Prison Setting Research Articles

"What's the point of telling them?": Unspoken struggles of pregnant women with substance use history in Australian prisons.

A pilot study of SEE FAR CBT in prison settings: Effects on PTSD symptoms and recidivism rates

In 2021, a unique experience began in the Uruguayan prison system. A re-entry programme was created to work with a small group of inmates within the country’s biggest and most complex prison, Unit No. 4. Allocated in a specific sector, where space and mobility are managed with more freedom than in the rest of the prison, the pre-release programme aims at delivering specific interventions to reduce the chances of re-incarceration. The experience posed major challenges not only due to its novelty, but also due to a structural penitentiary crisis with severe human rights violations, high intra-prisoner violence, and a wider context of mass incarceration (with over 458 prisoners per 100,000 of the Uruguayan population) (Comisionado Parlamentario para el Sistema Penitenciario, 2024). Based on participant observation and interviews with 15 programme participants and 18 prison officers conducted in 2023 and 2024, this article focuses on the spatial organisation of the sector and the contradictions and challenges associated with developing a technical intervention that seeks to dispute the dominant practices, customs, and material conditions of a peripheral and extremely complex prison. By discussing the examples of collective activities, supervision styles and carceral porosity, we show how space is fundamental to understanding how programmes are implemented and developed, through a situated analysis of an Uruguayan prison setting.

Increasing numbers of people require palliative end-of-life care (PEOLC) within prison settings, mainly because of aging populations and increasingly long sentences. There is limited research in this area, but evidence suggests that prisons possess limited resources to provide adequate care for aging and frail people at the end of life. This study aimed to explore how PEOLC is provided in prisons in different countries and identify factors that facilitate or impede its provision. A cross-sectional qualitative study using semistructured interviews was utilized to interview prison and health care staff involved in the organization and/or delivery of PEOLC to incarcerated adults in six countries. Sampling was purposive and adopted a snowball technique. Data were analyzed using framework analysis. This study provides evidence that numerous barriers exist that can impede the organization and delivery of PEOLC to people in prison, including barriers at the individual, staff, organization, and regulatory levels. Facilitators coexisted alongside the barriers. Similar barriers and facilitators were identified in each country. Despite some good practices, multiple challenges remain in providing the same quality of PEOLC that is available outside prison, and thus, those dying in prison continue to be disadvantaged.

People from ethnically minoritised backgrounds are significantly over-represented within the criminal justice system, as are those with personality difficulties. The offender personality disorder pathway offers services for people with personality difficulties associated with serious offending and aims to work in a culturally attuned way with individuals from ethnically minoritised backgrounds. To establish a baseline of how culturally informed formulations are within our services. Twenty-one formulations from community services were audited, and two audits of 23 and 24 formulations, respectively, were carried out in our custodial service. Training was implemented between these two audits. Formulations were audited using two tools: the London Pathways Partnership (LPP) formulation audit tool and the London Pathways Unit (LPU) culturally informed formulation (LPU-CIF) audit tool. The latter was not used in the community audit. There was a broad range of means on the LPP formulation audit tool and the LPU-CIF and both were below adequacy. There was a narrower range of scores on the LPU-CIF. The LPU-CIF scores increased across all items between the two audits but were below the threshold of adequacy. The audits suggest that formulations across both services are easily understood, psychologically informed and include developmental histories. However, they do not adequately consider people's cultural experience and protected characteristics. Although not without limitations, these audits highlight a need for further training to develop staff's confidence and competence when developing formulations for people under our service.

ABSTRACT The prevalence of HIV among individuals who experience incarceration is estimated to be three times higher than that of the general population in the United States. Currently, the standard of care, antiretroviral medications taken daily, is effective in reducing mortality and HIV transmission but individuals experiencing community re-entry face barriers while re-integrating with their community which may make adherence to daily medication challenging. Long acting injectable antiretroviral treatment (LAI ART) may offer an opportunity for individuals experiencing community re-entry to remain in treatment while prioritizing their other needs. Our team conducted 16 interviews with various staff in both community and carceral settings pertaining to the potential administration of LAI ART in prison settings with treatment continuing while individuals are experiencing community re-entry. Many participants were supportive of administering LAI ART in this population, but challenges related to ensuring continuation of care, access to clinics, and the lack of resources in health settings were frequently cited as potential barriers.

