Prison Service Research Articles

Assessment of mental health stigma among public safety personnel in Portugal

Purpose This paper aims to assess the presence of mental health stigma among public safety personnel (PSP) in Portugal. Design/methodology/approach An online self-administered form was applied, including the Attribution Questionnaire (AQ-9), the Attitudes Towards Mental Health Problems scale (ATMHP) and the socio-demographic characterisation: age, gender, marital status, children, education and geographical location. The sample included police officers, workers of the General Directorate of Reintegration and Prison Services (DGRSP) and workers of the National Institute of Medical Emergency (INEM), as well as a control group (general population). Findings In total, 1,441 people participated, of whom 85% were police officers, 3.3% were INEM staff, 2.6% were DGRSP staff and 9.1% were from general population. The most common socio-demographic characteristics were male, married/common-law marriage, two children, 12 years of education and living in Lisbon and Tagus Valley. On AQ-9, all groups showed higher scores on the stigmatizing constructs help, pity and coercion and lower scores on blame, anger, segregation and avoidance. For the total score, the authors found significant differences only in comparison with INEM, who scored lower. The ATMHP showed that INEM and police officers generally had lower total scores than DGRSP and the general population, with the general population having the highest score. There were no significant gender differences for most of the results in both questionnaires. Originality/value To the best of the authors’ knowledge, this is the first study assessing mental health stigma among PSP in Portugal. The authors found stigma among PSP, with INEM showing a lower score in stigmatizing attributions, and INEM and police officers showing better attitudes and less shame towards mental illness.

The “One Carceral State”: Mass Incarceration and Carceral Citizenship in Palestine/Israel

Abstract Using the concept of the carceral state, this article articulates how Israel’s control of the West Bank and the Gaza Strip has shifted to a nondemocratic one-state paradigm. While, initially, Israel operated a separate military carceral system for these areas, between 2000 and 2006 it dismantled the military system, transferred most Palestinian prisoners into Israel, and rebranded its civilian prison service as the National Prison Authority, making it the sole agency responsible for the incarceration of Palestinians. This reorganization consolidated a single carceral system inside Israeli territory—the one carceral state— which serves as crucial evidence of the de facto one-state paradigm and forms a centerpiece of this new regime in Israel/Palestine. By analyzing a broad range of archival and administrative documents and 168 Supreme Court decisions on the management of prisons and Palestinian prisoners, this study reveals how the massive “exclusionary inclusion” of the Palestinian prisoner population in Israeli state law and its administrative mechanisms changes the entire landscape of the Israeli settler-colonial citizenship regime. Palestinian prisoners become “carceral citizens” of the “one state” and are subject to a parallel, alternate legality, in which they expand their repertoire of resistance against the wider racialized and repressive regime across Palestine/Israel.

Patient or prisoner? Perceptions of prison healthcare services in Norway and the conflict between care and control

In Norway, prisons are part of the system of public welfare service provision, with the objective of providing equal high standards of public services to all. However, most incarcerated people seem to agree that the healthcare services available in prison are of a lower quality. This article explores this perception and what it tells us about the unsolvable conflict between care and control in prison. The article finds that, firstly, healthcare services in prison have objective shortcomings. Secondly, a gap between expectations and experiences can cause disappointment and thus create or exacerbate a negative perception. Incarcerated people anticipate, but do not always experience, to be treated as patients in a healthcare facility rather than as prisoners in a security-oriented setting. This inability to meet patients’ expectations, is arguably another shortcoming resulting from the prioritisation of control over care.

A Qualitative Systematic Review of Barriers and Facilitators to Hepatitis B and C Programmes in Prisons.

The prevalence of viral hepatitis among people in prisons is higher than in the general population. Screening, treatment and vaccination programmes exist within prisons to reduce the incidence of hepatitis, although lower uptake has often been reported compared to similar programmes outside of prisons. We conducted a systematic review of qualitative evidence to explore the barriers and facilitators to hepatitis B and C reduction programmes in prisons from the perspectives of people in prison, custodial staff and prison healthcare staff. Comprehensive searches of five databases (to November 2023) yielded 28 studies for review inclusion. Four synthesised findings were identified: (i) accurate, up-to-date knowledge of viral hepatitis disease and treatment among people in prison and staff is a facilitator to programme uptake, particularly when imparted by a trusted source; (ii) personal subjective and relative views have a bearing on participation with the programme; (iii) social interactions and relationships both within the community of people in prison and between them and staff groups influence participation in the programmes; and (iv) the organisational structure of the prison and healthcare services within it affect programme participation. Based on these findings, we make recommendations for the adaptation of viral hepatitis programmes to individual custodial settings thereby improving equitable programme access and hepatitis B and C reduction in this complex environment.

