High mortality rates among inmates during the year following their discharge from a French prison

While the poor health status of prisoners has been highlighted in Western countries, the surveillance of their mortality has been neglected. We studied the mortality of 1305 prisoners released during 1997 from a French prison. Vital status after release was obtained for 86.4% of them. Compared with the general population, ex-prisoners non-natural mortality rates were significantly increased both in the 15-34 and 35-54 age categories (3.5-fold and 10.6-fold respectively) and the risk of death due to overdose was 124 and 274 times higher in the same categories respectively. Prevention and care should be reinforced in the pre-release period without waiting more epidemiological data.     

Psychiatric morbidity among Finnish prisoners with special reference to socio-demographic factors: results of the Health Survey of Finnish Prisoners (Wattu Project)

The present study is part of the Health Survey of Finnish Prisoners (Wattu Project). The project dealt with a sample of 1099 Finnish prisoners, of which 82% participated in the study. Because of the representativeness of the sample the results can be generalized to all Finnish prisoners. The methods used consisted of questionnaires, interviews, a clinical examination by prison physicians and gathering of register data. The total prevalence rate of psychiatric cases was 56%. This is much higher than the rate for the Finnish population in general. The high number of mental disorders was due to alcoholism (43%) and personality disorders (18%). These disorders became even more prevalent as the number of prison sentences increased. There was no difference between the prisoners and the general population in the prevalence of psychoses and neuroses. Alcoholism is the most important mental disorder in Finnish prisoners, while drug abuse is rarely found among them in comparison to prisoners in many other countries.     

Static screening instruments for risk of minor and major violence

Background: Screens for violent convictions that are simple, accessible and parsimonious are needed, as a first stage in identifying those at high risk for further assessment. Aims: To construct and validate screening tools for minor and major violence convictions for released prisoners. Methods: Internal validation sample of 1647 serious offenders and an external validation of 46,704 general prisoners. The outcomes were binary indicators for having at least one conviction for minor and major violence. Risk factors were convictions for violence and age. Results: In the external validation sample, the instrument for risk of minor violence (PMIV) identified correctly 60.8% of male and 66.2% of female general prisoners. For risk of major violence, the instrument (PMAV) identified correctly 68.0% of male and 79.3% of female prisoners. Conclusions: The PMIV and PMAV will efficiently assist practitioners in a first stage of screening before in-depth clinical assessment of risk for future violent convictions.     

Psychopathy and Mortality

It is not known how mortality differs between psychopathic and nonpsychopathic individuals. We linked data from subjects having been in forensic mental examinations at Niuvanniemi Hospital during 1984–1993 to the data from the National Death Registry to estimate the association between psychopathy and mortality. One hundred psychopathic individuals scoring 25 or higher in the PCL‐R scale were followed up for 20–30 years. Two control groups were used as follows: 178 offenders scoring less than 25 on the PCL‐R, and sample of general population drawn from the Finnish National Statistics database. Results reveal that psychopaths die younger than the general population, and the causes of death are more violent than in the nonpsychopath control group. There was a significant positive correlation between PCL‐R score and mortality, and the mortality among psychopaths was about fivefold when compared with general population.     

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.     

Victimization and Poly-Victimization in Adolescent Outpatients from Mental Health Centers: A Case-Control Study

The aims of the present study were to establish interpersonal victimization rates in a clinical sample and to analyze this sample’s risk of victimization relative to the general population. The sample was composed of 472 adolescents (12–17 years of age): 118 outpatients from public mental health centers and 354 students who were matched by age and sex. Following previous studies, this research defined poly-victimization as four or more victimization types occurring during the previous year. The clinical group was more likely to report sexual victimization (OR = 9.540), conventional crime (OR = 3.120), caregiver victimization (OR = 3.469), witnessing and indirect victimization (OR = 3.466), electronic victimization (OR = 2.809), and poly-victimization (OR = 4.319) compared with the control group. Clinical samples present an increased risk of interpersonal poly-victimization compared with the general population. The influence of poly-victimization on mental health should be considered in the evaluation and treatment of adolescent outpatients.     

