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PubMed1991

Hidden severe psychiatric morbidity in sentenced prisoners: an Australian study.

OBJECTIVE: The aim of this survey was to estimate the prevalence of severe mental disorders in a representative sample of sentenced prisoners. METHOD: The subjects were selected as a random sample of sentenced prisoners in Melbourne's three metropolitan prisons. Interviews were conducted with 158 men and 31 women. Clinicians used the Structured Clinical Interview for DSM-III-R (SCID) to diagnose psychotic, affective, and substance use disorders. RESULTS: Six prisoners (3%) received current diagnoses of psychotic disorders, and 23 (12%) were diagnosed as having current mood disorders, mainly major depression. A lifetime diagnosis of at least one mental disorder each was made for 82% of the respondents, and in 26% more than one lifetime disorder was diagnosed. Sixty-nine percent received lifetime diagnoses of dependence on or abuse of alcohol, other psychoactive substances, or a combination of these. CONCLUSIONS: These findings do not indicate a large-scale shift of deinstitutionalized psychotically ill people from mental hospitals to prisons. They do, however, highlight the diversion into the corrections system of substance-dependent people and the apparent pool of prisoners with largely untreated major depression.

Adolescent↗

PubMedDate not supplied

Effect of release from prison and re-incarceration on the viral loads of HIV-infected individuals.

OBJECTIVES: The purpose of this study was to determine the effect of release from prison and subsequent re-incarceration on the viral loads of HIV-infected individuals receiving highly active antiretroviral therapy (HAART). METHODS: Fifteen re-incarcerated HIV-infected prisoners on HAART were identified from a retrospective cohort of HIV-infected prison inmates released from January 1, 1997, to August 31, 1999. The re-incarcerated prisoners were matched (1:2) to 30 HIV-infected incarcerated prisoners on HAART who remained incarcerated during the re-incarcerated participants' release time period. The outcomes measured were plasma HIV RNA levels, CD4+ lymphocyte counts, percentage of re-incarcerated and incarcerated participants with plasma HIV RNA levels <400 copies/mL, and the median change in plasma HIV RNA levels of the re-incarcerated and incarcerated participants at the end of the study. RESULTS: At the beginning of the study, 8/15 re-incarcerated participants had plasma HIV RNA levels <400 copies/mL, compared with 15/30 incarcerated participants. At the end of the study, only three of those eight re-incarcerated participants had plasma HIV RNA levels <400 copies/mL, compared with 14/15 incarcerated participants (p=0.0086). The median change in plasma HIV RNA levels of the re-incarcerated participants was 1.29 log10 copies/mL (interquartile range 0.04 to 1.70), compared with -0.03 log10 copies/mL (interquartile range -0.65 to 0.09) in the incarcerated participants (p=0.0183). CONCLUSIONS: Release from prison was associated with a deleterious effect on virological and immunological outcomes. These data suggest that comprehensive discharge planning efforts are required to make certain that HIV-infected inmates receive access to quality care following incarceration.

Adult↗

PubMed1999

The impact of primary mental health care in a prison system in Brazil.

OBJECTIVE: To analyze the impact of a psychiatric service in a prison general hospital that refers prisoners with mental disorders to a separate forensic psychiatric hospital (FPH). METHOD: Analysis of data on prison population and referrals to the FPH. RESULTS: Despite a 10.9% increase in the overall prison system population over 3 years, referrals from the prison general hospital with the new psychiatric service to the FPH were reduced by 36.5%, whereas referrals from other prisons increased by 120.4%. CONCLUSION: Our results demonstrate the efficiency of the new primary health care approach.

Brazil↗

PubMed1993

Psychiatric morbidity in sentenced segregated HIV-positive prisoners.

In this comparative study with a control group of prisoners, psychiatric morbidity was measured in two groups of sentenced prisoners, each group completing the GHQ-30 and 21-item Beck Depression Inventory (BDI). Group 1 consisted of 40 segregated HIV-positive prisoners and group 2 a matched control group in the main prison who had no history of HIV seropositivity. All members of group 1 had a history of intravenous drug abuse. The mean GHQ-30 and BDI scores were significantly higher in group 1, and 90% of group 1 were psychiatric 'cases' compared with just over 42% of group 2. Levels of psychiatric morbidity present in a third group, consisting of HIV-positive prisoners who had not been segregated (prison authorities were unaware of their seropositivity) are an interesting pointer for further research.

Adult↗

PubMed2006

Sexual behaviours of HIV-seropositive men and women following release from prison.

