Jail Detainees Research Articles

Prescription Patterns in Jails Before and Since the COVID-19 Pandemic: A Multisite Serial Cross-Sectional Investigation.

In response to the COVID-19 pandemic, jails were advised to reduce facility census, particularly the growing population of those with medical/behavioral health vulnerabilities that increased susceptibility to adverse outcomes. Although jail census decreased across the nation in the initial days to months following pandemic declaration, there are minimal data regarding the health status of those who remained in jail. The current investigation aspired to describe jail census trends before/since the onset of COVID-19 and offer snapshots of temporal changes and context for prevalence estimates of medical/behavioral health conditions in jail detainees from 2019 to 2023. Using a serial cross-sectional design, prescription information for individuals residing in 18 jails across the United States on June 30 of each respective year was extracted and categorized using MediSpan's ontological system to determine prevalence estimates of prescribed agents/products. Although data evidenced an initial 31% census reduction (followed by gradual return to prepandemic rates), prescribing patterns for all major therapeutic drug classes steadily increased, with 10% more individuals prescribed at least one agent in 2023 than 2019. The largest increases were observed for behavioral health agents (e.g., 32.4% of the sample was prescribed psychotropic agents in 2023 compared with 25.7% in 2019). We provide considerations for future investigations.

Legal settlement would expedite MH treatment for Oklahoma detainees

Yearlong negotiations have led to the proposed settlement of a federal lawsuit over long delays in providing mental health treatment to Oklahoma jail detainees who are found incompetent to stand trial. However, opposition from Gov. Kevin Stitt could derail the remediation plan set out in the settlement, which also requires state legislative approval.

Development of a measure for assessing malingered incompetency in criminal proceedings: Denney competency related test (D-CRT)

ABSTRACT Introduction Experts frequently assess competency in criminal settings where the rate of feigning cognitive deficit is demonstrably elevated. We describe the construction and validation of the Denney Competency Related Test (D-CRT) to assess feigned incompetency of defendants in the criminal adjudicative setting. It was expected the D-CRT would prove effective at identifying feigned incompetence based on its two alternative, forced-choice and performance curve characteristics. Method Development and validation of the D-CRT occurred in described phases. Items were developed to measure competency based upon expert review. Item analysis and adjustments were completed with 304 young teenage volunteers to obtain a proper spread of item difficulty in preparation for eventual performance curve analysis (PCA). Test-retest reliability was assessed with 44 adult community volunteers. Validation included an analog simulation design with 101 jail detainees using MacArthur Competency Assessment Test-Criminal Adjudication and Word Memory Test as criterion measures. Effects of racial/ethnic demographic differences were examined in a separate study of 208 undergraduate volunteers. D-CRT specificity was identified with 46 elderly clinic referrals diagnosed with mild cognitive impairment and dementia. Results Item development, adjustment, and repeat analysis resulted in item probabilities evenly spread from .28 to 1.0. Test-retest correlation was good (.83). Internal consistency of items was excellent (KR-20 > .91). D-CRT demonstrated convergent validity in regard to measuring competency related information and as well as malingering. The test successfully differentiated between jail inmates asked to perforfm their best and inmates asked to simulate incompetency (AUC = .945). There were no statistically significant differences found in performance across racial/ethnic backgrounds. D-CRT specificity remained excellent among elderly clinic referrals with significant cognitive compromise at the recommended total score cutoff. Conclusions D-CRT is an effective measure of feigned criminal incompetency in the context of potential cognitive deficiency, and PCA is assistive in the determination. Additional validation using knowns groups designs with various mental health-related conditions are needed.

Identifying Individuals With Early Psychosis in Jail: Lessons Learned for Coordinated Specialty Care Services.

This study sought to establish the feasibility of a two-component intervention embedded within a jail setting that would detect detainees with early psychosis and connect them to coordinated specialty care (CSC) in the community upon release. The two components of the intervention were a targeted educational campaign for correction officers and a specialized early engagement support service to facilitate jail discharge planning. Jail detainees with early psychosis were referred to the project and assessed for positive and negative symptoms, substance use, and duration of untreated psychosis (DUP). During a 24-month period, 25 individuals were referred, of whom eight were eligible and interviewed. The sociodemographic and clinical characteristics of the jail detainees were similar to those of individuals in hospital settings. The median DUP was 36 weeks. One of the eight detainees with early psychosis was successfully referred to CSC; for the other detainees, social or criminal legal factors precluded referral. A targeted educational campaign for correction officers and a specialized early engagement support service can be implemented in a jail setting, and referrals can be facilitated. Success of the campaign may depend on having dedicated liaisons within the jail setting (e.g., among correctional health staff) as well as liaisons in local CSC programs and leadership. Changes in the law and policy environments (e.g., criminal legal system reform) and changes in organizational practices and processes for corrections, correctional health, and local CSC programs (such as those made during the COVID-19 pandemic) require ongoing collaborations.