The validity of death certificates: routine validation of death certification and its effects on mortality statistics

The 3478 death certificates (7.1% of all annual death certificates) of this study comprise those national death certificates in 1995 submitted for validation to the panel representing both medical and nosological expertise. As such, it is highly selected and represents, from the nosological point of view, the most inconsistently filled-in portion of Finnish death certificates. The routine validation procedure is essentially based on exploitation of the extra medical information, i.e. the case history, on the Finnish death certificate form. Altogether, 2813 (80.9%) out of 3478 certificates could be adjusted at the primary panel session; the rest required further clarification. The re-assignment of cause of death by the panel and the impact of panel adjustments on the national mortality statistics is assessed here by comparing the initial death certification and the finally registered underlying cause of death grouped into ICD-9 major categories with special reference to the subcategories of neoplasm, cardiovascular disease (HVD) and unnatural death. A statistically significant decline (p<0.0001) in deaths, both in the category of symptoms, signs and ill-defined conditions and in the pulmonary circulation disease subcategory of HVD with 37.6 and 35.1%, respectively, was observed. The decrease of 11.1% in the benign or NUD neoplasm subcategory and the increase of 8.6 and 7.0% in the categories of endocrine disease, and musculo-skeletal and connective tissue disease, respectively, are essential observations as to the quality of the cause of death register. The effect on the HVD major category was practically nil. At the HVD-subcategorial level, a decrease of 14.0% for diseases of the veins and lymphatics and other circulatory diseases and an increase of 3.5% for hypertensive diseases (HYP) were the two next most obvious alterations to the diseases of the pulmonary circulation, but were without statistical significance. For ischaemic heart disease and other subcategories, the effects were minor. The unnatural deaths as a whole increased in the final statistics with only 0.9%. In the study data, categorial changes ranged from the decrease of 75.2% for symptoms, signs and ill-defined conditions to the increase of 77.3% for endocrine diseases. In conclusion, the Finnish death certificate form, death certification practices and cause of death validation procedure seem to serve the coding of causes of death for mortality statistics appropriately. The results of the study form a relevant reference background to evaluation of epidemiological studies on mortality.     

Evaluation of the ADViSOR project: Cross‐situational behaviour monitoring of high‐risk offenders in prison and the community

Purpose. The release on licence of prisoners who have committed serious violent and/or sexual offences requires rigorous risk assessment and risk management. This study evaluates the ADViSOR project, designed to examine the contribution of prison behaviour monitoring to community supervision of a sample of the highest risk offenders released in England and Wales under Multi‐Agency Public Protection Arrangements (MAPPA). Method. The offence‐related behaviour of a total group (n= 25) of MAPPA prisoners in one prison, due for release in the following year to two adjacent probation trust areas, was monitored. Their behaviours in the community were followed up for 1 year. A comparison group (n= 36) was formed of the total number of MAPPA prisoners released from prisons nationally to the same two probation trusts. Results. The frequencies of ADViSOR negative behaviours in prison and the community were strongly correlated, r_s (25) = .55, p= .004, as were positive behaviours, r_s (25) = .56, p= .004. No statistically significant correlations were found either under usual MAPPA processes in the ADViSOR prison or comparison group prisons. The frequency of ADViSOR negative behaviours statistically significantly predicted, with 92% accuracy, the offenders who would reoffend or be recalled to prison (n= 8). Statistically significant similarities in types of behaviour were also identified. Conclusion. Results are discussed in terms of the contribution of behavioural monitoring to risk prediction with high‐risk offenders, consistency of cross‐situational behaviours, and implications for policy and practice.     

Identification of Risk Factors for Self‐Injurious Behavior in Male Prisoners*

Abstract: Male prisoners with (n = 132) and without (n = 132) histories of engaging in self‐injurious behavior (SIB) were matched on conviction prefix and custody level. Conditional logistic regression revealed that a combination of risk factors from domains defined by developmental, offense history, mental health, and institutional functioning factors correctly classified 93% of the prisoners in the sample (ROC AUC = 0.89, S.E. = 0.005, p < 0.0001). Model specificity was 92.6% and sensitivity was 95.3%. False positive and false negative rates were 2.3% and 3.4%, respectively. Implications for the assessment of prisoners at risk for SIB as well as suggested future directions for SIB prisoner research are discussed.     

Who receives substance abuse treatment in the ‘real world’ of the prison? A register-based study of Finnish inmates

Assessing and targeting substance abuse-related treatment needs according to evidence-based practice has become the norm in most prison administrations. Not everyone with a need will, however, receive support in practical settings. Drawing on Finnish prison registers, we show that of all prisoners released in 2011, 60% were assessed as having a need for substance abuse-related support. Of these, 22% received an intervention in prison. Two multivariate models were used to examine the factors related to selection into interventions. The main factors associated with receiving an intervention with evidence-based programmes were a longer sentence, Finnish nationality, younger age and treatment motivation. The predictors for any substance abuse interventions (including non-evidence-based) were the same, with the exception that motivation was no longer a significant predictor, and female gender remained significant. The selective use of motivation as an entrance criterion for interventions can be a means of systemic adaptation to a combination of a high prevalence of substance abuse problems and a lower prevalence of treatment motivation in the prison population. We discuss how our results might reflect a Scandinavian way of doing evidence-based, prison-based drug treatment—one that stresses rehabilitation as a goal in itself in addition to reducing recidivism. Most prisoners, however, do not receive any intervention at all.     