Twenty-five percent of the US HIV-infected population is released from a prison or jail each year. As the extent of risky sexual behaviours after prison release is largely unknown, we interviewed a cohort (n = 64) of HIV-infected, recently released (mean 45 days, SD 28) prisoners about their current sexual risk behaviours. Almost half (47%, n = 64) of the released prisoners reported sexual activity after release, mostly with regular partners. Although 26% (n = 27) reported engaging in unprotected sexual activity with their regular partners, none (n = 4) reported unprotected sex with their non-regular partners. Furthermore, 33% percent (n = 15) of the releasees with regular partners reported engaging in unprotected sex with HIV-seronegative partners. These results suggest that regular partners of HIV-infected prison releasees are at risk of acquiring HIV infection, and secondary risk-reduction strategies are needed for HIV-infected prison releasees.

Adult↗

PubMed1996

Work conditions and mental health among prison staff in France.

OBJECTIVES: A cross-sectional epidemiologic survey was conducted among prison staff in France to investigate the relationships between work conditions and mental health. METHODS: The sample included men and women 20 to 64 years of age belonging to all categories of prison personnel (prison guards, administrative staff, socioeducational workers, technicians, health care workers, and managers). A postal self-administered questionnaire was used to assess sociodemographic factors, work conditions, and physical and mental disorders. Multiple logistic regression analyses were conducted to determine the effects of work conditions and social relationships on the mental health of prison staff. RESULTS: The results presented in this report only concern depressive symptomatology (measured by the French version of the Center for Epidemiologic Studies Depression Scale), anxiety (measured by the state version of the State-Trait Anxiety Inventory), and sleep disorders. The percentage of mental disorders was higher among prison staff than that determined for other occupational samples. Guards comprised the prison staff least affected by these symptoms. CONCLUSIONS: The results show that, in our sample, the factors concerning the subjective evaluation of work conditions and social support were more closely related to mental disorders than work conditions. In addition, seniority was associated with depressive symptoms and anxiety among the men.

Adult↗

PubMed1999

Tuberculosis control practices in some prison systems of the Asia-Pacific Region, 1997.

SETTING: Prison health services of Member States of the Western-Pacific Region (WPR) of the World Health Organization (WHO). OBJECTIVE: To assess tuberculosis control activities in prisons. DESIGN: Self-reporting questionnaire. RESULTS: A total of 15 responses out of a possible 26 (57%) were received from WPR countries. The estimated population for the respondent countries was 65 154 000 out of a possible 1 580 000 000 (4%); 69% of respondents stated that the prison health service was independent of the custodial service, 86% notified tuberculosis cases to national health authorities, and 84% of respondents applied directly observed therapy to tuberculosis cases. Only 76% of respondents reported that patients were transferred on release to community treatment services. CONCLUSIONS: Tuberculosis control practices in prisons are inconsistent, and do not conform to guidelines now promoted by the WHO. Emphasis on the diagnosis and treatment of infectious cases, improved surveillance of tuberculosis, and the integration of prison programmes into the National Tuberculosis Programmes (NTP) will improve the current epidemic behind prison walls.

Asia, Southeastern↗

PubMed2001

Tuberculosis in a prison population in Mwanza, Tanzania (1994-1997).

SETTING: Bugando Medical Centre, a referral consultant hospital in the lake zone to which all inmates from Butimba prison are admitted and treated. OBJECTIVE: To determine the extent of open (smear-positive) tuberculosis and other types of tuberculosis among prisoners with tuberculosis. DESIGN: A retrospective cohort study. Case notes of 501 prisoners from January 1994 to December 1997 were retrieved and reviewed. RESULTS: The proportion of open tuberculosis in this study was high, with 204 prisoners (40.7%) having smear-positive tuberculosis. Co-infection was recorded in the majority of patients; HIV/AIDS was recorded in 25.9% of cases. The mean length of imprisonment at the time of diagnosis was 19 months. CONCLUSION: The proportion of open, smear-positive tuberculosis among prisoners admitted with tuberculosis is high. Intervention measures specifically targeting this population are urgently needed in order to contain tuberculosis disease in the prison population.

AIDS-Related Complex↗

PubMedDate not supplied

HIV/AIDS in prisons: more new developments.

Since our last review, there have been new developments in several jurisdictions in the area of HIV/AIDS and prisons. This column reviews some important developments in Canada and in the US: the results of the evaluation of HIV/AIDS harm-reduction measures in the Canadian federal prison system; another Canadian inmate's fight for methadone maintenance treatment in prison; an important article on health care in Canadian prisons which states that there is little evidence that the federal prison system "is making any serious effort to provide treatment to any drug users"; the US Supreme Court's refusal to review a lower court's ruling permitting Alabama prisons to segregate HIV-positive inmates; an important ruling stating that inmates are entitled to receive medications in jail without interruption; and research showing that women inmates in the US are 23 times more likely to have AIDS than women in the general population.