Understanding the scale and nature of avoidable healthcare-associated harm for prisoners in England: protocol for a retrospective cross-sectional study

IntroductionAround 1 in 20 patients experience avoidable healthcare-associated harm worldwide. Despite longstanding concerns, there is insufficient information available about the safety of healthcare for prisoners. To address this, this study...

The Hierarchy of Victimhood: Prisons and States’ Responsibility to Protect Every Victim of Modern Slavery and Human Trafficking

In 2022, the prison service in England and Wales developed state-of-the-art guidance for prisons to enable them to better identify and support modern slavery survivors. This positive development in the UK’s anti-slavery regime is overshadowed by its increasingly restrictive immigration legislation, which leaves those without lawful residence and victims involved in criminal offences excluded from the support and assistance otherwise guaranteed by domestic and international law. This article presents an overview of the UK’s legal obligations towards survivors of modern slavery and human trafficking, explains how the prison service in England and Wales has sought to implement them, and discusses key challenges facing prisons in doing so. These efforts are contrasted with an increasingly hostile environment for certain categories of survivors, which effectively creates a “hierarchy of victimhood”, expressly prohibited by international law. In an environment where being a victim of a crime and human rights violation both matter less than the State’s interest in immigration and crime control, prisons will struggle to deliver on their commitment and international obligation to protect those inmates who have been or are at risk of being exploited.

“They are trying their best”: incarcerated individuals’ assessment of general healthcare services in selected Ghanaian prisons

BackgroundThe World Health Organization (WHO) has indicated that the absence of prison health poses a threat to public health, making it important to safeguard access to quality healthcare for incarcerated populations. Although several studies have explored the quality of care in prisons, there is a dearth of empirical evidence on the perspectives of incarcerated individuals. This study investigated incarcerated individuals’ perspectives and opinions on the general healthcare services in Ghanaian prisons.MethodsUtilizing a qualitative approach, focus group discussions were conducted with 51 incarcerated individuals in five prisons sited in the Northern, Middle and Southern zones of Ghana. Thematic analysis following the tradition of Braun and Clarke was conducted. Four of the six constructs of the WHO Health Systems Framework – service delivery, health workforce, access to essential medicines, and leadership and guidance – were applied deductively to organise the data into themes and subthemes.ResultsFour themes were generated from the analysis: “Health service delivery”, “Health workforce in prisons”, “Access to essential medicines” and “Leadership; regulating healthcare services”. Participants rated health services in prisons as below average compared to those available to the general population. The use of nurses as prescribers in prison infirmaries, though consistent with Ghana Health Service policy, seems to negatively influence prisoners’ perceptions of the quality of the health workforce in prisons. Lack of basic equipment and essential medications at the infirmary for common endemic conditions such as malaria coupled with the bureaucratic processes required to access care outside of the prison also negatively affected incarcerated individuals’ perceptions of the quality of health care.ConclusionsIncarcerated individuals perceived that the quality of health services provided in prisons was inferior to that provided in the general population. Addressing challenges associated with the unavailability of essential drugs and equipment, improving the number of health staff, and addressing bottlenecks in accessing urgent care will enhance the experiences of incarcerated populations on the quality of care given.

