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PubMed2007

Release from prison--a high risk of death for former inmates.

BACKGROUND: The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons. METHODS: We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race. RESULTS: Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide. CONCLUSIONS: Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.

Adolescent↗
PubMed2005

Rules of engagement: structuring sex and damage in men's prisons and beyond.

This paper analyses data from a recent study of ex-prisoners and prisoners in Gauteng Province, South Africa, to consider the moral economy established by hegemonic inmate culture in which sexual interactions are negotiated. It argues that while this system is based on outside norms of heterosexism, ruptures with these norms occur. Male prison populations are rearranged into gendered categories through intricate inmate rituals, causing dramatic breaks in the ways that some prisoners are understood by others and themselves. The rituals and rules involved in the constructions appear to be unfamiliar from an 'outside' perspective, but have roots beyond prison walls. Similarly, the gendered positions generated are distinct from those they imitate, but also emerge in relation to them, beyond mere imitation. Even as new structures of identity emerge then, breaks with the outside are never total. Neither is the hold of the moral economy that inmate culture works so hard to create. Another order of rupture happens when prisoners transgress the rules of this economy, and subvert the meanings on which both the oppressive gender-sex status quo of the inside and that of the outside, rely.

Ceremonial Behavior↗
PubMed2006

Availability of behavioral health treatment for women in prison.

OBJECTIVES: This study examined whether women with behavioral health needs are more likely to receive treatment for these problems in prison or in the community and to what extent prison disrupts or establishes involvement in treatment for these women. METHODS: Data were collected in August 2004 as part of a population survey of female inmates in the only state correctional facility for women in New Jersey. RESULTS: A total of 908 women were surveyed. Fifty-six percent of the women surveyed reported needing behavioral health treatment before incarceration, but only 62 percent of this group reported receiving such treatment in the community. The rate at which treatment matched need within this population before incarceration varied by type of treatment needed: it was the highest (58 percent) for women who needed treatment for mental health problems, lower (52 percent) for those who needed substance abuse treatment, and lowest (44 percent) for those who needed treatment for comorbid mental health and substance abuse problems. In comparison, the rate of match between need for and receipt of treatment in prison was higher for all three types of behavioral health treatment (78 percent, 57 percent, and 65 percent, respectively). Additionally, the findings suggest that prison did not disrupt the type of behavioral health treatment that inmates had previously received in the community. CONCLUSIONS: At least in New Jersey, prison appears to improve access to behavioral health treatment among female inmates. Although this conclusion is consistent with the rehabilitation goals of incarceration, it also suggests that some women may have been able to avoid prison if treatment had been provided in the community, especially for substance-related problems.

Behavior Therapy↗
PubMedDate not supplied

Hospice care in prison: general principles and outcomes.

In recent years, tougher sentencing laws have resulted in larger numbers of elder prison inmates and, consequently, more deaths occurring in prisons. In this context, the introduction of prison hospice programs takes on great significance. The purpose of this study is to identify the principle components and outcomes of prison hospice programs based on data gathered from semistructured telephone interviews with prison hospice providers in state and federal correctional institutions and from other sources. The results suggest that there is a growing effort to provide palliative care to dying inmates across the country and that all of the existing programs share common elements and similar structures. Major outcomes of prison hospice programs include cost-effectiveness, enhanced correction, and comfort care.

Hospice Care↗
PubMedDate not supplied

Prison hospice: an unlikely success.

Efforts to introduce hospice and palliative care into American prisons have become fairly widespread, in response to the sharp increase in inmate deaths. The primary impetus originally came from the alarming number of AIDS deaths among prisoners. The new combination therapies have proved very successful in treating AIDS, but are very costly, and many problems must be overcome to ensure their effectiveness in correctional settings. Although the AIDS epidemic seems to be in decline, prisons are experiencing a rise in the number of deaths due to "natural causes." In this article we present a review of the prison hospice scene--the response to this crisis in correctional health care. First, we discuss the challenges facing the introduction of hospice into the correctional setting. Then, we present a brief overview of recent developments and a discussion of some ways hospice components have been adapted for life behind bars. Finally, we indicate some of the prospects for the future. Hospice professionals, armed with thorough professional training and years of experience, often fear that correctional health care providers will only parody superficial aspects of the hospice approach. Continual nudging and nurturing by local and state hospice professionals is required in order to bring about this change in the first place and to sustain it through time. Prison hospice workers need not only initial training, but also ongoing education and personal contact with experienced hospice professionals. While the interest of the big national organizations is necessary, the real action happens when local hospices work with nearby prisons to attend to the needs of dying inmates.

