Global Prison Health Care Governance and Health Equity: A Critical Lack of Evidence.

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services.Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries.Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level.

Sex Offenders in Prison: Are They Socially Isolated?

Empirical literature has revealed that social isolation can affect the rehabilitation of sex offenders after serving their sentence. This process of social isolation can already start during incarceration due to strained relationships with fellow prisoners and correctional staff. The current study examined to what extent sex offenders felt socially isolated during incarceration, using survey and registered conviction data on a large sample of male adult prisoners from the Prison Project. It was found that support from and relationships with correctional officers and fellow prisoners were perceived less positive by sex offenders than nonsex offenders. No evidence was found for higher levels of loneliness in sex offenders compared with prisoners convicted for a nonsexual offense. In sum, although the effects were small, sex offenders reported more social isolation during imprisonment compared with nonsex offenders.

Short-Term Effects of Imprisonment Length on Recidivism in the Netherlands.

This article assesses the relationship between imprisonment length and recidivism. The data come from a unique longitudinal and nationwide study of Dutch prisoners, serving an average of 4.1 months of confinement (N = 1,467). A propensity score methodology is used to examine the dose-response relationship for three types of registered recidivism (i.e., reoffending, reconviction, and reincarceration) within a 6-month follow-up period. Findings indicate that length of imprisonment exerts an overall null effect on future rates of recidivism and that this conclusion holds across the various types of recidivism. These findings contribute to continuing scholarly debates over the social and economic costs of imprisonment.

A longitudinal study of mental health symptoms in young prisoners: exploring the influence of personal factors and the correctional climate.

BACKGROUND: Despite the high prevalence rate of mental health problems among young prisoners, little is known about the longitudinal course and covariates of their mental health symptoms during incarceration, especially the influence of the correctional climate. The current study aimed: (1) to examine changes in young prisoners' mental health symptoms during incarceration, (2) to identify personal factors associated with their mental health symptoms and perceptions of the correctional climate, and (3) to test the incremental effect of perceptions of the correctional climate on mental health symptoms. METHODS: Data were obtained from a sample of 75 youths (aged 17 to 22 years) detained in a Portuguese young offender prison. Data were gathered 1, 3, and 6 months after their admission in this facility. Socio-demographic, clinical and criminological variables were collected. Mental health symptoms and perceptions of the correctional climate were assessed through self-report assessment tools. Linear and logistic (multi-level) regressions and tests for differences between means were performed to analyze the data. RESULTS: Overall, mental health symptoms marginally declined by the sixth month in prison. Prisoners with a history of mental health treatment were more likely to have increased symptoms. Higher levels of mental health symptoms were associated with a history of mental health treatment, remand status, and a lower educational level. Better perceptions of the correctional climate were associated with Black race and participation in prison activities. A negative perception of the correctional climate was the strongest covariate of young prisoners' mental health symptoms and had incremental validity over that of personal variables. CONCLUSIONS: The results highlight that both characteristics of the prisoners and of the prison environment influence young prisoners' mental health. Prison management can try to reduce young prisoners' mental health problems by developing scientific procedures for their mental health assessment and creating a more beneficial correctional climate.

Procedural justice and prisoners' mental health problems: a longitudinal study.

BACKGROUND: Given the high prevalence of mental health problems among prisoners, knowledge on its determinants is important. Prior cross-sectional studies suggest that procedurally just treatment within prison is a significant predictor; however, longitudinal research is lacking. AIM: The aims of this study were to examine (1) the longitudinal relationship between prisoners' perceptions of procedural justice--including fairness, respect, humanity and relationships with officers--and their mental health and (2) the moderating role of coping style in this relationship. METHODS: Data were obtained from the Prison Project, a longitudinal study of adult male prisoners in the Netherlands, interviewed both 3 weeks and 3 months after their reception into pre-trial detention (N = 824). A cross-lagged structural equation model was employed to investigate associations. RESULTS: Prisoners who reported experiencing a higher level of procedural justice 3 weeks after their arrival in custody reported fewer mental health problems after 3 months. No evidence was found that coping style moderated this relationship. CONCLUSIONS: These findings suggest a causal relationship between procedural justice and psychological well-being. Fair and respectful treatment of prisoners is a predictor not only of prison order and prisoners' compliance but also of prisoners' psychological well-being.

Procedural Justice in Their Eyes: A Qualitative Interview Study Among Detainees.

