Prison Population Research Articles

Development and optimisation of a reception testing protocol designed to eliminate HCV in the UK prison population

Micro-elimination of hepatitis C virus (HCV) in high-risk populations is a feasible approach towards achieving the World Health Organization's targets for viral hepatitis elimination by 2030. Prisons represent an area of high HCV prevalence and so initiatives that improve testing and treatment of residents are needed to eliminate HCV from prisons. This initiative aimed to improve the HCV screening and treatment rates of new residents arriving at prisons in England. A rapid test and treat pathway was developed and implemented in 47 prisons in England between May 2019 and October 2021 as a healthcare service improvement initiative. Prison healthcare staff performed opt-out HCV testing for all new residents at each prison within 7 days of arrival, and those who were positive for HCV RNA were offered treatment with direct-acting antivirals (DAAs). The Hepatitis C Trust provided peer support for all residents on treatment and those who were released into the community. Of 107,260 new arrivals, 98,882 (92.2%) were offered HCV antibody testing, 63,137 (63.9%) were tested and 1,848 were treated. Testing rates increased from 53.7% in Year 1 to 86.0% in Year 3. Between May 2020 and October 2021, 40,727 residents were tested, 2,286 residents were positive for HCV antibodies and 940 residents were HCV RNA positive, giving an antibody prevalence of 5.6% and an RNA prevalence of 2.3%. A total of 921 residents were referred for treatment and 915 initiated DAA treatment (97.3% of whom were HCV RNA positive). This initiative showed that an opt-out HCV test and treat initiative in prison receptions is feasible and can be adapted to the needs of individual prisons as a viable way to achieve HCV micro-elimination. Prisons represent an area of high HCV prevalence and so initiatives that improve testing and treatment of residents are needed to eliminate HCV from prisons. The reception testing protocol improved HCV screening in new arrivals across 47 prisons in England and could be a viable way for countries to achieve HCV micro-elimination in their prison systems. The reception testing protocol presented here can be adapted to the individual needs of prisons, globally, to improve HCV screening and treatment in this setting.

Judiciarisation of the mentally ill and/or mentally incapacitated in the Malawi criminal justice system: Gaps and flaws of human rights protection

Rates (where recorded) of mental illness, intellectual disabilities and co-morbidities are disproportionately high and rising among global prison populations. There is little data on the extent of mental illness and/or mental incapacity in prison populations in the Global South. Criminal justice systems are generally under-resourced, with a lack of adequate forensic monitoring, availability of specialist psychological and psychiatric expertise, and system coordination with mental health treatment and support services.Very little is known with regard to the judiciarisation of the mentally ill and/or mentally incapacitated in African criminal justice systems. In this Commentary we focus on Malawi, as a least developed country in sub-Saharan Africa. We present the international human rights framework pertinent to the judiciarisation of people with disability, the global discourse around disability-neutral doctrines and the contentiousness of the link between mental and legal capacity. We discuss challenges and procedural complexities in the Malawi criminal justice system as it relates to how people with mental illness and/or mental incapacity navigate the process and to what extent their basic human rights are upheld.Mental health legislation and policies to uphold the rights of the mentally ill and/or mentally incapacitated in the criminal justice system are underdeveloped (and under-resourced). There are backlogs in forensic assessments to determine competency to stand trial and criminal responsibility; inadequate availability of forensic beds; and insufficient coverage of community and prison based mental health services. Lengthy detention periods in overcrowded unsafe conditions are common, with little or no access to specialist medical care.We present medico-legal and clinical recommendations for enhanced human rights monitoring and protections cognisant of the various challenges in ensuring the implementation of human rights and of due process in Malawi. We encourage the government to consider formal diversion options via mental health courts and invest in the capacity of forensic specialists and hospitals to support court assessments and community care. Oversight mechanisms preventing human rights abuses of these very vulnerable individuals are crucial in all mental health settings in Malawi, not limited to police custody, remand detention facilities and prisons. Ratification of the Optional Protocol of the Convention against Torture is imperative.

