Illness In Prisons Research Articles

Punishment and survival – incarcerated persons' experiences with extreme heat in Texas prisons

PurposeThe impact of extreme heat on prisons and carceral facilities is becoming increasingly visible, yet remains overlooked by scholars, practitioners and policymakers. Prisons are a unique type of infrastructure designed to severely limit and control the movement of hundreds and even thousands of individuals as a form of punishment. This leads to many significant challenges to mitigating the risk of heat-related illness in prisons and other carceral spaces that have remained overlooked across many disciplines including emergency management, disasters, corrections and public health.Design/methodology/approachFor this study, we analyzed 192 surveys from incarcerated persons in state prisons throughout Texas to understand how incarceration and the punitive prison environment create challenges to managing extreme heat in prisons.FindingsWe found that characteristics of modern incarceration, including communal distribution of resources, crowded conditions and a lack of agency for incarcerated people, create barriers to accessing resources during periods of extreme heat. Furthermore, the punitive nature of the prison environment as manifested in the relationship between staff and incarcerated persons and certain prison policies also create barriers to incarcerated persons accessing resources to reduce their risk of heat-related illness and death.Social implicationsThese issues are particularly relevant to the health and safety of incarcerated persons during periods of extreme temperatures but also speak broadly to the implications of incarceration, disaster risk, and the advancement of human rights for incarcerated people.Originality/valueThis article addresses a gap in the literature by including the perspectives of persons incarcerated in Texas prisons experiencing extreme heat and implicates the characteristics of incarceration and punishment in the production of disaster risk.

Stigma Associated with Mental Illness: Perspectives of Judges and Lawyers in Lebanon

IntroductionLegal professionals frequently encounter forensic mental health issues in the criminal justice system. These issues can significantly impact the outcome of cases, making it essential to understand the attitudes and perceptions of these experts towards mental illness. Despite a high number of individuals with mental illness in prisons, the availability of forensic mental health services is limited. While prior research has shown widespread stigma towards mental illness, there hasn’t been a study assessing the attitudes of judges and lawyers.ObjectivesThis study aims to investigate the stigma related to mental health among Lebanese legal professionals.MethodsAn online questionnaire was sent to judges and lawyers practicing in Lebanon. The survey included a section on demographics and personal data with the following scales: Reported and intended behavior scale (RIBS) which measures mental health stigma–related behavior and Perceived devaluation and discrimination scale (PDD) measuring the extent to which a person believes that most people will devalue or discriminate against someone with a mental illness.Results A total of 215 participants, with a mean age of 38.69 and a mean 13.16 years of experience, completed the questionnaire. Most were female (62.8%) and worked as civil attorneys (47.4%). Only a minority received instruction on mental health or mental health law during training (10.7% and 8.8%). About a quarter believed their education on mental health issues was sufficient (27%). Participants with positive attitudes (RIBS) were more likely to have a family member with a mental illness (p value = .001), feel comfortable handling cases involving mental health (p value = .001), and have lived with someone with a mental illness (p value = .007). Feeling adequately educated about mental health issues was associated with lower perceived stigma (PDDS, p value = .021). No significant associations with stigma scores were found for factors like age, gender, occupation, years of experience, contact with a mental health professional, taking psychotropic medications, disclosing personal mental health issues to friends or co-workers, receiving education on mental illness or mental health law, or working with individuals with mental health issues.ConclusionsThe findings imply that enhancing mental health education and awareness within the legal profession could be a key strategy to reduce stigma and improve the overall treatment of individuals with mental health issues within the criminal justice system in Lebanon.Disclosure of InterestNone Declared

The Multiple Punishment of Being an Older Adult Coping With Health Problems in Prison.

Studies have examined the vulnerabilities and the extent of health problems experienced by the older adult population in prison. However, reports about the subjective experiences of incarcerated older adults who are coping with health problems are scarce. This is alarming since older adults comprise the fastest-growing demographic in the prison systems of the United States and Europe. The aim of the current study was to bring forth the voices of older adults who are living with diseases in prison and to outline the landscape of struggling with everyday health care management. An interpretive phenomenological analysis was used to analyze the narratives of 23 individuals aged 60-88 who were coping with health problems in prison. The narratives revealed 3 major themes: (1) living day to day with illness in prison: fighting prison bureaucracy and public humiliation; (2) coping with complex medical issues: lack of professional medical care and cumulative problems, and (3) what does the future hold? Fear of living with illness out of prison. Intersectionality was used as a conceptual framework for understanding the participants' narratives. The cumulative effect of belonging to systematically oppressed and marginalized groups is discussed. The research findings point to issues and experiences that are unique to older adults coping with health problems in prison and can serve as a framework for developing tailored interventions for these individuals.

