors influencing the experience of empathy in a custodial setting. The findings suggest that the way in which young people and staff experience empathy in the custodial environment is unique. The findings suggest that empathy takes place within the context of relationships and is influenced by the nature of those relationships, along with the wider social context within which it occurs.Practical implicationsThe findings of the current study support a move away from understanding empathy as an individual personality trait and instead viewing it as a dynamic experience that is changeable based upon the relationship and the context within which it occurs. The findings suggest that interventions aiming to develop empathy should look beyond the level of the individual and the relationship and focus upon developing environments that are supportive of empathy.Originality/valueThis study provides unique insights into the subjective experience of empathy in a custodial setting, presenting as one of the first to take a more holistic approach to understand this phenomenon.

Treatment of opioid dependence with depot buprenorphine (CAM2038) in custodial settings.

Background and aimsOpioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under‐treatment of opioid dependence in these settings world‐wide. This study assessed the safety of subcutaneous slow‐release depot buprenorphine in custody.DesignOpen‐label, non‐randomized trial.SettingCorrectional centres in New South Wales, Australia.ParticipantsSixty‐seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM‐5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm.Intervention and comparatorDepot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone.MeasurementsSafety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self‐reported diversion and substance use at baseline and weeks 4 and 16.FindingsRetention in depot buprenorphine treatment was 92.3%. Ninety‐four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self‐reported non‐prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007–0.018, P < 0.0001).ConclusionsThis first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion.

Response measures to COVID-19 in prisons and other detention centers

PurposeThe purpose of this paper is to summarize activities being undertaken by the World Health Organization (WHO) Regional Office for Europe to prevent and control COVID-19 in and beyond prisons, activities specifically designed to increase information sharing and to support Member States, to comment on potential impacts of these initiatives at country-level responses and to underline the need for a rights-based approach to managing the pandemic, including the right to vaccination.Design/methodology/approachThe Health in Prisons Programme (HIPP) of the WHO Regional Office for Europe worked with partner organizations to review regularly the evidence on best practices in prison health and use it to inform policy recommendations at the global level. HIPP issued overarching guidance and specific tools to support implementation of measures to prevent and control the spread of COVID-19 in prisons and other custodial settings. Moreover, to monitor the emergence of outbreaks, the HIPP developed a minimum data set for countries voluntarily to report COVID-19 cases and identify situations in need of direct support.FindingsSince May 2020, the WHO has periodically received data from Member States, leading to the development of country-specific bulletins to support countries and, whenever appropriate, to organize virtual missions to further support ministries and public health bodies responsible for managing COVID-19 in prisons.Originality/valueThe development of a specific set of indicators for prisons enables exploring data in a disaggregated manner. Monitoring response measures developed in prison enables judging their appropriateness to minimize the spread of SARS-CoV2 in prisons and alignment with guidance issued by the WHO.

Psychotropic medication prescribing in people with autism spectrum disorders with and without psychiatric comorbidity

SUMMARYAutism spectrum disorders (ASDs) are a group of lifelong neurodevelopmental disorders characterised by difficulties in social interactions and social communication, and restricted and repetitive behaviours. Relative to the general population, individuals with ASDs are likely to be overrepresented in secure psychiatric care and custodial settings. Outcomes vary and can be problematic in the context of co-occurring intellectual disability, psychiatric disorder and challenging behaviours. To date, there is little in the way of specialised clinical guidance on the prescription of psychotropic medicines for individuals with ASDs, particularly information on any differences in efficacy and/or tolerability of specific medications. This review summarises the key research to date on the prescription of psychotropic medication in ASD with and without comorbid psychiatric or neurodevelopmental disorders, within the context of the existing clinical guidance. Some critical analysis is provided to aid clinicians in following a safe, effective and individualised approach to prescribing for people with ASDs.