Understanding Filipino Jail Detainees’ Self-Harming Behavior: A Grounded Theory Explortion

This grounded theory exploration aims to advance a theory that explains the development of self harming behavior (SHB) among a select group of Filipino jail detainees. Using the Classical Glaserian Grounded Theory procedure, a novel process that describes Filipino Detainees’ Phases of Self Harming Behavior (gravitational, transformational, interventional and dispositional) emerged. Findings from this inquiry may serve as bases for policy-making and intervention programs that inform the triggers and preventative factors associated with SHB in the penal setting. These may further raise awareness of forensic mental health and human rights violations among detainees in flawed justice systems in low-to-middle income countries (LMICs).

Improving the Continuity of Care for People Living with HIV Experiencing Incarceration in North Carolina Jails: Stakeholder Perspectives.

BACKGROUND Jail detention can disrupt the continuity of care for people living with HIV/AIDS (PLWH). Using a state's "Data to Care" (D2C) program might help overcome this barrier, but raises important questions of data security, personal privacy, resource allocation, and logistics.METHODS As part of a study involving in-depth expert stakeholder interviews, a 1-day workshop was convened to identify and discuss potential ethical challenges in extending North Carolina's D2C program to jail settings. Workshop participants included public health officials, community advocates, HIV clinicians, jail administrators, privacy experts, criminal justice researchers, and a formerly incarcerated PLWH. Workshop participants discussed the results of earlier stakeholder interviews with the goal of identifying the most important points to consider in assessing the merits of extending D2C surveillance to jail settings.RESULTS Although the workshop participants expressed support for improving the continuity of HIV care for jail detainees, they had mixed perspectives on whether a jail-based D2C program should include in-jail or post-release follow-up interventions. Their positions were influenced by their views on 4 sets of implementation issues: privacy/data-sharing; government assistance/overreach; HIV criminalization/exceptionalism; and community engagement.LIMITATIONS The limitations of this stakeholder engagement exercise include its purposive recruitment, relatively small number of participants, and limited duration.CONCLUSIONS Improving the continuity of HIV care in particular jail settings will depend on a number of local considerations. In deciding between models featuring in-jail and post-release follow-up care, the most important of these considerations will be the possibility of establishing good partnerships between the jail, the health department, and the community. Additional research on the dynamics and impact of different models is needed.

Proximal risk for suicide in correctional settings: A call for priority research.

Suicide is the leading cause of death among jail detainees and the third leading cause of death among state prison inmates. These populations have been recognized as a high-risk group deserving special clinical attention. The literature on deaths by suicide in correctional settings has identified numerous risk factors for eventual death, but few of these risk factors are specific to the last days of life to aid clinicians in estimating near-term risk of serious self-injury or death. The poor understanding of near-term risk is particularly important in jail settings where many suicide deaths occur within 24 hr of entry. Although screening instruments for suicide risk factors are commonly used with jail/prison populations, few have been validated in those settings and all have poor positive predictive value. We call for a focused research effort to improve the identification of those at risk of near-term suicide and to produce tools for clinicians that will reduce the burden of suicide among jail and prison inmates. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Environmental and Psychological Correlates of Self-Injurious Thoughts and Behaviors among Jail Detainees

ABSTRACT Death by suicide is the leading cause of death in American jails. Closely linked with suicides are self-injurious thoughts and behaviors. Even with this knowledge, the risk factors for self-harm ideation and self-harm behaviors have received little empirical work within a jail population. This study couples an integrated importation and deprivation model with an ideation-to-action approach to examine environmental and psychological correlates of self-harm ideation and self-harm behaviors among a sample of 231 individuals incarcerated in jail. Results from the ordinary least squares regression models demonstrate that both deprivation (institutional misconduct) and importation (hopelessness) factors are important when identifying self-harm ideation and self-harm behaviors. In addition, the results of this test of the integrated model offer a proposed new direction for integrated theory testing. Finally, a discussion of policy implications and actionable programs are suggested.

