Prison Mental Health Services Research Articles

Prison mental health in South-East Asia: A narrative review.

South-East Asia is a densely populated region with a considerable, however, under-prioritized mental health burden. Little is known about the mental health burden and services status in the prisons of the region. We aimed to investigate the individual country-wise prison mental health status in South-East Asian region. We performed a narrative review based on the evidence available in PubMed, Scopus, PsycINFO, Google, and Google Scholar considering the review objectives. We highlighted country perspectives on total population, prison numbers, prisoner numbers, the prevalence of psychiatric disorders and suicide among prisoners, prison mental health services, current challenges, and ways ahead. We discussed the prison mental health of five countries (Bangladesh, India, Indonesia, Nepal, and Sri Lanka). We found overcrowding (131.4%-215.6%) in the prisons, a high prevalence of psychiatric disorders in the prisons (40%-100%), negligible prison mental health services, and a lack of data on prison suicide with some variations among the five countries. Among the countries, Bangladesh has the highest prevalence (66.4%-100%) of psychiatric morbidity with an absence of a mental health system. Prison mental health in tSouth-East Asia is a neglected domain and warrants attention regarding ensuring adequate mental health services to the prisoners as there are high unmet mental health needs and an absence of poorly supported mental health needs.

Unveiling the Shadows: Childhood Traumas and the Dynamics of Seeking Psychological Help and Self-Stigmatization Among Prisoners.

Compared with the general population, prison inmates show a higher prevalence of mental disorders, particularly among those with childhood traumas. Despite childhood traumas being robust indicators of poor mental health, there is limited research on their relationship with prisoners' attitudes toward seeking psychological help. This study investigates the impact of childhood traumas on prisoners' attitudes toward help-seeking and self-stigmatization. This cross-sectional, explanatory study was conducted with 250 persons in prison. Data were collected using a sociodemographic information form, the Childhood Trauma Questionnaire, the Attitudes Toward Seeking Psychological Help Scale, and the Self-Stigma of Seeking Help Scale. Statistical analysis was performed using Spearman correlation test and multiple linear regression analysis with SPSS Version 28. A significant link was found between childhood traumas and self-stigmatization in seeking psychological help. Positive attitudes toward help-seeking were significantly associated with increased self-stigmatization. Childhood traumas were significantly related to single-parent families, conflicted intrafamilial relationships, entering prison at the age of 19 years or older, mental health issues, and behavioral disorders. Moreover, a meaningful association was observed between self-stigmatization in help-seeking and being from a single-parent family with a low socioeconomic status. In conclusion, imprisoned persons with childhood traumas exhibit higher levels of self-stigmatization in seeking psychological help, contributing to negative attitudes. Recommendations for adequate access to mental health services in prisons include fostering a culture of psychological help, enhancing mental health literacy, providing trauma-informed care, and developing comprehensive strategies. In addition, the suggestion is made for the development of societal reintegration programs.

Suicidal ideation, attempt and associated factors among prisoners in Northwest Ethiopia: A cross-sectional study.

Suicide is a prominent source of harm and death globally, and it is the leading cause of premature death among prisoners. Therefore, the main aim of this study was to determine the prevalence and factors associated with suicidal ideation and attempt among prisoners in Northwest Ethiopia. An institution-based cross-sectional study design was performed from May 23 to June 22, 2022. After proportional allocation to the three correctional institutions, a total of 788 study participants were randomly recruited. The World Health Organization Composite International Diagnostic Interview (CIDI) was used to evaluate suicide ideation and attempt. To determine factors associated with suicidal ideation and attempt, multivariate logistic regression analyses were conducted. At a 95% confidence interval (CI) of P-value <0.05, statistical significance was declared. The prevalence of suicidal ideation and attempt among prisoners was 23.6% and 10.7%, with 95% CI (20.76, 26.70) and (8.68, 13.02), respectively. Female sex (AOR = 2.38, 95% CI: 1.12, 5.05), family history of mental illness (AOR = 3.09, 95% CI: 1.93, 4.88), depression (AOR = 2.04, 95% CI: 1.43, 2.98), poor social support (AOR = 2.76, 95% CI: 1.56, 4.85) and previous incarceration (AOR = 1.84, 95% CI: 1.18, 2.86) were significantly associated with suicidal ideation. However, being single (AOR = 2.58, 95% CI: 1.47, 4.54), family history of suicide (AOR = 2.43, 95% CI: 1.18, 5.01), depression (AOR = 2.62, 95% CI: 1.59, 4.31) and previous imprisonments (AOR = 2.11, 95% CI: 1.20, 3.69) were associated with suicidal attempt. The prevalence of suicidal ideation and attempt among prisoners were found to be high. Therefore, the findings of this study recommend that early detection and design of prison mental health services should be delivered to develop mental health care, prevention, and intervention programs for incarcerated people to improve suicidal behavior in prison.