Canada↗

PubMed2001

[Changes in high-dose buprenorphine maintenance therapy at the Fleury-Merogis (France) prison since 1996].

Since the law of January 1994, the ministry of Health is responsible for inmate health in France. This law created medical wards inside French prisons by conventions between hospitals and prisons. Since July 1995, Fleury-Merogis state-prison is linked to the Sud-Francilien Hospital. During the last few years, more and more IV drug users have been incarcerated and the number of infectious diseases has increased (AIDS, hepatitis C and B). Risk behavior is rather frequent and it has become a major concern of public authorities to fight this evolution. Prisons are part of structures having to take care of IV drug users. A few months after the authorization of buprenorphine in France (March 1996), the ministry of Health decided to give access to this treatment for incarcerated IV drug users. The aim of this study is to present the evolution of maintenance medication by high dose buprenorphine in a big state-prison and to explain the difficulties we have to face. The aim of this study was also to present how this treatment can contribute to reducing infectious risks. Surveying prescription is under the control of the Pharmacy since 1995. We have studied since 1996 the number of prescriptions, segregating initialized inside the prison and prescriptions continued. We have also studied and evaluated the number of psychotropic drugs for each prescription since 1996 in "two test buildings". Evolution of self mutilations and reducing infectious risks support measures have also been studied.

Adolescent↗

PubMed2002

Perceived quality of life and mental health status of Irish female prisoners.

Mental health status and quality of life of female prisoners, the majority of whom are drug-users, was examined as part of a larger, cross-sectional, general healthcare study of the Irish prisoner population. Comparisons were made with drug using and non-drug using male prisoners and females from the general population. Instruments include the GHQ-12 and the WHOQOL-BREF. While their quality of life profile was closer to drug-using male prisoners than other comparison groups, female prisoners still had significantly poorer physical and psychological Quality of Life scores. While poorer quality of life scores may be associated with the more severe drug use patterns of female prisoners it is likely that other factors also contribute. Before resorting to drugs/crime women may have already experienced adversity. There may also be gender differences in response to the combined dimensions of environmental distress. If women are to be imprisoned appropriate comprehensive mental health promotion approaches must address their specific needs.

Adult↗

PubMed2002

Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment.

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.

Civil Rights↗

PubMed1999

Rational Choice theory and prison chaplaincy: the chaplain's dilemma.

Critical responses to the application of Rational Choice theories to the study of religious phenomena tend to be polarized between outright denial that the theories have any relevance to religion and equally outspoken claims that the theories are the only hope for progress in the sociology of religion. This article aims to avoid both of these extreme positions by raising a question, instead, about one of Rational Choice's central propositions about religion. This proposition holds that levels of religious vitality vary positively with the degree to which agencies of the state are prevented from regulating religious activity. The findings of recent research into prison chaplaincy in the UK and the USA will be used to test this claim. The main argument will be that the existence of an established church has facilitated a higher level of religious activity, especially for minority faiths, in prisons in England and Wales than is possible in American prisons. This difference in religious vitality is explained in terms of the Church of England's privileged position as a 'broker' between the state and minority faith communities. There is greater equality of opportunity for religious activity in American prisons, but the level of the activity is necessarily lower. In neither country is there anything truly resembling a 'free' market for religion in prisons, but the established Church of England is able to use its quasi-monopoly powers to broker advantageous conditions for minority faith communities. This brokerage function may be advantageous to all religious organizations in the highly regulated 'economy' of prisons.

Choice Behavior↗

PubMedDate not supplied

[HIVAb, HCVAb and HBsAg seroprevalence among inmates of the prison of Bologna and the effect of counselling on the compliance of proposed tests].

