Detention Settings Research Articles

Regional progress towards hepatitis C elimination in the Western Pacific Region, 2015-2020.

Chronic hepatitis C (HCV) infection is a major global public health threat and in 2019 there were an estimated 58 million infected globally and 290,000 deaths. Elimination of viral hepatitis B/C as a public health threat by 2030 is defined as a 90% incidence reduction and a 65% mortality reduction. The Western Pacific region is one of the most affected regions with 10 million people living with HCV, one-fifth of the global burden. We review progress towards HCV elimination in the Western Pacific region since 2015. Key developments in the region, which comprises of 37 high-and-middle-income countries, include the following: 20 countries have national hepatitis action plans, 19 have conducted recent disease burden and investment cases, 10 have scaled-up hepatitis services at primary health care level, and in 11 countries, domestic financing including social health insurance support DAA costs. We highlight six countries' experience in navigating the path towards HCV elimination: Cambodia, China, Malaysia, Mongolia, Philippines, and Viet Nam. Future initiatives to accelerate elimination are expanding access to community-based testing using HCV point-of-care tests among at-risk and general populations; adopting decentralized and integrated HCV one-stop services at harm reduction sites, detention settings and primary care; expanding treatment to include children and adolescents; address stigma and discrimination; and ensuring sustainable financing through domestic resources to scale-up testing, treatment and prevention. The COVID-19 pandemic has a significant impact on hepatitis response across the region on community and facility-based testing, treatment initiation, monitoring and cancer screening, which is projected to delay elimination goals.

Prisons, drugs and COVID-19: Early releases and continuity of care

Abstract Introduction Detention settings are high-risk environments for the spread of infectious diseases. Since 2020, COVID-19 has posed unprecedented challenges for governments and prison administrations. In some jurisdictions, this has catalysed early release programmes to decongest prisons to minimise the harm of COVID-19 in prison systems. Methods From March to June 2020, HRI monitored the adoption of prison decongestion measures in response to COVID-19 in Europe and worldwide. HRI tracked criteria for eligibility and implementation of the measures and distributed online expert surveys as part of the Global State of Harm Reduction 2020 that included questions on harm reduction in prisons and the response to COVID-19. Survey data was supplemented by a review of academic, governmental, and non-governmental literature. A review to update the data will be carried out by mid-2021. Results and discussion Results show prison decongestion schemes initiated in 17 countries in Europe and 109 countries worldwide. Overall, by July 2020 decongestion measures reduced the global prison population by 16% in Europe and just 6% worldwide. In a quarter of countries (including at least four in Europe), people incarcerated for drug offences were explicitly excluded, regardless of whether they suffered from health condition or belong to a vulnerable group. We found no evidence of expanded access to harm reduction programmes to address the risk of overdose after release. Issues that exacerbate overdose risk included interruptions to the provision of opioid agonist therapy (OAT) and the unavailability in most jurisdictions of naloxone on release. Conclusions People who use drugs and are in detention settings have been inadequately served during the COVID-19 pandemic. To address the unique health risks of detention settings, there is a need for greater commitment to the adoption of non-custodial measures, and diversion from criminal justice towards a health-led response to drug use.

Delivering Trauma-Informed Care in the Juvenile Justice Setting

Youth taken from the home and placed in emergency shelter, secure detention, and residential set-tings are exposed to new sources of trauma and danger that may re-activate severe stress symptoms leading to re-traumatization. A juvenile justice center planned a trauma-informed, system-focused in-tervention that included recommended elements: appropriate assessments of trauma symptoms, evi-dence-based programs and treatments to build resilience skills in youth and families, staff training, community collaboration and partnerships, and a safe environment to reduce the risk of re-traumatization. The purpose of this study was to describe the implementation over two years of the trauma-informed, system-focused intervention in the juvenile justice center and associated effects on youth trauma symptoms. Current and past traumatic event exposure, change in youth participants’ emotional regulation, effects of an evidence-based, trauma-informed therapeutic intervention on youth participants’ stress symptoms, and quality of the organizational trauma-informed care plan were assessed. Although efforts to improve participant emotional regulation and post-traumatic stress symptoms did not demonstrate significant differences, efforts to screen for trauma exposure at intake provided important information about participant multiple traumas to assist with the therapeutic pro-cess. Efforts in changing organizational culture and policy did result in minor self-reported facility envi-ronmental improvements. For the practitioner, even when an intervention is well planned, results are not always positive in actual practice.