The literature on procedural justice has been mainly focused on examining whether a fair and respectful treatment affects justice-involved individuals' legitimacy evaluations and their behavior. It is, however, equally important to examine (a) the role that perceptions of procedural justice play for individuals in their encounters with criminal justice authorities and (b) what makes individuals feel treated procedurally (un-)just. In this qualitative study, semi-structured interviews were conducted with 35 detainees in a Dutch prison, asking questions about their encounters with police officers, prison staff, judges, and probation officers. The findings showed that the majority of detainees raised issues of procedural justice, indicating that procedural justice plays an important role for them. In addition, five elements primarily shaped detainees' perceptions of procedural justice: (1) trustworthy motives, (2) interpersonal treatment, (3) neutrality, (4) participation, and (5) agency and process information. These elements of procedural justice were mentioned after encounters with most authorities.

Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR).

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes. METHODS: This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis). DISCUSSION: We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release. TRIAL REGISTRATION: ClinicalTrials.gov NCT05842330 . Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.

Strangers in a strange land: coping with imprisonment as a racial or ethnic foreign national inmate.

A wide range of scholarship examining the global effects of neo-liberalism draws attention to the precarious position of individuals who are not seen as part of the social body. While immigrants, racial minorities, and common criminals are central to this discourse, relatively little research has examined how the experiences of these individuals may vary based on statuses other than citizenship when they are imprisoned. Our research focuses on the interactions (between prisoners and between prisoners and correctional staff) of a racially diverse group of Dutch foreign national prisoners incarcerated in England. Although all of these prisoners clearly saw themselves as 'outsiders,' visible minorities faced a unique set of challenges relative to their White counterparts. We consider both the practical and theoretical import of these findings.

The health of detainees and the role of primary care: Position paper of the European Forum for Primary Care.

This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees' encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement.

Longitudinal trajectories of mental health problems and their association with reoffending in a Dutch pre-trial prison cohort.

The burden of mental health problems in detained persons is high. At the same time, mental health problems are discussed as possible predictors of criminal recidivism. During detention, mental health tends to improve. The aims of the study were twofold: First, to identify group-based trajectories of mental health problems over the course of detention; second, to test the association between trajectories and criminal recidivism. A prospective cohort of 1,904 adult males detained in Dutch pre-trial detention facilities was assessed at three time points after imprisonment (week 3, month 3, and month 9). Mental health problems were measured using the Brief Symptom Inventory. Recidivism was defined as reconviction and re-incarceration up to 18 months post-release. We used group-based trajectory modeling and logistic regressions for the analyses. On average, self-reported mental health improved during incarceration. Two distinct groups of mental health trajectories were identified: The majority (81%) reported relatively low levels of mental health problems, remaining stable over time. A small group (19%) reported high distress after prison entry with improvements over time. Older age, pre-existing functional impairment due to alcohol or drug use, diagnosis of psychiatric disorders, debts, use of psychiatric care during detention, and a more severe experience of detention were associated with membership in the second group. Group membership did not predict reoffending. The study confirms prior findings illustrating a generally positive change in mental health symptoms during detention. The course of mental health was associated with pre-existing socio-demographic and psychological characteristics that seem worthy to be considered in correctional treatment plans. Changes in mental health did not result in better legal outcomes. An interesting avenue for future research would be to examine changes in specific mental health symptoms or disorders in relation to recidivism risk.

Detainees' Perceptions of Procedural Justice: An Examination Throughout the Criminal Justice System.

Procedural justice literature proposes that when individuals perceive their treatment by criminal justice authorities as more procedurally just, they will be more likely to view those authorities as legitimate and, in turn, show more compliant behavior. Knowledge on potential determinants of procedural justice is, therefore, crucial. Research suggests that prior perceptions of procedural justice may influence later judgements of procedural justice. The current study used data from the Prison Project, including information on detainees' perceptions of their treatment by the police, the judge, the prison staff, the probation officer, and the lawyer. The findings show that detainees perceive the treatment by the lawyer as most procedurally just, while they evaluate the treatment by the police as least procedurally just. Further, how detainees experience the procedurally just treatment by the police is associated with how they feel treated by other authorities at a later stage in the criminal justice system.

PriSUD-Nordic-Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study.

BACKGROUND: A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. OBJECTIVE: The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. METHODS: PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. RESULTS: PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. CONCLUSIONS: PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35182.

Mental and physical health problems before and after detention: A matched cohort study.

