Review of point-of-reception mental health screening outcomes in an Australian Prison

The point-of-reception into prison is a critical juncture as it provides early opportunities to identify mental illness and initiate treatment. Although large numbers of mentally ill prisoners are received into prison each day, research investigating mental health screening outcomes at the point-of-reception is limited. This study aimed to address this gap by examining reception screening outcomes for all prisoners received into an Australian prison during 2009 (n?=?4229). Overall, 19% of all prisoners were mentally ill, and another 20% had a history of psychiatric illness that required ongoing care. Mentally ill prisoners had a higher risk of suicide or self-harm and required more observation than other prisoners. At reception, no mentally ill prisoners were transferred to the state’s forensic hospital and few were transferred to the prison’s mental health unit, or provided support service referrals. These findings highlight that outcomes made at the point-of-reception are heavily influenced by the availability of prison mental health resources.     

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.     

A Call for Help: Women Offenders' Reflections on Trauma Care

Female prisoners have extensive trauma histories and complex treatment needs that contribute to their criminality, yet trauma screening and treatment is not widespread in prisons. This article examines qualitative data gathered from face-to-face interviews with 31 female offenders in Canadian prisons. Using a grounded theory approach we demonstrate an unmet need for trauma-specific services for female offenders. These services go beyond trauma-informed practice and treat the psychological and behavioral sequelae of trauma exposure (e.g., mental illness and addictions) to facilitate recovery. The findings suggest that women in prison want and need specific treatment for trauma exposure. Integrating trauma-specific services involves a cultural shift within the prison environment that might be achieved by positioning trauma within the risk–need–responsivity model as an additional risk factor for criminality. Although counter to the public health perspective that trauma is a health concern, it is a way to ensure that trauma becomes part of the battery of care in corrections so that the needs of traumatized women are addressed while they are in custody. This was a unique opportunity to learn about what women would like to help deal with their experiences of trauma.     

Interventions with women offenders: a systematic review and meta-analysis of mental health gain

Currently, a conjunction of policy, legislative change in health and social care and the criminal justice system, combined with funding for innovative services make it opportune to assess the evidence base for interventions with women offenders. Women offenders have a distinctive criminological, health and social profile and a gender specific approach to their difficulties is advocated. This systematic review and meta-analysis focus on mental health gain in adult women offenders in forensic health settings, criminal justice institutions and in the community, following therapeutic interventions. Interventions were assessed in terms of specific outcome measures of depression, trauma symptomatology and global mental health status. Comprehensive search strategies yielded 3018 articles, from which we obtained 199 full text articles. Seventeen articles were included in the final review, of which six were excluded from the meta-analysis as there was no comparator group. There is a modest, but increasing, body of evidence for the utility of some interventions, notably those addressing the consequences of earlier trauma, including interventions which also address comorbid substance misuse. This does not amount, to date, to a robust evidence base. Limitations of these studies are discussed and include small sample sizes, their restriction mainly to prison populations and that they were substantially undertaken in the US. Variations in outcome measures follow-up and the difficulties inherent in measuring change in this complex population are also detailed. However, the review delineates definite avenues for further work. To achieve this, those responsible for policy, practice and purchase of services should both be mindful of existing evidence and promote additional, high quality research into interventions which are designed around a coherent, theoretical approach.     

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.     

Actions taken in response to mental health screening at reception into prison

Screening for mental health problems on reception into custody has been criticised. However, there have been few studies on care pathways through custody as a result of screening identification. We aimed to identify what actions were taken as a result of screening positive for suicidal ideation and mental health problems. Case records for 2166 prisoners newly received into five prisons in England and documented contact with health care professionals in the following month were examined by hand over a four-month period. Altogether, 3% of prisoners were screened as having current suicidal ideas, of whom 30% had no contact with mental health services or risk assessment documentation. Another 21% of new receptions received psychotropic medication, for whom over 60% received no primary mental health assessment, and only 36% received psychotropic medication in prison. Care pathways need to be defined, and screening needs to be delivered as originally intended by initial screen for life-threatening matters, followed by a later, comprehensive assessment of health needs.     

How do professionals experience working with offenders diagnosed with personality disorder within a prison environment?