Adverse childhood experiences, mental illness, HIV and offending among female inmates in Durban, South Africa.

Childhood adversities and adult trauma are common among female inmates. Associations have been documented with childhood adversities and mental illness, personality disorders, human immunodeficiency virus (HIV) and violent offending. However, no such study had been conducted in South Africa (SA), despite the high prevalence of HIV and trauma in SA. To measure the prevalence of childhood adversities and adult trauma; and to determine if there is a relationship between childhood adversities, mental illness, personality disorders, HIV and violent offending among female inmates. The study was conducted at the largest correctional centre in Durban, KwaZulu-Natal, South Africa. This cross-sectional, descriptive study randomly recruited 126 female inmates. The World Health Organization's Adverse Childhood Experiences- International Questionnaire (WHO ACE-IQ) was used to measure childhood adversities; the Structured Clinical Interview for the Diagnostics and Statistical Manual-5 Research Version (SCID 5-RV) was used to diagnose mental illness; and a structured questionnaire was used to measure adult trauma. Human immunodeficiency virus data was confirmed from prison medical records. Elevated rates of individual childhood adversities and adult trauma were found. Associations were found between cumulative childhood adversities and post-traumatic stress disorder (PTSD), alcohol use disorder, substance use disorder, borderline personality disorder, and HIV. Female inmates are a highly traumatised population. Prison mental health services should provide trauma-informed and trauma-focussed care to improve inmates' mental health outcomes and decrease recidivism. This study contributes to the emerging literature on adverse childhood experiences (ACEs) and their associations among incarcerated female populations, in a low- and middle-income, South African setting.

Understanding the impact of Covid-19 on the delivery and receipt of prison healthcare: an international scoping review

BackgroundPeople being held in prison are particularly vulnerable to Covid-19 infection, as places of detention are high-risk environments for spread of infection. Due to this risk, many prisons across the globe introduced measures to reduce the risk of Covid-19 transmission. The pandemic changed almost all aspects of prison life, including prison healthcare provision. We undertook a scoping review to understand what is known about the impact of the Covid-19 pandemic on the receipt and delivery of prison healthcare. This scoping review is part of a wider mixed-methods study focusing more specifically on the impact that Covid-19 had on prison healthcare delivery in England.MethodsWe conducted an international scoping review of peer-reviewed articles published between December 2019 and January 2022, across six electronic databases. We also conducted a hand search of key journals and the reference lists of included articles.ResultsTwelve articles met our inclusion criteria. The articles focused primarily on prisons in high-income countries and mostly explored the impact that the pandemic had on the provision of drug treatment services. Some aspects of drug treatment services were more impacted than others, with those delivered by external providers and preparations for release particularly hindered. Whilst prison mental health services were purportedly available, there were changes regarding how these were delivered, with group therapies suspended and most consultations taking place using telehealth. The articles reported both digital and non-digital adaptations or innovations to prison healthcare services to ensure continued delivery. Collaboration between different agencies, such as the prison itself, healthcare providers, and non-governmental organisations, was key to facilitating ongoing provision of healthcare to people in prison.ConclusionsCovid-19 impacted on prison healthcare internationally, but different treatment services were affected in disparate ways, both within and between countries. The published literature concentrates on the impact on drug treatment services. Prison healthcare providers rapidly adapted their processes to attempt to maintain service provision.

Women Behind Bars: A Scoping Review of Mental Health Needs in Prison.