OBJECTIVES: The aims of the study were to evaluate the HIVAb, HCVAb and HBsAg seroprevalence among Italian and foreign inmates of the prison of Bologna, to evaluate if the extensive counselling of "new" inmates has significantly enhanced adherence to laboratory tests. DESIGN: The serological status was determined by a blood withdraw following the informed consent. Before asking their consent, patients were informed by cultural mediators who had been instructed about the aims of the study/exam during introductory meetings. The initial step managed by mediators was followed by further individual counselling interventions, carried out by hospital infective disease unit, prison and prison drug abuse service physicians. The laboratory tests were performed in an external structure. SETTING: Prison of Bologna. PARTICIPANTS: The study was conducted on 433 subjects among a whole population of 900 inmates in the local prison: 390 subjects were males (90.1%) and 43 were females (9.9%). The median age of the whole population was 34.86 years (+/- 9.9). The studied population counted 147 (33.9%) intravenous drug users (IDU) and 286 not addicts (66.1%). As regards nationality, 212 subjects were Italian (48.9%) and 221 (51.1%) foreigners. Among the total 433 inmates considered, 78 (18%) were known as previous IDU with conviction history or condemned to long term sentences, while 59 (13.6%) were inmates recently convicted active IDU assisted by the internal drug abusers service. The third group was composed by 296 inmates imprisoned during the summer (103 Italians and 193 foreigners) self declared not IDU. RESULTS: A. 12.5% of inmates were HIV positive, 8.1% HBV positive and 31.1% HCV positive. 25 subjects were found positive both to HIV and HCV; 1 both to HIV and HBV and 5 to HIV, HBV and HCV. HIV positivity is more common among Italian vs. foreigners inmates, among IDU vs. not IDU. HCV positivity is more common among Italian vs. foreigners inmates, and among IDU vs. not IDU. The distribution of HBV seropositivity among the different groups shows no statistically significant differences. All subjects receiving multi-focal counselling reached better compliance levels: 10% vs. 1% for HIV, 16% vs. 1% for HBV and 35% vs. 0.3% for HCV, with statistically significant coefficients of contingency. CONCLUSIONS: In the prison of Bologna drug addiction is prevalent in italian seropositive personers and it is often associated with HIV and HCV positivity. Foreign inmates, mostly in the not-IDU group, show a lower prevalence of these two infections. Multi-focal counselling before test increased significantly the adherence of inmates to the study.

Adult↗

PubMed1989

Suicides by prisoners.

In a consecutive series of 44 deaths of male prisoners in Brisbane Prison, a maximum-security prison, in the 15-year period 1973-1987, 20 deaths were a result of suicide. More than half the suicides occurred within the first two months in custody. Prisoners on remand were more prone to commit suicide than were sentenced prisoners. A history of psychiatric disorder was frequent, and more than one-third of the prisoners previously had received psychiatric inpatient treatment. In 40% of cases suicide had been attempted previously. Hanging was the usual method of suicide. The application of preventive measures in the presence of risk factors for suicide at the present level of knowledge are discussed.

Adult↗

PubMed1980

[Medical ethics in prison medicine].

A series of situations and decisions involving medical ethics in a prison medical service are discussed. The doctor's independence is considered in relation to his contract with administrative authorities. In contrast with most private doctor-patient relationships, there is usually no possibility for prisoners to choose their doctor and vice-versa. Freedom of consent on the part of the patient may also imply a right to no-treatment. Medical care in prison is not easy to delineate, also because patients often try to involve the doctor in non-medical demands. A prison doctor should avoid taking part in decisions which ought to be made by the judiciary or by administrative authorities. Programmes involving preventive medicine and sociotherapy imply collaboration between therapeutic and security staff. The continuous interplay and readjustment between powers based on public authority, on the rights of each individual prisoner and on the medical programmes makes it possible for some sort of therapeutic freedom to exist in the prison.

Ethics, Medical↗

PubMed1997

[The health of prisoners].

In twenty years, the prison population, from the mother country and the overseas departments, has more than doubled, in spite of reprieve and amnesty decisions. This increase is more a consequence of longer penalties than of a rise in the number of imprisoned people The law no. 94-43, dated january 18th 1994, concerning the prisoners' medical care and welfare is an unprecedented health revolution. It comes in addition to provisions from 1986 and 1987 for the programme "13,000" prisons and those endowed with a regional medical and psychological service (SMPR). The prisoners' health must urgently be dealt with and particularly as regards infectious diseases, vaccination check-up, campaign against drug addiction health and nutrition education and dental care. As soon as incarceration has begun, the exist must be prepared and taken into consideration by the different interveners inside and outside the prison, in order to make sure of an efficient medical follow-up. As the number of intervening medical and social personnel, is increasing in prisons, a coordination inside the their walls as well as on the regional and national levels, would prove useful.

Delivery of Health Care↗

PubMed1997

[Study of tuberculosis in Huelva prison].

OBJECTIVES: Knowing about the rate of tuberculous infection and disease in prison population and workers in Huelva prison, and the association of tuberculosis with the sociosanitary risk factors. EQUIPMENT AND METHODS: Descriptive research for a year in 141 male prisoners at the age of 20 to 52 years old, from the 1sT of February in 1994 to the 1sT in 1995. RESULTS: The prevalence on tuberculous infection is 46.4% (accumulative incidence); and tuberculous disease 3.5% (accumulative incidence 1.4%) on the prisoners and the prevalence on tuberculous infection on the prison officers is 18.8% (there wasn't incidence) and the was no disease. CONCLUSIONS: It's perceived a high rate of tuberculous disease on the prisoners at the expense of people with infection by HIV and drugs addicts by parenteral way. The socio-cultural variables affect the tuberculous infection and disease tuberculous.

Adult↗