Acquired Immunodeficiency Syndrome↗
PubMed1984

How many psychiatric patients in prison?

The paper compares the prevalence of psychiatric morbidity amongst sentenced prisoners and in the general population. Major psychosis was no more common in the majority of studies of criminal populations. Although prisoners have a higher level of neurotic symptomatology, this was mainly found to be secondary to imprisonment itself. Long term imprisonment was not found to be a precipitant of severe psychiatric morbidity or intellectual deterioration, and prisoners adopt elaborate coping mechanisms which may themselves be protective. However, there is a higher prevalence of mentally handicapped and epileptic prisoners, and doctors in the Prison Medical Service have to cope with frequent, serious behavioural problems. Prisons appear to be a particularly important area for future psychiatric research.

Behavior↗
PubMedDate not supplied

The effects of peer education on STD and AIDS knowledge among prisoners in Mozambique.

The study was designed to evaluate the impact of education on AIDS knowledge among prison inmates in Maputo, Mozambique. A 6-month follow-up study was carried out in 1993 among 300 prisoners. A knowledge, attitudes, and practices questionnaire regarding AIDS and STD was administered to each subject as part of the intake medical examination and after an educational intervention provided by 30 prisoner 'activists'. A large proportion of prisoners had high risk behaviours (65% had 2 or more sexual partners per month and 39% had a history of STD) and low AIDS knowledge at incarceration. Statistically significant increases in knowledge occurred after the intervention. Prisoners with less formal education had a poorer performance on the initial questionnaire (43% vs 69% P < 0.00001) and had a greater improvement after the intervention (41% vs 24%, P < 0.00001). The results demonstrate that educational interventions involving peer health educators contribute positively to the acquisition of knowledge among prisoners.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Prison in-reach mental health nursing.

Surveys have shown that over 90 per cent of the prison population have a diagnosable mental illness, substance abuse problem, or both (ONS 1998). There is general agreement that although there are areas where practice is excellent, practice is not consistent across England and Wales, and often does not equate to standards in the NHS. In 2001 the Department of Health and the prison service set out their joint approach to the modernization of mental health services in prisons (DoH 2001), and proposed mental health in-reach as a means of improving services and achieving the objectives of the NHS Plan (DoH 2000). This article looks at the one of the first prison in-reach services that was launched at HMP Leicester early in 2002, and considers the effect these nurses have had on the care of mentally ill adults at the prison. A case study outlining the in-reach team's approach to one of the prison's greatest challenges, self-harm, is also included.

England↗
PubMed2003

[Narcotic abuse and HIV infection in prisons].

Number of drug using people in Lithuanian prisons has been growing every year: in the beginning of 2001, 1010 people in total were on a record of dispensary care, which made 8.8% of all imprisoned persons at that time. The same percent has increased in the beginning of 2002 reaching 12.25%, and growing up to 13.3% in the beginning of 2003. Drug availability and unsafe use of illegal drugs, especially sharing of needles and syringes in one of the fourteen country's penal establishments - Alytus strict regime correctional facility - resulted in a rapid HIV outbreak in spring 2002. Three hundred prisoners infected with HIV were identified during the voluntary testing. Though majority of prisoners are quite well informed about HIV, their knowledge does not alter the risky behavior. The well-informed on HIV prisoners, nevertheless, use drugs despite the risk of HIV infection. Furthermore, shortage in treatment of drug use, in rehabilitation and occupation of prisoners provide benevolent conditions for rapid spread of HIV and other blood-born infections in the Lithuanian penitentiaries. Many prisoners are not able to reintegrate into society after their release because of broken social relationships, lack of social services in the country, therefore they do often relapse into a drug use, and endanger not only their close people but also society in whole. HIV and virus hepatitis might be transmitted from them to a general population by a variety of transmission modes.