To explore the different experiences of a Multidisciplinary Team working with offenders diagnosed with personality disorder (PD) and produce a substantive model of the Offender PD Pathway strategy from a staff perspective. Fourteen participants were recruited from ‘Unit A’ located within a high security prison. Semi-structured interviews were conducted with participants and the data collected were analysed using constructivist grounded theory. A model was constructed depicting the experiences of those working with offenders with PD. Main themes identified were: prison environment; synergy of the workforce; understanding of the client; individual perceptions; support; and personal change. Although there was enough similarity within the participants’ responses to consider them to be a homogenous population, there were some noticeable differences in trends of responses evident between the two sub-groups of health service-based clinical staff and prison staff as expressed in the model. There is interplay between factors which influence an individual’s experience of working with offenders with PD. How a member of staff experiences working with offenders with PD depends on more than just the nature of the client and the challenges they pose. These factors external to the client group appear to have a significant impact on the professional and their emotional experiences of their work.     

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。     

Mental Health Among Incarcerated Women: An Examination of Factors Impacting Depression and PTSD Symptomology

Female offenders experience mental health symptoms at a higher rate than male offenders and females in the community. The current study investigated individual characteristics and experiences that may impact symptoms of depressive disorders and posttraumatic stress disorder (PTSD) among a sample of female inmates in a large Southern prison system. Results showed high rates of reported childhood and adult victimization experiences among the sample. Factors such as seeking mental health treatment prior to incarceration significantly impacted the reporting of depressive and PTSD symptoms, as did victimization histories. Findings suggest that women would benefit from screening to identify mental health needs at the onset of incarceration as well as gender responsive needs assessment and programming to address histories of victimization and current mental health symptomatology.     

“A different world” exploring and understanding the climate of a recently re-rolled sexual offender prison

Understanding how sexual offenders experience prison and its environment is important because such experiences can impact on rehabilitation outcomes. The purpose of this research investigation was to explore the rehabilitative and therapeutic climate of a recently re-rolled sexual offender prison. The research took a mixed methods approach and consisted of quantitative and qualitative phases. There were differences between prisoners and staff on their perception of the prison climate and for prisoner and staff relationships. The qualitative results helped to explain the quantitative findings and added a more nuanced understanding of the experience of the prison, the nature of prisoner and staff relationships and the opportunities for personal growth within the prison. The study has important implications for prisons that co-locate sexual offenders and want to provide an environment conducive to rehabilitation.     

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     

Not All Substance Dependence Problems are Recognized as Risks—Comparing a Medical Health Study with Prison Assessments

Substance abuse is viewed as one of the main factors (criminogenic needs) to be assessed and targeted in prison. Prison assessments of risk and needs are known to validly predict reoffending. However, there seems to be lacking research in how reliably the individual prisoner’s problems, such as substance abuse, are represented in the assessments. In this study, we compare an independent medical health study (N?=?510) with in-prison assessments for the same persons to see whether some of the inmates’ substance abuse disorders were overlooked in prison. We found that sentence plans (257) were in poor agreement with the health study (Kappa 0.315); they recognized only 65 % of all diagnoses. The risk and needs assessments (178) were in closer agreement with the health study, however, alcoholism diagnoses were recognized less accurately (Kappa 0.519) and less frequently (78 %) than drug diagnoses (Kappa 0.627, 87 %). The main factors predicting an assessment of substance abuse risks in prison, analysed through logistic regression were: longer stay in prison and one or more dependence diagnoses. We conclude that, a number of potentially criminogenic dependence problems remain unrecognized since some groups of prisoners are either completely left out from the more thorough instrument, the risk-and-needs assessment, or are not assessed thoroughly enough. This puts prisoners in unequal positions, since all interventions in prison are based on assessments. The study alerts us of the selectiveness of prisoner assessments in practical settings; the unrecognition of problems of shorter sentenced prisoners and prisoners with alcohol dependence.     

Prison visitation as human ‘right’ or earned ‘privilege’? The differing tales of England/Wales,and Scotland

Prison visitation has been widely recognised as an important feature of a just and humane prison system, providing important benefits for prisoners and their family in maintaining ties. However, emphasis on maintaining prisoner–family ties over the sentence has remained a low priority for the prison service in England and Wales, with prison visits ideologically framed as a ‘privilege’ rather than a ‘right’ for prisoners. This paper contrasts England and Wales with Scotland where a diverging approach to supporting visitation and family contact has been implemented. In Scotland, a strong focus on human rights as a justification for these policies has occurred, in tandem with more palatable historical context of penal welfarism. This paper assesses differences between the two governmental approaches to prison visitation, situated in discussion of some of the broader resettlement outcomes which may be garnered via these policy responses.     

Life Before “I Killed the Man That Raped Me”: Pre-Prison Life Experiences of Incarcerated Women With Life Sentences and Subsequent Treatment Needs

The number of incarcerated women serving a life sentence is growing. This subpopulation rarely receives programming in prison or even inclusion in intervention studies’ samples. According to importation theory, characteristics of prisoners’ pre-prison experiences guide the types of interventions provided to prisoners. This study examined the importation factors for a sample of women serving life sentences and used thematic analysis to understand these factors. The primary theme was the dominance of trauma in women’s pre-prison lives with four connected sub-themes that highlight treatment needs pre-and during prison. One implication of this study is improving prison policies to include this subpopulation in treatment opportunities.     