Prescription drugs with potential for misuse in Irish prisons: analysis of national prison prescribing trends, by gender and history of opioid use disorder, 2012 to 2020

BackgroundPharmacotherapy is essential for the delivery of an equivalent standard of care in prison. Prescribing can be challenging due to the complex health needs of prisoners and the risk of misuse of prescription drugs. This study examines prescribing trends for drugs with potential for misuse (opioids, benzodiazepines, Z-drugs, and gabapentinoids) in Irish prisons and whether trends vary by gender and history of opioid use disorder (OUD).MethodsA repeated cross-sectional study between 2012 and 2020 using electronic prescribing records from the Irish Prison Services, covering all prisons in the Republic of Ireland was carried out. Prescribing rates per 1,000 prison population were calculated. Negative binomial (presenting adjusted rate ratios (ARR) per year and 95% confidence intervals) and joinpoint regressions were used to estimate time trends adjusting for gender, and for gender specific analyses of prescribing trends over time by history of OUD.ResultsA total of 10,371 individuals were prescribed opioid agonist treatment (OAT), opioids, benzodiazepines, Z-drugs or gabapentinoids during study period. History of OUD was higher in women, with a median rate of 597 per 1,000 female prisoners, compared to 161 per 1,000 male prisoners. Prescribing time trends, adjusted for gender, showed prescribing rates decreased over time for prescription opioids (ARR 0.82, 95% CI 0.80–0.85), benzodiazepines (ARR 0.99, 95% CI 0.98–0.999), Z-drugs (ARR 0.90, 95% CI 0.88–0.92), but increased for gabapentinoids (ARR 1.07, 95% CI 1.05–1.08). However, prescribing rates declined for each drug class between 2019 and 2020. Women were significantly more likely to be prescribed benzodiazepines, Z-drugs and gabapentinoids relative to men. Gender-specific analyses found that men with OUD, relative to men without, were more likely to be prescribed benzodiazepines (ARR 1.49, 95% CI 1.41–1.58), Z-drugs (ARR 10.09, 95% CI 9.0-11.31), gabapentinoids (ARR 2.81, 95% CI 2.66–2.97). For women, history of OUD was associated with reduced gabapentinoid prescribing (ARR 0.33, 95% CI 0.28–0.39).ConclusionsWhile the observed reductions in prescription opioid, benzodiazepine and Z-drug prescribing is consistent with guidance for safe prescribing in prisons, the increase in gabapentinoid (primarily pregabalin) prescribing and the high level of prescribing to women is concerning. Our findings suggest targeted interventions may be needed to address prescribing in women, and men with a history of OUD.

Dementia and the prison population: identifying need.

Older adults are the fastest growing group within the UK prison population yet there continues to be a lack of national strategy to ensure consistent care is provided to this group, in line with the general population. The number of older adults with dementia is also rising globally however the prevalence of dementia in prisons remains largely unknown. The impact of dementia on older adults in prison is also largely unexplored. Subsequently a review by Brooke et al. 2020 was undertaken to identify prevalence of dementia in the UK prison population and to explore how such prisoners are assessed, diagnosed, treated and supported. This article critically appraises and evaluates the systematic review by Brooke et al. 2020, and expands upon the findings in context to practice.

Prioritizing Diversion and Decarceration of People With Dementia.

An aging prison population means more people who are incarcerated will experience dementia and related symptoms (eg, cognitive impairment, behavioral outbursts, poor impulse control). This article canvasses clinical and ethical complexities of caring for people with dementia who are incarcerated and examines how to adapt carceral settings to better meet the needs of people with dementia. This article also recommends policy reforms, such as treatment-based diversion programs, early parole, and medical release, to decrease numbers of individuals with dementia who are incarcerated whenever possible.