Can we trust that CBT-based batterer intervention programmes are effective?—Use of evidence for the treatment of IPV offenders in the prison and probation service

Can we trust that CBT-based batterer intervention programmes are effective?—Use of evidence for the treatment of IPV offenders in the prison and probation service

Co-designing the INHSU Prisons Hepatitis C Advocacy Toolkit using the Advocacy Strategy Framework

BackgroundThe World Health Organization (WHO) has established targets to eliminate the hepatitis C virus (HCV) by 2030. Prisons are a key focus of elimination efforts, however, access to HCV services in prisons remains low globally. With the aim of increasing advocacy efforts to help address this gap, the International Network on Health and Hepatitis in Substance Users (INHSU) Prisons, developed a Prisons Hepatitis C Advocacy Toolkit. MethodsToolkit development involved a co-design process to ensure advocacy resources met end-user needs. A scoping study was conducted, involving a web-based survey and in-depth interviews, to understand advocacy resource needs of key stakeholders from countries of different socio-economic strata. Data were analysed, and suggested advocacy resources were mapped onto the Advocacy Strategy Framework with the audiences resources are targetting and the changes they aim to influence. Advocacy resources were co-developed and validated by interview participants before incorporation into the web-based platform. ResultsSurvey responses (n = 181) and interview data (n = 25) highlighted several barriers to enhancing HCV services in prisons globally, and an understanding that advocacy efforts are needed to bring about this change. Advocacy resources were suggested for influencing three key audiences: policymakers/funders, implementers, and community. Thereafter, a suite of 20 de novo tools were co-developed with key stakeholders including case studies of evidence-based models of HCV care, policy briefs, HCV infographics, and fact sheets about how to leverage funding and build advocacy campaigns. Findings underscore the importance of capitalising on the knowledge and expertise of potential end-users, to ensure Toolkit resources are context-specific and match their needs. ConclusionThe Toolkit holds promise for progressing the WHO elimination goals by increasing advocacy efforts for enhanced prison HCV services globally. The co-design of Toolkit resources with potential end-users has increased its potential accessibility, acceptability, and inclusivity for a globally diverse audience.

Introducing vaccination services in prison settings: case study from Moldova

Abstract Introducing vaccination services within prison settings presents a multifaceted challenge and opportunity, particularly evident in the case of Moldova. This Eastern European nation grapples with various socio-economic and healthcare disparities, with its prison population often experiencing heightened health vulnerabilities. Amidst such complexities, the implementation of vaccination services emerges as a crucial strategy not only to safeguard the health of incarcerated individuals but also to contribute to broader public health goals. Moldova’s journey in this regard reflects a commitment to advancing preventive healthcare within its correctional facilities. The introduction of vaccination services in prisons necessitated a comprehensive approach, encompassing policy development, infrastructure enhancement, staff training, and community engagement. Infrastructure enhancement was imperative to ensure the provision of vaccination services in a safe, efficient, and dignified manner within prison settings. This involved the establishment of designated vaccination areas equipped with the necessary medical supplies and equipment. Staff training emerged as a cornerstone of the initiative, empowering healthcare professionals working within prisons with the knowledge, skills, and confidence to deliver vaccination services effectively. Training programs encompassed various aspects, including vaccine administration, adverse event management, and communication strategies tailored to the specific needs of incarcerated individuals. Collaboration with people living in prison facilitated the dissemination of accurate information, addressed concerns, and encouraged participation in vaccination programs. During the period 2021-2023 7454 doses of antiCOVID-19, 1298 doses of anti-Flu vaccine, 3083 doses of anti-HBV vaccines were administered.

Advancing Public Health Equity through Expanded Vaccination Services in prison: case studies from Italy and France

Abstract In Montpellier prison in France and San Vittore remand house in Italy, the provision of expanded, age-appropriate, coercion-free, and tailored vaccination services to PLP has emerged as a cornerstone in improving health outcomes within prison settings. The implementation of life course vaccination programs required the full integration of prison health into public health systems building on existing vaccination services covering HBV, flu and COVID-19. In San Vittore, a vaccination clinic aimed at people living in prison was set-up. Universal vaccination status assessment and vaccination catch-up was introduced targeting people admitted into prison. The vaccination clinic-related activities included information and awareness sessions on vaccination and health literacy offered regularly to PLP: increased vaccination knowledge is effective to enhance uptake. The vaccination clinic team consisted of infectious diseases physicians and a health assistant with an anthropological background, who ran the information and awareness sessions combining and adapting core content on vaccination with individual and community social and cultural contexts. Besides seasonal flu vaccination and anti-SARS-CoV-2 immunisation campaigns, vaccinations against pneumococcal pneumonia and herpes zoster were also offered to older and fragile individuals as per national immunization plan. One of the priority objectives of the vaccination clinic was the increase in vaccination coverage against HBV and HPV, not only as a tool for the prevention of infectious diseases, but as an innovative and effective tool of cancer prevention. As part of a more ambitious program to protect sexual health in prison and related to updated screening tools for the early diagnosis of lesions due to HPV infection, vaccination against HPV was also offered as part of a health empowerment project tailored to women in detention, with the aim of building self-awareness of their own health needs.

