Offenders as victims: post-traumatic stress disorder and substance use disorder among male prisoners

Background: Comorbid substance use disorder(s) and post-traumatic stress disorder (SUD-PTSD) is common among prisoners and linked to an increased risk of criminal recidivism; however, little is known about the characteristics of prisoners with this comorbidity. Aim: This study provides a preliminary examination of the clinical and criminal profile of male inmates with symptoms of SUD-PTSD, and examines whether this profile differs according to whether a person has experienced a trauma while in prison. Methods: Thirty male inmates from two correctional centres in Sydney, Australia, were recruited and assessed using a structured interview. Results: The sample reported extensive criminal, substance use and trauma histories. A history of substance dependence was almost universal (90%) and 56.7% met diagnostic criteria for PTSD with the remainder experiencing sub-threshold symptoms. Forty-three per cent reported a traumatic event while in prison. Those who had experienced trauma in prison, compared to those who had not, were more likely to nominate heroin as their main drug of concern and to be receiving drug treatment in prison. There was also a trend toward inmates who had experienced a trauma in prison being more likely than inmates who had no prison trauma to have experienced a physical assault. Conclusion: Male prisoners with SUD-PTSD are a high-needs group yet treatment responses are poor. Further research examining treatment options for this comorbidity may improve prisoner well-being and reduce recidivism.     

Early criminal recidivism among mentally disordered offenders

Criminal recidivism was studied during 2 years in a Swedish population-based cohort (N = 318) of mentally disordered male offenders who had undergone a pretrial forensic psychiatric investigation, been convicted in subsequent trials, and been sentenced to forensic psychiatric treatment (FPT; n = 152), prison (n = 116), or noncustodial sanctions (n = 50). Recidivism was analysed in relation to index sanctions, levels of supervision, diagnoses, and criminological factors. Significantly lower recidivism in the FPT group was related to lower crime rates during periods at conditional liberty in this group alone, and recidivism was significantly more common among offenders with at least one of the two diagnoses of substance abuse disorder and personality disorder than among those with psychotic or other mental disorders alone. Age at index crime and number of previous crimes emerged as significant predictors of recidivism. The results of this study suggest that the relapse rates depend as much on level of supervision as on individual characteristics.     

Prevalence of mental disorders and deliberate self-harm in Greek male prisoners

The aim of this survey was to determine the prevalence of current and lifetime mental disorder and deliberate self-harm among male prisoners in Greece. The subjects were 80 randomly selected remanded and sentenced prisoners in a Greek prison. They were assessed for mental disorder including suicidality and substance misuse using the Mini International Neuropsychiatric Interview (MINI). We also collected information regarding contact with psychiatric services, previous deliberate self-harm as well as physical health and conducted a brief assessment of their intellectual functioning. Mental disorder was diagnosed in 63 (78.7%) prisoners. The main diagnoses were: anxiety disorder, 30 (37.5%); major depression, 22 (27.5%); antisocial personality disorder, 30 (37.5%); alcohol dependence, 21 (26.3%) and opiate dependence 22 (27.5%) and schizophrenic or bipolar disorder 9 (11.2%). Deliberate self-harm prior to and during imprisonment was reported by 15% and 2.5% of prisoners, respectively, and 12 prisoners (15%) had IQ below 75. This survey identified a significant level of need for specialist mental health services in prison. Further studies are required to assess the specific needs of those patients who are too unwell to remain in prison, the need for specific treatments for substance misuse and improved assessment/treatment of common psychiatric disorders.     