가석방 없는 종신형의 입법과 그 정당성 고찰

In recent years, there has been an increase in citizens’ anxiety about violent crimes due to ‘abnormal motives’ resulting in murders and indiscriminate violent crimes. As one of the measures, the government (Ministry of Justice) is seeking to establish a so-called “Life imprisonment without parole”.
 However, there has not been sufficient discussion and social consensus on issues such as whether the system contributes to reducing the rate of violent crime over the introduction of life imprisonment without parole, whether it may violate the Constitution, which values human dignity as the highest value, by fundamentally blocking prisoners’ rehabilitation, improvement, and rehabilitation into society, and whether it increases medical and administrative costs due to overcrowding in prisons and the increase in the number of elderly prisoners.
 In this paper, while keeping in mind the relationship between life imprisonment and the death penalty, we provide an overview of the legislation and application of life imprisonment in the United States, and examine the problems of life imprisonment based on the results of recent important research on life imprisonment. Based on these findings, we examined the legitimacy of the “life sentence without parole” that the Ministry of Justice is currently seeking to introduce.
 Many states in the United States either introduce life imprisonment without parole after abolishing the death penalty, or still retain the death penalty after introducing life imprisonment without parole. Life imprisonment is also applied to non-murder offenses. However, recent legislation and precedent recognize life imprisonment without parole as a cruel punishment with the same characteristics as the death penalty. In other words, life imprisonment without parole places all the blame on criminals, deprives them of hope of rehabilitation and seriously undermines their dignity and humanity as human beings.
 In conclusion, when examining penal reforms, including the abolition of the death penalty, countries with the rule of law should always take humanitarian and human rights considerations as the criteria for the purpose of modern punishment: rehabilitation into society. However, life imprisonment without parole cannot contribute to the realization of the purpose of modern punishment, which is to humanize, rehabilitate, rehabilitate, and resocialize punishment. Therefore, the introduction of life imprisonment without parole as an alternative and sub-sentence to the death penalty should be avoided.

Derecho Penal y Políticas de Seguridad en Ecuador: Análisis de la Eficacia

The analysis of the effectiveness of Ecuador's criminal law and security policies highlights both advances and persistent challenges in the fight against crime. Legislative reforms between 2021 and 2023 focused on increasing penalties for violent crimes, implementing stricter laws against organized crime, and aligning legislation with international standards. Although these measures have shown positive results, such as a reduction in robberies and kidnappings in certain areas, the perception of insecurity among the population remains high. Police training and professionalization have improved their competence, but the lack of coordination between government and judicial entities limits the effectiveness of security policies. Socioeconomic and cultural factors, such as economic inequality, insufficient education and prevention programs, and the normalization of violence, also play a crucial role in perpetuating crime. Prison overcrowding, lack of rehabilitation and reintegration programs, and corruption in the judicial system are additional challenges. The adoption of modern technologies offers opportunities to improve the effectiveness of the criminal justice system but requires careful implementation and protection of privacy rights.

Hepatitis C virus point-of-care RNA testing: Experience from screening an entire high-security Australian prison population over 3 days

ObjectivePoint-of-care testing for hepatitis C virus (HCV) in high-risk populations is key to diagnosing and eliminating HCV. We aimed to test all occupants for HCV in an entire prison. MethodsAll consenting participants at the Brisbane Women’s Correctional Centre were tested for HCV over 3 days using fingerstick samples. Participants with HCV were linked to care by a Nurse Practitioner experienced in HCV management. Results211 of 244 participants of the prison population at the time (86%) consented and were tested. 17 participants (8%) had HCV, of who 14 commenced antiviral therapy ≤1 week of testing, 1 was later approved for antiviral therapy in consultation with a physician, and 2 due for release were followed-up and linked to care in the community. Education and counselling provided before testing was rated as very good or excellent by 47% of participants. ConclusionsTesting occupants in a high-security prison of this size is feasible and can provide an overview of HCV infectivity. Testing combined with linkage to care will support the elimination of HCV in this high-risk population. Implications for public healthPoint-of-care testing for HCV in prisons with dedicated clinicians, resources, and partnerships, particularly at prison entry, can contribute to eliminating HCV in Australia by 2030.

Dementia care behind prison walls: A descriptive study understanding nurse’s knowledge and educational needs

Aim/objectiveTo establish correctional nurses’ dementia knowledge base and identify their educational needs related to caring for prisoners with dementia. BackgroundThe aging prison population is growing, posing a heightened risk of dementia among older inmates. This study examined the knowledge and perceived educational needs of nurses caring for prisoners with dementia. DesignA descriptive study which was qualitative in nature was undertaken. MethodsData was collected using an online survey which included Demographics, the Dementia Knowledge Assessment Tool 2 and open-ended questions. Descriptive statistics such as percentages and frequency were used to analyse the quantitative data and a qualitative analysis was undertaken to identify common themes and extract meaningful insight from the open-ended questions. ResultsNurses showed a general understanding of dementia and its environmental impact but lacked knowledge of late-stage changes. Eight main themes relating more broadly to the environmental and staffing challenges faced by nurses are presented. ConclusionAlthough participants appeared to have a reasonable dementia knowledge base the study highlights the need for specific dementia education and support focussed on the correctional setting and collaborative partnerships with dementia experts in the community.