ABSTRACT Background: Exposure to potentially morally injurious events (PMIEs) can contribute towards serious mental disorders. Prisons are uniquely challenging environments where staff must fulfil competing roles of security, care, and rehabilitation. Currently no manualised intervention for moral injury-related distress exists for prison staff. Here we describe the ‘Co-designing a program for Addressing staff wellbeing and Reducing moral injury Experiences’ (CARE) study protocol, which aims to co-develop an intervention to prevent and respond to moral injury-related ill health. Methods: Data will be collected from current and ex-prison staff. Current staff will be recruited from at least three prisons across the UK. We will survey a cross-section of prison staff exploring the prevalence of PMIEs and the impact of exposure on wellbeing, before carrying out qualitative interviews to explore the lived experiences staff moral injury. In addition, we will conduct interviews with ex-prison staff to understand the impact of PMIEs on wellbeing. These data will feed into the co-design of an intervention programme, designed to reduce distress among staff with PMIEs. Further feedback on the programme protocol will be sought from interview participants to ensure the co-developed programme is acceptable, and feasible to implement in future. Results: Quantitative staff survey data will be cross-sectional and will be analysed using multilevel regression models to explore associations between relevant factors. Qualitative data will be analysed using thematic analysis. Conclusions: Dissemination will include presentations at conferences, publication in academic journals, and free training events. By providing information about prison staff experiences, findings will not only inform the development of an evidence-based approach for staff in prison settings affected by moral injury but may also help inform broader approaches to providing support to other high-risk occupational groups.

Literature on drug recovery programs has mostly emanated from the West, and there is a dearth of literature on drug treatment from a gender perspective. This study aims to contribute to these gaps by examining gender differences in the impact of drug counseling programs for drug offenders in the Philippines. This study consisted of 246 persons incarcerated for drug use who participated in a drug counseling program as part of their plea-bargaining agreement. Participants came from 19 jail facilities in six regions in the Philippines. The Katatagan, Kalusugan at Damayan ng Komunidad (resilience, health and care in community) for persons deprived of liberty program consisted of drug recovery, life skills and family modules. The sessions were facilitated by trained jail personnel who delivered the program in small groups, conducted once a week for up to six months. The study used a cohort design and administered pre- and post-test surveys before and after the program. Structural equation modeling was used to test the program's theory of change. As hypothesized, the active ingredients (recovery skills, life skills and family support) were positively associated with psychological well-being, perceived quality of life and intent not to use. The active ingredients were negatively associated with substance use disorder symptoms. Analysis of variance revealed the interaction between time and gender for recovery skills, life skills, family support, well-being, intent to refuse and substance use disorder symptoms. The program had a greater effect size among female participants compared to males. The cohort design does not allow for causal generalizations on the impact of the program. Future studies using randomized control trials and longitudinal designs post incarceration are needed for more robust conclusions on the impact of the program. In addition, the program was created primarily to treat drug use and does not include those involved in drug distribution or manufacturing. More research is needed to address this population and identify appropriate interventions to avoid recidivism. Majority of those incarcerated in the Philippines are because of drug charges. The study is the first in the Philippine prison setting examining gender differences in outcomes of a drug rehabilitation program. It suggests the viability of implementing a treatment program for persons who use drugs in detention facilities. In many countries, drug use is treated as crime. However, more than punishment, the study suggests the viability of reformation in detention facilities. These can potentially prevent recidivism and provide individuals the skills they need to achieve greater quality of life after incarceration. The study validated the importance of recovery skills, life skills and family support in the rehabilitation of drug offenders. Significant gender differences in the impact of the program highlight the importance of using a gender lens in implementing and evaluating drug recovery programs in jails.

