Prison Mental Health Care Research Articles

Asserting Prisoners' Right to Health: Progressing Beyond Equivalence

The concept of the "right to health," regardless of a person's legal status, is a guiding force in establishing adequate standards of health care for all, including prisoners with mental illness. Prison health care in the United States, however, often falls below acceptable minimum standards. In the United Kingdom, the notion of equivalence has been the main driving force in improving prison mental health care. Although improvements have been made over the past ten years, demand for services continues to outstrip supply, as in the U.S. prison system. In both prison systems, prisoners often present with complex and multiple needs, much greater than those found in community samples. Even mental health care equivalent to that provided in the community falls significantly short of what is required. Further improvements to prison health care, therefore, remain a priority, and a more suitable model needs to be established and implemented. The authors propose an assertive application of a person's right to health with a well-defined framework for health care that is available, accessible, acceptable, and of good quality (AAAQ). The authors explore how the AAAQ framework can move beyond minimal or equivalent standards to deal with complex prison structures, meet health care needs, and measure progress more effectively. The AAAQ framework could lead to more equitable standards of health care that can be applied to international settings.

The role of health systems factors in facilitating access to psychotropic medicines: a cross-sectional analysis of the WHO-AIMS in 63 low- and middle-income countries.

Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability.

Secondary mental healthcare in prisons in England and Wales: results of a postal questionnaire

Aims and methodPrison mental health inreach teams (PMHITs) were introduced in response to policy from 2003. This provision comes under the responsibility of the National Health Service. Service development and structure was not defined in policy. A total of 97 prisons of an estimated 100 known to have a PMHIT were targeted by postal questionnaire and responses covered 62 prisons. Team structures were captured in the data with specific regard to the number of available professional sessions.ResultsFindings determine there is generally no correlation between input and prison capacity, although there was some evidence of correlation in the high secure (category A) estate and that the female estate was generally better served.Clinical implicationsIt is evident from this study that PMHITs have evolved piecemeal, with no clear standards or equity across the estate. This is of concern.

Law & Psychiatry: Lost in the Crowd: Prison Mental Health Care, Overcrowding, and the Courts

Skyrocketing inmate populations have put considerable pressure on prison mental health services. In California, prison populations have exceeded 200% of capacity, and litigation to rectify constitutionally inadequate care has been under way for more than two decades. After the failure of other remedies, a federal court ordered the state to reduce its inmate population to 137.5% of capacity in two years. The U.S. Supreme Court upheld the order, although it signaled that California could obtain more time to comply. Other states now are on notice that the justices will not permit grossly inadequate treatment conditions to continue indefinitely.

Law & Psychiatry: Lost in the Crowd: Prison Mental Health Care, Overcrowding, and the Courts

Skyrocketing inmate populations have put considerable pressure on prison mental health services. In California, prison populations have exceeded 200% of capacity, and litigation to rectify constitutionally inadequate care has been under way for more than two decades. After the failure of other remedies, a federal court ordered the state to reduce its inmate population to 137.5% of capacity in two years. The U.S. Supreme Court upheld the order, although it signaled that California could obtain more time to comply. Other states now are on notice that the justices will not permit grossly inadequate treatment conditions to continue indefinitely. (Psychiatric Services 62:1121–1123, 2011)

Feminist Therapy with Incarcerated Women: Practicing Subversion in Prison

Feminist psychotherapy is essential to the well-being of women of marginalized women, especially incarcerated women. Although some feminist principles have been applied to programming for women in prison, major feminist inroads have yet to be made into correctional systems. There is a need for a shift to an activist feminist paradigm of “corrections” to transform women's correctional facilities into rehabilitative environments. This article describes the characteristics of incarcerated women and issues of mental health care in prisons, explains some of the challenges of conducting feminist therapy in prisons, and presents strategies for feminist therapists involved in this transformative endeavor.

Embracing the notion that context is crucial in prison mental health care

This paper focuses on the mental health of adult male prisoners and the mental health care provided within Her Majesty's Prison Service (HMPS), United Kingdom (UK). Currently, the level of mental health need within this population is high, and prison mental health services require additional positive developments. The prison milieu is not always conducive to good mental health, and is not often a useful catalyst for mental health care. Arguably, prison mental health services ought to be increasingly fashioned (commissioned, provided, managed and practised) in direct accordance with the prison social environment, institutional set‐up and specific mental health requirements of prisoners/patients. In this paper, therefore, attention is devoted to social and institutional structures which permeate the prison setting. The proposition is that situation‐specific and culturally responsive mental health care is a must; context is crucial.

