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PubMed1992

A survey of pre-arrest drug use in sentenced prisoners.

The paper presents the results of a retrospective, self-report survey of pre-arrest drug use in a representative sample of 1751 men serving a prison sentence. Reported drugs used were cannabis (34%), opiates (9%), amphetamine (9%) and cocaine (5%), including 1% 'crack' users. Pre-arrest injecting was reported by 11% of inmates, including 68% of all opiate users and 57% of amphetamine users. Drug dependence was reported by 11%, including 7% dependent on opiates, 2% on amphetamines and 1% on cocaine. Relative to other drugs, the figure for cocaine is higher than is suggested by a previous clinic survey. Pre-arrest cannabis use was reported by 54% of black prisoners and 34% of white. White prisoners are more likely to report use of 'hard' drugs, drug dependence and injecting, but this masks a higher rate of cocaine use by black prisoners. Opiate use varied between health regions, from 3% of prisoners in the West Midlands to 25% of those from the Mersey region. These findings have implications for service provision and for an understanding of cultural influences on illicit drug use.

Adolescent↗
PubMed1997

Feigned mental disorder in prisoners referred to forensic mental health services.

This paper describes a study that aimed to identify the extent to which feigning of mental illness represents a significant problem in prisoners referred to a medium secure unit. A clinical method was used to assess the prisoners, employing the Structured Interview of Reported Symptoms (SIRS) and selected Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity indices. Stringent criteria were used to classify 60 consecutive referrals to a secure unit as feigning mental disorder or not. In addition, the study examined characteristic differences, on a number of selected variables, between those prisoners who feign and those who respond honestly. The personality profiles of prisoners who feign were also investigated. Analysis of data showed that 32% of the sample (P < 0.01) could be classified as fabricating or exaggerating symptoms of mental illness. It is suggested that such presentations may be more prevalent than previously considered. Few differences were observed between the groups on selected variables, although prisoners who feigned mental illness demonstrated significantly higher dependent and anxious (avoidant) personality types. The implications of the findings are discussed in relation to available models of feigned presentations.

Adult↗
PubMed2004

Children of prisoners: a growing public health problem.

OBJECTIVES: To estimate the number and proportion of children in New South Wales affected by parental incarceration, and to describe the health impact of punitive incarceration on the children of prisoners. METHODS: In 2001, NSW Corrections Health Service conducted a cross-sectional survey of prison inmates randomly selected from each of the 29 prisons in NSW, representing 11% of male and 30% of female inmates in the State. The survey included questions regarding parental status and number of children. A population model was developed, which incorporated increases in the prison population and recidivism, to estimate the number of children under 16 years of age in NSW ever having experienced parental incarceration. RESULTS: In 2001, there were approximately 14,500 children under the age of 16 years in NSW who experienced parental incarceration during the year. It is estimated that in 2001 there were 60,000 children under 16 years in NSW who had ever experienced parental incarceration in their lifetime, representing 4.3% of all children and 20.1% of Indigenous children. CONCLUSIONS: The number of children who have experienced parental incarceration is significant in NSW and across Australia. Indigenous children are much more likely to experience parental incarceration than non-Indigenous children. IMPLICATIONS: Children of prisoners are at high risk of negative health outcomes and are themselves at an increased risk of offending later in life. The needs of these children must be recognised and policies introduced to reduce the adversities they face. The social, politico-legal and economic conditions that are contributing to the continuing rise in incarceration rates must be recognised, and measures must be taken to reduce this trend.

Adolescent↗
PubMed2005

Mortality among prisoners: how accurate is the Australian National Death Index?

OBJECTIVE: The effectiveness of the National Death Index (NDI) in identifying deaths among different populations has been studied before. Prisoners represent a segment of the population that might be expected to be difficult to link. The objective of this research was to evaluate the accuracy of the Australian NDI to ascertain the mortality status of prisoners in New South Wales, Australia. METHODS: Data on 311 inmates who had died in custody between January 1988 and March 2003, and on 7,558 inmates known to be alive at the end of May 2003, were matched to the NDI database. Matching was undertaken using a probabilistic linkage method followed by a clerical review. The underlying causes of death reported by the NDI were compared against those reported by the NSW Coroner and held at the Legal Branch of the Department of Corrective Services. RESULTS: Linkage correctly identified 275 of the 311 known deaths (sensitivity: 88.4%). Of the 7,558 prisoners known to be alive in custody at the end of May 2003, linkage to the NDI incorrectly identified 23 as dead (specificity: 99.7%). Cause of death was accurately reported by the NDI for 95.5% of deaths identified by the linkage. CONCLUSION: The results of this study show that the NDI is an accurate and feasible means for evaluating mortality among prisoners. The nature of the prisoner population makes the linkage a difficult task for the NDI. The success of the data linkage depends on the extent and accuracy of information contained in the index file and type and quality of information available.