Women prisoners are a population that is vulnerable to mental health problems. Women prisoners have a higher risk of mental health problems than women in the general population. So far, there have been very few studies with specific on women prisoner populations discussing mental health needs in prisons. The high prevalence of mental health problems in women prisoners is inseparable from meeting the mental health needs of women prisoners in prison. This review aimed to identify the mental health needs of women prisoners. A scoping review was used, a systematic search of the articles on Oxford Academic Journals, Emerald Insight, Science Direct, PubMed, and Google Scholar using the keywords "Mental Health" OR "Health" AND "Needs" OR "Needs Assessment" OR "Addressing Needs" AND "Female" OR "Woman" OR "Women" AND "Inmates" OR "Prisoners" OR "Offenders" OR "Convicts". A total of 10 out of 254 selected, were considered eligible for inclusion and the results showed that the six major themes of mental health needs of women prisoners were treatment of substance, drug, and alcohol abuse, support system, empathy, training, mental illness treatment and access to health services, and health intervention: therapy and counselling. It is recommended for further research to focus more on the problem of access to gender-based mental health services in prisons.

Prison Mental Health in the United States of America and India

Approximately 40% of the incarcerated population in the world are reported to suffer from a mental health condition. People in correctional settings are subjected to multiple psychosocial adversities which negatively affect their mental health. Moreover, people with mental illness are at higher risk for abuse and exploitation within the criminal justice system. The prison populations of the United States (US) and India are among the highest, among both high-income and low-middle-income countries, respectively. In this article, we aim to describe the existing prison mental health services in the US and India and discuss their challenges.

Continuity of mental health care during the transition from prison to the community following brief periods of imprisonment.

PurposeThe prison-to-community transition period is one of high risk and need, particularly for those with mental illness. Some individuals cycle in and out of prison for short periods with little opportunity for mental health stabilization or service planning either in prison or the community. This study describes the socio-demographic, clinical and criminal justice characteristics of individuals with mental illness and frequent, brief periods of imprisonment, examines continuity of mental health care between prison and the community for this group, and reports on their post-release mental health and criminal justice outcomes.Design/methodology/approachThis study examined a sample of 275 men who had recently entered prison in New South Wales (NSW), Australia, who had been charged with relatively minor offenses and had been identified on reception screening as having significant mental health needs. Baseline demographic and mental health information was collected via interview and file review and contacts with the prison mental health service were recorded for the period of incarceration. Follow-up interviews were conducted 3 months post-release to determine level of health service contact and mental health symptoms. Information on criminal justice contact during the 3 month period was also collected.FindingsThe majority (85.5%) of the sample had contact with a mental health professional during their period of incarceration. Mental health discharge planning was, however, lacking, with only one in 20 receiving a referral to a community mental health team (CMHT) and one in eight being referred for any kind of mental health follow-up on release. Of those followed up 3 months post-release (n = 113), 14.2% had had contact with a CMHT. Of those released for at least 3 months (n = 255), one in three had received new charges in this period and one in five had been reincarcerated.ConclusionContinuity of mental health care for those exiting prison is poor, particularly for those with mental health needs experiencing brief periods of imprisonment, and rates of CMHT contact are low in the immediate post-release period. These findings suggest a need for early identification of individuals in this group for timely commencement of intervention and release planning, and opportunities for diversion from prison should be utilized where possible.

The full spectrum of clinical stages of psychosis among mentally ill prisoners in New South Wales (NSW), Australia

Research on the association between psychosis and criminal offending has typically focused on violent offenders with chronic psychotic illness. This stages of psychosis in prison (SOPP) study used a clinical staging approach to identify adult men referred to prison mental health services who had an at-risk mental state (ARMS), first episode of psychosis (FEP) or an established psychotic illness. Of the 105 participants included, 6% were determined to have FEP, 6% met ARMS criteria and the remainder had an established psychotic illness. Compared to a prison control sample, individuals on the psychosis spectrum were found to have higher levels of social disadvantage and other co-occurring mental health and substance use problems but were not more likely to have committed a violent offence. These findings support the notion that risk of criminal justice contact and complex illness burden exist across the full spectrum of psychotic illness.