What will the future bring? Prison mental health care in England

Abstract Evidence suggests that, compared to the population as a whole, offenders are considerably more likely to suffer from mental health problems (especially from severe/multiple mental health problems). Some authors estimate that the proportion of people with mental health problems in prisons is as high as 90 per cent (e.g.Roberts and Cobb, 2008). Recent research published in cjm advocates putting more robust court diversion mechanisms in place which would ensure that offenders with mental illness are directed into mental health services (Roberts and Cobb, 2008). What happens however, when these mechanisms are not in place or do not perform as expected, and offenders with mental health problems end up in prisons?

Mental health care in prisons in England and Wales: its state and changes over the last decade

Mental health care in prisons in England and Wales: its state and changes over the last decade

Health Advocacy- Counting the Costs

Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of different population groups, each with distinct but also similar health needs in the Auckland and Northland regions of New Zealand. The costs of advocating for a fair share of funding for the provision of health advocacy services for approximately a third of New Zealand’s population and the legal journey and involved is discussed as well as the lessons those involved have learnt along the way. A focus is made on the importance of health advocacy to address the health needs of Maori, especially those in mental health services, specialist forensic services and those who are need of mental health care in prison.

Pathways to psychiatric care in European prison systems

The aims of this study were to describe and analyse the concepts of provision of mental health services for prison inmates in 24 countries in the European Union and the EFTA. Data were gathered by means of a structured questionnaire that was completed by national experts in the participating countries. This article stresses the different organizational models of mental health care for inmates, different legal standards for screening their mental health status and different pathways to psychiatric care and aftercare. The study revealed serious shortcomings. Even the most rudimentary health reporting standards for mental health care in prison are lacking almost everywhere in Europe. Psychiatric screening and assessment procedures at prison entry and during imprisonment differ substantially and do not fulfil recognized quality standards. In many countries, the appointment of inadequately trained staff to perform such screenings increases considerably the risk that mental disorders or psychiatric needs of the inmates will remain undetected. Furthermore, the pathways to care in the case of an acute psychotic episode differ significantly, since referral to prison hospitals, medical prison wards, forensic hospitals, or general psychiatric hospital are used in various combinations depending on different national legal regulations and on the availability of services or other regional circumstances. Therefore, the collaborating experts place the quality of European prison mental health care into serious question.

The second national survey of mental health in-reach services in prisons

The prevalence of mental disorder among prisoners is considerably higher than that in the general population. Historically, mental healthcare in prisons has been criticised for being under-funded and provided by the Prison Service. The 2001 policy Changing the Outlook envisaged multi-professional prison mental health teams funded by the local primary care trusts. Such teams are now in place, managing offenders with severe mental illness, but they have faced challenges. The second mental health in-reach team survey was conducted in 2007 and aimed to capture a variety of data, including: workforce features; connections with primary care services; the role of in-reach services, their caseload, the interventions provided, and barriers to successful operation; and the relationship with the wider NHS. It was found that the role and activities of in-reach teams had changed considerably since the first in-reach survey was undertaken in 2005.

P02-153 Organisation and practice of prison mental health care in Europe - the EUPRIS study

Among the more than 9.25 million people currently being held in penal institutions worldwide, mentally disordered inmates constitute a serious problem. Despite the standard doctrine in most countries that mentally ill offenders lacking criminal responsibility have to be referred to in forensic psychiatric facilities for specialised care, the prevalence of psychiatric morbidity among prisoners by far exceeds the rate of mental disorders in the general population. However, international research on this issue is scarce. The EU has recently funded a study on the overall concepts and capacities of mental health care in prisons from 25 European countries. Hindered by very bad health reporting standards, the study revealed deficient mental state screening and assessment procedures at prison entry as well as during the term or prior to release. This is an obstacle for implementing adequate primary, secondary or tertiary prevention programmes for most prevalent mental disorders in prisons. Additionally it increases the risk of relapsing and re-offending of released prisoners. None of the included countries provides regular national statistics on the frequency of mental disorders of prisoners or on the availability of psychiatric treatments. Together with a mostly unknown share of general psychiatry involvement into prison mental health care, the information gap currently prevents from identifying favourable concepts of prison mental health care in Europe. The paper presents the data collected during the study as well as a suggested set of standardized indicators whose implementation would enable to describe and evaluate this seriously neglected field.