Social support among releasing men prisoners with lifetime trauma experiences

High rates of lifetime trauma experiences exist among men incarcerated in US state and federal prisons. Because lifetime trauma experiences have been linked to problematic behavioral and psychiatric outcomes for incarcerated populations, trauma-informed interventions could improve post-release well-being of releasing men prisoners with trauma histories. Social support has consistently been found to have a positive impact on trauma-related outcomes in non-incarcerated populations. Therefore, it is reasonable to hypothesize that social support may be an important intervention component for releasing men prisoners with trauma experiences; yet, the relationship between trauma experiences, psychiatric and behavioral factors, and social support has received almost no attention in research with men prisoners. Using a probability sample of 165 soon-to-be-released men, the present study examined differences in certain demographic, criminal justice history, mental health, substance abuse, and social support (type, quality, amount, and source) variables between releasing men prisoners with and without lifetime trauma experiences. Results indicate that men with trauma histories had more negative social support experiences and fewer positive social support resources before prison than their counterparts. Men with trauma histories also had more lifetime experiences with mental health and substance use problems. On further investigation of the subsample of men with trauma histories, those who were older, had substance use disorders, and histories of mental health problems anticipated fewer post-release social support resources. Study findings underscore the nuances of social support for men prisoners with trauma experiences and point to implications for future directions in targeted trauma-informed intervention development for releasing men prisoners.     

A replication study of obsessional followers and offenders with mental disorders

The purpose of this study was to compare certain demographic, clinical, and criminal variables within subgroups of obsessional followers, and compare them to a group of offenders with mental disorders to attempt to replicate earlier findings. A static group archival design utilized a non-random group of convenience and a randomly selected comparison group. Sixty-five obsessional followers and 65 offenders with mental disorders were evaluated by psychiatrists and psychologists for court ordered reasons during their criminal proceedings. Both groups were evaluated during the same period, in the same court diagnostic clinic, and generally for sentencing determinations. The obsessional followers were measured on demographic, diagnostic, pursuit, victim, threat, violence, emotional, motivational, and defense variables. Inferential comparisons that used parametric and nonparametric statistics were done within and between groups on select variables. The obsessional followers had significantly greater estimated IQ than the offenders with mental disorders, but were neither older nor better educated. There were no significant differences in the high prevalence of both DSM-IV Axis I and II diagnoses. Obsessional followers who stalked prior sexual intimates were significantly more likely to have a substance abuse or dependence diagnosis. Obsessional followers who stalked strangers or acquaintances were more likely to be delusional. The majority of the obsessional followers, primarily motivated by anger, both threatened and were violent toward person or property. The modal obsessional follower is an average or above IQ, unemployed, unmarried male in his fourth decade of life. chronically pursuing a prior sexually intimate female. He is diagnosed with substance abuse or dependence and a personality disorder NOS, and has a prior psychiatric, criminal and substance abuse history. He is angry, likely to threaten her, and assault her person or property without causing serious injury.     

Stability of life-time psychiatric diagnoses among offenders in community and prison settings

The dearth of studies investigating diagnostic stability among offenders, and diagnostic stability being important from the patient’s mental health perspective, as well as from a public health, training and research standpoint, highlights the need to evaluate lifetime stability of ICD-10 psychiatric diagnoses for offenders in community and prison settings. A case-linkage design linked a two-year population-based cohort of male-sentenced prisoners with a state-wide psychiatric register (23,742 psychiatric consultations). Four measures of diagnostic stability were calculated for each setting as well as across settings, for all offenders who received at least two psychiatric diagnoses. Temporal consistency was moderate for schizophrenia spectrum disorders and low for affective, anxiety and personality disorders, and was higher in prison setting than community settings. Diagnostic instability highlights that the course of mental illness and clinical features among offenders may genuinely vary over time, across community and prison settings and may lead to complexities regarding psychiatric care for this population     

Measuring criminal thinking styles: The construct validity and utility of the PICTS in a Dutch prison sample

Purpose. Criminal thinking and thinking styles are important areas in the assessment and treatment of offenders. The Psychological Inventory of Criminal Thinking Styles (PICTS: Walters, 2005) is designed to assess such criminal thinking styles. In the current study, the associations between criminal thinking styles on the one hand, and criminal histories, personality traits, and mental disorders of Dutch prisoners on the other, were explored. The aim is to test the reliability and construct validity of the PICTS in a population of male Dutch detainees. Methods. A sample of 191 randomly selected male prisoners of a large Dutch correctional institution were assessed by means of the PICTS, NEO‐PI‐R, and the MINI psychiatric interview. Prison inmates with very severe psychiatric symptoms and severe disruptive behaviours were excluded. Results. The psychometric qualities of the PICTS were found to be fair‐to‐good. The construct validity of the PICTS was supported by various convergent results with the criminal antecedents of the offenders, as well as with the scores on the scales measuring personality traits and psychiatric disorders. Conclusions. The associations between criminal thinking styles on the one hand and personality traits, antisocial personality disorder, and mental disorders on the other were rather strong. The current results suggest that the PICTS may be a valid and useful tool for assessing criminal thinking styles.     