A qualitative investigation of healthcare professionals’ viewpoints of the healthcare process of persons with a serious mental illness in prisons with a traditional model for mental health care provision in Spain

IntroductionHealthcare delivery in prisons depends on the national Ministry of Interior in 14 of 17 autonomous regions in Spain. A traditional model for health and mental health care provision prevails.ObjectivesTo increase understanding of the mental health care process of imprisoned persons with a serious mental illness (SMI) in Spanish prisons with a traditional model of health care provision.Methods10 healthcare professionals (6 physicians, 3 nurses, 1 pharmacist) working in small (<450 imprisoners), middle size (450-1,000) and big (>1,000) prisons took part in 3 online focus groups between 31st May and 2nd June 2022. The moderator used open-ended questions to research into the healthcare process (diagnosis, treatment, follow up, prevention) of imprisoners with SMI. Focus groups lasted 2 hours, and were audiotape recorded and transcribed. Transcripts were analysed applying constant comparative method and theoretical saturation.ResultsMental healthcare provision varies across prisons, but commonalities exist. Healthcare professionals reported that about 60% of SMI are diagnosed by the correctional general practice physician (GP) at incarceration. Severe cases are assessed by an external psychiatrist. Once a week (average) the psychiatrist visits the prison to either confirm diagnoses or adjust treatments. One third of imprisoners who would benefit from a psychiatric assessment has it. Follow up occurs in the prison infirmary for close supervision. If addiction concurs, referral to therapeutic modules happen. Polypharmacy and overmedication are common. Simplification of therapies and slow-release injectable formulations of antipsychotics are desirable. Everyday mental health care and rehabilitation take place throughout a specific, little equipped, psycho-social support programme implemented in most prisons but restricted to the most disabled SMI persons. Acute psychiatric episodes occur due to treatment interruptions or deviations and are managed by the correctional GP. Hospital referrals are problematic without protocols. Prevention of relapses relies on imprisoners supervision and staff observation. Healthcare records are only available to healthcare professionals working in prisons. Outside prisons, continued care needs of mental health and social support in the community. Due to healthcare services modest readiness to respond to needs and poor social networks, SMI persons are prone to relapse and recidivism.ConclusionsFocus groups found that working in isolation from the public healthcare system, shortage of psychiatrists, poorly implemented therapeutic and rehabilitation programmes, and lack of mental health and social care services in the community negatively affect the care of imprisoners with SMI in Spain.Disclosure of InterestNone Declared

Pattern of Illness in Prisoners Admitted in a Tertiary Care Hospital of South Eastern Rajasthan

The delivery of health care among prisoners is one of the most important aspects of improving human rights compliance. Estimating common healthcare problems in prisoners will be helpful in assessing their health status and recommending the rectifying steps. Therefore, knowing the types of morbidities will help us in making health policies which will be helpful in reducing the health burden in prisoners and will also help in reintegration of prisoners into mainstream society. The present study is a retrospective analysis to find out the common medical conditions in prisoners. The study was carried out by collecting data of 500 admitted prisoner in a tertiary care institute in south-east Rajasthan. The majority (95.2%) of referred prisoners were male, from age group of 30-39 years, mean age of prisoners being 39.6 years and the majority (90%) were referred from Central Jail, Kota. The majority (53.2%) of prisoners were admitted to medicine department followed by psychiatry department (26.4%). A higher prevalence of anemia and pulmonary tuberculosis was reported among prisoners. Surgical illness related to infectious etiology and poor personal hygiene was common in prisoners. Psychosis not specified (17%), schizophrenia (8%), mixed anxiety depressive disorder (8%) and substance use disorders (16%) were common psychiatric conditions. Mean duration of hospitalization was 9 days.

Reducing the Use of Segregation for People with Serious Mental Illness

This study, using data from a state correctional agency, examines the use of segregation for people with serious mental illness in prisons. Our investigation shows deviations from departmental policy regarding the housing of individuals with serious mental illness (SMI); frequent use of segregation as a response to self-harm episodes and suicide attempts; and that people determined to be most impaired by a serious mental illness were typically placed in segregation. These findings suggest that correctional staff need to decouple disciplinary actions and responses from mental health symptoms, and avoid a punitive approach to incidents of self-harm or suicidality.