The Ninth Circuit Court of Appeals and Jail-Based Competency Evaluation and Restoration.

The U.S. Ninth Circuit is the largest of the federal appeals courts, encompassing the states of Alaska, Washington, and Oregon to the north, Hawaii, Guam, and the Northern Mariana Islands to the west, California and Arizona to the west and southwest, along with the three intermountain states of Idaho, Montana, and Nevada. The landmass within the Ninth Circuit represents great diversity of geography, climate, population density, and cultural and political traditions. This article considers two landmark Ninth Circuit decisions, one from Oregon and the other from Washington, two states that share geography, culture, and political orientation. Informed by these decisions, we consider how the Ninth Circuit might view the jail-based competency evaluation and restoration programs in the state of Arizona. We explore: the due process rights of jail detainees who are awaiting an evaluation of trial competency; and the time necessary for admission to, and the adequacy of, Arizona's jail-based competency restoration programs after a finding of incompetency.

Increased propensity for violence among female jail detainees with PTSD, panic disorder and alcohol use disorder

Purpose The female jail population is steadily growing in rural jails across the country. Detainees have high rates of mental health and substance use disorders, some of which are linked to violent offenses. These conditions include post-traumatic stress disorder (PTSD), panic disorder (PD) and alcohol use disorder (AUD). This study aims to examine the associations between these disorders among females charged with violent offenses. Design/methodology/approach The sample consists of 167 female detainees from local rural jails in the USA. To assess participants’ behavioral health, the Comprehensive Addictions and Psychological Evaluation – 5 (CAAPE-5) was administered. The associations between PTSD, PD, AUD and violent offenses were investigated using bivariate statistics and multivariate logistic regression. Findings Over half of the female detainees in the sample met criteria individually for PTSD, PD or AUD, substantiating previous work on prevalence rate. Of the sample, only 10% were charged with violent offenses, from which the predominant condition reported was PTSD. Among detainees arrested for violent offenses, 69% also met criteria for PTSD, 56% for AUD and 44% for PD. Multivariate results indicate AUD was the only significant predictor for violent offenses. Research limitations/implications Female detainees experience trauma and mental health conditions at high rates. Research-informed mental health care may result in increased treatment efficacy. Provided the links between PTSD, PD and AUD, special considerations for this population should address interpersonal factors in treatment that may relate to violent offenses. Originality/value Little research exists examining female jail detainees and the implications of AUD, PTSD and PD on violent offending. To the authors' knowledge, this is the first study to examine the relationship between AUD, PTSD and PD in female jail detainees with violent offenses.

Factors of Recidivism among Individuals with Co-occurring Conditions in Rural Mental Health Jail Interventions.

Estimates indicate that nearly half of rural jail detainees meet the criteria for co-occurring disorders (COD). It is critical to examine factors of recidivism among detainees with COD in rural communities. This exploratory study aimed to examine factors of recidivism among adults in rural jails. Administrative data sources were utilized to assess postyear recidivism among 191 individuals with COD who participated in a jail-based intervention. Results indicated that a greater number of previous jail bookings and not receiving continuity of care were the strongest associations of overall recidivism, and a greater number of previous jail bookings was associated with of multiple recidivism events. The protective effect of receiving continuity of care was diminished in reducing recidivism 4- to 12-months following jail release. Re-entry services should consider developing or further expand specialized psychiatric care parole and connections to evidence-based integrated dual diagnosis treatment with a focus on programs with adaptability for rurality.

Genomic Epidemiology of MRSA During Incarceration at a Large Inner-City Jail.

Congregate settings, such as jails, may be a location where colonized detainees transmit methicillin-resistant Staphylococcus aureus (MRSA). We examined MRSA acquisition during incarceration and characterized the genomic epidemiology of MRSA entering the jail and isolated during incarceration. Males incarcerated at the Cook County Jail were enrolled within 72 h of intake and MRSA surveillance cultures collected. Detainees in jail at Day 30 were re-cultured to determine MRSA acquisition. A survey was administered to identify acquisition predictors. Genomic sequencing of surveillance and clinical isolates was integrated with epidemiologic and jail location data to track MRSA transmission pathways. 800 males were enrolled; 19% MRSA colonized at intake. Of 184 who reached Day 30 visit, 12 acquired MRSA. Heroin use before entering (OR 3.67, P = .05) and sharing personal items during incarceration (OR = 4.92, P = .01) were predictors of acquisition. Sequenced clinical USA300 isolates (n = 112) were more genetically similar than diverse intake USA300 strains (P < .001), suggesting jail transmission. Four acquired colonization isolates were within 20 single-nucleotide variant (SNVs) of other isolates; 4 were within 20 SNVs of an intake isolate, 2 for an acquisition isolate, and 1 for a clinical isolate. Individuals with genetically similar isolates were more likely to have had overlapping stays in the same buildings. There was a high MRSA burden entering jail. Genomic analysis of acquisition and clinical isolates suggests potential spread of incoming strains and networks of spread during incarceration, with spread often occurring among detainees housed in similar locations. Sharing personal items during incarceration is associated with MRSA acquisition and could be a focus for intervention.