BACKGROUND: Individuals with poor health are largely overrepresented in prison populations. However, it remains unclear whether their poor health status already exists prior to their detention or reflects an effect of detention. We examined the health of detainees in the year before and after their detention and compared this with the health of matched non-detainees. METHODS: In this matched cohort study, we linked national data on all persons detained in the Netherlands in 2014/2015 to electronic health records (EHR's) of a representative sample of general practitioners in the Netherlands. Participants include 952 detained persons and 4760 matched non-detained persons (matched on age, sex and general practice). Prevalence rates of health problems in the year before and after detention and odds ratios with 95% confidence intervals were calculated. Rates for a variety of physical and mental health problems are presented. FINDINGS: Detainees and matched controls differed statistically significant in their pre-detention health status. Compared with controls, male detainees were more likely to report psychological (odds ratio [OR] 3·64 [95% CI 3·11-4·26]), social (1·96 [1·46-2·64]), neurological (1·34 [1·02-1·76]), digestive (1·23 [1·02-1·49]), genital system-related (1·36 [1·07-1·72]), and unspecified health problems (1·32 [1·10-1·59]) in the year before their detention. For example, 43·7% of detainees and 17·6% of controls reported psychological problems in this pre-detention year. To some extent these pre-detention health differences were related to socioeconomic differences. Nevertheless, after taking these characteristics into account, a number of pre-detention health differences between detainees and controls remained statistically significant. No statistically significant changes in prevalence rates from pre- to post-detention and no differences in the levels of change across detainees and controls were observed. For female detainees a similar pattern was found. INTERPRETATION: People who experience detention have high and complex health needs both pre- and post-detention. While this study did not show a health deteriorating effect of detention, it also did not show a health improving effect. This latter finding may indicate a missed opportunity for health care services to address detainees' health, especially since persons entering detention have elevated health problems. Knowledge on detainees' specific health problems may help health care providers in prisons and in the community to adequately address the health care needs of this vulnerable group. FUNDING: None.

Managing Risk or Supporting Desistance? A Longitudinal Study on the Nature and Perceptions of Parole Supervision in the Netherlands.

PURPOSE: Little is known about how ex-prisoners' parole supervision experiences support or hinder the process of desistance. The aim of this article is to analyse the nature of parole supervision of Dutch (ex-)long-term prisoners in terms of official conditions, as well as the way in which parole officers (POs) and ex-prisoners navigate these conditions. The focus is particularly on the experienced supervision style and how this interacts with different dimensions of efforts at desistance. METHODS: Twenty-three Dutch parolees were interviewed in depth at three waves starting in prison up to one year after their release from prison. A thematic analysis was undertaken to analyse the 69 interviews. In addition, the parole files of these ex-prisoners were examined containing information about conditions, violations and sanctions. RESULTS: Parole files revealed the practice of highly engaged parole officers, who worked with parolees to strengthen factors known to foster desistance and tried to accommodate the difficulties of navigating 'life outside' after a relatively long prison sentence. However, the interviews showed that most parolees found their parole experience predominantly surveillance-oriented and not very helpful for desistance. Parole was experienced as most beneficial when parole officers were viewed as social workers or mentors and used their discretionary power to adjust conditions creating 'space' for trial-and-error. CONCLUSIONS: This longitudinal study suggests that a policy culture and discourse of risk management do not necessarily preclude desistance support in parole supervision in the Netherlands, due to discretionary power of parole officers.

Disaster-related posttraumatic stress disorder and physical health.

OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and self-reported as well as physician-recorded physical health in a sample of survivors (n = 896) of a man-made disaster, using a longitudinal design that included predisaster health data. Most studies on the relationship between PTSD and physical health are cross-sectional and use self-reported physical health outcomes. METHODS: A surveillance using the electronic medical records of survivors' family practitioners (FPs), 1 year predisaster until 4 years postdisaster, was combined with a survey, 3 weeks and 18 months postdisaster. Self-reported PTSD and self-reported physical health were assessed at 18 months postdisaster. FP-recorded physical health problems in the subsequent 2 years were classified according to the International Classification of Primary Care. Multiple regression analyses were used to describe the relationships between PTSD and physical health. RESULTS: After adjusting for demographics, smoking behavior, and predisaster physical health, PTSD was significantly associated with FP-recorded vascular, musculoskeletal, and dermatological problems, and with all self-reported physical health aspects. Prospectively, PTSD signaled an increased risk of new vascular problems (odds ratio = 1.92; 1.04-3.55). CONCLUSIONS: This study suggests an effect of PTSD in the development of vascular problems. The results imply that clinicians should be alert that disaster survivors with PTSD can suffer from comorbid medical problems as well.

The influence of a disaster on the health of rescue workers: a longitudinal study.

