Psychiatric Prison Research Articles

Different perspectives of prison guards and mental health workers in forensic care.

This study investigates the differences in treatment perspectives of prison guards and mental health practitioners within a Psychiatric Prison Unit (PPU). This qualitative study uses questionnaires and focus groups to explore the relationships between prison guards (N = 4) and mental health professionals (N = 6) working at the Psychiatric Prison Unit in Zwolle, the Netherlands. Two questionnaires (the Recovery Attitude Questionnaire and the Recovery Knowledge Inventory) were completed by the participants. A selected subsample based on diverging beliefs concerning treatment perspectives was recruited for additional focus groups. The dialogues were transcribed and coded into a comprehensive scheme. Responses were analyzed to describe perceptions and attitudes of respondents towards forensic care. This study identified three main themes: policy, communication, and person-dependent factors. Understaffing and high turnover rates in the correctional facility led to prioritization of safety concerns over treatment objectives. Guards and mental health professionals had different communication styles which hindered the alignment of treatment goals. Person-dependent factors, including personality traits and individual attributes, were significant in shaping collaborative interactions. This study reveals agreement in the viewpoints between prison guards and mental health professionals but highlights the complex challenges in providing effective treatment within the confines of a correctional facility. These challenges are influenced by policy dynamics, communication limitations, and individual-specific factors.

Practitioners' Experiences of the Influence of Bonsai Art on Health.

Bonsai art refers to the cultivation of a miniature tree. This study was motivated by the hypothesis that bonsai art may also be an ecopsychological, therapeutic practice that can have meaningful healing qualities. An international online survey elicited the meaning of bonsai art for 255 skilled bonsai practitioners. Questionnaires and interviews were used to elicit the experiences of participants. The findings supported the hypothesis that, for skilled practitioners, bonsai art was associated with meaningful healing experiences. In particular, the evidence suggests that bonsai art facilitates improved ecological, spiritual and emotional awareness, as well as various healing dimensions, including aesthetic creativity, resilience, adaptability, and social, physical, and personal health. It is viewed as an intervention technique that requires few resources, is easy to apply, and has a minimal impact on any environmental setting. The conclusions drawn point to the ethically sound health promotion value of bonsai art in various settings, such as psychiatric hospitals, retirement homes, rehabilitation centres and prisons.

Child abuse, gender differences and their clinical and criminological implications in incarcerated individuals

IntroductionSeveral studies show high rates of childhood traumatic events in subjects incarcerated in prison institutions. ObjectiveTo assess the prevalence and gender differences of different types of childhood adverse experiences and their correlation with psychopathological and criminological variables in incarcerated individuals. Material and methodsAn epidemiological, descriptive-observational study was conducted in two psychiatric prisons located in Argentina and 84 subjects of both sexes participated. A socio-demographic questionnaire was used, the SCID I and II scales and the Adverse Childhood Experiences questionnaire. Results91.7% of the participants had suffered some adverse experience in childhood. A high rate of physical (63%) and emotional abuse (61%) was detected. We found gender differences in the type of child abuse and the crimes committed. Significant relationships were found between some childhood adverse events and psychiatric disorders, crimes committed and recidivism. ConclusionsIn accordance with other studies, there was a high prevalence of adverse childhood experiences in incarcerated individuals and significant gender differences in the type of child abuse, in psychiatric disorders, in the crimes committed and recidivism.

Applicability of two violence risk assessment tools in a psychiatric prison hospital population.

The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, "FoVOx," and Mental Illness and Violence Tool, "OxMIV") were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)-for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80-0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.

Maltrato infantil, diferencias de género y sus implicaciones clínicas y criminológicas en personas privadas de su libertad

IntroductionSeveral studies show high rates of childhood traumatic events in subjects incarcerated in prison institutions. ObjectiveTo assess the prevalence and gender differences of different types of childhood adverse experiences and their correlation with psychopathological and criminological variables in incarcerated individuals. Material and methodsAn epidemiological, descriptive-observational study was conducted in two psychiatric prisons located in Argentina and 84 subjects of both sexes participated. A socio-demographic questionnaire was used, the SCID I and II scales and the Adverse Childhood Experiences questionnaire. Results91.7% of the participants had suffered some adverse experience in childhood. A high rate of physical (63%) and emotional abuse (61%) was detected. We found gender differences in the type of child abuse and the crimes committed. Significant relationships were found between some childhood adverse events and psychiatric disorders, crimes committed and recidivism. ConclusionsIn accordance with other studies, there was a high prevalence of adverse childhood experiences in incarcerated individuals and significant gender differences in the type of child abuse, in psychiatric disorders, in the crimes committed and recidivism.