The social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.     

浅析女犯矫正激励机制的优化简

随着社会的不断发展和监狱押犯结构的变化，女性罪犯的狱内需求也在不断变化。按照需求理论，只有当激励措施满足于需求时，才能发挥其最大作用。根据在上海市女子监狱某监区进行问卷调查和数据统计，监区尝试探索女犯的改造需求，并优化已有矫正措施和手段，以此激发女犯本身的改造潜力，期望能够达到提高罪犯改造质量、减少重新犯罪率的目标。     

Psychiatric disorders and personality characteristics of prisoners at regular prison wards

BackgroundDutch correctional officers are trained to observe prisoners with severe mental disorder. This ‘behavioural’ approach is assumed to detect psychiatrically disordered prisoners with striking symptoms. On the basis of this screening procedure about 10% of the Dutch prison population is classified as needing special care or control. In the current study, what psychopathology can still be found among the remaining 90% prisoners residing at regular wards is investigated and which personality traits characterize them. When the prevalence of major mental illness would still turn out to be high in this group, the question arises whether the current, rather unstandardized, way of screening prisoners is sufficient.AimsTo assess the prevalence of psychiatric disorders among adult Dutch prisoners on regular wards, and to determine the concurrent and convergent validity of self-report measures and their screening characteristics in such a sample.Method191 randomly selected prisoners admitted to the general wards were administered a number of tests (SCL-90, NEO-PI-R, MINI) during the first weeks of their incarceration.ResultsIncluding substance abuse, 57% of the participants suffered from one or more Axis I disorders. About seven out of ten detainees with psychopathology as assessed with the MINI did not receive professional help. The concurrent and convergent validity of the SCL-90 and the NEO-PI-R turned out to be reasonable. The predictive validity of self-report measures in detecting prisoners with an Axis I disorders or suicide risks was moderate.ConclusionsThe Dutch ‘behavioural approach’ seems to be quite accurate in detecting prisoners with psychotic disorders. Most prisoners with other mental disorders on regular wards, however, did not receive professional help. The current study suggests that self report scales such as the SCL-90 and the NEO-PI-R may be helpful in screening detainees on important DSM-IV disorders.     

Prevalence and screening of mental disorders in short-term correctional facilities

A majority of people incarcerated in correctional facilities have been affected by mental problems at least once in their lifetime. Among them, 12 to 25% suffer from severe and persistent mental disorders at the time of admission. Certain “profiles” are more likely to be detected than others. This is why the main objectives of this research are to establish, in both male and female offenders admitted in short-term detention facilities, the rate of those who have received medical diagnoses of mental disorders, the rate of screening for “mental health problems” at admission and the psychiatric diagnoses (last five years) most strongly associated with a positive screening. Using computerized medical and prison files, it can be established that 61% of the 671 offenders sent to a short-term correctional facility received, during 2002–2007, at least one diagnosis for mental disorder. A total of 227 subjects (33.8%) obtained a positive score to the indicator of mental health problem.” In the case of men, correctional services workers identified as mental health problems: psychotic disorders, adjustment reactions, «neurotic»/anxiety disorders, being coupled to drug dependence. Positively detected women tend to exhibit problems of anxiety, personality disorder and substance related disorders. This study highlights, the difficulties faced by correctional services workers in detecting recent depressive disorders both in men and women offenders and also difficulties to detect recent affective psychoses.     

