Pregnancy in prison,Mother and Baby Unit admission and impacts on perinatal depression and ‘quality of life’

Limited research exists on the impact of prison mother and baby unit (MBU) residence. Research in the UK suggests women in MBUs have lower prevalence of mental disorder. Higher rates of mother-child attachment for women in prison nurseries in the US have been reported. Eighty-five pregnant women were interviewed at baseline and 62 followed up in nine different prisons. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure perinatal depression; the World Health Organisation Quality of Life (WHOQOL – BREF), for quality of life; and the Mother-to-Infant Bonding Scale (MIBS) for mother-child bonding. EPDS scores were higher at baseline than follow-up. Women admitted to MBUs had lower EPDS scores at baseline and follow-up, and this reduction was greater than for women not admitted to MBUs. WHO-QOL scores were higher at follow-up than baseline on all domains, except the social domain for those not admitted to MBUs. Findings suggest women with perinatal depression are less likely to be admitted to MBUs, and MBU placement may contribute to a reduction in perinatal depression. Increased QOL-BREF scores at follow-up suggest improved quality of life for all participants. Reduced support post-separation may contribute to lower social domain scores for women not admitted to MBUs.     

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.     

Information pathways into prison mental health care

Police and court liaison and diversion services provide important specialist mental health input along critical stages of the criminal justice pathway. Effective sharing of information between the services and relevant justice agencies is essential. However, various problems exist with the flow of information between agencies and services across the criminal justice pathway. This service evaluation explored how clinically relevant information is transferred, by drawing on the perspectives of prison health care staff in a large urban UK male prison. A qualitative service evaluation was conducted using semi-structured interviews with a purposive sample of 11 prison staff. The main themes included: gaps in the transfer of essential information, (particularly concerning risk and offending information); information gathering to fill these gaps; the importance of professional relationships, information sharing between agencies; and information solutions. Improving information transfer across the criminal justice pathway could prevent treatment delays and ensure more timely mental health care in prison.     

The mental health and substance misuse needs of male ex-armed forces personnel in prison

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.     

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.     

The use and readability of mental health self-help in Scottish prisons

Prisoners are at higher risk of mental health problems than people in the general community. One possible way of optimising mental health care resources in prisons is to offer self-help materials. In order for these to be effective, they must be appropriate for the reading ability of the patient. This study aimed to determine, by way of a survey distributed to Scottish mental health care teams, how self-help resources are being used currently in the Scottish prison system, and to analyse the materials using four different readability tools: FRE, FKGL, SMOG and the Drivel Defence programme. It was found that there is currently widespread provision of self-help to Scottish prisoners; however, only 53% of these materials are suitable for the quoted average prisoner reading age. Mental health practitioners should be aware of this when providing self-help to patients, and consider easy-read options where available.     

Soldier,civilian, criminal: identifying pathways to offending of ex-armed forces personnel in prison

Little is known about why some ex-armed forces personnel become involved in the criminal justice system, however, they represent the largest known occupational group in prison. In-depth interviews were employed to explore possible pathways to offending. Twenty ex-armed forces personnel in prison were recruited from five prisons in England. Data were analysed using a combination of thematic analysis and constant comparison methods rooted in grounded theory. Four predominant themes were identified: experiences of trauma and adversity; belonging; impulsivity and creating a soldier. Participants had experienced a number of traumatic incidents and adversity in their lives, encompassing pre, during and post-service but felt a sense of belonging in the armed forces. Participants demonstrated impulsivity in a number of areas with links to both their service in the armed forces and offending behaviour. The creation of the identity of ‘soldier’ was perceived to impact participants’ lives in a number of ways, including their offending, alcohol use and coping with trauma. The interplay of these themes and their potential impact on participants’ pathways to offending are discussed.     

History of spouse violence against mother: Correlated risks and unique effects in child mental health

The present study examined mental health risk associated with lifetime occurrence of spouse violence against mother among 303 10 to 12 year-old inner-city children. Maternal report data showed a 30% prevalence rate for lifetime occurrence of spouse violence in this sample. Results of correlational analyses indicated that violence against mother was associated with several other historical risk factors including divorce, parental drinking problems, and incarceration of father. Multiple regression analyses controlling for the effects of demographic and historical risk factors that correlated with violence against mother revealed that violence accounted for significant unique variance in girls' self-reports of conduct problems, but did not account for unique variance in boys' symptomatology. Implications of these results for understanding the effects of violence against mother on children and for the development of empirically based interventions for children in those families are discussed.     