Feasibility and effects of an exercise-based intervention in prison inmates with psychiatric disorders: the PsychiActive project randomized controlled trial

Objective: To evaluate the feasibility and effects of a 12-week intervention combining aerobic and strength exercises in prison inmates with psychiatric disorders. Design: Two parallel-group, randomized controlled trials. Setting: A psychiatric prison hospital. Subjects: Forty-one men prison inmates (mean age ± SD = 38.2 ± 9.2 years, mean prison duration ± SD = 2.6 ± 2.5 years) with psychiatric disorders (primarily personality disorder, n = 27; mean illness duration ± SD = 12.0 ± 10.5 years). Interventions: Participants were randomly allocated to intervention group consisted of exercise plus usual care (n = 21) or control group which received usual care (n = 20) for 12 weeks. The exercise programme included three weekly sessions of group-based moderate-to-high intensity combined exercises designed and supervised by exercise professionals. Main measures: Fitness and anthropometric measures were assessed using field-based tests (6-minute walk, Incremental Shuttle Walk, Arm-Curl, and Chair-Stand), handgrip dynamometry, bioelectrical impedance, and waist and hip circumferences. Results: There were no adverse events, and 10 intervention participants withdrew. The remaining 11 participants attended a mean of 28 sessions, of which nine met the compliance criteria. Between-group change differences substantially favoured the compliance intervention group for the 6-minute walk (+21.2%), Incremental Shuttle Walk (+33.9%), Arm-Curl (+13.8%), waist (−3.5%), waist/height0.5 (−1.7%) (−2.7%), waist/hip (−3.4%), and Body Shape Index (−3.3%) (−3.5%). Additional analysis showed beneficial effects of exercise participation on handgrip strength. Conclusion: The intervention was safe, had a high dropout rate, and seemed to be effective for improving fitness and anthropometric measures in men prison inmates with psychiatric disorders who attended and participated in the exercise sessions.

Animal-assisted therapy in a Canadian psychiatric prison.

Prison-based animal programs are becoming increasingly common in North America. The majority focus on community and animal well-being, with less explicit therapeutic goals for human participants. The purpose of this paper is to measure the objectives of a canine animal-assisted therapy (AAT) program in a Canadian psychiatric prison and examine whether the program supports inmates' correctional plans. A modified instrumental case study design was applied with three inmates over a 24-AAT-session program. Quantitative and qualitative AAT session data were collected and mid- and end-of-program interviews were held with the inmates, their mental health clinicians and the therapy dog handlers. Inmates connected with the therapy dogs through the animals' perceived offering of love and support. This development of a human-animal bond supported inmates' correctional plans, which are largely situated within a cognitive-behavioral skill development framework. Specifically, inmates' connections with the therapy dogs increased recognition of their personal feelings and emotions and positively impacted their conduct. The findings suggest that prison-based AAT programs emphasizing inmate mental well-being, alongside that of animal and community well-being generally, merit further exploration. It would be worthwhile to assess this AAT program with a larger and more diverse sample of inmates and in a different institutional context and also to conduct a post-intervention follow-up. This is the first study of a prison-based AAT program in a Canadian psychiatric correctional facility.

