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In a previous issue of the Review we published an article about the positive results of the evaluation of the first needle exchange programs in Spanish prisons. Recently it was reported that Spain's Ministry of the Interior has ordered that sterile needles be distributed in prisons.
Two studies from the Department of Community Health and General Practice at Trinity College, Dublin, have highlighted the extent of the HIV and hepatitis C (HCV) crisis in Irish prisons. The studies confirm that rates of HIV and HCV are disproportionately high in Irish prisons, and that high risk behaviours are commonplace.
AIMS: to assess referrals to a prison liaison service of regional forensic services in Auckland. METHODS: data on forensic psychiatric referrals from Auckland prisons 1 October 1989 to 30 September 1990 were collected. This was the first year of the service. RESULTS: there were 127 forensic psychiatric referrals in the period. The characteristic profile of such a case was that of a 28.5 year old male, unemployed remanded of Maori ethnic background. The commonest charge was nonsexual assault together with a prominent history of polysubstance misuse. Schizophrenia was the most frequent diagnosis. CONCLUSIONS: these findings have implications for regional forensic psychiatry services and other mental health providers, and the community in general.
The Australian Injecting and Illicit Drug Users League (AIVL) recently released a discussion paper on prison-based needle exchange or distribution programs, expressing concern "about the gaps in service provision and neglect for the health and human rights of injecting and illicit drug users within the Australian prison systems."
This paper employs an Eliasian perspective to provide an historical overview to the contemporary crisis in British prisons. It argues that some of the roots of this crisis lie within the very attempts to bring prison development in line with the cultural values of modern society.
Ex-offender managed health care can enhance post-release continuity of care by increasing access, decreasing acute-care episodes, controlling the spread of communicable diseases, and reducing the financial impact on public health-care systems. This study describes transitional health care for inmates with AIDS, tuberculosis (TB), hepatitis, mental illness, and substance abuse. The relationship between size of prison system and coordination of care was also investigated. A mail survey was completed by 33 chief medical officers of prison systems in the United States. Transitional health-care programs for ex-offenders vary widely and no significant relationship was found between number of inmates released per state annually and state coordination of transitional health care for supervised ex-offenders. All respondents reported some type of transitional health-care planning, usually either 1 month or 6 months prior to release. This included provision of post-release medication, referral to community health agencies, scheduling of appointments, and instruction in prevention of transmission. The majority of respondents reported that transitional health-care planning was coordinated by registered nurses. Specific measures for inmates with HIV/AIDS,TB, mental illness, and substance abuse were reported. Information about existing transitional health-care programs can help nurses and other health-care providers identify trends in transitional health-care planning and ensure continuity of care for released offenders.
Despite the improvement and the diversification of the circuits for care in the city, the number of drug addicts sentenced to prison sentences in the Canton of Vaud in Switzerland has not decreased in recent years. It is therefore imperative for the Prison Medicine and Psychiatry Service (SMPP) to provide a medical follow up which respects as closely as possible the principle of the equivalence of care with the outside environment. This article presents the way in which the SMPP takes its place in the continuity of the therapeutic assistance which drug dependent individuals can take advantage of. In this way, the range of therapeutic protocols in force in the different regimes of detention (preventive detention, custody and the execution of sentence) are examined, whether initial treatment, drug weaning or substitution therapies.
In 2002, as part of a larger injection drug use social network study undertaken in Winnipeg, a study was undertaken at Stony Mountain Institution to obtain data on the social network interactions in the prison and the potential role these interactions have on facilitating or inhibiting the spread of bloodborne pathogens among injection drug users. The study, although small in size and largely exploratory, provides further evidence of the risk of HCV and HIV transmission in prisons and its potential public health implications.
Treatment of survivors of political terror is an emerging and difficult field. Reports on posttraumatic stress disorder (PTSD) in political prisoners within the former Eastern Block countries is low and mostly restricted to German sources. During the totalitarian period administrative and clinical decisions often had to take into account political realities not found in other treatment environments. That practice might have lead to biased professional training, lack of experience extending into the post-communist era and leading to current underpresentation of PTSD. The authors present a case report of a Hungarian political prisoner with long history of PTSD who had a "carry over" diagnosis of paranoid schizophrenia even 15 years after the collapse of the communist regime. After decades of continuous administration of antipsychotic and antidepressive medications, either alone or in combination, Zeldox monotherapy has proven to be the most effective treatment for this patient.
South African prison populations continue to grow because of the escalating crime and an overstretched judicial system. The aim of this study was to assess the oral health status of prison inmates in the Western Cape (Pollsmoor, Goodwood, Paarl and Worcester). A cross-sectional epidemiological survey involving a clinical oral examination and face-to-face interviews was used to collect information on DMFT, periodontal health, perceived needs and the knowledge, attitudes and behaviour of inmates to oral health. Clinical examinations were carried out using WHO criteria. Of the 340 study participants, 264 were male and 76 were female. The prevalence of oral disease was high. The mean DMFT was 15.45 and the total DMFT increased with age. There was a reported impact on oral health quality of life, with many citing problems with eating, drinking and pain. Self-reported dental needs indicated a perceived need for dentures, scaling and fillings. Over two thirds of the sample (72%) reported that the dental services that they presently receive are poor. This study found a high prevalence of dental caries and periodontal disease among the correctional service populations. There is an urgent need for the development of a basic oral health care package that should be offered to all inmates as eventually many of them will be returning to the community.