Intellectual disability in a prison population with anger problems in Trinidad

This paper describes the characteristics of groups of prisoners selected to take part in an anger management programme in prisons in Trinidad. Participants completed demographic measures, an IQ assessment, mental health measures and anger rating scales. Fifty-six inmates were screened with the WASI-2 and characteristics of this group are explored in this paper. The mean IQ for the group was 72.34 and 22 had a recorded IQ below 70 (37.5%). All of the respondents reported high levels of mental health problems with their mean ratings on the SCL-90 being closer to those of inpatient psychiatric group norms than non-clinical groups. A score of less than 70 on the WASI-2 is not sufficient for a diagnosis of an Intellectual Disability. Nevertheless, the results suggest that a significant number of individuals in these prisons may have an Intellectual Disability. More research is needed to help identify these individuals and provide support.     

Moving prison health promotion along: towards an integrative framework for action to develop health promotion and tackle the social determinants of health

The majority of prisoners are drawn from deprived circumstances with a range of health and social needs. The current focus within ‘prison health’ does not, and cannot, given its predominant medical model, adequately address the current health and well-being needs of offenders. Adopting a social model of health is more likely to address the wide range of health issues faced by offenders and thus lead to better rehabilitation outcomes. At the same time, broader action at governmental level is required to address the social determinants of health (poverty, unemployment and educational attainment) that marginalise populations and increase the likelihood of criminal activities. Within prison, there is more that can be done to promote prisoners’ health if a move away from a solely curative, medical model is facilitated, towards a preventive perspective designed to promote positive health. Here, we use the Ottawa Charter for health promotion to frame public health and health promotion within prisons and to set out a challenging agenda that would make health a priority for everyone, not just ‘health’ staff, within the prison setting. A series of outcomes under each of the five action areas of the Charter offers a plan of action, showing how each can improve health. We also go further than the Ottawa Charter, to comment on how the values of emancipatory health promotion need to permeate prison health discourse, along with the concept of salutogenesis.     

Propensity to support prison gangs: its relationship to gang membership,victimisation, aggression and other disruptive behaviours

Propensity to support prison gangs and its association with aggression, victimisation and disruptive behaviour is explored. The sample comprised 423 adult male prisoners from three Canadian prisons. Participants completed the PGB (Propensity to support Gang-related Behaviour scale) and DIPC-R (Direct and Indirect Prisoner behaviour Checklist-Revised). The former indicated gang membership propensity and included a direct question on whether or not participants considered themselves a gang member. It was hypothesised that prison-based aggression would be predicted by a propensity to support prison gangs and by gang membership. It was also hypothesised that aggression and disruptive behaviours would be reported more frequently by gang members than non-gang members. Propensity to support prison gangs was associated with aggression and other disruptive behaviours, as was actual gang membership. Aggression and other disruptive behaviours were reported more frequently by gang members. Prisoners reporting both aggression perpetration and victimisation simultaneously (i.e. ‘perpetrator/victims’) were over-represented as gang members. Gang membership did not appear to protect against being victimised. Propensity to support prison gangs was composed of beliefs that gangs were supportive, well-ordered and protective, and comprised of friends. The importance of accounting for propensity to support prison gangs and not just self-reported gang membership is discussed.     

Psychiatric symptoms and mental health court engagement

People with mental illnesses are overrepresented in the criminal justice system. Many interventions have been implemented to treat the underlying causes of criminal justice involvement and prevent people with mental illnesses from recidivating. Mental health courts (MHC) are one of these programs. This analysis examines the relationship between psychiatric symptoms and MHC engagement. Eighty MHC participants from two Midwestern MHCs were interviewed. Symptom severity was assessed at baseline using the Brief Psychiatric Rating Scale. MHC engagement was estimated by treatment adherence, substance use, days spent in jail, probation violations, and MHC retention during a six-month follow-up period. Using nonparametric statistical tests and logistic regression, results indicate symptoms of depression, anxiety, and guilt are more severe at baseline for those people who are incarcerated during the follow-up period. Symptoms of anxiety are more severe for people who are terminated or went missing during the follow-up period. Further research is needed to determine the directionality and causality of these relationships. MHCs professionals should be aware of the relationship between symptom severity and MHC engagement and attempt to connect participants with treatment and services as early as possible and individualize treatment plans based on current symptoms and need.     

Parent coordinators: Effective interventions in adolescent mental health

The mental health system in the US was not meeting the increasing needs of teens before the pandemic started in 2020. The pandemic served to stress adolescents and their parents while significantly limiting the availability of services. Separated parents may have disputes about whether adolescents have mental health care needs, what services the child needs, where those services will be obtained, and who will be involved. The Parenting Coordinator as a dispute resolution professional can assist families in reaching agreements and meeting their teen's needs for care.     