95 Experiences of Detained Asylum Seekers During the COVID-19 Pandemic

COVID-19 disproportionately affects racial and ethnic minority groups as well as people in jails and immigration detention centers in the United States. Between April and August of 2020, the mean monthly COVID-19 case ratio for ICE detainees was 13.4 times that of the general US population. This study aims to understand the experiences of detained asylum seekers during the pandemic and to provide insight into COVID-19’s impact on this population. This qualitative study employed first-person, in-depth narratives gathered via semi-structured interviews with 12 asylum seekers, all of whom were detained in immigration detention centers during part of the COVID-19 pandemic and who had subsequently been released. Interview transcripts were analyzed using a consensual qualitative research approach. The analysis yielded seven domains and 22 categories. The first domain focused on participants’ health before detention, including reports of good physical health, previous experiences of psychological distress, and pre-existing conditions. The next domain contained descriptions of detention conditions and reflected interviewees’ experiences of poor conditions, lack of food and/or poor quality of food, limited freedom of movement, isolation, and disrupted sleep. The third domain represented themes of COVID-related detention conditions, such as lack of access to masks, inability to social distance, poor facility hygiene, and insufficient or extended isolation/quarantine. The fourth domain encompassed asylum seekers’ reports of the prevalence of COVID-like symptoms in detention settings. They indicated that they knew someone who had symptoms or experienced COVID-like symptoms themselves. The fifth domain included participants’ health care experiences in detention. They noted a poor response to COVID-19 in the facility, obstacles to receiving care, and dissatisfaction with management of their symptoms while detained. The sixth domain included the impact of detention conditions on the health of interviewees; they reported a deterioration of their physical health and mental health. The final domain consisted of the interviewees’ perceptions of their current health. Some stated their experiences in detention continue to impact their health; others reported improvement in their physical health and mental health after their release. Detained asylum seekers are a vulnerable population who face inadequate medical care, an inability to social distance, poor hygiene, restricted movement, and a lack of infection control which exacerbate their risk of contracting and spreading COVID-19. Advocating for improved disease prevention, screening, prompt access to health care and treatment, cohorting of cases, and community alternatives to detention to decrease population size are crucial to halt the communicability of the virus.

LGBTQ+ mental health in detention settings

LGBTQ+ mental health in detention settings

Human rights violations, detention conditions and the invisible nature of women in European immigration detention: a legal realist account

PurposeThe purpose of this paper was to conduct a legal realist assessment of women’s situation in European immigration detention which focuses on relevant international and European human rights instruments applicable to conditions and health rights in detention settings, academic literature and relevant European Court of Human Rights (ECtHR) jurisprudence since 2010.Design/methodology/approachIn spite of the United Nations human rights frameworks and European Union (EU) standards, conditions in European immigration detention settings continue to pose a health risk to those detained. Migrant health rights when detained are intertwined with the right not to be subjected to arbitrary detention, detention in conditions compatible for respect for human dignity and right to medical assistance. Migrant women are particularly vulnerable requiring special consideration (pregnant and lactating women; single women travelling alone or with children; adolescent girls; early-married children, including with newborn infants) in immigration detention settings.FindingsThe situation of women in immigration detention is patchy in EU policy, academic literature and ECtHR jurisprudence. Where referred to, they are at best confined to their positionality as pregnant women or as mothers, with their unique gendered health needs ill-resourced. ECtHR jurisprudence is largely from male applicants. Where women are applicants, cases centre on dire conditions of detention, extreme vulnerability of children accompanying their mother and arbitrary or unlawful detention of these women (with child).Originality/valueConcerns have been raised by the European Parliament around immigration detention of women including those travelling with their children. There is a continued failure to maintain minimum and equivalent standards of care for women in European immigration detention settings.