Abstract Socially marginalised populations-including people in prison, migrants, and individuals facing social exclusion-experience a disproportionate burden of infectious diseases and often remain invisible in public health surveillance. Although behavioural responses to outbreaks are critical to epidemic dynamics, these groups are frequently excluded from both traditional and digital monitoring systems, limiting the scope and equity of behavioural surveillance. This presentation reflects on how structural barriers-such as poor data interoperability, the fragmentation of health records between institutional and community systems, and the lack of standardised indicators-affect our ability to monitor behaviours and design responsive interventions for high-risk populations. Using the prison setting as a case study, it explores how surveillance gaps compromise real-time insight into behavioural trends during outbreaks and perpetuate health inequities. Building on insights from the COVID-19 response, the presentation also considers how rapid improvements in data integration and monitoring were achieved when public health urgency aligned with political will. This offers lessons for building more inclusive systems that systematically collect and use behavioural data across all segments of the population. Closing these gaps is not only a matter of health equity but a prerequisite for effective and resilient epidemic preparedness. Behavioural surveillance must be designed with inclusion in mind-from data infrastructure to participation models-so that no group is left behind in public health decision-making.

Abstract In contexts marked by vulnerability, marginalisation, or structural exclusion, populations such as people in prison, migrant women, and youth living in under-resourced settings often experience barriers to health care. These groups often face overlapping social determinants that exacerbate health inequities, while also remaining underrepresented in the design of health interventions. This workshop aims to explore novel approaches in mental health care research and how they can contribute to the promotion of health, mental well-being, and inclusion in diverse vulnerable settings. The objective is to share research insights and experiences, reflect on methodological and ethical considerations, and discuss the potential of these approaches to inform research, practice, and policy in public health. The added value of this workshop lies in its focus on tools that facilitate the interpretation of participants’ realities and inner worlds. They uncover specific experiences of groups in vulnerable conditions that are often excluded from standardized health interventions, thus enriching the understanding of health needs and broadening the scope of public health. The workshop brings together four studies that apply diverse methodologies in contexts marked by structural vulnerability and social marginalisation. The first presentation investigates the perceived availability of health care services and its associations with sociodemographic and health factors from the perspective of persons living in a rural area in Northern Germany. The second presentation provides important insights into the role of the arts in the promotion of mental health outside of clinical settings. The third presentation is about the 10306 helpline in Greece, which integrates immediate crisis support, structured short-term therapy and coordinated referral pathways. The fourth presentation is dedicated to the international Joint Action Programme JA ImpleMENTAL, which has supported numerous countries in the transition to community-based mental health care. The fifth presentation draws on the Erasmus+ funded project PARTNER, which applies participatory future-oriented thinking in prison settings. The workshop will follow an interactive format. Following the presentations, a moderated discussion will highlight cross-cutting themes such as methodological challenges, contextual adaptation, and implications for public health practice. The final part will engage the audience in a participatory reflection, with the goal of generating shared insights and recommendations for the integration of participatory approaches in public health strategies. Key messages • Innovative methods help uncover unmet mental health care needs in vulnerable populations. • In order to be more inclusive, equitable and responsive to structural vulnerability, adaptations of systems and services are needed in future health care.

The tenth anniversary of the Strategic Plan for Addressing Hepatitis C in the National Health System (PEAHC) is a milestone in Spanish healthcare, consolidating the country as a global leader in the fight against this disease. In these ten years it has been demonstrated that a well-structured strategy can transform a health crisis into an opportunity, reducing the prevalence of active hepatitis C virus (HCV) infection in the general population from 1.2% (95% CI: 0.3%-1.8%) in 2014 to 0.12% (95% CI: 0.03-0.24) in 2022, achieving a cure rate greater than 94% in the more than 172,000 patients treated with direct-acting antivirals until 2024, a marked and sustained improvement in all morbidity and mortality indicators in the last decade such as the reduction from 32% in 2015 to 7% in 2024 of patients with HCV on the waiting list for liver transplant. Reductions in active HCV infection among people living with the human immunodeficiency virus, people who inject drugs (PID), and people in the prison setting have been spectacular. Key factors ensuring success have been political commitment and sustainable funding, integrated Public Health strategies for the primary prevention of new HCV cases (improvements in health care safety, transfusion safety, risk and harm reduction programs for PID), a universal public health system that ensures equitable access to treatment, decentralized tasks and, finally, interinstitutional coordination.