Reducing the dangers of COVID-19 through shared governance in a Philippine jail

ABSTRACT The Covid-19 pandemic poses a grave threat to the welfare of detainees and personnel in correctional facilities worldwide. This is especially true in jails and prisons with acute problems of overcrowding, such as in the Philippines, where the congestion rate hovers around 463%. This article documents shared governance practices in Manila City Jail Male Dormitory, the Philippines' most populous jail. Despite limited space and resources, jail personnel and detainees cooperatively addressed the pandemic threat. Using interviews with jail personnel and detainees, and a review of social media postings and official internal reports, we document the varied manifestations of shared governance. Specifically, jail personnel and prisoner leaders cooperated by disseminating information, crafting policies, identifying makeshift quarantine areas, assigning prisoner medical staff, and instituting discipline. The shared governance approach entails addressing the Covid-19 crisis as community and family, where prisoners actively take part in identifying, reporting, and addressing problems. While other jails and prisons in the Philippines experienced Covid-19 infections and social tensions within their facilities due to restrictive protocols, the Manila City Jail Male Dorm experienced no infections or violent incidents. Implications to theory and practice of jail governance, especially in periods of public health emergency, are discussed.

PTSD, panic disorder and alcohol use disorder as a triple threat for violence among male jail detainees

PurposeDespite ranking among the most prevalent mental health conditions and their likely contributions to violent offending, post-traumatic stress disorder (PTSD), panic disorder (PD) and alcohol use disorder (AUD) have not been examined closely among adult males detained in rural jails. The purpose of this paper is to assess the prevalence of co-occurring PTSD, PD and AUD within this population and identify their associations with violent offenses.Design/methodology/approachThe sample consists of 349 males recently booked into local jails. The Comprehensive Addictions and Psychological Evaluation – 5 was administered to assess mental health conditions. Bivariate statistics and multivariate logistic regression were used to examine associations between PTSD, PD, AUD and violent offenses.FindingsA disproportionate number of participants met criteria for PTSD, PD and AUD. Co-occurrence was prevalent among detainees booked for violent offenses with 25% reporting symptoms of all three disorders. PD emerged as the strongest single condition associated with violence, while the combination of PTSD, PD and AUD significantly increased the likelihood of violent offenses.Practical implicationsA better understanding of the relationship between mental health conditions and violent offenses is essential for efficacious assessment and treatment. Appropriately informed mental health care for jail detainees can increase public safety and guide practices for addressing these conditions within criminal justice populations.Originality/valueThere is limited research on mental health within the rural jail detainee population. To the authors’ knowledge, this is the first study to examine the association between PTSD, PD, AUD and violent offenses drawn from local detention centers.

Barriers to linking high-risk jail detainees to HIV pre-exposure prophylaxis.

Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release.

Study Protocol: A randomized controlled trial of suicide risk reduction in the year following jail release (the SPIRIT Trial)

PurposeThis article describes the protocol for a randomized effectiveness and cost-effectiveness trial of Stanley and Brown's Safety Planning Intervention (SPI) during pretrial jail detention to reduce post-release suicide events (suicide attempts, suicide behaviors, and suicide-related hospitalizations). BackgroundWith 10 million admissions per year and short stays (often days), U.S. jails touch many individuals at risk for suicide, providing an important opportunity for suicide prevention that is currently being missed. This study (N = 800) is the first randomized evaluation of an intervention to reduce suicide risk in the vulnerable year after jail release. Given that roughly 10% of all suicides in the U.S. with known circumstances occur in the context of a criminal legal stressor, reducing suicide risk in the year after arrest and jail detention could have a noticeable impact on national suicide rates. DesignPretrial jail detainees at risk for suicide were randomized to SPI during jail detention plus post-release phone follow-up or to enhanced Standard Care. Outcomes assessed through 12 months post-release include suicide events, suicide attempts, weeks of active suicide ideation, severity of suicide ideation, time to first event, psychiatric symptoms, functioning, and cost-effectiveness. Methods accommodate short jail stays and maximize trial safety and follow-up in a large sample with severe suicide risk, access to lethal means including substances and firearms, high rates of psychiatric illness, and unstable circumstances. ConclusionAdequate funding was important to create the infrastructure needed to run this large trial cleanly. We encourage funders to provide adequate resources to ensure clean, well-run trials.