Cause of Death↗
PubMed1977

The HDHQ results of long-term prisoners: relationships with criminal and institutional behaviour.

The HDHQ (Foulds, Caine & Creasy, 1960) was administered to 100 long-term prisoners as part of routine psychological assessment prior to their allocation to training prisons. The questionnaire results were analyzed in terms of the prisoners' past and present criminal and institutional behaviour. Additionally they were used to test Megargee's (1966) hypothesis that extremely assaultive individuals are generally overcontrolled and will thus express less hostility than moderately assaultive individuals. The results showed that the sample of long-term prisoners had a significantly higher total hostility score than normals but did not differ significantly in the direction of their hostility. Violent offenders were significantly more extrapunitive than non-violent offenders, and prisoners who had attempted suicide were more extrapunitive than those with no history of attempted suicide. Apart from these findings no significant relations were found between the HDHQ results and criminal and institutional behaviour, whether violent or non-violent. Megargee's (1966) over- and under-controlled hypothesis failed to receive support. The results suggest that the HDHQ would be of little value in making predictions about future violent or criminal behaviour.

Adult↗
PubMed2003

Human organs from prisoners: kidneys for life.

A proposal to allow prisoners to save their lives or to be eligible for commutation of sentence by donating kidneys for transplantation has been a subject of controversy in the Philippines. Notwithstanding the vulnerabilities associated with imprisonment, there are good reasons for allowing organ donations by prisoners. Under certain conditions, such donations can be very beneficial not only to the recipients but to the prisoners themselves. While protection needs to be given to avoid coercion and exploitation, overprotection has to be avoided. The prohibition on the involvement of prisoners in organ transplantation constitutes unjustified overprotection. Under certain conditions, prisoners can make genuinely independent decisions. When it can be reasonably ascertained that they are able to decide freely, society should recognise an obligation to help them implement their decisions, such as when they intend to donate an organ as a way of asserting their religious faith and performing a sacrifice in atonement for their sins.

Attitude to Health↗
PubMed2005

[Mental morbidity and social support in prisoners in treatment with antiretrovirals].

OBJECTIVE: To define the incidence of depressive disorders and anxiety disorders in prisoners of three prisons of CCAA in treatment with antiretrovirals, and moreover the associated variables and the intensity of social support within the prison. METHODS: Through a cross-sectional design 281 prisoners were studied. RESULTS: 42% showed mental morbidity and 53.4% lacked social support. To be imprisoned in the Granada prison, to be a woman, poor health state, to describe difficulties for compliance with antiretrovirals drug, a history greater than 13 years for drugs consumption, and usual residence with the couple of family, all were factors associated with mental morbidity. Factors associated with social support non-existence were history of more than one imprisonment, lack of familiarity with the medical equipment, to be more than 35 years old, and to suffer mental morbidity.

Adult↗
PubMed2002

Recidivism and use of services among persons with mental illness after release from prison.

OBJECTIVE: Despite large numbers of mentally ill offenders in prisons, few studies of mentally ill offenders released from prison have been conducted. This study describes such a population of mentally ill offenders, the postrelease services they received, new offenses they committed, and factors associated with recidivism. METHODS: The authors reviewed electronic files and archived medical charts from the state corrections department to identify mentally ill offenders who left Washington state prisons in 1996 and 1997. Data on the individuals identified were then provided by several public agencies. Summary statistics were computed on subjects' characteristics and postrelease outcomes, and logistic regression analysis was used to identify variables that predicted convictions of new felonies and new crimes against persons. RESULTS: A total of 337 mental ill offenders were identified. Men and women differed with regard to offenses, diagnoses, rates of drug abuse, and use of mental health resources. Although most subjects (73 percent) received postrelease social or mental health services, few received clinically meaningful levels of service during the first year after release. Charges for new crimes or supervision violations were common (70 percent of subjects), but only 10 percent committed new felonies against persons, and 2 percent committed very serious crimes. Youth, frequency of past felonies, and variables such as misbehavior in prison were associated with new offenses. CONCLUSIONS: Whether community mental health treatment affects recidivism cannot be assessed fairly in the absence of higher levels of service during the first months after release. This study also identifies actuarial risk factors that predict new offenses at a level comparable to that of published risk assessment instruments. Commission of less serious offenses that usually precede felonies may provide an early warning of risk for new felonies and an opportunity for strategic intervention. The low rate of serious violence in the community by mentally ill offenders released from prison suggests that the risk of violence may be a weak and potentially counterproductive rationale for community support and mental health treatment of mentally ill offenders.