Abstract Health and well-being are understood as multidimensional, shaped by social, cultural, and emotional factors as well as healthcare services. In contexts marked by vulnerability, marginalisation, or structural exclusion, populations such as people in prison (PIP), refugees, and youth in under-resourced settings often face overlapping barriers to health equity and remain underrepresented in the design of health interventions. In this context, participatory methods that incorporate creative expression - such as storytelling, active techniques, photography, and collective future thinking - offer tools to engage individuals in articulating their experiences of distress, resilience, and well-being. These methods encourage individuals to express themselves, their needs and their experiences, which are essential to culturally sensitive, contextually relevant and responsive interventions for structurally marginalised populations. This workshop explores how these methods contribute to health, well-being and inclusion in diverse vulnerable settings. The objective is to share experiences, reflect on methodological and ethical considerations, and to discuss the potential of these approaches. The added value of this workshop lies in its focus on tools that facilitate the interpretation of participants’ own realities and inner worlds. These methodologies improve psychological well-being and support socio-emotional learning. They also uncover experiences of groups often excluded from standardised health interventions, enriching the understanding of health needs and broadening the scope of public health. The workshop presents four case studies applying participatory methodologies in contexts of structural vulnerability. The first explores the use of psychodrama with adolescents and young adults in Beira, Mozambique, through a project by Doctors with Africa-CUAMM. This approach uses collective enactment to foster emotional expression, build resilience, and strengthen group dynamics. The second draws on the Erasmus+ funded PARTNER project, which applies participatory futures thinking in prison settings. Through co-creative laboratories, PIP reimagine life trajectories and reflect critically on time, agency, and care. The third focuses on a photography project implemented by RedLab with adolescent refugees in Iraqi Kurdistan. The workshops facilitated self-narration and group dialogue, promoting emotional awareness and community connection. The fourth discusses participatory methods used in a project with Roma women in Greece to promote cervical and breast cancer screening and HPV vaccination, alongside health education. The session will conclude with a reflective exercise, inviting participants to respond to a shared prompt on applying expressive methods in their own contexts. This exchange will surface common challenges, tensions, and enablers, and support the co-development of insights for integrating participatory approaches into public health strategies. Key messages • Participatory methods amplify voices often excluded from public health and foster culturally responsive, equity-oriented interventions. • Creative expression strengthens mental well-being, collective reflection, and community-driven solutions in vulnerable contexts.

Correctional higher education programming remains one of the most effective strategies for reducing recidivism and promoting long-term public safety. Despite this, many associate and bachelor’s degree programs offered within correctional facilities focus heavily on academic content while failing to integrate structured reentry preparation. This article, written from the perspective of a professor who teaches within the prison system, argues for the intentional embedding of reentry education into existing degree programs to better prepare incarcerated students for life after release. Drawing on extensive experience teaching thousands of incarcerated individuals, this article examines the challenges and opportunities involved in curriculum development within the technological and institutional limitations of prison settings. It also highlights the value of engaging incarcerated learners in the co-creation of reentry-focused content to ensure relevance and impact. Additionally, it outlines practical strategies for supporting students during the critical post-release transition, including case management, mentorship, and academic continuity. The article concludes with actionable recommendations for educators, correctional administrators, policymakers, and academic institutions seeking to improve reentry outcomes. By integrating academic and reentry preparation, correctional education programs can empower justice-impacted learners to achieve personal success while contributing to safer, more equitable communities.