Examining the utility of the Personality Assessment Screener in three criminal justice samples.

Many individuals in forensic/correctional settings experience significant mental health problems, yet effective screening tools to identify such difficulties are in relatively short supply. This study investigates the clinical utility of the Personality Assessment Screener (PAS; Morey, 1997), a 22-item self-report measure of risk for emotional and behavioral dysfunction, across three archival criminal justice samples (incarcerated sex offenders, prison inmates housed in general population and psychiatric units, and jail detainees). The PAS is derived from the Personality Assessment Inventory (PAI; Morey, 1991, 2007), a more comprehensive measure of emotional and behavioral disturbances that is widely used in forensic/correctional settings. The PAS total score effectively identified those with clinically significant elevations on the PAI and also significantly correlated with various criterion measures tapping psychological dysfunction. Existing interpretive ranges and labels used to describe PAS scores in general clinical settings were problematic, however, and may require revision for use in these contexts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Judge ends decades‐old lawsuit over jail services in Arizona county

A federal class‐action lawsuit that dates back to the 1970s has finally been concluded, with a U.S. District Court judge's official closing of a case involving inadequate mental health care and other inhumane conditions for jail detainees in Maricopa County, Arizona.

Posttraumatic stress, panic disorder, violence, and recidivism among local jail detainees.

Most research on posttraumatic stress disorder (PTSD) and offending has been conducted with special populations (e.g. veterans and female inmates) and generally overlooks the additive effect of panic disorder (PD) in offending patterns. The purpose of this paper is to assess the prevalence of PTSD and PD among jail inmates, while simultaneously examining the relationships between these disorders, offending types and frequency. A random sample of adults recently booked into a local county jail participated in the Comprehensive Addictions and Psychological Evaluation-5 (CAAPE-5), a structured psychological assessment. The study sample was comprised of 200 male and 83 female inmates. Indications of PTSD were observed among 44.0 percent of male inmates and 57.8 percent of female inmates. Most male inmates (78.4 percent) with positive PTSD indications also met criteria for PD, with a similar proportion (78.1 percent) of female inmates also meeting criteria for both. The combination of PTSD and PD was not associated with offending frequency, but inmates presenting indications of both PTSD and PD were more likely to be charged with a violent offense relative to those with only PTSD. Inmates with PTSD who also have panic attacks may have a more severe condition with possible implications for other risks. Observations of these conditions among adults recently booked into local jails should coincide with each other. Few studies have examined mental health conditions among local jail detainees, despite the ever-present need to address them. The current study considers this important population and investigates the prevalence of co-occurring conditions.

Results of the Brief Jail Mental Health Screen Across Repeated Jail Bookings.

The Brief Jail Mental Health Screen (BJMHS) is widely used at intake in county jails to identify detainees who may have serious mental illness and who should be referred for further mental health evaluation. The BJMHS may be administered multiple times across repeated jail bookings; however, the extent to which results may change over time is unclear. To that end, the authors examined the odds of screening positive on the BJMHS across repeated jail bookings. Data were drawn from the administrative and medical records of a large, urban county jail that used the BJMHS at jail booking. The study sample comprised BJMHS results for the 12,531 jail detainees who were booked at least twice during the 3.5-year period (N=41,965 bookings). Multilevel logistic modeling was used to examine changes over time overall and within the four decision rules (current psychiatric medication, prior hospitalization, two or more current symptoms, and referral for any other reason). Results show that the odds of a positive screen overall increased with each jail booking, as did the odds of referral for any other reason. In contrast, the odds of screening positive for two or more current symptoms and prior hospitalization decreased. There was no change in the odds of screening positive for current psychiatric medication across bookings. Findings show that BJMHS results changed across bookings. Further research is needed to determine whether changes reflect true changes in mental health status, issues with fidelity, the repeated nature of the screening process, or other factors.