No involuntary treatment of mental illness in Australian and New Zealand prisons

ABSTRACT Reflecting worldwide trends, as the prison population in Australia and New Zealand has risen over the past decade, the number of inpatient beds available for the involuntary treatment of mentally ill prisoners transferred from correctional custody has not increased commensurately. In this context, there have been calls to allow involuntary treatment of serious mental illness in prisons. This narrative review considers the extent of unmet psychiatric need within prisons in Australia and New Zealand and considers whether there is any evidence base for involuntary treatment of serious mental illness in prisons. The review concludes that the involuntary treatment of serious mental illness in custodial settings is likely to compromise clinical care, carries a significant risk of serious harms, encourages inappropriate management of prisoners and breaches human rights conventions. The authors found no evidence of improved clinical outcomes or any other benefits directly or indirectly linked to involuntary treatment of serious mental illness in correctional settings. Finally, the review describes the Prison Mental Health Service in the Australian jurisdiction of Queensland and suggests that this represents a ‘best practice’ model for the management of mentally ill prisoners.

Mental-Health Courts in Canada: Opportunities for OT Practice

Abstract Date Presented 03/27/20 Nova Scotia, Canada, established its first problem-solving court in 2009 in response to an over-representation of people with mental illness in prisons. This research project examines the ideological foundations of the Nova Scotian problem-solving court programs. Findings indicate that the ideological foundations of these programs are consistent with the values and principles underpinning OT, making OTs a critical presence on these multidisciplinary teams. Primary Author and Speaker: Crystal Dieleman Additional Authors and Speakers: Lisa Jaegers Contributing Authors: Niki Kiepek

Health Network’s Developing in Prison Communities by Empowerment

Correctional institutions or prisons are places with a large number of people living crowded, which affects the health status of inmates. The main objective of this developmental research is to studied the model of health network development in prison communities by using empowerment process and has a specific purpose were 1. To study the characteristics of communities and health problems of Kalasin Prison Communities. 2. To develop an appropriate health care model for people in Kalasin Prison Community and 3. To develop the potential of the health network in the Kalasin prison. The population is as many as 3,005 inmates living in prisons. The sample consists of 75 inmates in the Kalasin Prison Community, 2 nurses’ inmates of nurse units in the prison, the total of 77 person. The instruments consisted of knowledge assessment form, understanding of case manager in community health care of public health volunteers in prisons and in-depth interviews, focus group interviews, and transcription lessons in supervision. The results showed that 1. The top 5 health problems that sick inmates were: 1.1 Upper respiratory infection 1.2 Rash / itch 1.3 Muscle pain 1.4 Arthritis 1.5 Gastrointestinal disease and health risks such as Stress, Depression, Obesity, Diabetes, Hypertension and Dyslipidemia. 2. Appropriate forms of health care for people in Kalasin prison community, namely Public health volunteers in prisons have a role in screening health conditions. Illness surveillance and education for self-care in order to prevent illness. 3. After the training in general knowledge about public health volunteers in prisons. The sample group had the mean scores and knowledge median of 11.65 and 12.00 (X = 11.65, Med. = 12.00) respectively which increased statistically significant. And the development of the potential of the health network in prisons should focus on participation providing empowerment to volunteers with appreciation and record the merit points. Suggestions since it is a studied in a closed community. Therefore should be cooperation from all sectors involved in driving the public health volunteers in prisons for strength and sustainability, which will lead to further reduction of illness in prisons.

End Coercion in Mental Health Services—Toward a System Based on Support Only

Based on the UN Convention on the Rights of Persons with Disabilities (CRPD), several UN bodies, among them the High Commissioner for Human Rights, have argued for a complete ban of all coercive interventions in mental health care. The authors conceptualize a system for mental health care based on support only. Psychiatry loses its function as an agent of social control and follows the will and preferences of those who require support. The authors draw up scenarios for dealing with risk, inpatient care, police custody, and mental illness in prison. With such a shift, mental health services could earn the trust of service users and thereby improve treatment outcomes.