Adult↗
PubMed2003

Prison health. A different place for GPs.

BACKGROUND: Imprisonment rates in Australia have been steadily increasing over the past decade. Prisoners have high rates of substance use and dependence, mental illness, self harming behaviours and infectious disease. OBJECTIVE: This article discusses health issues of prisoners and the role of general practitioners in prison health. DISCUSSION: The standard of health care provided for prisoners should be equivalent to that available in the general community. Medical officers working within prisons need to be competent GPs with particular skills in managing the unique patterns of morbidity encountered. In addition, public health advocacy, an ability to examine the frequent ethical issues at stake, and close links with colleagues both within prisons and in the community are needed.

Australia↗
PubMed2004

[Mental diseases and disorders among inmates in Norwegian prisons].

BACKGROUND: Surveys of serious mental disorders in prisons in the western world show high prevalences; on average 4% with psychosis, 10% with major depression, and 65% with personality disorders among male inmates. A few investigations in Norwegian prisons indicate a similar tendency. MATERIAL AND METHODS: With participation from prisons with 2850 inmates of a national total of 3000 (95%), we recorded prevalence and severity of psychiatric illnesses, other behavioural disorders, and treatment facilities available during the term served. We asked four vocational groups in each prison to reply, independently of each other, to ten semi-structured questions about these items. The groups were: prison management, guards, affiliated primary health services, and affiliated psychiatric services. RESULTS: Guards reported the highest prevalences, followed by the primary health services, then prison management; the lowest prevalence was reported by the psychiatric services. 23.5% of inmates received some kind of treatment for psychiatric disorders. INTERPRETATION: On a national scale, the average prevalence estimates for psychosis and major depression seem somewhat lower than in international surveys. Reasons for the differences in reported estimates among the vocational groups are discussed. The groups seem to have given pragmatic numbers for what they consider to be "first needs".

Behavioral Symptoms↗
PubMed2004

Prevalence of pulmonary tuberculosis in Karachi central prison.

OBJECTIVE: To determine the extent of pulmonary tuberculosis among prisoners in Karachi central jail, so that strategy for targeted intervention can be planned. METHOD: This prospective observational study was done at Karachi central prison from 7-2-2002 to 14-2-2002. A team of doctors, laboratory and x-ray technicians visited the central prison. Patients who had symptoms suggestive of pulmonary tuberculosis were included in the study. Their chest x-ray was taken in the jail and three "spot specimens" of sputum were collected for three consecutive days. The sputum specimens were processed at the laboratory of Ojha Institute of Chest Diseases, Karachi. RESULTS: Out of 4870 prisoners, 79 (1.62%) were pulmonary tuberculosis suspects. All were male and their mean age was 32 (22-75) years. Sixteen suspects already diagnosed were on anti-tuberculosis treatment (ATT) while 11 suspects gave history of ATT in the past for incomplete duration varying from 3-4 weeks to 3 months either regularly or irregularly. Twenty-two (28%) suspects were not expectorating while fifty-seven (72%) submitted the sputum for AFB (Acid Fast Bacilli), of which only one was smear positive. Radiologically, 39 (49%) chest x-rays including those of 22 who were not expectorating were normal. Eight (10%) showed healed lesion. Thirty-two (40.5%) chest x-rays were suggestive of active pulmonary tuberculosis, so clinically and radiologically 32 prisoners were suffering from active pulmonary tuberculosis. The prevalence of active pulmonary tuberculosis in jail population determined by using the formula, number of persons with active TB in jail divided by the total number of persons booked into jail was 657 per 100,000, which is 3.75 times higher than general population. CONCLUSION: Pulmonary tuberculosis is 3.75 times more common than general population in Karachi central prison and concrete efforts are needed to eradicate tuberculosis from this segment of population. The integration of provincial TB control program with that of jail health services is urgently required.