Addressing the Situation of Women Deprived of Liberty: Recent Practice of the UN Working Group on Arbitrary Detention

Abstract: The arbitrary deprivation of liberty of women is a global problem. Women continue to be deprived of their liberty on discriminatory grounds in proceedings that do not meet basic standards of due process, both in the criminal justice and administrative detention contexts. Despite the development of standards to address this phenomenon and greater recognition by international human rights mechanisms of the challenges faced by female detainees, governments and private actors repeatedly exercise control over women by depriving them of their liberty, often for prolonged periods. This not only violates the right to liberty, but may in some circumstances prevent women from enjoying other fundamental human rights to equality, dignity, fair trial, privacy and family life, health, housing, education, work, as well as freedom from torture and ill-treatment, freedom of movement, religion or belief, expression, peaceful assembly and association. In this practice note, I consider five recent cases encountered by the UN Working Group on Arbitrary Detention involving women deprived of their liberty in different detention settings and countries. I argue that the increasing focus on gendered detention practices by the Working Group, which has a worldwide mandate from the Human Rights Council to investigate cases of arbitrary deprivation of liberty, may offer opportunities for change.

Preventing the Spread of COVID-19 in Immigration Detention Centers Requires the Release of Detainees.

Immigration detention centers are densely populated facilities in which restrictive conditions limit detainees' abilities to engage in social distancing or hygiene practices designed to prevent the spread of COVID-19. With tens of thousands of adults and children in more than 200 immigration detention centers across the United States, immigration detention centers are likely to experience COVID-19 outbreaks and add substantially to the population of those infected.Despite compelling evidence indicating a heightened risk of infection among detainees, state and federal governments have done little to protect the health of detained im-migrants. An evidence-based public health framework must guide the COVID-19 response in immigration detention centers.We draw on the hierarchy of controls framework to demonstrate how immigration detention centers are failing to implement even the least effective control strategies. Drawing on this framework and recent legal and medical advocacy efforts, we argue that safely releasing detainees from immigration detention centers into their communities is the most effective way to prevent COVID-19 outbreaks in immigration detention settings. Failure to do so will result in infection and death among those detained and deepen existing health and social inequities.

COVID-19 and torture


 
 
 
 Over the past few weeks, and with the Editorial already at completion, the COVID-19 pandemic has invaded our lives. Its systemic impact has affected, and continues to affect in equal measure the provision of rehabilitation to victims of torture.
 Amongst the many areas in which COVID-19 has impacted the field of prevention and rehabilitation of torture survivors, at least 8 areas of concern can be highlighted.
 1. Attacks on basic fundamental rights and unnecessary increase in social control measures (Human Rights Watch, 2020a)
 2. Increases in cases of ill-treatment or torture linked to the pandemic itself. For instance, various media sources have reported cases related to the dissemination of information in countries where this was considered to be against the interest of the State (Wang, 2020; Human Rights Watch, 2020b; Amnesty International, 2020a)
 3. Respect for the rights of detainees and COVID preventive measures in detention settings that are compliant with human rights (Council of Europe, 2020; OHCHR, 2020; Council of Europe, 2010) and especially amnesty processes for political prisoners or the use non-custodial measures (Comninos, 2020; Amnesty International, 2020b).
 4. Increases in cases of gender-based violence (Ford, 2020; UNFPA, 2020; UN Women, 2020) and assaults on homeless populations (Phasuk, 2020; Hartley, 2019), both related to fear and isolation.
 5. Relapse of symptoms, especially night mares, flashbacks and somatic symptoms, in survivors that were ill-treated or tortured while in custody, due to COVID- related self-confinement or measures of medical isolation.
 
