Finnish female prisoners - heavy consumers of health services.

AIMS: Previous prison studies show that female prisoners often have more health problems than male prisoners do and that they have many chronic health conditions. Few studies have been made among offenders concerning the use of health services, and even fewer concerning physical diseases. We studied the self-reported lifetime somatic diseases, the use of health services and the current use of prescription medicines among Finnish female prisoners and compared them with males. METHODS: The sample consisted of 101 females and 309 male prisoners as controls. The study included several questionnaires and interviews conducted by experienced prison nurses. RESULTS: The women had more commonly genitourinary, virus hepatitis/HIV infections and group "other diseases" than the men. Over 80% of the women and men have had accidents/injuries. Four out of five women, and half of the men, used some medicine regularly. Of the females, 92% (80% of the males) reported lifetime hospital care and 65% (61%) treatment in surgery department, respectively; 70% of the females (53% of the males) reported lifetime use of any psychiatric service; 66% of the women (46% of the men) had received psychiatric out-patient services, and 43% (31%) psychiatric in-patient hospital care and 38% (30%) substance abuse services, respectively. CONCLUSIONS: The heavy use of health services among female prisoners resulted mainly from the use of services for substance use and other mental disorders and treatment in surgery department. Compared to men, the difference in using health services was associated with psychiatric services.

The changing picture of substance abuse problems among Finnish prisoners.

PURPOSE: Marginalized people are often absent from population surveys of substance use and from research based on care data. Special methods are needed to reach these small but very significant groups. This study analyses how patterns of intoxicant use have changed over time among one of the most marginalized group of people, the prisoners. METHODS: Nationally representative samples of Finnish prisoners were examined: 903 prisoners in 1985, 325 prisoners in 1992, and 410 prisoners in 2006. Comprehensive field studies consisting of interviews and a clinical medical examination were used. RESULTS: In 1985, a diagnosis for alcoholism was given to 41% of the men and 36% of the women prisoners. An increase over time was observed, and in 2006, 52% of men and 51% of women prisoners were alcohol dependent. Dependence on a drug was diagnosed in 6% of men and 3% of women in 1985; this prevalence had increased to 58% of men and 60% of women in 2006. CONCLUSIONS: A dramatic change in prevalence of illegal drug use and drug addiction among prisoners has taken place in the past 20 years. Recognizing this shift from alcohol to other intoxicants is important since drugs are illegal substances and thus tend to lead to involvement with the judicial sector, thus stigmatizing and deepening the spiral of marginalization.

Drug use among prisoners: by any definition, it's a big problem.

According to several studies, the prevalence of drug use (1) among prisoners is manyfold compared to general population. However, comparisons across studies are hampered by the use of a variety of mutually noncomparable methodologies. We report substance use among Finnish prisoners using three methods and analyze these differences. The material consisted of 610 Finnish prisoners in 2006 and represents all Finnish prisoners. The subjects participated in a comprehensive field study including a standardized psychiatric interview (SCID-I). Alcohol abuse/dependence was diagnosed in 68% (SCID-I) and 72% (ICD-10) among men and 70% (both SCID-I and ICD-10) among women. Drug abuse/dependence was diagnosed in 62% (SCID-I) and 69% (ICD-10) among men and 64% (SCID-I) and 70% (ICD-10) among women prisoners. Interview data revealed that the majority had at least tried most substances. Both alcohol and drug abuse/dependence were vastly more common among Finnish prisoners than reported elsewhere. The DSM-IV-based SCID-I produced slightly lower prevalence estimates than an ICD-10 clinical examination, but overall SCID/ICD agreement was very good. It seems that physicians use information other than that captured by standardized structured clinical interview when placing a diagnosis. Nonclinical interview-based prevalence figures may overestimate harmful use of drugs unless known risk patterns of use (e.g., intravenous use) are specifically addressed.

Work ability and treatment needs among Finnish female prisoners.

PURPOSE: The purpose of this paper is to assess the work ability and employment history of Finnish female prisoners and their need for treatment. DESIGN/METHODOLOGY/APPROACH: The sample consisted of 101 female prisoners, with 309 male prisoners for comparison. The methods included interviews, the Structured Clinical Interview for DSM-IV Axis I, II Disorders and medical examination including ICD-10 diagnoses. FINDINGS: Among women, 78 per cent were unemployed and only 6 percent were employed whereas among men, the proportion of those employed was four times greater than for women. Of women, 42 per cent were unable to work; of men 11 per cent. Substance abuse disorders were the most common reason for impaired work ability (over 70 per cent in both genders). Among women, other mental disorders were the second most common reason (39 per cent), somatic diseases caused impairment in 23 per cent. Basic socio-demographic factors were not associated with impaired work ability among women. Violent crime as the present main offence was significantly more common among prisoners with limited working capacity. Need for treatment was found in 94 per cent of women and 90 per cent of men. In both genders, the majority of treatment needs were for mental disorders. Finnish female prisoners have serious problems with substance abuse, of both alcohol and drugs, which impairs their work ability, employability and is the cause of their need for treatment. In addition, female prisoners have other mental disorders commonly complicating their situation. ORIGINALITY/VALUE: This paper is a part of the first comprehensive health study of Finnish female prisoners.