This is also a prison, although more in a therapeutic sense: practices, discourses and thoughts from the prison world in regards to the SPF psychiatric services

The progressive system is the mode of execution of the prison sentence used in Argentina, through which it seeks to promote the “social reinsertion” of prison system inmates (since the constitutional criminal justice system reform in 1994). This is the central axis on which the institutional dynamics of the Federal Prison Service is structured, both as regards the spatiotemporal organisation of prisoners and workers, and also the relations between them inside the contemporary prison in the country. However, the national law enforcement regulatory process decided that all persons held permanently or temporarily in psychiatric prisons are excluded from this system. The article analyses some of the negative implications this exclusion has on both the development of prisons and the spaces destined for the treatment of mental health in federal prisons. This is based on data obtained in the development of an anthropological project (2010-2014) carried out

Analysis of response patterns on the MMPI-2 in psychiatric prison inmates

In order to assess mental health status, and the classification of both the overreporting and underreporting scales and indexes, 102 psychiatric prison inmates deemed mentally incompetent to stand trial completed the Spanish adaptation of the MMPI-2 under standard instructions (honest responding). The results showed patterns of consistent, non-random, nor extremely acquiescent responses. Moreover, no-outlier responses were detected. In line with the psychiatric diagnosis, all the psychiatric prison inmates were classified by the basic clinical scales as clinical cases of the psychotic dyad i.e., schizophrenia and paranoid ideation. The overreporting scales and indexes (i.e., F, K, Fb, F-K, Fp, Ds and FBS) classified the participants as malingerers, whereas the L, Wsd, and Od underreporting scales as good feigners. These scales assessing impression management i.e., consciously faking good biased responses, did not classify overreporters. Thus, they are robust indicators of honest responding among psychiatric prison inmates. The implications of these results for the practice of forensic psychology are discussed.

Clinical Characteristics and Service Use of Incarcerated Males with Severe Mental Disorders: A Comparative Case-Control Study with Patients Found Not Criminally Responsible

Since the drop in the bed capacity of civil psychiatric hospitals, an increase in the bed capacity of forensic psychiatric care and prison units has been reported in the United States and Europe. However, in Canada, a decrease in the number of people with severe mental illness (SMI) during the last two decades in penitentiaries has been reported. At the same time, an increase in individuals found not criminally responsible on account of mental disorder (NCRMD) was observed in forensic hospitals. The aim of this study is to compare incarcerated severely mentally ill (I-SMI) individuals with forensic-hospitalized SMI individuals in terms of their clinical profiles and service use in the province of Quebec (Canada). A case-control study design was selected using a sample of 44 I-SMI individuals and 59 forensic-hospitalized SMI individuals. Important findings include the following: I-SMI persons had less schooling; they more often reported suicide attempts and violent and non-violent crimes; and they had a higher level of comorbidity involving Cluster B personality disorders and substance-use disorders. Forensic-hospitalized SMI persons were more likely to have been receiving psychiatric follow-up before hospitalization. The final logistic regression model showed that lifetime suicide attempts, non-violent crimes, and psychopathic traits were higher among I-SMI individuals than among forensic-hospitalized SMI individuals. In contrast, receiving regular psychiatric follow-up was associated with forensic-hospitalized SMI individuals. Differences in psychopathological characteristics and the use of mental health services were found for I-SMI persons. More research is needed to determine which new initiatives might be efficacious in addressing the mental health needs of I-SMI individuals.

Treating Justice Involved Persons with Mental Illness

In this article, we present the results of a preliminary evaluation of a comprehensive treatment program specifically designed to treat co-occurring issues of mental illness and criminal risk in persons with mental illness (PMI) that are criminal justice involved. Participants include 47 incarcerated male PMI in a secure psychiatric prison or a residential treatment facility. Of the 47 participants, 31 (66%) completed the program, attended 94% of all sessions, completed 83% of assigned homework, and actively participated in treatment sessions as evidenced by participation ratings. Change was examined using a four-tiered assessment strategy, including pre–post significance testing, magnitude of effect sizes, clinical cutoffs, and reliable change indices. Results showed evidence of strong therapeutic alliance and treatment program satisfaction, as well as symptom reduction and some evidence for reduced criminal thinking. Program modifications and implications for enhancing service delivery to justice involved PMI are discussed.