An Empirical Examination of the In-Prison Behaviors of Foreign-Born Individuals: Does Nationality Predict Misconduct?

The current study investigates how immigrants cope and adapt to the “pains of imprisonment” by examining a specific maladjustment outcome—disciplinary infractions. Like other groups (e.g., females, LGBTQ, elderly), immigrants are regarded as a special population in prison considering that they encounter a unique set of challenges that the typical incarcerated person does not. At the same time, immigrants are not a monolithic group, and there are reasons why misconduct may differ when we separate them by country of birth. To this end, we explore whether the frequency and probability for institutional misconduct varies across Cubans, Puerto Ricans, Haitians, Jamaicans, Mexicans, as well as immigrants from other countries. We also consider whether any nationality group exhibits a higher (or lower or similar) propensity for in-prison offending than the native-born. Our results reveal there are greater differences in disciplinary infractions among our foreign-born groups than between them and natives, a finding that is obscured when immigrants are lumped into a single measure (i.e., all foreign-born).

Between Democratic Modernization and Authoritarian Punitiveness in Brazil: Mass Incarceration, Political Rationalities and the Dynamics of Subnational Variation

Abstract Since the return to democracy in the 1980s, the Federal government in Brazil promoted the democratic modernization of the criminal justice apparatus. However, the arrival of a post-neoliberal government to the federal administration at the beginning of the century took place simultaneously with the emergence of mass incarceration. Rather than readily blaming their penal policies for this development, the present work addresses aspects of subnational variation and different political rationalities for comprehending this increase in the prison population. The coexistence of neoliberal and post-neoliberal rationalities of governance around the country between 2007 and 2018 corresponded to significantly diverse trends in incarceration at the state level, in which neoliberal governments played a more prominent role. Besides, authoritarian punitiveness has acted as an obstacle to the modernization of crime and punishment practices and institutions throughout this period. The resurgence of authoritarianism as an autonomous political rationality in the 2018 elections reconfigured policies and attitudes in the field, mostly by reversing past modernizing efforts.

Cheap on Punishment: Examining the Impact of Prison Population Racial Demographics on State-Level Corrections Spending

Research has explored the effects of various state-level characteristics, such as racial composition and economic conditions, on correctional budgetary decisions. However, researchers have yet to consider how the racial makeup of state prison populations themselves may impact subsequent corrections spending decisions. Drawing on work suggesting that people of color are simultaneously over-punished and neglected by criminal justice systems, and utilizing a time-series cross-section analysis of 50 states from 1979 through 2017, we explore differences in state budgetary allocations for correctional expenditures based on the racial demographics of prison populations. We find that the relationship between the Black-to-White incarceration ratio and spending on corrections is curvilinear: once a tipping point of Black-to-White incarceration is reached, spending on corrections decreases. This finding is especially pronounced in Southern and Midwestern states. Overall, our results provide a strong starting point for understanding the ways in which Black Americans are neglected in the incarceration setting.

Substance Use Disorder and Prison: Special Focus on Opioid Dependence

Incarceration and substance use disorder (SUD) are closely related. SUDs are associated with almost all the steps of incarceration, and also with recidivism. In this narrative review, we will evaluate the existing evidence regarding the prevalence of substance use, and the efficacy of comprehensive management of SUD in prison settings. The prevalence of substance use is significantly higher in the prison population around the world. The criminalization of substance use aggravates the situation and also limits treatment access. There is a dearth of research on SUD s in low- and medium-income countries including India. Evidence suggests effective management of SUD in prison settings can improve quality of life, reduce high-risk behavior, and minimize post-discharge overdose deaths in patients with opioid dependence. Effective withdrawal management and maintenance therapy including opioid substitution treatment should be available in a prison setting. Comprehensive management of SUD in the prison population will ascertain the right of health for the prison population in particular and improve the well-being of society as a whole.