ObjectiveMalawi’s prisons are overcrowded, contributing to tuberculosis (TB) and Human Immunodeficiency Virus (HIV) transmission and service delivery gaps for both conditions. We applied an empirically supported three-stage model of HIV/TB care to guide the improvement of TB/HIV service delivery in select Malawian prisons.DesignWe conducted a pilot implementation research study using multimethods from May 2022 to April 2023.SettingTwo semi-urban prisons in Malawi.ParticipantsWe purposively sampled participants detained at the study sites during the study period.Methods and interventionWe collected data on sociodemographics, medical history and screening results for sexually transmitted infections (STIs), HIV and TB results. We conducted in-depth interviews with prison professional staff and used content analysis to explore the feasibility of implementing the three-stage model of HIV and TB care in Malawian prisons.ResultsMean participant age was 35 years (SD 12.2 years). We screened 100 out of 647 (15%) incarcerated people for TB/HIV according to the three-stage model and identified the following: five cases of TB disease; two cases of HIV-associated TB; seven persons living with HIV; eight persons diagnosed and treated for STIs, including genital ulcer disease and syphilis. For those tested for HIV at entry, midpoint and exit screening, there was no documented case of seroconversion during the incarceration period. There was evidence of potential STI transmission during incarceration, as suggested by a 4% rate of new urethral discharge among participants. Qualitative data suggest that it is feasible to implement the three-stage model of HIV/TB in the Malawi prison setting.ConclusionsWe found evidence of HIV, TB and STIs among incarcerated people in two semi-urban prisons in Malawi, with low HIV status awareness on prison entry. It is feasible to implement the three-stage model of HIV/TB in prison settings, although with material support to overcome implementation challenges. Coordination with Ministry of Health officials could facilitate model feasibility and sustainability in Malawi’s prisons.

BackgroundPeople living in prison face exceptionally high prevalence rates of tooth decay, periodontal disease, and poor oral health-related quality of life. Despite its importance, various aspects of oral healthcare in prison settings remain understudied. The present study investigates the barriers and facilitators associated with providing and utilizing oral health services in prison settings, drawing on insights from prison health experts, managerial and custodial staff, healthcare providers, and individuals with lived experience of imprisonment.MethodsFrom March to June 2023, a total of fifteen participants participated in semi-structured in-depth interviews. Interviews were conducted until data saturation to identify barriers and facilitators of oral health services in prisons. Potential areas for improvement were also explored. Thematic analysis was used to analyze the data. Themes and sub-themes were derived from the dataset and converted into preliminary codes which aligned with research objectives.ResultsThe first topic, barriers, included two themes: organizational barriers related to the provision of services, and individual barriers related to the utilization of services. The second topic, facilitating factors, included six themes: funding, community partnership, substance use treatment, communicating with policy makers, transportation, and education.ConclusionEnsuring the oral health of incarcerated individuals is a fundamental aspect of their right to health and a crucial factor in their successful reintegration into society. Formerly incarcerated people are often hard to reach in the community, making the period of confinement a unique opportunity to deliver quality oral healthcare. Given that most incarcerated individuals will eventually return to their communities, providing comprehensive healthcare, including oral health interventions, represents a valuable public health investment.Supplementary informationThe online version contains supplementary material available at 10.1186/s12889-025-24447-9.