8.D. Scientific session: Equitable Immunization: Leveraging Prisons for Vaccination Equity in Europe

Abstract Addressing low vaccine coverage is a pressing public health concern in Europe, where pockets of unvaccinated individuals persist despite ongoing efforts. The European region sees an estimated 1.4 million individuals detained on any given day, with a significantly higher number passing through prisons annually due to high turnover rates. Those experiencing incarceration often come from socially marginalized and disadvantaged groups, facing a multitude of health challenges including non-communicable diseases, infectious diseases, mental illness, cognitive disabilities, and substance dependence. Despite their elevated health needs, individuals in prison frequently encounter barriers to accessing healthcare services, including preventive measures such as vaccination. Available but limited data suggest that individuals entering the prison system are often under-immunized, particularly against Hepatitis B Virus (HBV), influenza, measles, mumps, rubella (MMR), and pneumococci. Unfortunately, vaccination services within prisons are often insufficient, typically being provided according to national schedules or in response to outbreaks of vaccine-preventable diseases (VPDs). It’s crucial to distinguish between the availability of vaccination services and actual coverage, as the modalities of vaccination offerings vary across the region. While individuals in prison are recognized as a target group for HBV vaccination, the methods of offering vaccines may differ based on factors such as age or risk group. Nevertheless, systematic implementation of HBV vaccination in prisons has shown clear benefits for both incarcerated individuals and the wider community. Given the significance of vaccinations in preventing diseases like HBV and human papillomavirus (HPV), which are linked to cancer, initiatives like the Europe Beating Cancer Plan and the European Council Recommendation on vaccine-preventable cancer emphasize their importance. Prisons can serve as a strategic point for delivering comprehensive healthcare and vaccination services to incarcerated individuals, yet routine data on vaccination coverage at entry and uptake during incarceration are often lacking, hindering effective health planning. To address this public health challenge, the ‘Reaching the hard-to-reach: Increasing access and vaccine uptake among prison population in Europe’ (RISE-Vac) project consortium has been formed. This collaborative effort brings together diverse expertise and established networks in the field of prison health, reflecting the varied epidemiological and structural landscapes across Europe. The objective of this workshop is to showcase recent research findings, evidence-based practices, and policy recommendations aimed at enhancing vaccination equity in the European region. By sharing insights and best practices, we aim to bolster efforts to improve vaccine access and uptake among incarcerated populations, ultimately contributing to broader public health goals. Key messages • Prison health is public health: vaccination services in prison are essential to achieve immunization targets in Europe. • Maximizing inter-sectoral collaboration is crucial for bridging the gap in vaccination access and uptake among people living in prison in Europe.

Drug Use during Incarceration: A Comprehensive Quality and Prevalence Study in Three Danish Prisons

Background Drug use in Danish prisons has previously not been investigated in detail using confirmatory, laboratory analysis. The objective of the present quality study, initiated by the Danish Prison and Probation Service, was to i) evaluate the performance of an initial, on-site drug screening strategy; ii) gain insights into emerging drug trends; and iii) suggest evidence-based strategies for future drug testing. Methods Over a two-year period, routine urine samples (n = 1952 from 710 inmates) from three Danish prisons were subjected to comprehensive drug testing. Immunoassay screening was conducted on-site. A parallel sample aliquot was forwarded to laboratory analysis by confirmatory methods: High-performance liquid chromatography and tandem mass spectrometry (LC-MS/MS) and gas chromatography and mass spectrometry (GC-MS) targeting 56 drugs-of-abuse/medical drugs, 26 key metabolites, 41 new psychoactive substances (NPS), including specific biomarkers for heroin, crack cocaine, or ethanol (a total of 123 target analytes/sample). Results The on-site immunoassay method showed a sensitivity from 66 to 100%; specificity was above 98%; accuracy was above 95%. Laboratory analysis detected compounds not screened for including tramadol, oxycodone, buprenorphine, ketamine, MDMA, 4-fluoroamphetamine, and GHB. The prevalence of drug use was in the order: cannabis > ethanol > cocaine > benzodiazepines > amphetamine. Conclusion The performance of the immunoassay was found acceptable; however, the screening program was inadequate for detecting other significant substances. Based on these findings, a broader screening method will be implemented in future at Danish Prisons to minimize false negative results. The data did not indicate a trend of using NPS in Danish prisons.