Estimates of Hepatitis C Seroprevalence and Viremia in State Prison Populations in the United States.

Prior studies demonstrate that eliminating hepatitis C virus (HCV) in the United States (US) heavily depends on treating incarcerated persons. Knowing the scope of the carceral HCV epidemic by state will help guide national elimination efforts. Between 2019 and 2023, all state prison systems received surveys requesting data on hepatitis C antibody and viremic prevalence. We supplemented survey information with publicly available HCV data to corroborate responses and fill in data gaps. Weighting HCV prevalence by state prison population size, we estimate that 15.2% of the US prison population is HCV seropositive and 8.7% is viremic; 54.9% of seropositive persons have detectable RNA. Applying prevalence estimates to the total prison population at year-end 2021, 91 090 persons with HCV infection resided in a state prison. With updated and more complete HCV data from all 50 states, HCV prevalence in state prisons is nearly 9-fold higher than the US general population. The heterogeneity in HCV prevalence by state prison system may reflect variable exposure before arrest and/or differences in treatment availability during incarceration. Elimination of HCV in the country depends on addressing the carceral epidemic, and one of the first steps is understanding the size of the problem.

Pattern of non-suicidal self-injury in Chinese male prisoners: A latent class analysis.

Nonsuicidal self-injury (NSSI) occurs more frequently in the prisoner population than in the general population. Monitoring and management of this behavior is challenging because NSSI may present in diverse ways. People often use more than one method of NSSI, and there are many possible combinations of these behaviors. We used latent class analysis (LCA) to identify subgroups of male inmates based on methods and frequency of NSSI. A total of 1042 male prisoners in China (Mage = 38.45, SD = 10.67) completed measures of hopelessness, sensation seeking, identity integration, and suicidal ideation, and NSSI was assessed in a structured interview. Results of the LCA supported a three-class model: high-NSSI (1.8%), moderate-NSSI (8.0%), and no-or-negligible NSSI (90.2%). Multinomial logistic regression analyses showed that prisoners in the high-NSSI and moderate-NSSI classes were significantly more likely than those in the no-or-negligible NSSI class to show high hopelessness, high sensation seeking, and low identity. Furthermore, suicidal ideation was significantly higher in the high-NSSI and moderate-NSSI classes than in the no-or-negligible NSSI class. Classifying groups of prisoners based on features of NSSI is potentially useful for understanding risk factors and for developing tailored prevention and treatment strategies.

Opioid Misuse and Associated Health Risks among Adults on Probation and Parole: Prevalence and Correlates 2015–2020

Background As state legislatures work to reduce prison populations and increase the use of community-based alternatives, limited knowledge exists about the service needs of those under criminal justice supervision in the community. Preliminary research indicates unusually high rates of disease, disability, and death. Health risks for this population include opioid misuse, a form of substance misuse that has reached epidemic proportions in the U.S. Evidence indicates this may be one of multiple epidemics this population experiences, complicating intervention. Methods Our study included 5154 individuals on probation or parole. Using 2015–2020 data from the National Survey of Drug Use and Health (NSDUH), we conducted a series of logistic regressions examining associations between opioid misuse and a range of health risks, controlling for sociodemographic variables and survey year. Results Approximately 17% of those on probation or parole indicated past-year opioid misuse, a rate 4 times higher than in the general population. Compared to those on probation and parole who did not misuse opioids, it was associated with higher odds of other health risk behaviors and mental health problems. For example, the odds of marijuana and cocaine use were 4-6 times higher and the odds of substance use disorder were 10 times higher. Similarly, the odds of experiencing major depressive episodes and serious psychological distress were 2–3 times higher. Conclusions Our findings reveal a markedly high risk for opioid misuse within this population along with associated risks for behavioral and mental health problems. The complex treatment needs of this population require greater policy attention and further research.

Enriching Prison Environments via Peer-Led Activities.