Introduction Prison population is particularly vulnerable to communicable diseases, including vaccine-preventable infections [1], due to various factors such as low social distancing, high turnover rates, and a high proportion of migrants [2]. However, vaccination coverage among people living in prison (PLP) remains low, largely due to limited access to healthcare services, low levels of vaccine literacy and general health literacy [3]. Additional challenges include persistent vaccine hesitancy and widespread distrust in institutions. Objectives As part of the RISE-Vac project—co-funded by the 3rd EU Health Program—we developed and implemented an evidence-based educational program aimed at boosting vaccination rates in both PLP and prison staff (PS) and evaluated the effect of the intervention on vaccine hesitancy, vaccine literacy and vaccine attitude. Methods We conducted a cross-sectional non-randomised study in 24 prisons of 6 European countries. The sample included 782 PLP and 717 PS members. In participant prisons, an educational program about vaccination for preventable infection diseases was implemented; for PLP, the program consisted in the distribution of educational material (leaflet and a short video) and/or an educational event; for PS, it consisted in a 4-hours online course. Within the study sample, 387 from PLP (49%) and 285 from PS (40%) undertook the intervention. Vaccine hesitancy was measured through a scale previously validated in a sub-cohort of participants – in the following referred to as pre-test [4]. A structured questionnaire was administered to measure vaccine literacy, general health literacy and socio-demographic characteristics of participants. Vaccine attitude was determined as the willingness to accept a vaccine if offered. Linear regression model was applied to assess the effect of the intervention and pre-test on vaccine and general health literacy and vaccine hesitancy. Logistic regression was applied to assess the association between the intervention and pre-test on vaccine attitude. All analyses were stratified by group (PLP and PS) and adjusted for socio-demographic variables. Mediation analysis was conducted to quantify the proportion of the effect of the intervention on vaccine attitude mediated by vaccine hesitancy, adjusting for pre-test and socio-demographic variables. Results In both PLP and PS, the intervention was associated with higher levels of vaccine literacy and stronger associations were observed among those who undertook the pre-test (PLP: interaction between pre-test and intervention, p=0.03; intervention, p=0.005 and p<0.001 in the non-pre-test and pre-test group respectively; PS: interaction, p<0.001; intervention, p=0.02 and p<0.001 in the non-pre-test and pre-test group respectively). In PLP, the intervention was inversely associated with vaccine hesitancy only in those who did not take part of the pre-test but not in the others (interaction, p=0.02; intervention, p<0.001 and p=0.22 in the non-pre-test and pre-test group respectively). In PS, no significant interaction was observed between the intervention and pre-test (p=0.11); the intervention was significantly associated with lower vaccine hesitancy (p=0.002). In both PLP and PS, the intervention was significantly associated with a positive vaccine attitude toward vaccination with no significant interaction with pre-test: in PLP, OR=5.21 (95% CI: 2.74 to 9.91); in PS OR=2.52 (95% CI: 1.54 to 4.13). Finally, mediation analysis showed that less than 30% of the effect of the intervention on vaccination attitude was mediated by a reduction in vaccine hesitancy (24% with p<0.001 and 28% with p=0.002 in PLP and PS respectively). Conclusion Evidence-based educational interventions are effective in improving vaccine hesitancy and vaccine literacy among PLP and PS. Also, they enhance the willingness of participants to be vaccinated, through a mechanism that is only partially explained by their effect on vaccine hesitancy. Further research should be conducted to quantify the real impact of this kind of intervention on vaccine uptake in prison population.

Injectable buprenorphine during transition out of prison: A pilot partially randomized preference trial protocol.

The global prison population exceeds 11.5 million, with a 3% Human immunodeficiency virus (HIV) infection rate, significant burden of Hepatitis C, and risk of undiagnosed infectious diseases due to limited prior healthcare access. On release, prisoners may reintegrate into society, contributing to the spread of infections. To estimate the burden and correlates of HIV, coinfections, and risk behaviors among prison inmates in three Indian states. This study utilizes data from the 17 th round of HIV Sentinel Surveillance Plus 2021, among prison inmates in Chhattisgarh, West Bengal, and Nagaland. Participants were interviewed using a structured questionnaire, and blood specimens were tested for HIV, Syphilis, Hepatitis B virus (HBV), and Hepatitis C virus (HCV). Data were analyzed using STATA version 17. Stratified data analysis was done employing Pearson Chi-square testing. Factors associated with HIV and any infection were assessed with multivariable logistic regression analysis controlling sociodemographic factors as potential confounders. Nagaland records the highest HIV (4.6%), Syphilis (3.6%), and HCV (1.0%), and West Bengal has the highest HBV burden (1.5%). Logistic regression revealed higher odds of HIV infection among those with a history of imprisonment, undertrial status, and good HIV knowledge. The burden of any infection was higher in the 30-39 age group and those with a prior history of imprisonment. This study highlighted the interplay between sociodemographics and high-risk behaviors within prison settings and the concentrated HIV epidemic. The findings should drive actionable strategies, guiding strategic planning, intervention prioritization, and resource allocation to enhance overall public health outcomes beyond prison confines.

Moderating effects of the effectiveness of psychological interventions for suicide behavior and non-suicidal self-harm prevention in prison settings: a systematic review and meta-analysis

The Use of Clozapine in Incarcerated Persons with Borderline Personality Disorder