 
 6. The reshaping of society: Will there be a change in values towards more egalitarian, empathetic and supportive societies? Or an evolution towards a more fearful society with an increasing lack of solidarity as fear instils?
 7. The use of warlike metaphors (the “war” on the Coronavirus) as a prelude to restrictions in freedoms, censorship or authoritarianism in the name of the collective good (Human Rights Watch, 2020a).
 8. Cutting budget allocations for the most disadvantaged, vulnerable groups in general and survivors of torture specifically, in favour of security policies or market-based post-COVID decisions (UNDP, 2020; European Council, 2020).
 
 
 
 
 These are some of the many areas of reflection on COVID-19 as a global crisis in the field of human rights and the prevention of torture and rehabilitation of torture victims.
 Torture Journal invites our readers to share your experiences, reflections, research and data in the form of a Letter to the Editor, News or Research Report for inclusion in future issues of the Journal. This is a global crisis which may, in turn, foster a shared learning opportunity for all.
 
 
 
 
 
 
 

Migrant health situation when detained in European immigration detention centres: a synthesis of extant qualitative literature.

Many migrants are detained in Europe not because they have committed a crime but because of lack of certainty over their immigration status. Although generally in good physical health on entry to Europe, migrant detainees have complex health needs, often related to mental health. Very little is known about the current health situation and health care needs of migrants when detained in European immigration detention settings. The review aims to synthesize the qualitative literature available on this issue from the perspectives of staff and migrants. The authors undertook a synthesis of extant qualitative literature on migrant health experience and health situation when detained in European immigration detention settings; retrieved as part of a large-scale scoping review. Included records (n = 4) from Sweden and the UK representing both detainee and staff experiences were charted, synthesised and thematically analysed. Three themes emerged from the analysis, namely, conditions in immigration detention settings, uncertainties and communication barriers and considerations of migrant detainee health. Conditions were described as inhumane, resembling prison and underpinned by communication difficulties, lack of adequate nutrition and responsive health care. It is crucial that the experiences underpinning migration are understood to respond to the health needs of migrants, uphold their health rights and to ensure equitable access to health care in immigration detention settings. There is a dearth of qualitative research in this area because of the difficulty of access to immigration detention settings for migrants. The authors highlight the critical need for further investigation of migrant health needs, so as to inform appropriate staff support and health service responses.

Upholding confidentiality in the preparation and distribution of medication in prisons: implementing recommendations of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment.

Confidentiality must be ensured even in the preparation and distribution of medications in detention settings. In this respect, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment found during recent prison visits several instances where prison staff, and at times detainees, dispensed prescribed treatments and supervised their intake. Such a practice compromises medical confidentiality requirements and the establishment of a trusting doctor-patient relationship. To respect medical confidentiality and ensure safety and quality of care, the authors argue that only qualified healthcare personnel should prepare and distribute prescribed medications, all of which require specialized training. They call for robust research that examines the operational barriers and facilitators as well as the respect of human rights related to various approaches to medication preparation, distribution, and intake so that people in detention can access their treatment with safety, confidentiality, autonomy, and dignity.

New approaches to controlling an outbreak of chickenpox in a large immigration detention setting in England: the role of serological testing and mathematical modelling.