Criminologists have long claimed that states of deprivation engendered by restrictive prison environments account for much of the problematic behavior that occurs there. It is logical to assume that any efforts to provide greater access to meaningful and appropriate activities may therefore serve to reduce such behavior by altering motivating operations for misconduct and occasioning reinforcement for other types of behaviors. Given the higher rates of trauma exposure and other mental health issues in prison populations, considering trauma-informed practices in intervention design is prudent. The current study evaluated the effects of environmental enrichment via prisoner-selected, peer-led activities conducted during association times. We used direct observation to assess engagement, existing facility data collection to detect changes in problematic behavior, and prisoner and staff surveys to assess perceptions of the overall acceptability and effects of the intervention. Prisoners engaged with and led a range of activities, with the majority reporting positive effects on behavior, social relationships, and general well-being; staff responses were generally positive but more tempered. Institutional behavior records did not appear sensitive enough to detect treatment effects. We discuss the results in terms of integrating trauma-informed care into prison interventions and the need to develop more robust measures of behavior change.

Understanding the organisational influences on the quality of and access to primary care in English prisons: a qualitative interview study.

Primary care for routine healthcare conditions is delivered to thousands of people in the English prison estate every day but the prison environment presents unique challenges to the provision of high-quality health care. Little research has focused on the organisational factors that affect quality of and access to prison health care. To understand key influences on the quality of primary care in prisons. This was a qualitative interview study across the North of England from 2019 to 2021. Interviews were undertaken with 43 participants: 21 prison leavers and 22 prison healthcare professionals. Reflexive thematic analysis was undertaken. The overarching organisational issue influencing quality and access was that of chronic understaffing coupled with a workforce in flux and dependence on locum staff. This applied across different prisons, roles, and grades of staff, and was vocally discussed by both patient and staff participants. Intricately related to understaffing (and fuelled by it) was the propensity for a reactive and sometimes crisis-led service to develop that was characterised by continual firefighting. A persistent problem exacerbated by the above issues was unreliable communication about healthcare matters within some prisons, creating frustration. Positive commentary focused on the characteristics and actions of individual healthcare professionals. This study highlights understaffing and its consequences as the most significant threat to the quality of and access to prison primary care. Strategies to address health care affecting prison populations urgently need to consider staffing. This issue should receive high-profile and mainstream attention to address health inequalities.

The impact of the COVID-19 pandemic on TB diagnosis in the Brazilian prison population, 2020-2021.

BACKGROUND: TB is an infectious disease with a worldwide impact. TB is closely associated with social and housing conditions, exerting a significant impact on the prison population, which is particularly susceptible to the disease. Evidence suggests that the COVID-19 pandemic has exacerbated social vulnerability. This study therefore aimed to analyse the impact of the pandemic on the diagnosis of new cases of TB in the Brazilian prison population in the years 2020 and 2021.METHODS: This is an ecological study involving cases of TB recorded in the prison population of Brazil from 2015 to 2021. Data were collected from the Brazil's Information System for Notifiable Diseases.RESULTS: The incidence of TB in the prison population in Brazil fell from 1,005.9/100,000 population between 2015 and 2019 to 852.3/100,000 population between 2020 and 2021. In 2021, there was a deficit of 539 cases (-7.6%) compared to what was expected for the year. In 2020, there was a 10% reduction in TB diagnoses in January and February, reaching 3.8% in March. A negative percentage was observed in most of the subsequent months. In 2021, the year began with a 21.6% decline in January, returning to positive values only in August and September.CONCLUSION: The first years of the COVID-19 pandemic resulted in underdiagnosis of TB in the Brazilian prison population.

A Perspective on Using the Addiction Severity Index in Prison Populations

ABSTRACT Despite significant social efforts to reduce substance-related imprisonment, the United States prison population continues to have high percentages of individuals who suffer from substance use disorders. This already marginalized group continues to make up substantial portions of the incarcerated population. This perspective paper overviews the Alcohol Severity Index (ASI) and its use within incarcerated populations. It highlights several shortcomings of the assessment, including validity, time of the assessment, the window of detection, and individual inmate consequences due to high assessment scores. In addition, it advocates for change within the assessment process of substance use disorders within the prison population that would navigate toward better outcomes for both inmates and the prison system.