Facing drug problems and advancing sentence plan. Prisoners’ perspectives on drug treatment programmes in Finland

ABSTRACT

In Nordic countries, the rapid development of various prison-based drug treatment (PDT) programmes emerged in the mid-1990s, and this development can be viewed as a criminological shift towards a “new form” of penal welfarism combining control and rehabilitation in a revised form in a new era. This article examines PDT programmes from the prisoners’ perspective to analyse their motives to participate, experiences, and relationships with counsellors, guards, and prisoners. Data were collected from interviews of the prisoners and observations in three Finnish prisons. Both the motives connected to handling drug problems and those connected to gaining an advantage for the duration of time spent in prison were experienced simultaneously by participants. Prisoners made a clear distinction between guards and drug counsellors and were somewhat confused by staff roles that combined both rehabilitative and control features. These findings suggest that new hybrid roles already found among correctional staff seem to exist also for prisoners.     

How do psychiatric patients on prison healthcare centres differ from inpatients in secure psychiatric inpatient units?

Abstract

Mentally ill prisoners have consistently been highlighted as a group with complex needs. However, it is not clear what these needs are, how effective prison health services are in meeting the needs of this vulnerable group, and whether there would be any benefit to transferring them to psychiatric facilities. This study compared the characteristics and needs of mentally ill patients in prison healthcare centres (HCC prisoners) with patients in forensic medium secure psychiatric units (MSU inpatients) in the UK. HCC prisoners and MSU inpatients were in fact very similar. Where they did differ, though, was that MSU inpatients were significantly more likely to be of non-white ethnicity, diagnosed with psychotic or substance use disorders, and have recorded histories of drug misuse. HCC prisoners and MSU inpatients reported the same number of needs overall, according to the CANFOR-S (Camberwell Assessment of Need Forensic Short Version), but HCC prisoners reported significantly higher levels of unmet need. The need for transfer to alternative services was common in both groups, with bottlenecks evident at all levels. The high level of unmet need reported in the HCC prison sample is of particular clinical concern and highlights the need for improved assessment and treatment services in this setting.     

Prediction of attitudes towards child sexual abuse among three different Norwegian samples

Abstract

The aim of the current study was to reveal attitudes towards child sexual abuse and investigate predictors of such attitudes. A random sample of the Norwegian adult population (n = 296), active Christians (n = 125) and prisoners convicted of child sexual abuse (n = 36) were included in the study. The results show that women were more negative towards child sexual abuse than men, and the prisoners had more accepting attitudes than the other samples. Predictors of attitudes differed across the samples. Empathy and normlessness were the best predictors of attitudes among the random sample of adults and the active Christians. The largest predictor of attitudes among the prisoners was their view of women. The implications of the results for prevention strategies are discussed.     

Gang activity in English prisons: The prisoners’ perspective

Abstract

Gang activity in American prisons has resulted in serious problems for prisoners and staff. This study assessed prisoners’ perceptions of gang-event frequency in the UK. Interviews with 360 prisoners from nine prisons in England and Wales indicated gang-related events were perceived as more frequent in all male categories of prison than they were in female institutions. Prisoners reported drug possession and prisoner groups being formed along regional origins as the most frequent gang-related activities. Recidivists perceived higher levels of gang-related activity than did first-time prisoners. Gang-related variables also predicted prisoners’ perceptions that groups of prisoners have more control over events in the prison than do staff and that order in the prison may not be maintained. The merits of interviewing prisoners and the implications of the results for maintaining order in prison are discussed.     