Using the ADA's 'Integration Mandate' to Disrupt Mass Incarceration

As a result of the disability rights movement's fight for the development of community-based services, the percentage of people with intellectual and developmental disabilities (I/DD) and mental illness living in institutions has significantly decreased over the last few decades. However, in part because of government failure to invest properly in community-based services required for a successful transition from institutions, individuals with disabilities are now dramatically overrepresented in jails and prisons. The Americans with Disabilities Act's (ADA) -- a principle strengthened by the Supreme Court's 1999 Olmstead v. L.C. decision, entitling individuals with disabilities to receive services in the most integrated setting appropriate to their needs -- may provide one avenue to disrupt the school-to-prison pipeline and overrepresentation of people with I/DD and mental illness in prisons and jails. In this Article, we explore how the federal government and private parties have used--and are beginning to use in new ways -- the integration mandate to advocate for the rights of individuals with disabilities to receive the supports they need to thrive in the community and avoid unnecessary entanglement with the criminal justice system.

'Close confinement tells very much upon a man': Prison Memoirs, Insanity and the Late Nineteenth- and Early Twentieth-Century Prison.

This article explores prisoners’ observations of mental illness in late nineteenth- and early twentieth-century British prisons, recorded in memoirs published following their release. The discipline of separate confinement was lauded for its potential to improve prisoners’ minds, inducing reflection and reform, when it was introduced in the 1840s, but in practice led to high levels of mental breakdown. In order to maintain the integrity of the prison system, the prison authorities played down incidences of insanity, while prison chaplains lauded the beneficent influence of cellular isolation. In contrast, as this article demonstrates, prisoners’ memoirs offer insights into the prevalence of mental illness in prison, and its poor management, as well as inmates’ efforts to manage mental distress. As the prison system became more closed, uniform and penal after the 1860s, the volume of such publications increased. Oscar Wilde’s evocative prison writings have attracted considerable attention, but he was only one of many prison authors criticizing the penal system and decrying the damage it inflicted on the mind. Exploration of prison memoirs, it is argued, enhances our understanding of experiences of mental disorder in the underexplored context of the prison, highlighting the prisoners’ voice, agency and advocacy of reform.

The CORE-10 in screening for current mental health problems and severe mental illness in prisoners.

Few mental health screening tools are validated for prisoners. Existing tools do not guide referral between primary and secondary care pathways. This study aimed to assess performance of the CORE-10 in screening any current mental health problem and current severe mental illness (SMI) in prisoners. CORE-10 ratings were compared with mini international neuropsychiatric interview (MINI) version 6.0 ratings and current practice outcomes for 150 male prisoners. Receiver operating curve (ROC) analyses were used to estimate the likelihood with which CORE-10 ratings matched MINI ratings, yielding "area under the curve" statistics. ROC analyses suggested a strong relationship between CORE-10 screen scores and the more detailed assessment both in identifying any problem (AUC 0.85) and severe mental illness (AUC 0.76). Sensitivity was 0.88 and 0.83, and specificity was 0.64 and 0.61, respectively. Retest reliability was moderate (ICC=0.83). The CORE-10 identified many cases of "any problem" and of severe illness also identified by the MINI who had not been referred to clinical services in routine practice. This study provides evidence for the potential of the CORE-10 for improving appropriate referrals for prisoners to mental health services.

Prevalence of psychiatric morbidity among prisoners attending OPD of Central Jail Hospital, Kathmandu

Introduction: Prisoners are one of the most vulnerable groups for having high prevalence of mental illness. There is a dearth of major studies conducted amongst prisoners in Nepal. The basic objective of this study is to study prevalence and nature of psychiatric morbidity in prisoners attending general OPD of Central jail Hospital, Kathmandu.
 Material and Method: This was a descriptive, cross-sectional study carried out in prisoners attending OPD of central jail for a period of six months. Initial screening was done with self- reporting questionnaire (SRQ) and those having distress on SRQ were interviewed and diagnosis was made based on ICD-10 DCR and data analysis was done using SPSS version 16.
 Results: A total of 121 prisoners out of 300 prisoners attending OPD of central jail hospital during a period of six months had been diagnosed to suffer from psychiatric morbidity. Majority of cases were within age group 26-30 years (20.7%) with male preponderance (76.9%), married (69.4%), educated up to higher secondary level (38%), doing occupation as labor work (24%), Hindus (62.8%) with janajatis (32.2%), having low socioeconomic status (51.2%), belonging to joint family (50.4%) and were from rural areas (45.4%). Murder was the most common offence committed (33.9%) followed by drug trafficking (28.1%). Most common primary diagnosis belong to Neurotic, stress related and somatoform disorder (57%) followed by mood disorder (32.2%). Most common psychiatric morbidity among prisoners was generalized anxiety disorder (36.4%) followed by Moderate depressive episode (23.1%) and somatoform disorder (9.1%). The overall prevalence of psychiatric morbidity in prisoners attending OPD of central jail hospital was found to be 40.33%.
 Conclusion: A substantial burden of psychiatric morbidity exists in prison population of Nepal. Prompt recognition and treatment of mental illness in prison lead to decrease in functional disability and better quality of life.