Scoping Review of Mental Health Problems among Female Prisoners

BACKGROUND: Detention can cause problems and stressors for prisoners, one of which is mental health problems. Female prisoners have a high rate of mental health needs in prisons. Awareness and the ability to recognize prisoners’ health problems are important. Therefore, the mental welfare of female prisoners is the responsibility of each prison. AIM: This review aimed to identify mental health problems among female prisoners. METHODS: The method used was a scoping review. A systematic searched of the literature between 2000 and August 2021 on several databases and search engines, namely, PubMed, CINAHL, SAGE Journals, and Google Scholar using keywords in English, namely, mental health, female prisoners, and prison. RESULTS: Of the 112 articles found, nine were eligible for inclusion. It was found that the mental health problems of female prisoners were anxiety, depression, substance abuse, stress, loss and grief, trauma, and suicide attempts that put them at risk of psychological distress. There was still limited study on female prisoners, especially to explore mental health problems in prison, and there were few studies discussing adjustment to female prisoners in prison, as well as mental health services which are still rarely carried out in prisons. CONCLUSION: Based on the findings, it is recommended for future research to focus more on how female prisoners can access mental health services in prisons to overcome their mental health problems, conduct a deeper exploration of the extent to which mental health services in prisons have been carried out so far.

Quality of Life as a Predictor of Psychological Distress and Self Esteem among Prisoners

Purpose: One of the most vulnerable areas for poor mental health is prisons. This study was conducted to investigate whether quality of life predicts psychological distress and self-esteem among prisoners as well as to look at any gender differences that might exist.&#x0D; Design/Methodology/Approach: This study utilized a correlational design carried through the survey method. A purposive sampling technique was used to collect the data from prisoners. The sample (N=200) included 100 male and 100 female prisoners. The sample was selected from Lahore, Faisalabad, Sahiwal, and Gujranwala jails. The age range of the participants was 20 to 50 (M = 38.12, SD=6.50). Data was collected through validated questionnaires.&#x0D; Findings: Regression analysis indicates quality of life as a significant negative predictor of psychological distress and significant positive predictor of self-esteem. Compared to female prisoners, male prisoners have higher self-esteem and a better quality of life. Female prisoners have higher levels of psychological distress than male prisoners.&#x0D; Implications/Originality/Value: These findings highlight the need to improve mental health services in prisons.

Planning effective mental healthcare in prisons: findings from a national consultation on the care programme approach in prisons

AimsThe Care Programme Approach (CPA) can be an effective tool in coordinating the care and treatment needs of people with mental illness and learning disabilities. Within prisons settings, the CPA has been poorly implemented and the principles underpinning this approach have been lost. The aim of this research was to look at the key themes identified as part of a consultation process to develop quality guidance on planning effective mental healthcare in prisons in relation to the CPA.MethodThe consultation exercises included telephone interviews and hosting a national consultation event to represent the views of prisons nationally. It was conducted by the Quality Network for Prison Mental Health Services, a quality improvement initiative organised by the Royal College of Psychiatrists’ Centre for Quality Improvement.ResultThe results derived from the consultation process indicates that CPA in prisons is inconsistently adopted and that there is lack of confidence in the process from prison mental health teams, particularly with how to engage community mental health teams.ConclusionThis concludes that there is a substantial need for standardisation and consistency in the application of the CPA process within prisons, for the purposes of enhanced care delivery, greater continuity of care, and improved patient outcomes. The Quality Network for Prison Mental Health Services used the findings from this consultation to produce a national guidance document on planning effective mental healthcare in prisons, which can be accessed for free by all prison mental health teams.

Remote consultations in prison mental healthcare in England: impacts of COVID-19.

Telemedicine has become increasingly used by prison mental health services throughout the COVID-19 pandemic. In this editorial, we explore the benefits and risks of the remote provision of forensic mental healthcare, with consideration of the clinical, financial, ethical and legal consequences.

Planning effective mental healthcare in prisons: Findings from a national consultation on the Care Programme Approach in prisons

The Care Programme Approach (CPA) can be an effective tool in coordinating the care and treatment needs of people with mental illness and learning disabilities. Within prisons settings, the CPA has been poorly implemented and the principles underpinning this approach have been lost. This paper presents the key themes identified as part of a consultation process to develop quality guidance on planning effective mental healthcare in prisons in relation to the CPA. It was conducted by the Quality Network for Prison Mental Health Services, a quality improvement initiative organised by the Royal College of Psychiatrists' Centre for Quality Improvement. The information derived from the consultation process indicates that there is a substantial need for standardisation and consistency in the application of the CPA process within prisons, for the purposes of enhanced care delivery, greater continuity of care, and improved patient outcomes.