Adult↗
PubMed2005

Prisoners who inject drugs: public health and human rights imperatives.

This article examines the human rights and public health implications of injection drug use in prisons with a specific focus on HIV and hepatitis C (HCV) viruses. The authors argue that prisoners who inject drugs have a right to access harm reduction measures--those that reduce the harmful consequences of drug use without necessarily reducing drug consumption. Moreover, states that fulfill their obligation to provide prisoners with harm reduction measures such as access to bleach, substitution therapy, and sterile injection equipment implement sound public health policy with a positive impact for a population particularly vulnerable to HIV and HCV. Ultimately, this approach benefits not only prisoners but also prison staff and the public, and does not entail lessening of the safety and security of prisons.

AIDS Serodiagnosis↗
PubMedDate not supplied

[Prisons following reform. Current status and prospects].

The Author has examined the period successive to July 1975, namely, from the approval of the new prison System to the present day, highlighting the manifold negative aspects due to the incomplete application of the reform and not neglecting to review also the positive aspects of the regulations applied. The Author laid special stress on the distorted interpretations given to some different regulations of the System and on the ensuing wrong procedure that has been established, whose correction represents the only way not only towards a proper application of the reforming law, but also for preventing the most serious risk the reform is liable to run; that of being made the object of revisions and abrogations that might ultimately change their nature and jeopardise their objectives. The Author reviews the practical consequences of both the erroneous interpretations of the law and of its misapplications, dwelling on Article 30 in the first place, which has prompted some to define the law the "reform of leaves". Also examined was the problem of the special prisons, the usefulness of which is confirmed by the Author, who upholds the view that they must function in full observance of the regulations, for reasons of equity and opportuneness. From the rehabilitation treatment angle, the prison work, the participation of the extramural community, the "leasure time", the assistance after release. Still in the framework of his critical approach as to the prison reality, the Author illustrates the situation of the health service, and reviews the positive points that have been achieved in the implementation of some reform institutions, with special regard to the new disciplinary approach and its satisfactory results that have already been statistically observed. More adequate talks and correspondence by letter or through the telephone, a better compensation for the prison work, the convict representation in some sectors of intramural life, the measures as an alternative to enprisonment, all these actions represent the practical results of the reform achieved so far in a rather satisfactory way. After dealing with the figure of the surveillance judge, of the director and of the military personnel of prisons, setting forth observations and proposals to enhance their work, the Author declares, by way of conclusion, that he is fully convinced that the reform will ultimately attain its important targets, laying stress on the fact that the good will and the contribution of all those who are called upon to participate in its realization, may prove instrumental in shortening the period of time required for making the reform fully operative.

Criminal Law↗
PubMed1977

Characteristics of state prisoners who demonstrate severe adjustment problems.

Hypothesis was tested that prison inmates who present serious disciplinary problems during incarceration that result in human injury, threat to personal safety, or extensive property damage also will tend to show a history of significant societal maladjustment as compared to prisoners who do not demonstrate adjustment problems. Societal maladjustment was defined to include significant problems in education, marriage, military service, and job stability. This project was an effort to present a picture of the types individuals who cause what generally are considered to be the more severe prison disturbances. The social and relevant background areas were investigated of 50 male state prison inmates who had committed serious acting-out infractions. The same background data were checked on 50 inmates who demonstrated good prison adjustment within the same time period. When background data were analyzed carefully, a trend was discovered that indicated that prisoners who create serious trouble while confined also tend to have significant histories of social failures. The results are interpreted as in favor of the hypothesis.

Adolescent↗
PubMed1988

[The drug addict in prison: Medical response and its limitations].