Trauma-informed sentencing of serious violent offenders: an exploration of judicial dispositions with a gendered perspective

Experience of psychological trauma is correlated with violent offending, with exposure reported for most offenders entering the criminal justice system. The practice of trauma-informed sentencing recognises this complex and consistent relationship, and endeavours to respond in a way that avoids re-traumatisation and reduces harm to offenders and victims. Trauma-informed approaches to offenders improve safety in custodial settings, enhance prospects of correctional rehabilitation and recovery from mental illness and promote the health and welfare of staff working with offenders. This quantitative pilot study examines the identification and impact of trauma – as recorded in sentencing decisions – for homicide perpetrators in Victoria, with particular attention to trauma-informed sentencing and whether or not gender makes a difference. Traumatic experiences were described in a high proportion of cases but only explicitly recognised in a minority. Trauma-informed sentencing recommendations were rare. Collaboration between clinical and legal professionals to inform and enhance trauma-informed procedures is recommended.

Expert stakeholder perspectives on the acceptability of treatment-as-prevention in prison: a qualitative substudy of the 'Surveillance and Treatment of Prisoners with Hepatitis C' project (SToP-C).

Mathematical modelling has demonstrated the theoretical feasibility of HCV treatment-as-prevention strategies in custodial settings, yet limited empirical data exists. The Australian 'Surveillance and Treatment of Prisoners with Hepatitis C' study is the world's first trial of hepatitis C virus (HCV) treatment-as-prevention in prison. This study aimed to analyse how expert stakeholders involved in the Australian HCV response assessed the acceptability of HCV treatment-as-prevention in prison using interview data from the SToP-C qualitative substudy. Qualitative analysis using semi-structured interviews in Australia. Nineteen key HCV experts. Drawing upon Sekhon's theoretical framework of acceptability, data were organized thematically under four component constructs of acceptability: affective attitude; ethicality; opportunity costs; and perceived effectiveness. Most differences in participant assessments of acceptability were a matter of relative emphasis and prioritization rather than absolute polarity. Nonetheless, a small minority of participants was overtly critical of the approach. Arguing against the focus on treatment, they instead advocated for prevention-as-prevention, including the improvement and expansion of existing harm reduction measures. Qualitative analysis of expert stakeholder assessments of the acceptability of hepatitis C virus treatment-as-prevention in Australian prisons found no opposition to the universal rollout of direct-acting anti-virals, but most voiced concern regarding the lack of effective primary prevention in Australian prisons.

Children’s education in secure custodial settings: Towards a global understanding of effective policy and practice

This unique editorial paper is one of the first that discusses the education of incarcerated young people in an international education journal. We review the eleven papers in the Special Issue on children’s education in secure custodial settings to provide key insights with the aim of moving towards a global understanding of what effective policy and practice may look like. In examining the range of cross-disciplinary papers from a range of different cultural contexts including the UK, Germany, UAE, US, Nigeria and South Africa, we are able to illuminate some of the commonalities in the education of young people who are incarcerated as well as some of the background characteristics – many of which are strikingly similar. We employed the ideas of the bio-socio-ecological systems model to explore the proximal and distal systems that interact to affect the educational experiences of the young people. These included at the microsystemic level the importance of relationships in engaging the young people with education and learning and that, the relationships between the key actors (mesosystem) as well as the importance of effective leadership (exosystem) were critical elements in improving the experience of education in custodial settings. But rather predictably, the structural disadvantages (macrosystem) that young people who come into contact with youth justice face and how these are not appropriately addressed that came into sharp focus, possibly because many countries take a punitive approach to youth offending. We argue that there are things that can be done at each systems level but that in order to make the changes to genuinely improve the lives of these young people, we make a bold call upon the global community (macrosystem), through the UNCRC to challenge themselves for a radical overhaul of youth justice approaches which put the child as child first and offender second in order to meet the commitment in Article 28.

COVID-19 Inmate Risk Appraisal (CIRA): development and validation of a screening tool to assess COVID-19 vulnerability in prisons.

To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). Cross-sectional study with a representative sample (development) and a case-control sample (validation). The two largest Swiss prisons. (1) Development sample: all male persons detained in P&ouml;schwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors). The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age &ge;60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer. Based on the development sample, we proposed a three-level classification: average (&lt;3.7), elevated (3.7-5.7) and high (&gt;5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category &ldquo;elevated risk&rdquo; maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category &ldquo;elevated risk&rdquo; maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category &ldquo;high risk&rdquo; had a high discriminatory capacity (sensitivity =0.89, specificity =0.97). The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.