PW01-04 Organisation and practice of prison mental health care in Europe - the EUPRIS study

Among the more than 9.25 million people currently being held in penal institutions worldwide, mentally disordered inmates constitute a serious problem. Despite the standard doctrine in most countries that mentally ill offenders lacking criminal responsibility have to be referred to in forensic psychiatric facilities for specialised care, the prevalence of psychiatric morbidity among prisoners by far exceeds the rate of mental disorders in the general population. However, international research on this issue is scarce. The EU has recently funded a study on the overall concepts and capacities of mental health care in prisons from 25 European countries. Hindered by very bad health reporting standards, the study revealed deficient mental state screening and assessment procedures at prison entry as well as during the term or prior to release. This is an obstacle for implementing adequate primary, secondary or tertiary prevention programmes for most prevalent mental disorders in prisons. Additionally it increases the risk of relapsing and re-offending of released prisoners. None of the included countries provides regular national statistics on the frequency of mental disorders of prisoners or on the availability of psychiatric treatments. Together with a mostly unknown share of general psychiatry involvement into prison mental health care, the information gap currently prevents from identifying favourable concepts of prison mental health care in Europe. The paper presents the data collected during the study as well as a suggested set of standardized indicators whose implementation would enable to describe and evaluate this seriously neglected field.

A Theoretical Framework for Goal‐directed Care within the Prison System

Mental health care in prisons involves many stakeholders. As a consequence, the goals involved are divergent but there is no sound theoretical framework that accounts for the complexity of care in prison. This paper considers a broad theory and its conceptual framework that differentiates between prisoners with emotional suffering and those without, the need for care from an objective point of view as opposed to a subjective one, and the need for care related to mental health problems versus care related to limiting recidivism.

Epidemiology and models of care for mentally disordered prisoners in Europe – the EUPRIS study

More than 9.25 million people are held in penal institutions throughout the world at the moment, with rapidly increasing numbers. Strengthening the competence of mental health care services for prison inmates is an issue of major concern. However, this field is widely neglected by health services research internationally. Research activities are scarce even for the most basic indicators (psychiatric prevalence, care offers, services, number of professionals). Evidence is much too poor to identify care approaches which may serve as models of good practice. This EU funded study aimed at assessing available administrative data on prison mental health care and psychiatric prevalence of prisoners from 25 European countries. Results show that mostly non-standardized data that is available allows for describing responsibilities, assessment procedures or general concepts of prison mental health care. However, identifying actual bed capacities, the size of treatment programs or the number of professionals available for mentally disordered prisoners is prevented by a most common but seldom quantified involvement of general psychiatry into prison mental health care. For the same reason, prevalence rates of mental disorders in prison are available only from a small minority of countries. As a conclusion, efforts should be directed to define standardized indicators for prison mental health and prison mental health care that should be agreed upon by all European countries and implemented into national health or juridical reporting systems. from WPA Thematic Conference. Coercive Treatment in Psychiatry: A Comprehensive Review Dresden, Germany. 6–8 June 2007

Mental healthcare in prisons - and on release

In general, there's been significant improvement over the last four to five years, particularly when the responsibility for commissioning services was taken over by the NHS from the prison service.

Traumatized Offenders: Don't Look Now, But Your Jail's Also Your Mental Health Center

SUMMARY There are more than a million prison and jail inmates in the United States who have mental illness. As funding for State Hospitals has decreased, funding for needed community programs has often not kept pace. This has led to a population of homeless mentally ill, many of whom have co-occurring substance use disorders. Society's perhaps unconscious response has been to create 24 hour mental health units within prisons and jails. The authors contend that by doing so, we have ‘re-criminalized’ mental illness. The mentally ill prisoner is most often the victim of extreme family turmoil including physical and/or sexual abuse, parental substance dependence, and parental incarceration. Prisons and jails most often do not provide services for this highly traumatized population or recognize the need for such services. The authors report on problematic aspects of mental health care in prisons, and on several attempts to establish ‘trauma-aware’ care within the legal system.

Mental health care in prison: How to manage our care

In the prison system there are high percentages of mentally disordered offenders, often with co‐morbid psychiatric disorders. In addition, the setting and ward atmosphere in prisons are not designed to care for psychiatric patients and places a burden on vulnerable inmates. Management of care of the different subgroups in the prison population is therefore necessary on four different levels, from basic health care to forensic psychiatric treatment. A fifth level is forensic care, which is directed towards re‐integration into the community rather than treatment at the symptom‐level of disease. Continuity of care, evidence‐based care and coercion within mental health care are discussed with regard to their forensic ethical meaning towards both patients and the community. Drawing on the Dutch situation a case is made for the promotion of voluntary treatment for those prisoners

Equivalent to what? Mental health care in Britain's prisons

Prisoners are supposed to receive health care that is equivalent to that provided in the community. There is a high prevalence of mental ill health in prisons, and prisoners tend to have complex needs. Prison mental health care has received only limited attention until recently. The impact of the new in ‐reach teams appears to have been positive, but primary mental health care is weak across the prison estate and the vast majority of prisoners with mental health problems still receive little or no service. The development of prison mental health care has not been evidence‐based and there has been no policy implementation guidance that compares to that provided for reforms in services for the wider community. There is no model for prison mental health care and the role of the prison mental health practitioner is not well defined, nor is the health care workforce prepared for the task.