Over the past twenty years, the proportion of drug dependent inmates has risen dramatically in the prisons of Western Europe. In the Geneva romand prison, where about 30% of entries present problems of opiate abuse and dependence, treatment of withdrawal symptoms with decreasing doses of methadone over a period of 5-10 days has been available since 1974. The rational of this treatment policy is to limit immediately disabling symptoms during the stressful period following imprisonment, when the prisoner has to make important decisions concerning the criminal proceedings in which he is involved. On the other hand, methadone maintenance treatment is not provided within the prison, even for patients on methadone maintenance programs prior to imprisonment. This paper traces the evolution of withdrawal treatments with methadone over the period 1974-1987 in relation to the total number of entries, the age and sex distribution. During the three year period 1985-1987, we found that 6% of prisoners had received at least one course of withdrawal treatment. Many drug dependent individuals have repeated arrests: we found that 27% of those receiving withdrawal treatment in a three year period had more than one treatment. The frequency of suicidal gestures (including wrist slashing) and suicide was not greater during the withdrawal phase than at other times. A number of therapeutic approaches to opiate withdrawal now exist. No method seems clearly to be the treatment of choice within the prison environment. Arrest and imprisonment imply enforced withdrawal in a context of conflict and stress without the possibility of close medical supervision or psychological support.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed2005

Suicidal ideation in prisoners: risk factors and relevance to suicidal behaviour. A prospective case-control study.

OBJECTIVE: To investigate risk factors for suicidal ideation (SI) in prisoners, as well as the prediction of suicidal behaviour by SI. METHOD: Participants were recruited from the all-male,adults', high security prison of Patras, Greece. Sixty-seven prisoners who expressed SI were evaluated using a structured interview, Hamilton's Rating Scale for Anxiety (HAMA) and the Montgomery-Asberg Rating Scale for Depression (MADRS). Sixty-seven control prisoners without SI, matched for age, nationality and penal status were evaluated using the same structured interview and rating scales. All participants were followed-up prospectively for 12 months after their initial assessment and any acts of self-destructive behaviour were recorded. RESULTS: Independent significant risk factors for SI in prisoners were the family history of suicidal behaviour (OR = 56.34, 95% CI = 4.23-750.1, p < 0.002), history of psychiatric hospitalisation (OR = 7.18, 95% CI = 1.83-28.16, p < 0.005), and higher scores in the MADRS (p < 0.03) and HAMA (p < 0.03) scales. During the follow-up period, suicidal behaviour (suicide attempt or self-mutilation) was observed in 12 (17.9%) inmates with SI, as opposed to none of the controls (p < 0.0001). CONCLUSION: A family history of suicidal behaviour, history of psychiatric hospitalisation and symptoms of anxiety or depression were independent risk factors for SI in prisoners. Inmates with SI had a higher risk for self-destructive acts at follow-up. Inmates with SI are a high-risk group for future self-destructive acts, so special precautions designed to reduce this risk are warranted.

Adult↗
PubMed2005

Can morbidity be inferred from prescription drug use? Results from a nation-wide prison population study.

AIM: To estimate psychiatric and somatic morbidity in a nation-wide prison population, as inferred from detailed medication sheets. METHOD: Medication sheets from 37 prisons, covering 90% of the Norwegian prison population, were collected and examined by experienced clinicians. All inmates on medication were assigned best-estimate psychiatric and/or somatic diagnoses according to the International Classification of Primary Care diagnostic system. RESULTS: Among the 2617 inmates 919 (35%) had psychiatric disorders, as estimated by our methodology. Depressive disorders (11%) and sleep disorders (11%) were most prevalent. Twenty-six inmates (1%) were prescribed medication indicative of affective psychosis and an additional 77 (3%) received anti-psychotic drugs in doses indicating other psychotic disorders, bringing the sum total of psychosis up to 103 (4%). A total of 848 inmates (32%) were estimated to suffer from somatic disorders. Various pain conditions were prevalent (11%) in addition to obstructive airway diseases and asthma (4%). Both psychiatric and somatic disorders were more prevalent in female prisoners. CONCLUSION: This study has demonstrated high psychiatric and somatic morbidity in a nation-wide population of prison inmates receiving adequate health services. As the morbidity estimates are inferred from prescription drug use they must be interpreted with caution. However, we do believe that our study, utilizing this unconventional but readily available source of information, has yielded valuable knowledge regarding the physical and mental health of a nation-wide prison population.

Adult↗