Imprisonment and diagnostic delay among male offenders with schizophrenia

Psychotic symptoms are common among prisoners, a diagnosis of schizophrenia probably more likely than in the general population; however, less is known about the extent to which prisoners may show a different course of illness. The aims of the study were to characterise schizophrenic male offenders and to compare their age at diagnosis with that of people with schizophrenia in general mental health services in Finland. The study population comprised all the male offenders in Finland who left the national psychiatric prison hospital between 1 January 2003 and 31 December 2006 with an International Classification of Diseases, Tenth Edition, diagnosis of schizophrenia. The comparison group was drawn from 9992 Finnish people screened at random for psychotic illnesses. There was no overall difference in age of diagnosis between prisoners and their community peers, but three-quarters of the offenders had received their diagnosis of schizophrenia in the prison hospital rather than in the community, and for them, the median age at diagnosis (30) was significantly older than that (27) in the community comparison group. Our findings show that men with schizophrenia who have to serve prison sentences are not a homogenous group, but that for a majority, complex presentations are likely to delay diagnosis and appropriate treatment. If replicated, the findings raise concerns that psychiatry is failing such men who can only access treatment for a severe illness through the penal system.

Measuring Group Climate in Prison

The present study examines the construct validity and reliability of the Prison Group Climate Instrument (PGCI) in a sample of 77 adolescents placed in a Dutch youth prison and 49 adult prisoners living in a Dutch psychiatric prison with a therapeutic living group structure. Confirmatory factor analysis of a four-factor model—with “repression,” “support,” “growth,” and “group atmosphere” as first-order factors—and “overall group climate” as a second-order factor shows an adequate fit to the data, indicating construct validity of the PGCI. Cronbach’s alpha reliability coefficients are good for all factors. The PGCI is a parsimonious instrument, enabling future research on group climate in youth prisons and secure forensic psychiatric institutions. The instrument can be used as an assessment tool for judicial interventions that use group climate to improve outcomes in delinquent youth and adult delinquents receiving treatment for psychiatric problems.

Mobile asylums: psychopathologisation as a personal, portable psychiatric prison

Psychopathologisation, broadly understood as processes that lead to the effects of being psychopathologised, can have considerable consequences for isolating students from education. This can be especially the case for children and young people affected by the racialisation of behaviour and/or socio-economic disadvantage. Drawing on Foucault's analysis of the relationship between the psychiatrist and the asylum in his lectures ‘Psychiatric Power’, the argument is made that these effects can be tantamount to being institutionalised in a mobile asylum. Portrayal of the asylum in the American television series House MD is used to highlight how, if we rely on classic depictions of the asylum–psychiatrist couplet, we risk missing – or minimising, the mobile asylum that some young children experience when they are psychopathologised in schooling.

Penrose’s law: reality or fiction? Mental health system and the size of prison population – international overview

According to the Penrose's law, outlined on the basis of a comparative study of European statistics, there is an inverse relationship between the number of psychiatric beds and prison population. Based on international data, interrelationship among prison, asylum, psychiatric disease and criminal action are investigated in the present study, paying particular attention to the event of deinstitutionalization. Prevalence of mental and addictive diseases as well as psychological disturbances in prison is characterized by epidemiological data. As proposed by Penrose, an inverse relationship between the number of psychiatric beds and prison population can be observed in Hungary, too. To get a deeper insight into the mainstream of the events, economic, sociological, philosophical, as well as therapeutic aspects initializing deinstitutionalization are highlighted in the course of analysis. On the basis of data, it can be assumed that members the same population are confined to both systems. The author arrives at the conclusion that deinstitutionalization has in fact led to trans-institutionalization, because of, on one hand, the limited capacity of community treatment facilities; on the other hand, the community treatment itself cannot provide adequate treatment options to those suffering from severe, chronic mental diseases or comorbid states. In addition, the rate of financial support and the methods for prevention and treatment are insufficient to protect patients from the effects of revolving door.

Variables sociodemográficas y síndrome de burnout en una muestra multiocupacional del Hospital Psiquiátrico Penitenciario de Sevilla

This study aims to assess the relationship between sociodemographic variable and the burnout syndrome in a multiocupational sample of the Hospital Psychiatric Prison ofSeville. The sample consisted of 136 workers of the Hospital Psychiatric Prison (93% of the total staff) that were gathered in three groups (security, services and treatment) their level of contact with the inmates was also taked into account. Results show that prison employees with high levels of contact with the inmates experience higher levels of depersonalization and were less satisfied with their personal accomplishment at work than the personnel with less contact. Significant differences were also found among the three groups (security, services and treatment). Depersonalization and low personal accomplishment were higher in the security officer’s group. On the other hand, lower levels of depersonalization were found between women and personnel with university studies. This study also shows that to have an only child is positively related to depersonalization and emotional exhaustion.