The inefficiency of centralised control and political short-termism: the case of the Prison Service in England and Wales

A paradox of the New Public Management reform – an influential school of thought in the management of public services in some countries – is that, despite its rhetoric of discretion for public managers, governments frequently reassert direct input controls at the expense of managerial freedoms to deliver – and be held accountable for – agreed output/outcome objectives. The existing literature explains this by highlighting elite incentive structures and institutional norms, but often neglects the wider implications for public managers beyond the centre. Addressing this gap, we trace the effects of public spending control from allocation to delivery through a detailed case study of prisons in England and Wales. We show how ‘top-down’ public spending control, hyper-centralised governance arrangements and ministerial activism combine to subvert managerial freedom and undermine ongoing service improvement. The overriding importance of year-by-year fiscal performance results in short-term, poorly evaluated decision making and limited capacity for strategic policy implementation. This case points to wider lessons regarding performance budgeting regimes in the UK and elsewhere.

A review of general cognitive-behavioral programs in English and Welsh prisons and probation services: Three decades of quasi-experimental evaluations.

For over 30 years, general cognitive-behavioral programs have contributed to the rehabilitation services offered within His Majesty's Prison and Probation Service in England and Wales. There is an extensive body of international evidence that demonstrates the effectiveness of such interventions as a correctional strategy. However, there is widespread variability of program effects associated with the standards of implementation. Over the last 3 decades, British researchers have produced a steady output of quasi-experimental program evaluations that have contributed to the evidence base. The most recent additions are some of the largest and most rigorous available worldwide. This review documents those evaluations and provides a meta-analysis that statistically aggregates the effects of programs delivered in His Majesty's prisons in England and Wales. We suggest there is sufficient evidence from evaluations of acceptable scientific rigor to conclude that general cognitive-behavioral programs delivered in prisons during the last decade and a half (circa 2006 to 2019) have had a small statistically significant mean reductive effect on general reoffending (odds ratio = 0.91). Program characteristics and implementation factors, including program dose, the scale of service delivery and program integrity, are discussed as possible factors associated with the size of the effect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patterns of care contacts in the final year of life among opioid overdose fatalities in southern Sweden: a latent class analysis

BackgroundUnderstanding the heterogeneity of opioid overdose fatalities is critical to developing effective preventive interventions. This study examines patterns of care contacts among people who subsequently died from opioid overdose. The aim was to identify distinct groups of deceased individuals, based on their contacts with different care agencies in their last year of life.MethodsA retrospective registry study was conducted in Skåne, Southern Sweden. All recorded opioid overdose fatalities during the study period were included, n = 191. Latent class analysis was used to identify patterns of care contacts in the last year of life.ResultsThree distinct classes were identified: “Few care contacts,” with limited interaction with any services; “Social service contacts,” comprising individuals who predominantly had contacts with the social services and, to a lesser extent, with prison and probation services; and “Numerous care contacts,” with extensive contacts with both healthcare and social services. The “few care contacts” class comprises about half of the population. This is an important finding, since this group has not been clearly visible in previous research. The analysis indicates significant gaps in service provision, particularly regarding substance use treatment and mental health support.ConclusionsUsing a person-centred approach, this article offers a novel way of analysing care contacts among people who subsequently died from opioid overdose. The identification of distinct groups, particularly a large group of people with minimal contact with the community care system, highlights the need for more targeted outreach and support work. Developing targeted interventions in emergency and inpatient care settings may provide an opportunity to reach the group with few care contacts.

Waxy- or Putty-Like Materials as a Novel Drug Preparation for Synthetic Cannabinoid Receptor Agonists: Detection in Prisons and InVitro Cannabinoid Receptor Activity.