Psychologists as ‘the quiet ones with the power’: understanding indeterminate sentenced prisoners’ experiences of psychological risk assessment in the United Kingdom

ABSTRACT

Prisoners serving indeterminate sentences in the United Kingdom do not know when or if they will be released from prison. Release and progression decisions are determined by the risk the ISP presents of reoffending. This makes the assessment of risk a high stakes business for ISPs. Whilst there is a large body of literature focused on prisoners’ general experiences of prison, there is an absence of specific empirical exploration of prisoners’ experiences of risk assessment. This paper aims to address this gap by reporting the results of a qualitative exploration of ISPs’ experiences of psychological risk assessment. Interviews with 10 ISPs were conducted and analysed using Grounded Theory methods. Analysis indicated that prisoners experienced the prison environment as characterised by violence, volatility and suffering. Psychological risk assessment is embedded within this emotionally and physically challenging context but also contributes to the experience of suffering. Within this context, prisoners felt stuck, powerless and out of control in relation to risk assessment, and experienced psychologists as untrustworthy yet powerful. Understanding prisoners’ experiences is the first step in resolving some of the long-reported difficulties in working relationships between psychologists and prisoners as well as making the process more procedurally just.     

Prison structure, inmate mortality and suicide risk in Europe

Suicide presents a major complication during imprisonment and greatly contributes to the high mortality rate of prisoners. All international studies have found increased suicide rates among prisoners compared to the general population. This study examines risk factors for suicide and mortality in prisoners using supranational data from the Council of Europe Annual Penal Statistics (Statistiques Penales Annuelles du Conseil du L'Europe or SPACE) from 1997 to 2008. Macrostructural risk factors for prison suicide are analyzed from this supranational data set and the identified indicators are further evaluated on the single country level. Sexual offenders, offenders charged with violent crimes and prisoners sentenced for short- and long-term imprisonment are considered to be at an elevated risk for suicide. In addition, prison mortality is associated with overcrowding.     

The Portuguese adaptation of the Gudjonsson Suggestibility Scale (GSS1) in a sample of inmates

This paper comprises two studies which address the validity of the Portuguese adaptation of the Gudjonsson Suggestibility Scale, GSS1. In study 1, the means and standard deviations for the suggestibility results of a sample of Portuguese inmates (N = 40, M_age = 37.5 years, SD = 8.1) were compared to those of a sample of Icelandic inmates (Gudjonsson, 1997; Gudjonsson & Sigurdsson, 1996). Portuguese inmates' results were in line with the original results. In study 2, the means and standard deviations for the suggestibility results of the sample of Portuguese inmates were compared to those of a general Portuguese population sample (N = 57, M_age = 36.1 years, SD = 12.7). The forensic sample obtained significantly higher scores in suggestibility measures than the general population sample. ANOVA confirmed that the increased suggestibility in the inmates sample was due to the limited memory capacity of this latter group. Given that the results of both studies 1 and 2 are in keeping with the author's original results (Gudjonsson, 1997), this may be regarded as a confirmation of the validity of the Portuguese GSS1.     

Psychopathy among prisoners in England and Wales

Most research into psychopathy among prisoners is based on selected samples. It remains unclear whether prevalences are lower among European populations. This study aimed to measure the prevalence of psychopathy, and the distribution and correlates of psychopathic traits in a representative national sample of prisoners. Psychopathy was measured using the revised Psychopathy Checklist (PCL-R) in a second stage, cross-sectional survey of prisoners in England and Wales in 1997 (n = 496). Poisson regression analysis was carried out to examine independent associations between correlates and PCL-R total and factor scores. The prevalence of categorically diagnosed psychopathy at a cut off of 30 was 7.7% (95%CI 5.2–10.9) in men and 1.9% (95%CI 0.2–6.9) in women. Psychopathic traits were less prevalent among women. They were correlated with younger age, repeated imprisonment, detention in higher security, disciplinary infractions, antisocial, narcissistic, histrionic, and schizoid personality disorders, and substance misuse, but not neurotic disorders or schizophrenia. The study concluded that psychopathy and psychopathic traits are prevalent among male prisoners in England and Wales but lower than in most previous studies using selected samples. However, most correlates with psychopathic traits were similar to other studies. Psychopathy identifies the extreme of a spectrum of social and behavioral problems among prisoners.     

Post release arrest experiences of federal prisoners: A six-year follow-up

The likelihood of further criminal conduct is important in allocation decisions for parole supervision resources. In this article, the relationship between arrest-free time after release (alone and in combination with other variables) and the probability of subsequent arrest is examined for a relatively large random sample of released federal prisoners (N=1,806). A six-year follow-up period is made possible by the use of “rap sheet” records provided by the Federal Bureau of Investigation.Knowledge of this relationship may be used to provide empirical guidance for decisions about the intensity and/or duration of supervision; and a method for the practical application of this knowledge in case decision-making is illustrated.