20 years of developing European standards. Fieldwork and ongoing dialogue with governments

In the last two decades the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment has been visiting mental hospitals, forensic psychiatric establishments and prison hospitals in all member states of the Council of Europe. Its delegations have paid particular attention to the questions of involuntary placement, compulsory treatment and means of restraint. The Committee has issued recommendations to the governments and developed standards. Success and insufficiencies of an international inspection system in a European setting with different legal provisions and clinical practices, few international standards and research but in a state of development are discussed.

Validez factorial del Maslach Burnout Inventory (MBI) en una muestra de trabajadores del Hospital Psiquiátrico Penitenciario de Sevilla

This study was designed to assess the structures of the Maslach Burnout Inventory (MBI) for 136 professional of Hospital Psychiatric Prison of Seville, from prison officers to psychiatrist. Responses were factor analysed using principal components and a Varimax rotation. Exploratory factor analysis offered five factors with eigenvalues exceeding unity. Items offer Emotional Exhaustion loaded on Factor I, items of Depersonalisation on Factor II, and items of Personal Accomplishment on Factor III, FactorIV and Factor V. A second factor analysis was carried out with a specification to extract three factors. This factor analysis showed a factor structure consistent with the original. However, items 6, 14 and 16 loaded on Emotional Exhaustion and Depersonalisation dimensions. As a whole, results show that the MBI appears to be valid and reliable for Spanish prison professionals.

Detection of Malingering in Psychiatric Unit and General Population Prison Inmates: A Comparison of the PAI, SIMS, and SIRS

In this study, we compared the utility of three instruments, the Personality Assessment Inventory (Morey, 1991), the Structured Inventory of Malingered Symptomatology (Smith & Burger, 1997), and the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) to detect malingering among prisoners. We examined 4 inmate samples: (a) prisoners instructed to malinger, (b) “suspected malingerers” identified by psychiatric staff, (c) general population control inmates, and (d) psychiatric patients. Intercorrelations among the measures for the total sample (N = 115) were quite high, and receiver operating characteristic analyses suggested similar rates of overall predictive accuracy across the measures. Despite this, commonly recommended cut scores for these measures resulted in widely differing rates of sensitivity and specificity across the subsamples. Moreover, although all instruments performed well in the nonpsychiatric samples (i.e., simulators and controls), classification accuracy was noticeably poorer when attempting to differentiate between psychiatric patients and suspected malingerers, with only 2 PAI indicators significantly discriminating between them.

Burnout among employees in human service work: design and baseline findings of the PUMA study

To present the theoretical framework, design, methods, and baseline findings of the first Danish study on determinants and consequences of burnout, and the impact of workplace interventions in human service work organizations. A 5-year prospective intervention study comprising 2,391 employees from different organizations in the human service sector: social security offices, psychiatric prison, institutions for severely disabled, hospitals, and homecare services. Data were collected at baseline and at two follow-ups. The authors developed a new burnout tool (the Copenhagen Burnout Inventory) covering work-related, client-related, and personal burnout. The study includes potential determinants of burnout (e.g. the psychosocial work environment, social relations outside work, lifestyle factors, and personality aspects) and consequences of burnout (e.g. poor health, low job satisfaction, turnover, and absenteeism). Here, the focus is on the description of the study population at baseline, including associations of work burnout with psychosocial work environment scales and absence. Response rate at baseline was 80.1%. Midwives and homecare workers had high levels on both work- and client-related burnout. Prison officers had the highest level on client-related burnout. Supervisors and office assistants had low levels on both scales. Work burnout showed the highest correlations with job satisfaction (r = -0.51), quantitative demands (r = 0.48), role-conflicts (r = 0.44), and emotional demands (r = 0.42). Sickness absence was 13.9 vs 6.0 days among participants in the highest and lowest work burnout quartile, respectively. The findings indicate that study design and methods are adequate for the upcoming prospective analyses of aetiology and consequences of burnout and of the impact of workplace interventions.