The Impact of Early Detection of Mental Illness in Jails and Prisons

The research was concerned with discovering the impact of early detection of mental illness in prisons, using selected prisons across the five regions of the United States as case studies. Therefore, the research project set out with the following research questions: (a) What is psychological trauma, and how vulnerable are individuals who are experiencing an unwanted change of scene (from their homes to prisons) to becoming traumatic?, (b) Is the prison system equipped to detect mental illness among incoming inmates?, (c) What are the effects of the inability to detect mental illness among new prisoners on the prison?, (d) To what extent has the justice system contributed to mental illness of imprisoned individuals?, (e) To what extent can the actions of concerned reformed groups prevent the exacerbation of mental illness among incoming prison inmates?, and (f) What recommendations can be made to engender reformation of the prison system in order to bring about salutary benefits to the society, prison inmates, and prison administrators?. Consequently, relevant literatures were reviewed with respect to as the concept of mental illness, early signals of mental illness, symptoms and signs of mental illness and mental illness in prisons. A survey was carried out via the questionnaire method among ninety‐eight informed stakeholders in the prison system with the aim of providing solutions to the above broad research questions. Findings from the survey revealed that: (i) the American prison system is apparently not well equipped to detect mental illness among incoming inmates, (ii) the justice system contributed to mental illness among convicts, and (iii) advocacy and pressure groups have played a significant role in preventing the exacerbation of mental illness among incoming prison inmates. Thus, this study showed that the prison system must engender researches that will provide prison officers with needed technical, medical, and psychological tools for the early detecting of mental illness among incoming inmates at an early stage of their incarceration.Support or Funding InformationSupported by Institutional Resources of USAT and Einstein Medical Institute

Human rights and correctional health policy: a view from Europe

PurposeCorrectional healthcare should promote the protection of human rights. The purpose of this paper is to bring a discussion of human rights into debates on how such policy should be best organized.Design/methodology/approachThe paper achieves its aim by providing an analysis of European prison law and policy in the area of prison health, through assessing decisions of the European Court of Human Rights, as well as policies created by the European Committee for the Prevention of Torture.FindingsThe paper describes the position of the European Court of Human Rights on the topics of access to healthcare, ill health and release from prison, mental illness in prison, and the duty to provide rehabilitative programming for those seeking to reduce their level of “risk.” It also argues that human rights law can be a source of practical reform, and that legal frameworks have much to offer healthcare leaders seeking to uphold the dignity of those in their care.Originality/valueThis paper will provide a rare example of the engagement of human rights law with correctional health policy. It provides practical recommendations arising out of an analysis of European human rights law in the area of prisons.

Le trouble de stress post-traumatique parmi les détenus en centre pénitentiaire en Guyane française

Despite the recent interest in psychiatric illness in prison, the psychopathology of the Remire-Montjoly prison population remains largely unknown. Subject to significant population movements, French Guiana and its prison houses a very mixed population in which recent history has left a strong mark (earthquake in Haïti, civil war in Suriname, violence related to gold mining population and drug trafficking). These negative life events appear as potential vectors of psychological trauma. Additionally, strong links have been established in the literature between post-traumatic stress disorder (PTSD) and many other psychiatric disorders, including suicidal behavior and addictions. Under these conditions, we felt it essential to focus on the identification of PTSD in this sensitive population.Through adapted reception interviews, we tried to identify the PTSD, to describe by means of socio-demographic factors the studied population and to detect psychiatric comorbidities. The screening tool was the M.I.N.I.5.0, which identifies 17 psychiatric disorders including the PTSD, based on the DSM IV definition. The target population was the prison incomers, agreeing to participate in the study, aged more than 18 years old and imprisoned between 18 January 2013 and 31 December 2013. To this date, 549 inmates were included in the study.The main result of this study was a prevalence of PTSD of 17% for incomers in detention. We found that the PTSD+ population is more likely to be female (15% against 7% p = 0.0246), which is consistent with the literature data. The M.I.N.I.5.0 showed a higher prevalence of psychiatric disorders in the PTSD+ group. This association was confirmed in several types of pathology like mood disorders including: major depressive episode and manic or hypomanic episode, suicidal risk, some anxiety disorders including: panic disorder, obsessive-compulsive disorder and generalized anxiety disorder. Strong association was found for current major depressive episode, current manic or hypomanic episode and suicidal risk (p<0.005).The prevalence of PTSD is very high in this study, about 24 times higher than in a general population survey using the same screening tool.A large number of comorbidities have been identified, which corresponds to those described in the literature. The specific issues of psychiatry in prison lead us to examine more specifically the significance of the results about suicide risk. A comprehensive suicide risk (sum of medium and high risk screened by the M.I.N.I.) was found in significantly more PTSD+ inmates (17% versus 7%, p = 0.005). This study supports the need for routine screening of PTSD among incomers in detention. This disease is both worrying and common in this population but the real issues are the comorbidities. Suicidal potential is among the most important issues in detention. Its evaluation should be completed by an early recognition of a PTSD.