After the Scottish Prison Service (SPS) introduced mail photocopying procedures in December 2021, a shift in smuggling methods was observed for synthetic cannabinoid receptor agonists (SCRAs) and other new psychoactive substances (NPS) from drug-infused papers back to traditional sample matrices (e.g., tablets and powders), although new matrices also emerged. This study reports on waxy- or putty-like materials as a novel drug preparation for SCRAs and other drugs seized from UK prisons. In 2023, 22 of these new preparations were seized from Scottish prisons, with eight found in sealed vape pods. The materials were positive for SCRAs, phytocannabinoids, novel benzodiazepines, and/or gabapentinoids. Additionally, 11 preparations were seized from an English prison, all containing the SCRAs MDMB-4en-PINACA and MDMB-INACA. MDMB-INACA was pharmacologically characterized using invitro CB1 and CB2 bioassays, revealing moderate efficacy but low potency at CB1. Furthermore, the invitro CB1 bioassay was also used to evaluate the CB1 activating potential of extracts from eight seized samples. Six of these showed high CB1 activity, whereas the samples lacking SCRAs or containing only MDMB-INACA showed no or only weak CB1 activity, respectively. Lastly, applying the bioassay as an activity-based "untargeted" screening method effectively identified the presence of SCRAs in one waxy preparation, which was initially not detected by gas chromatography-mass spectrometry (GC-MS). This underscores the effectiveness of the bioassay for evaluating these new waxy- or putty-like materials for the presence of SCRAs.

What contributes to fewer cases of recidivism? Treatment, education, and work in prison

Since the turn of the millennium, levels of recidivism following a prison term have declined in Sweden. The composition of the inmate population has changed, which provides a partial explanation. This study examines whether prison service interventions, such as the provision of treatment, education, and work, might have contributed to the decline in recidivism. The study sample comprises women and men who were released from Swedish prisons between 2012 and 2015. Data have been collected from the Prison and Probation Service registers and the Convictions Register. The analysis employs propensity score matching and regression analysis. The results show that the interventions examined have a positive effect on reducing recidivism, but that their explanatory power is limited.

Delivering inclusive hypertensive care in the prison service.

Morisenuola Ladele, Chief Nurse Fellow, Birmingham Community Healthcare NHS Foundation Trust (Morisenuola.ladele1@nhs.net), was the Gold Award winner in the Nurse of the Year category in the BJN Awards 2024.

A protocol for identifying the needs related to drug use, health and social (re)integration of people living in prison within five European countries

BackgroundCompared to the general population, people living in prison are at an increased risk to experience negative (mental) health outcomes. Moreover, delinquency and drug use have many risk factors in common. A need exists for increasing the knowledge about health needs, drug use patterns and the coverage of drug-related interventions in prison within Europe. The current protocol describes the design of a study about wellbeing, drug use and related care in prison.Methods/designA multicentre mixed method design is implemented in five European countries (Belgium, Cyprus, Greece, Lithuania and Luxembourg). Qualitative and quantitative data collection tools are combined in order to generate complementary and comprehensive results. First, a cross-sectional survey among people living in prison is conducted. This survey is based on a model questionnaire, the European Questionnaire on Drug use among people living in Prison, developed by the European Monitoring Centre for Drug and Drugs Addiction. Second, people living in prison and people who have been recently released from prison are involved in qualitative semi-structured face-to-face interviews. The main topics of interest are the use of drugs and other health related topics such as loneliness, anxiety, depression, infectious diseases, suicide and treatment. Third, data regarding health and social reintegration measures in prison is collected through a quantitative survey addressed to the prison authorities.DiscussionThis study protocol presentes a European study which aims to assess drug use among people living in prison and recently released people who use drugs as well as the existing care services in prisons. Hereby, factors related to the prison environment and their needs, both inside and outside prison are taken into account. Importantly, this study protocol describes a methodology which is developed to be executed in different prison settings within different countries simultaneously. Accordingly, for each country the protocol is adjustable to specific national legal requirements, regional differences and distinct local regulations of prison administrations. However, extensive modularity inevitably comes with significant limitations of comparability and generalizability of the results.