Commitment of Persons with Psychiatric Disorders↗
PubMed2001

A cross-sectional study which measures the prevalence and characteristics of prisoners who report a family history of epilepsy.

Epilepsy is often a familial disorder, although it is not known if relatives of an epileptic proband suffer from any psychological disorders, even without a clinical manifestation of epilepsy. The present study considers this concept in the setting of the largest male prison in Europe, HMP Liverpool. The study formed part of the National Prison Needs Assessment Survey, and consisted of a cross-sectional, questionnaire study. There was a high response rate, and the results indicate that prisoners have a high prevalence of a family history of epilepsy. The study also showed that prisoners who report such a history have significantly more psychological symptoms than those prisoners without such a family history. The conclusion is that the psychological health of relatives of those with epilepsy requires further investigation because the morbidity is higher than expected and may be associated with offending behaviour.

Adult↗
PubMed1997

Inadequacies in the Mental Health Act, 1983 in relation to mentally disordered remand prisoners.

There are widely recognized problems regarding access to NHS facilities for mentally disordered remand prisoners (Robertson et al., 1994). The Bentham Unit was set up in February 1994 to provide the earliest possible hospital admission for mentally disordered remand prisoners. Over the first twelve months of the service's operation we assessed 150 and admitted 62 remand prisoners: a full description of the service is in preparation. Because admission is restricted to remand prisoners, the inadequacies of current legislation in allowing effective, uninterrupted care for remand transfers have become very apparent. There have been recent proposals to review the 1983 Mental Health Act (Murphy, 1995) and we suggest that provisions for assessment and treatment of mentally disordered remand prisoners should be revised in this context.

Forensic Medicine↗
PubMed2005

Correlates of Mycobacterium tuberculosis infection in a prison population.

Prisons represent a crucial setting for tuberculosis control. Currently, there is scarce information concerning Mycobacterium tuberculosis (MT) infection in European prisons, and no data are available for Italy. This study aims to describe the prevalence and correlates of MT infection in an Italian prison population. In this multicentre cross-sectional study, 1,247 inmates from nine prisons were recruited and asked to undergo questioning regarding socio-economic and demographic variables, tuberculin skin testing (TST), chest radiographs and testing for HIV, hepatitis B and hepatitis C virus infection. TST was positive in 17.9% of the 448 evaluable subjects. With multivariate logistic regression (performed among male inmates), MT infection was correlated with age (adjusted odds ratio (OR) 4.12 for inmates aged 31-40 yrs; 3.78 for those aged >40 yrs), being foreign-born (OR = 4.9), education < or =5 yrs (OR = 1.88) and length of detention (increased risk per yr: 11%). As with elsewhere in the world, the prison system in Italy features a population with an increased rate of Mycobacterium tuberculosis infection and at-risk rate for Mycobacterium tuberculosis transmission. Improved tuberculosis surveillance and control measures are deemed necessary in correctional facilities nationwide, especially for subjects with the above risk factors and those who are HIV infected, in whom the tuberculin skin testing can be misleading. The screening of entrants is particularly important to avoid undiagnosed smear-positive tuberculosis cases.

Adult↗
PubMed1994

Psychotic men remanded in custody to Brixton Prison.

All referrals to medical officers in Brixton Prison over a five-month period in 1989 were examined. This paper reports the progress through this remand prison of those men who were considered to be suffering from a major psychiatric disorder. Many men had been charged with relatively minor offences. The net effect of medical intervention was to delay release from custody. Because of the administrative delays inherent in the system of medical referral and hospital admission under section 37 of the Mental Health Act 1983, it was those prisoners who were most ill who tended to remain in prison for the longest periods. Judged in terms of its efficiency to ensure speedy treatment for mentally ill remanded offenders, the present system is regarded as cumbersome and extremely inefficient. It is suggested that greater use should be made of section 48 of the 1993 Act to divert mentally ill, remanded offenders from prison.

Adolescent↗
PubMed2006

Psychiatric morbidity among sentenced prisoners: prevalence study in Iran.