An Integrative Review of Sensory Approaches in Adult Inpatient Mental Health: Implications for Occupational Therapy in Prison-Based Mental Health Services

Sensory modulation approaches are being used in prison mental health services as a means of empowering clients with self-regulation tools to improve occupational performance and overall well-being. However, the argument must be made whether this is an evidence-informed intervention. The purpose of this integrative review was to examine the evidence for using sensory modulation approaches in prison mental health services, and discuss its relevance to occupational therapists. The consistency of positive findings, its safety in use, low cost, and its link with person-centered, trauma-informed, and recovery-oriented practices, suggests that sensory modulation is a promising approach in prison mental health services.

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.

Providing mental health services in prisons during the Covid-19 pandemic — challenges and opportunities for growth

The impact of Covid-19 makes provision of mental health care in prisons particularly challenging. The current impact on staff and prisoners is significant. Staff are under pressure to make ongoing adaptions to how they work and the interventions they are able to offer, whilst increased time spent in lock down and a reduction in services is having a negative effect on the mental health and wellbeing of prisoners. The potential for longer term deleterious consequences is also great given the currently high levels of psychological distress. Clinical psychologists could be invaluable in supporting staff and adaptations to services so support is maintained, but providing this increased level of support within an already stretched system is challenging, particularly given that prisons are predominantly staffed by forensic rather than clinical psychologists. The need for an adequate level of clinical psychology provision within prisons may never have been greater.

Self-harm in prisons: what do we know and how can we move forwards?

Research has consistently shown that the prevalence of poor mental health among prisoners is considerably higher than that in the community. Mental health services in prisons cite several other vulnerabilities, such as substance misuse problems and poor physical health, and report high rates of self-harm behaviour.1 In prisons, little is known about the underlying mechanisms for self-harm behaviour and research on this topic is crucial to understand more about how the problem can be addressed. Louis Favril and colleagues2 reported on the results of a systematic review and meta-analysis of four databases with the aim of identifying risk factors for self-harm in prison.

Evaluating a mental health service in a young offender’s institution: a thematic analysis of prison officer experiences

PurposeThe purpose of this paper is to evaluate the current service provision offered by a mental health service in a young offenders institute (YOI) in England.Design/methodology/approachA qualitative exploratory approach was adopted. Five prison officers (POs) (four male and one female) with direct experience supporting young people through mental health intervention were interviewed using semi-structured interviews. Data was analysed using thematic analysis (Braun and Clarke, 2006), which allowed evaluation of the current mental health provision to evolve.FindingsFive overarching themes (process of referrals; intervention and its impact; role and function of the health and well-being team; collaboration and involvement; and feedback, communication and intervention) were found to be highly salient when evaluating service provision. Notably all themes interrelated with one another, demonstrating that changes or improvements made to the service need to consider all factors individually and collectively.Research limitations/implicationsThis study was based on a small sample of POs in only one YOI in England, and therefore cannot be generalised to the entire prison estate. However, it does offer a rich insight into local service provision from the perspective of a group whose opinion is rarely sought.Practical implicationsPOs’ perspectives of service provision are important in informing service developments. Lessons can be learnt from their unique insight into how prison mental health services are run to improve processes and collaborative working in the management of young offenders with mental health difficulties.Originality/valueThis preliminary and exploratory study is, to the best of the authors’ knowledge, the first study evaluating service provision by using the perspectives of POs. The findings suggest that POs make valuable contributions to the service development and should be involved in similar evaluations in future.

Reforming prison mental health services in Ukraine

The Ukrainian prison service is going through a process of reform. One of the areas that is in urgent need of intervention is prison mental health. In collaboration with the Ministry of Justice a team of international experts assessed the current situation with regard to penitentiary psychiatry and came to a set of recommendations. This article reflects the outcome of the assessment visit and the recommendations made to the ministry.