Chickenpox is caused by varicella-zoster-virus (VZV) and is highly contagious. Immigration detention settings are a high-risk environment for primary VZV transmission, with large, rapidly-changing populations in close quarters, and higher susceptibility among non-UK-born individuals. During outbreaks, operational challenges occur in detention settings because of high-turnover and the potential need to implement population movement restriction for prolonged periods. Between December 2017 and February 2018, four cases of chickenpox were notified amongst 799 detainees in an immigration removal centre (IRC). Microbiological investigations included case confirmation by vesicular fluid polymerase chain reaction, and VZV serology for susceptibility testing. Control measures involved movement restrictions, isolation of cases, quarantining and cohorting of non-immune contacts and extending VZV immunity testing to the wider detainee population to support outbreak management. Immunity was tested for 301/532 (57%) detainees, of whom 24 (8%) were non-immune. The level of non-immunity was lower than expected based on the existing literature on VZV seroprevalence in detained populations in England. Serology results identified non-immune contacts who could be cohorted and, due to the lack of isolation capacity, allowed the placement of cases with immune detainees. The widespread immunity testing of all detainees was proving challenging to sustain because it required significant resources and was having a severe impact on operational capacity and the ability to maintain core business activities at the IRC. Therefore, mathematical modelling was used to assess the impact of scaling back mass immunity testing. Modelling demonstrated that interrupting testing posed a risk of one additional case compared to continuing with testing. As such, the decision was made to stop testing, and the outbreak was successfully controlled without excessive strain on resources. Operational challenges generated learning for future outbreaks, with implications for a local and national policy on IRC staff occupational health requirements, and proposed reception screening of detainees for VZV immunity.

The 6/24 rule: A review and proposal for an international standard of a minimum of six hours of continuous sleep in detention settings.

Editorial.

1617. Mumps in Detention Facilities that House Detained Migrants—United States, September 2018–April 2019

BackgroundStarting in September 2018, an unusually high number of mumps cases were reported in US adult detention facilities. Detention facilities usually involve close contact among detainees, facilitating transmission of mumps. Detainees in close contact with a mumps patient are at increased risk for acquiring mumps and should be offered a dose of MMR vaccine. We summarize the epidemiologic, clinical, and laboratory data for mumps cases in adult detention facilities during September 2018-April 2019.MethodsData were collected by health departments and US Immigration and Customs Enforcement (ICE) Health Services Corps and reported to CDC. Cases were classified according to the CSTE case definition for mumps and confirmed by RT-qPCR; molecular sequencing was performed on mumps-positive specimens.ResultsFrom September 2018-April 2019, 389 confirmed and probable mumps cases in adult migrants detained by ICE in 44 detention facilities were reported in 16 states (figure). The median age of patients was 24 years (range: 18–66); 94% were male. Vaccination status was unknown for all patients. Most (80%) patients were exposed while in custody of ICE or other US legal agency, 7% were exposed before apprehension, and custody status at exposure was unknown for 13%. Among 265 patients with data on complications, 15% had orchitis; at least 3 were hospitalized. Mumps genotype G, the most common genotype in US, was identified in specimens from 70 patients. This mumps response included >7,000 MMR vaccine doses distributed to affected facilities, and hundreds of exposed detainees placed under restricted movement in their facility each week. The response is ongoing as new cases continue to be reported.ConclusionThis is the first report of mumps outbreaks occurring in multiple states and detention facilities during the same period. These outbreaks are costly and challenging to control. Identifying target groups for vaccination is challenging since detainees are frequently transferred and MMR vaccine does not prevent mumps in persons already exposed and infected. Effective public health interventions require an understanding of detention settings. Development of national guidance and resources for public health response to mumps and other infectious diseases in detention facilities would be beneficial. Disclosures All authors: No reported disclosures.

Impact of a Trauma-Informed Intervention for Youth and Staff on Rates of Violence in Juvenile Detention Settings.