BACKGROUND: Information on psychiatric morbidity of prisoners has almost entirely been based on research in Western countries and it is uncertain whether these research findings are applicable to other settings. AIMS: The primary objective was to investigate the prevalence of psychiatric disorders in Iranian prisoners. METHOD: Through stratified random sampling, 351 prisoners were interviewed using the clinical version of the Structured Clinical Interview for DSM-IV Axis I Disorders and the Psychopathy Checklist: Screening Version. RESULTS: The majority (88%) of prisoners met DSM-IV criteria for lifetime diagnosis of at least one Axis I disorder and 57% were diagnosed with current Axis I disorders. Opioid dependence (73%) had the highest prevalence among lifetime diagnoses, whereas major depressive disorder (29%) was the most common current diagnosis. Psychopathy was recorded in 23%. Prevalence rates of psychiatric disorders were significantly different among offence categories. CONCLUSIONS: The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of Iran, with treatment challenges that appear to be different from those observed in inmates in Western countries.

Adolescent↗
PubMed2001

Syphilis in New South Wales (Australia) prisons.

This paper describes the prevalence of, and risk factors for, exposure to syphilis in a random sample of male and female prisoners. We found that only 2% of male and 1% of female prison inmates in New South Wales (NSW) had confirmed evidence of untreated syphilis, and none appeared to be in an infectious phase. In the multivariate analysis, indigenous ethnicity remained the most potent predictor for confirmed syphilis (either past or present). There was some evidence to suggest that syphilis among indigenous prisoners may be associated with limited access to health services outside prison. The epidemiology of syphilis reflects that of the general community suggesting that prisons could be used as sentinel sites to help evaluate the effectiveness of STD prevention and control strategies.

Adult↗
PubMed2003

Heterosexual activity of male prisoners in England and Wales.

A random sample of 1009 adult male prison inmates from 13 prisons covering short-, medium- and long-term establishments across England and Wales was interviewed about sexual behaviour, drug use and tattooing, inside and outside of prison. We report here on their heterosexual behaviour. Inmates had had a high number of sexual partners compared to population samples. The majority of sexual partners were casual and there were high levels of sexual involvement with injecting drug users and with prostitutes. Prisoners engaged in more risky sexual practices than did the general population and used condoms infrequently. A high number of prisoners had also injected drugs. Inmates reported a high frequency of past sexually transmitted diseases.

Adolescent↗
PubMed1998

A lasting public health response to an outbreak of HIV infection in a Scottish prison?

Between April and June 1993, 8 cases of acute clinical hepatitis B infection and 2 seroconversions to HIV infection were detected among drug injecting inmates of HM Prison Glenochil in Scotland. To prevent the further spread of infection, an initiative which involved counselling and voluntary attributable HIV testing was conducted over a 10-day period commencing at the end of June. A team of 18 counsellors and phlebotomists was brought together rapidly as part of a unique organizational exercise in the field of public health. Fourteen cases of HIV infection were identified of which 13 were almost certainly infected in Glenochil. Following the exercise, a range of harm reduction measures for injecting prisoners was introduced; these included the availability of hepatitis B vaccine, provision of bleach tablets which could be used to clean injecting equipment, a methadone detoxification programme, increased training for prison officers and improved access to drug and harm minimization counselling for inmates. By mid-1996 all these measures had been sustained and several could be found in many other prisons throughout Scotland. Follow-up investigations showed no evidence of epidemic spread of HIV during the 12 months after the initiative. While the frequency of injecting and needle/syringe sharing may have decreased over the last 3 years, these activities are still being reported and it is highly likely that transmissions of bloodborne infections, in particular hepatitis C, continue to occur. The surveillance and prevention of infections associated with injecting drug use in the prison setting remain a high public health priority.

Disease Outbreaks↗
PubMed2004

The successes and challenges of developing a prison telepsychiatry service.

Prisoners are not typical of the general population with regard to their health needs, as they have a disproportionately high incidence of mental health problems and drug misuse. Health-care delivery in prison faces a significant number of challenges not experienced by other health-care organizations. Telepsychiatry is one strategy to improve the accessibility and quality of mental health-care in the prison setting. Despite some initial challenges, a telepsychiatry service was successfully established between a medium-secure unit in Fareham, Hampshire, and a category B training prison on the Isle of Wight. A low-cost, PC-based videoconferencing system was used, connected by ISDN lines at 128 kbit/s. A valuable lesson that was learnt was the importance of having the support of key individuals in a prison setting.

Delivery of Health Care↗
PubMed2003

The oral health of a group of prison inmates.

The oral health of prison inmates in England has come under increased scrutiny with the arrival of joint responsibility between the Home Office and the NHS for prison healthcare. This brief study indicates very high levels of oral disease amongst a group of prisoners attending for treatment in an English prison. Further study of the oral health of prisoners seems timely, as does the exploration of effective oral health promotion for this group of people.

Adolescent↗