A cross-sectional study on expression of anger and factors associated with criminal recidivism in prisoners with prior offences

OBJECTIVE: The purpose of this study is to determine demographical characteristics leading to crime recidivism and define anger levels and anger expression manners for those who re-commit crime. METHOD: All the literate inmates in Izmit Closed Penitentiary were included in this cross-sectional study. The prisoners were asked to respond to State-Trait Anger Expression Inventory. Their socio-demographic data were collected and a questionnaire was given to them to determine their state of imprisonment, sentence, nature of the crime in which they were involved, their criminal history, their relationship with inmates and prison staff and substance and alcohol use. RESULTS: Of the 438 prisoners, 302 (68.9%) responded to the questionnaires. Crime recidivism among the study cohort was observed to be 37.4%. Mean trait anger, anger out and anger in scores were significantly higher in prisoners with criminal recidivism in comparison with those who did not have prior criminal records. However, mean anger control scores for prisoners with or without criminal recidivism were similar. Unemployment, education level completed at secondary school or below, having committed a crime under the influence of alcohol or narcotics, having been involved in prison fights, having resisted police officers, caused damage in their vicinity when angry and violent crimes were all found to be possible causes of criminal recidivism. Educational level completed at secondary school or below, getting into fights with other prisoners, unemployment and resisting police officers were determined to be the strongest indicators to predict criminal recidivism when all variables were considered according to a logistic regression model. CONCLUSION: It can be proposed that those who have problems with officials or hostile towards others constitute a risk group for criminal recidivism. If prisoners with criminal recidivism can be helped to identify and control their anger, their risk of committing a new crime can be minimised.     

Risk of harm: inmates who harm themselves while in prison psychiatric treatment

In this study, 242 randomly selected male offenders who were receiving psychiatric treatment in prison were administered psychological and neuropsychological evaluations and were followed during their treatment in a prison psychiatric hospital. Offenders who harmed themselves in treatment were compared to those who did not harm themselves. Eighteen percent of offenders harmed themselves, the severity of which required medical intervention. Young age, drug abuse, absence of Axis I mental disorder but presence of Axis II borderline personality disorder identified offenders who harmed themselves. Psychopathy checklist-revised (PCL-R) total rating > or = 30 and PCL-R Factor 2 (antisocial lifestyle) rating also identified offenders who harmed themselves. Additionally, offenders who harmed themselves also were 8.36 times more likely than their cohorts to harm treatment staff. Theoretical understanding of offenders who harm themselves, the importance of considering the environmental context in identifying risk factors for self-harm, and implications for treatment are suggested.     

A cross-sectional study on expression of anger and factors associated with criminal recidivism in prisoners with prior offences

Objective: The purpose of this study is to determine demographical characteristics leading to crime recidivism and define anger levels and anger expression manners for those who re-commit crime.Method: All the literate inmates in zmit Closed Penitentiary were included in this cross-sectional study. The prisoners were asked to respond to State-Trait Anger Expression Inventory. Their socio-demographic data were collected and a questionnaire was given to them to determine their state of imprisonment, sentence, nature of the crime in which they were involved, their criminal history, their relationship with inmates and prison staff and substance and alcohol use.Results: Of the 438 prisoners, 302 (68.9%) responded to the questionnaires. Crime recidivism among the study cohort was observed to be 37.4%.Mean trait anger, anger out and anger in scores were significantly higher in prisoners with criminal recidivism in comparison with those who did not have prior criminal records. However, mean anger control scores for prisoners with or without criminal recidivism were similar. Unemployment, education level completed at secondary school or below, having committed a crime under the influence of alcohol or narcotics, having been involved in prison fights, having resisted police officers, caused damage in their vicinity when angry and violent crimes were all found to be possible causes of criminal recidivism. Educational level completed at secondary school or below, getting into fights with other prisoners, unemployment and resisting police officers were determined to be the strongest indicators to predict criminal recidivism when all variables were considered according to a logistic regression model.Conclusion: It can be proposed that those who have problems with officials or hostile towards others constitute a risk group for criminal recidivism. If prisoners with criminal recidivism can be helped to identify and control their anger, their risk of committing a new crime can be minimised.     