The majority of youth in the juvenile justice system have experienced multiple traumatic events in their lives, including community violence, physical abuse, neglect, and traumatic loss. These high prevalence rates, coupled with the known negative consequences of trauma in childhood and adolescence, have led to a greater emphasis on implementing trauma-informed services and practices within juvenile justice settings. However, although many stakeholders and government entities have expressed support for creating more trauma-informed juvenile justice systems, there is still limited empirical knowledge about which interventions are most effective at improving outcomes, particularly at the organizational or facility level. In an effort to fill this gap, the current study evaluated the impact of a trauma-informed milieu intervention, including skills training for youth and training for staff, on rates of violence at two secure juvenile detention facilities (N = 14,856) located in a large Northeastern city. The analyses revealed that the intervention was significantly related to a reduction of violent incidents in Facility A, with no impact on incidents in Facility B. Follow-up analyses revealed that a larger proportion of eligible youth in Facility A completed the skills group program as compared with eligible youth in Facility B (16% vs. 9%). This finding has important implications for the implementation of trauma-informed interventions for youth in juvenile detention settings, as it suggests that to impact outcomes at the facility level, a minimum threshold of youth may need to be exposed to the intervention. In addition, reductions in violence at Facility A were only realized after both staff training and youth skills components were implemented, suggesting that both components are necessary to create change at the facility level. Future research is needed to further explore the impact of organizational and implementation-level factors on trauma-informed care outcomes in juvenile justice settings.

Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis.

Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD.Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining “ADHD” and “prison” keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses.Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7–29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9–47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics.Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.

Reliability of ADHD in Prison Populations: A Response to Murphy and Appelbaum

Free AccessReliability of ADHD in Prison Populations: A Response to Murphy and AppelbaumRobert Eme and Susan YoungRobert EmeSearch for more papers by this author and Susan Young1 Professor of Clinical Psychology at the Illinois School of Professional Psychology at Argosy University, Schaumburg Campus.2 Clinical Senior Lecturer in Forensic Clinical Psychology in the Centre for Mental Health, Imperial College London.Search for more papers by this authorPublished Online:August 2017https://doi.org/10.1521/adhd.2017.25.5.1PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Next article FiguresReferencesRelatedDetails Cited byCited by1. Online publication date: Go to citation Crossref Google Scholar2. Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-AnalysisOnline publication date: 2 August 2018. Go to citation Crossref Google Scholar3. Sex differences in temperament: A partial explanation for the sex difference in the prevalence of serious antisocial behaviorsOnline publication date: Go to citation Crossref Google Scholar Volume 25Issue 5Aug 2017 Information© 2017 The Guilford PressPDF download

Mental health of children and adolescents in Australian alternate places of immigration detention.

Mental health of children and adolescents in Australian alternate places of immigration detention.

A Hydra in Detention Settings: A Context-Based Inquiry of Corruption’s Many Heads

A Hydra in Detention Settings: A Context-Based Inquiry of Corruption’s Many Heads

International Youth Justice Systems: Promoting Youth Development and Alternative Approaches: A Position Paper of the Society for Adolescent Health and Medicine

Youth incarceration is an international public health concern among developed and developing countries. Worldwide, youth are held in incarceration, detention, and other secure settings that are inappropriate for their age and developmental stages, jeopardizing their prosocial development, and reintegration into society. Youth incarceration lacks evidence and cost-effectiveness. The well-being of youth is a key indicator of the welfare of families, communities, and society at large; therefore, the Society for Adolescent Health and Medicine (SAHM) supports a paradigm shift in the role of the justice system as it relates to treatment of youth. SAHM recommends justice systems focus greater attention and resources on identifying and reducing the antecedents of high-risk and criminal behaviors, recognizing the rights and freedom of young persons, and prioritizing the well-being of youth over punitive measures that may harm and disrupt healthy adolescent development. SAHM supports the following positions: (1) incarceration is a last option for selected offenders who have committed the most serious violent crimes and are unable to remain safely in the community; (2) youth justice policies, programs, and practices affecting youth be evidence based and trauma informed; (3) youth justice policies, programs, and practices must incorporate research and ongoing program evaluation; (4) youth justice policies shall protect the privacy and dignity of children younger than 18 years; and (5) health care professionals and media will promote positive portrayals of youth in healthy relationships within their communities and reduce representations and images of youth that are negative, violent, deviant, and threatening.