This document affirms as final, without change, an interim final rule that established presumptions of service connection for atherosclerotic heart disease, hypertensive vascular disease, and stroke in former prisoners of war; set forth guidelines to govern future actions by the Department of Veterans Affairs (VA) to establish presumptions of service connection for other diseases associated with service involving detention or internment as a prisoner of war; and revised VA's regulations to conform to statutory changes made by the Veterans Benefits Act of 2003.
An epidemiological survey was conducted to evaluate the prevalence of drug use among new entrants in Italian prisons. Overall, 1267 inmates were recruited by 9 prisons. Drug use before imprisonment was reported by 55.8% of the participants. Cocaine was the most commonly used drug (42%), followed by heroin (34%), marijuana/cannabis (33%), ecstasy (7%), hallucinogens (6%), amphetamines (5%); more than one drug was reported by 68% of abusers. Recent use (1 month before imprisonment) was admitted by up to 27% of inmates. Alcohol or tobacco use was reported by 38 and 77% of the inmates, respectively. Our findings indicate that a high proportion of inmates has ever used drugs; adequate intervention is needed to reduce the risk of addictive behaviour in this population group.
Restorative justice initiatives have been identified as primarily, if not exclusively, useful as a "front-end" diversionary option reserved for non violent property crimes and minor assaults. In-prison restorative justice programs are rare and have not been examined for their impact on recidivism. Bridges to Life (BTL) is a voluntary, manualized, ecumenical faith-based restorative justice program offered to incarcerated offenders who are within nine months of their release. A survey of BTL graduates (n=1021) found an appreciatively lower recidivism rate than the general population of released inmates. Quantitative and qualitative analyses suggest that BTL helps break through offenders' denial and self-centeredness, exposing them to the impact of their actions and helping them feel the pain their crimes created. Possible reasons for the positive nature of participants' responses are advanced. The use of in-prison restorative justice programs to facilitate offender re-entry is also discussed.
Forensic staff--police officers, corrections officers, or other escorts of patient-prisoners--frequently are unaware of hospital rules and procedures. The article describes guidelines for medical police and hospital security for briefing forensic staff and dealing with patient-prisoners.
Suicide is a sentinel event in prison, and preventive efforts reflect the adequacy and comprehensiveness of mental health, psychiatric, custodial, and administrative services in a correctional system. This article reviews the literature on suicide in prison during the past three decades and identifies the pattern and occurrence of risk factors. These risk factors are classified as demographic, institutional, and clinical. Based on this review, the author outlines specific administrative, custodial, and clinical steps and procedures that form the basis of a comprehensive suicide-prevention program that can be implemented in small and large systems. The author recognizes the limitations of staff availability, the budget constraints, and the ineffectiveness of efforts to prevent suicides that occur without any warning. Ultimately, a prevention program is the collective responsibility of administrative, custodial, and clinical staff.
The large numbers of prisoners taken during Operation Desert Storm strained available medical resources. The experiences and difficulties of the 300th Field Hospital in providing medical care to approximately 20,000 enemy prisoners of war is discussed.
The 'right to die' is not of an absolute character but is subject to definite qualification. There are legal and social interests reflecting profound ethical values which militate against an absolute right on the part of a prisoner to die by means of a hunger strike. The declared policy of the South African authorities is that a prisoner who resorts to a hunger strike may not be subjected to force-feeding. This is in accordance with the 1975 Tokyo Declaration. Unfortunately the Declaration is silent on the question of whether a doctor may provide medical treatment once a hunger striker has reached the point where he is no longer capable of rational thought. In this article it is submitted that a doctor would be legally entitled to do so.
Serum specimens that had been obtained for routine operational procedures from consecutive entering male inmates during Spring 1987 and the same calendar period in 1988 were tested to identify prevalence and risk groups for antibody to HTLV-I/II. Specimens were assayed for antibody to HTLV-I/II using ELISA, RIPA, and Western blot techniques. Demographics were compared by serostatus using chi 2 and Fisher's exact tests. Of the 1,932 inmates entering prison, 49.3% were 25 years of age or older, 70.1% were black, 62.4% were committed from the Baltimore metropolitan area, 34.1% were intravenous drug users, and 7.0% demonstrated antibody to HIV-1. Among 1,932 inmates, 18 (0.9%) were HTLV-I/II seropositive. All seropositives were black; age greater than 25 years old was significantly (p less than 0.01) associated with seropositivity. Reactivity to HTLV-I/II did not vary significantly by year of entry, HIV-1 serostatus, jurisdiction, offense category, or sentence. Prevalence of HTLV-I/II among incoming male inmates was elevated compared to available local population comparisons. Additional blinded epidemiological serosurveys of antibody to HTLV-I/II are indicated for prison populations in order to monitor the extent and scope of infection in this population.