Beyond the dichotomy: Incarceration dosage and mental health*

The findings from a growing body of research reveal that incarceration is detrimental for both physical and mental health. Incarceration, however, is typically conceptualized and operationalized as a dichotomy; individuals either have, or have not, been incarcerated. Considering that incarceration can range from one day to several years, a dichotomous measure may be overlooking important variations across lengths of exposure. In addition, most inmates are incarcerated more than once. In this study, we help to fill this gap by examining the relationship between incarceration dosage, measured as time served and number of spells, and mental health among a sample of young adults from the National Longitudinal Study of Youth 1997. By using fixed‐effects modeling, we find that the number of spells and the months incarcerated are positively related to mental health symptoms and the likelihood of depression. The association, however, is contingent on whether a respondent is currently or formerly incarcerated. Among current inmates, more time served is expected to improve mental health and the number of spells is unrelated to either outcome.     

The relationship between childhood traumatic events,social support,and mental health problems in prisoners

This study examined the prevalence of childhood traumatic events (CTE), social support levels as well as mental health problems (MHP), to test for differences between traumatized and non-traumatized individuals, and to investigate the relationship among the aforementioned parameters in a sample of 49 prisoners in Switzerland. This cross-sectional study used standardized self-report measurements. In line with expectations, prisoners reported a high rate of traumatic events. Furthermore, results indicated that those traumatized differed from those non-traumatized regarding the level of social support, interpersonal sensitivity, and depression. However, no relationship between CTE and social support as well as MHP was found. This points to specific therapeutic needs of those traumatized, and to the necessity of a trauma-informed correctional care. Moreover, these study results are a further step into more integrated models of criminal behavior.     

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.     

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.     

The effects of treatment exposure on prison misconduct for female prisoners with substance use,mental health,and co-occurring disorders

Inmates with mental health and co-occurring mental health and substance use disorders present difficult challenges for correctional institutions and treatment providers. The complex nature of co-occurring disorders further exacerbates these difficulties and is associated with poor treatment compliance and increased likelihood of engaging in institutional misconduct. The current study examines whether exposure to prison-based treatment reduces involvement in prison misconduct among a sample of female prison inmates controlling for disorder types (i.e. mental health disorder only, substance use disorder only, and co-occurring mental and substance use disorders). Findings revealed that with exposure of more than 181?days of treatment, the odds of misconduct involvement among females with co-occurring disorders more than doubled compared to receiving no treatment. This finding is at odds with treatment retention literature that suggests that a minimum period of time in treatment is needed to affect post-treatment success. Possible explanations for these findings and policy implications are discussed.     

Comparison of HoNOS and HoNOS-Secure in a forensic mental health hospital

The Health of the Nation Outcome Scale (HoNOS) is a widely used tool for monitoring consumer outcomes within mental health services. However, concern about its suitability in forensic mental health settings led to the development of a forensic version of this tool (HoNOS-Secure). To date, no direct comparison of these versions has appeared in the empirical literature. In the present study, a cohort of forensic mental health consumers was rated using the HoNOS and HoNOS-Secure. Pearson correlations were generated to compare the tools at a total score and item level. Logistic regression was employed to evaluate how well these tools categorise patients on a range of measurable outcomes. HoNOS scores were also compared against civil mental health consumers to evaluate differences between these populations. The HoNOS/HoNOS-Secure correlated strongly at the total score level, but demonstrated variable correlations at the item level. Logistic regression suggested that the HoNOS-Secure ‘clinical and social functioning scale’ adds little to the HoNOS in a forensic setting; however, the HoNOS-Secure ‘security scale’ added significant benefit to both versions. Results remained stable when re-evaluated over time. Forensic and civil mental health patients were found to demonstrate the same degree of psychopathology at the point of admission; however, they differed at review and discharge collection occasions. Implications for clinical practice and policy are explored.     

Procedural justice in mental health court: an investigation of the relation of perception of procedural justice to non-adherence and termination

Mental health courts (MHCs) operate on the principles of procedural justice (PJ). PJ highlights the importance of process over outcomes in encounters with authority. Subjective perceptions of having voice, being heard by decision-makers, and being treated with respect and concern by figures of authority are influential in assessment of fairness and in cooperation with decisions, regardless of favorability of the outcome. In this paper, we investigate MHC participant perception of PJ in interactions with MHC staff and the association between perceptions and recidivism (i.e. time in jail, new arrests, and probation violations), treatment adherence, and MHC termination. Participants from two MHC programs (n?=?80) took part in this study. Results suggest that perception of PJ during interactions with the entire MHC team is significantly associated with program termination, but not with participant behaviors during MHC. Implications for MHC practitioners and researchers are discussed.