The tension between cross-border cooperation in the European Area of Freedom, Security and Justice and the fundamental rights of mentally ill offenders in detention

In two recent judgements, the European Court of Human Rights (ECtHR) has given an alarming signal regarding the placement, care and treatment of mentally disordered offenders in Belgium. This article analyses these judgements and the Court's assessment that Belgium faces a structural problem regarding the detention of people with a mental illness in prison. By exploring other recent ECtHR decisions across the EU and combining this with an analysis of international norms and standards, it contends that there is something amiss regarding the post-trial approach towards mentally disordered offenders in an EU-wide context. The potential hazards of this situation, from both an individual and an EU perspective are then presented by analysing the EU Framework Decision on the transfer of prisoners (which aims to facilitate offender rehabilitation) and the EU Court of Justice's interpretation of the relationship between instruments like the Framework Decision that are based on mutual recognition and fundamental rights. Lastly, the EU's initiative for enhancing procedural rights in criminal proceedings through the Roadmap trajectory, and the subsequent Commission Recommendation of 27 November 2013, are scrutinized. Based on this research, the article pinpoints the flaws and vacuums that currently exist for mentally disordered offenders, and the negative outcome this may have on the legitimacy and effectiveness of the European Area of Freedom, Security and Justice.

The Practice of Electroconvulsive Therapy in US Correctional Facilities: A Nationwide Survey.

There are little data regarding the practice of electroconvulsive therapy (ECT) in correctional settings in the United States. A survey was conducted to study the current practice of ECT in US prisons. We hypothesize that ECT is underutilized in the correctional setting. We also review the ethical aspects of using ECT for the treatment of mental illness in the prison population. A 12-question survey via a Survey Monkey link was emailed to chiefs of psychiatry, or the equivalent, of each state's department of corrections. We examined the frequency of Likert-type responses, tabulated individual comments for qualitative review, and grouped for comparison. Email contacts for chiefs of psychiatry, or the equivalent, for the department of corrections in 45 states (90%) were obtained and a survey link was sent. Thirty-one (68.9%) of 45 responded to the survey. Respondent estimates of the number of inmates with mental illness in 31 prison systems varied from less than 500 to more than 4500. Of these 31, 12 (38.7%) had more than 4500 inmates with mental illness. Four systems reported the use of ECT within the last 5 years. Of those, one reported use in the last 1 to 6 months, and 3 reported use in the last 2 to 5 years. Of these 4 prison systems, all felt that they had up to 10 patients who would benefit if ECT continued to be offered or became available in the future. None of these systems provided ECT within the prison. The inmates were referred to a local state psychiatric facility, a university hospital, or other institutions. The reasons for not using ECT as reported by the respondents are grouped under subheadings of stigma, ethical concerns, logistical concerns, and others. Considering the high prevalence of mental illness in prisons, one might expect a high prevalence of ECT responsive mental illness and, hence, provision of ECT to some prisoners with mental illness. However, our survey suggests that the use of ECT in prisons in the United States is low. Stigma, ethical concerns, and logistical concerns were the main hindrances for providing ECT to prisoners with mental illness. Given that ECT is the standard of care in certain clinical scenarios, physicians are obligated to offer such treatment to inmates when necessary. It can be argued that failure of the prison to offer the standard of care is unethical and unconstitutional.

Out of sight, out of mind: mental illness behind bars.

Out of sight, out of mind: mental illness behind bars.