‘Social Services will not touch us with a barge pole’: social care provision for older prisoners

Older prisoners are the fastest growing subgroup in the English and Welsh prison estate. Older prisoners have high levels of health and social care needs. This mixed-method study involved the distribution of a questionnaire examining the availability of health and social care services for older prisoners to all prisons housing adult males in England and Wales, followed by qualitative telephone interviews with representatives from eight prisons. Over half of establishments had some contact with external social care services, but reported significant difficulties in arranging the care for individuals. A professional lead for older prisoners had been identified in 81% of establishments; however, the value of this role to positively affect practice appeared questionable. Statutory social care was often non-existent in prison due to the lack of understanding of what it constituted and who was responsible for its provision.     

Women Prisoners and the Drive for Desistance: Capital and Responsibilization as a Barrier to Change

There is a significant and growing volume of research into the way in which offenders desist from crime and their resettlement and reentry into society following a custodial sentence. As is too often the case in criminological research, women are underrepresented in these areas of investigation. This research aimed to investigate how women in the last 3 months of a prison sentence plan and prepare for their release. Using data generated from qualitative interviews with women prisoners and prison staff over a 13-month period in a closed women’s prison in England, this paper will argue that women prisoners have motivation and desire to desist from crime post-release, but their attempts to plan for release are hindered by a responsibilization discourse that runs throughout the institution and by a severe lack in all forms of capital (social, cultural, economic, and symbolic). This not only results in many women being released with little support in place to help them achieve their aims of a crime-free life in the future but also highlights the problems with a prison system based on male-centered knowledge.     

Factors associated with desistance from violence in prison: an exploratory study

Desistance from crime has been of increasing interest within criminal justice literature, but desistance from offending behaviour whilst in custodial environments has not yet been investigated. Violence within prison establishments continues to be a significant problem; therefore, this study investigated the factors that are associated with desistance from custodial violence in 63 UK Category C adult male prisoners with a record of violence in prison. Participants completed measures of eight social and subjective factors associated with desistance in community samples. Those who had desisted from prison violence for 12 months or more showed greater levels of pro-social attitudes, agency and resilience than those who persisted in violence. Agency independently predicted desistance and this was particularly the case for younger offenders. Internal shifts appeared to be supported by a positive work environment. It is concluded that in custody an internal shift in perspective is especially important for desistance, and that this can be supported by the social environment. Opportunities to intervene may be greater in younger prisoners. It is recommended that current initiatives in developing agency and positive social interaction, such as Psychologically Informed Planned Environments, are further developed.     

Mental health expertise at prison reception

Although screening has become an established procedure in prison health care, some difficulties persist. In attempts to improve this, many local adaptations have been introduced, but few have been evaluated. We introduced an adaptation – mental health expertise (a Community Psychiatric Nurse, CPN) – into the reception area of a busy remand prison, and compared standard and enhanced assessment procedures over a six-month period. Referrals (n = 67) were significantly more likely to be suitable for onward caseworking by the clinical team after a CPN was introduced. The team showed little evidence of the ‘mission creep’ (where teams operating at a secondary level absorb mental health problems at a primary care level) that has been described elsewhere in the literature. Despite its limitations, this evaluation suggests that prison pathways can be improved by relatively inexpensive local initiatives, and that advancing specific mental health expertise into prison reception areas can enhance existing processes.     

Brief mental health screening of prison entrants: psychiatric history versus symptom screening for the prediction of in-prison outcomes

While prisoners are known to suffer very high rates of mental illness, evidence is often lacking to inform the development of effective approaches to prison mental health service provision, including the approach to mental health screening. In addition, research to date has been dominated by prevalence studies and little is known about the mental health needs of prisoners over time. A random sample of prison entrants was recruited from a large remand and reception prison in New South Wales, Australia (n = 707) for the completion of a brief health survey. A second survey was completed during the subsequent six months (n = 317) in order to examine the effect of timing of assessment on mental health status. Those followed up within three months (n = 182) were further included in an analysis of predictive validity comparing the performance at baseline of self-reported history of previous diagnosis versus current symptom screening for psychological distress, in predicting subsequent mental illness. When assessed over six months from prison entry, mental health status was found to vary by timing of assessment. At prison entry, self-reported history of previous diagnosis of a mental health disorder was found to be a better predictor of mental illness over three months than screening for psychological distress.