Effectiveness of cognitive remediation for female inmates: a pilot study

There is considerable evidence that neurocognitive deficits are frequent among incarcerated offenders. However, current correctional programming does not directly seek to remediate deficits in offenders’ neurocognitive deficits. In this pilot project, we sought to treat neurocognitive deficits in incarcerated Portuguese adult women offenders (n?=?28) using cognitive remediation to target cognitive flexibility, memory, and planning. Statistically significant positive changes, with medium to large effect sizes, were discovered across several neurocognitive domains, including attention, speed of processing, verbal learning and memory, cognitive flexibility, and planning. We also found a decrease in the negative emotional states of depression, anxiety, tension/stress, and on disturbed behavior in prison. Cognitive remediation has the potential to enhance the neurocognitive functioning of incarcerated women. Controlled research is needed to establish cognitive remediation fully as an intervention for the treatment of neurocognitive deficits of incarcerated women.     

Attention deficit hyperactivity disorder does not predict criminal recidivism in young adult offenders: Results from a prospective study

As the state of research on the relationship between attention deficit hyperactivity disorder (ADHD) and recidivism can be considered controversial, our prospective study investigated whether ADHD predicts recidivism in a sample of 283 male, German, young adult prisoners. Currently existing ADHD symptoms and symptoms that were present in childhood were screened according to the DSM-IV checklist criteria. Information on general and violent recidivism was gathered using government records with a follow-up period of up to five years. The prevalence of adult ADHD was six times greater than in the general population, and the number of participants who retrospectively met the criteria for a diagnosis with ADHD in childhood was ten times greater than found in community samples. Survival analyses did not identify ADHD as a predictor of recidivism. Controlling for conduct disorder, substance dependence, and other relevant variables did not alter results. However, among individuals who were released from prison and then reconvicted for a new crime, offenders diagnosed with ADHD were found to reoffend sooner after release. These findings stress the necessity of differentiating between risk factors for delinquency and risk factors for recidivism.     

Evaluation of the improving access to psychological therapies for offenders programme at HMP Lincoln: a three year prospective cohort study

The mental health needs of prisoners are significant with a high incidence of common mental health problems including anxiety and depression. Extending national initiatives such as the National Health Service Improving Access of Psychological Therapies programme to people in prison offers a valuable opportunity to address these mental health problems and improve continuity of care from prison to the community. This study adopts an observational, prospective cohort design and evaluates an IAPT for offenders service over the first three years of operation within a male Category B prison holding remand/convicted prisoners. The evaluation found large effect sizes for changes in anxiety and depression with clinical recovery being achieved in 55% of depression and 52% of anxiety cases. On average, prisoners were treated in less than five sessions employing a low-intensity cognitive-behavioural approach. The lack of established formal diagnoses and a control group limits the findings.     

Determinants of prisoners’ perceived need for care in association with criminal recidivism

This study explored determinants of perceived need for care among male inmates of general prison wards in Amsterdam (N = 208) with a normative need for care. Also, it assessed the relation between perceived need for care and criminal recidivism. Normative need for care was defined as having a mental health problem, assessed with the Brief Jail Mental Health Screen, or being substance dependent. Perceived need for care was defined as a subjective problem experience and a wish to receive care. Mental health and/or addiction problems were highly prevalent (68%). Of those inmates, only 29% had a perceived need for care. Age and borderline personality disorder were associated with perceived need for care, prior care utilization intermediated these associations. No direct relation between perceived need for care and criminal recidivism was observed. All inmates should be well screened and the benefits of mental health care should be promoted.     

Dangerous mentally disordered criminals: unresolvable societal fear?

The average person fears dangerous criminals, especially those suffering from mental illness. Existing mental health and criminal justice systems provide social control for some of these dangerous individuals, but may be inadequate to deal with those mentally disordered offenders who were not found not guilty by reason of insanity (NGI). In California, innovative laws have attempted to address this problem. However, putative lack of efficacious treatment of mentally ill criminals, insufficient economic support, and individual liberty concerns loom as limiting factors in solving the criminal and psychiatric recidivism problem posed by non-NGI dangerous mentally disordered offenders.