BACKGROUND: Rescue workers strive, after disasters, to help victims and restrict damage, often in dangerous circumstances. We examined the effect of a disaster on the physical and psychological health of rescue workers (firefighters, police officers and medical emergency services personnel) who provided assistance after the explosion of a fireworks depot in the Netherlands in May 2000. METHODS: We carried out a 4-year longitudinal study of 1403 rescue workers employed in or near the affected neighbourhood (the study group) and a control group of 1650 uninvolved rescue workers (from another city of similar size and urbanization). Health outcomes were measured as prevalence, incidence (both measured as the percent of workers who took sick leave), frequency of the absences and number of sick days (both per 100 workers), and duration (mean length of sickness absences, in days). RESULTS: Sick leave among the study workers increased substantially during the 18 months after the explosion. For example, the prevalence of absences attributed to psychological problems increased from 2.5% of workers during the 6 months before the disaster to 4.6% during the first 6-month period after the explosion and 5.1% during the second. That for respiratory problems rose from 5.4% predisaster to 14.9% 6-12 months afterward. In comparison with controls, immediate increases occurred in musculoskeletal, psychological, respiratory and nonspecific ill health (e.g., malaise, fatigue) during the first year postdisaster. Rates of sick leave for musculoskeletal and respiratory reasons remained elevated until 3 years postdisaster, whereas leave for psychological problems and other ill health had returned to predisaster levels by then. Neurological problems increased after a 1-year delay. No significant increase in gastrointestinal problems was observed among the study workers, in comparison with controls. INTERPRETATION: Many health problems arise immediately after a disaster and may persist for years. Health care workers should realize, however, that some disaster-related effects may not emerge until a year or more after the event.

Use of mental health services among disaster survivors: predisposing factors.

BACKGROUND: Given the high prevalence of mental health problems after disasters it is important to study health services utilization. This study examines predictors for mental health services (MHS) utilization among survivors of a man-made disaster in the Netherlands (May 2000). METHODS: Electronic records of survivors (n = 339; over 18 years and older) registered in a mental health service (MHS) were linked with general practice based electronic medical records (EMRs) of survivors and data obtained in surveys. EMR data were available from 16 months pre-disaster until 3 years post-disaster. Symptoms and diagnoses in the EMRs were coded according to the International Classification of Primary Care (ICPC). Surveys were carried out 2-3 weeks and 18 months post-disaster, and included validated questionnaires on psychological distress, post-traumatic stress reactions and social functioning. Demographic and disaster-related variables were available. Predisposing factors for MHS utilization 0-18 months and 18-36 months post-disaster were examined using multiple logistic regression models. RESULTS: In multiple logistic models, adjusting for demographic and disaster related variables, MHS utilization was predicted by demographic variables (young age, immigrant, public health insurance, unemployment), disaster-related exposure (relocation and injuries), self-reported psychological problems and pre- and post-disaster physician diagnosed health problems (chronic diseases, musculoskeletal problems). After controlling for all health variables, disaster intrusions and avoidance reactions (OR:2.86; CI:1.48-5.53), hostility (OR:2.04; CI:1.28-3.25), pre-disaster chronic diseases (OR:1.82; CI:1.25-2.65), injuries as a result of the disaster (OR:1.80;CI:1.13-2.86), social functioning problems (OR:1.61;CI:1.05-2.44) and younger age (OR:0.98;CI:0.96-0.99) predicted MHS utilization within 18 months post-disaster. Furthermore, disaster intrusions and avoidance reactions (OR:2.29;CI:1.04-5.07) and hostility (OR:3.77;CI:1.51-9.40) predicted MHS utilization following 18 months post-disaster. CONCLUSION: This study showed that several demographic and disaster-related variables and self-reported and physician diagnosed health problems predicted post-disaster MHS-use. The most important factors to predict post-disaster MHS utilization were disaster intrusions and avoidance reactions and symptoms of hostility (which can be identified as symptoms of PTSD) and pre-disaster chronic diseases.

Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care.

BACKGROUND: Medically unexplained physical symptoms (MUPS) are common in general practice (GP), and are even more problematic as they become persistent. The present study examines the relationship between persistent MUPS in general practice on the one hand and quality of life, social conditions, and coping on the other hand. Additionally, it is examined how patients with persistent MUPS evaluate the quality of GP-care. METHODS: Data were used from a representative survey of morbidity in Dutch general practice, in which data from the electronic medical records were extracted. A random sample of patients participated in an extensive health interview and completed self-reported measures on social isolation, coping and the quality of GP-care. Patients with persistent MUPS (N = 192) were compared with general practice patients not meeting the criteria for persistent MUPS (N = 7.314), and with a group of patients that visited the GP in comparable rates for medical diagnoses (N = 2.265). Multiple logistic regression analyses were used to control for relevant socio-demographic variables and chronic diseases. RESULTS: After adjustment for demographics and chronic diseases, patients with persistent MUPS reported more psychological distress, more functional impairment, more social isolation, and they evaluated the quality of GP-care less positive than the other two patient groups. Although the majority of MUPS patients were positive about the quality of GP-care, they more often felt that they were not taken seriously or not involved in treatment decisions, and more often reported that the GP did not take sufficient time. The three groups did not differ with respect to the statement that the GP unnecessarily explains physical problems as psychological ones. CONCLUSION: Strengthening MUPS patients' social network and encouraging social activities may be a meaningful intervention in which the GP may play a stimulating role. To further improve MUPS patients' satisfaction with GP-care, GPs may pay extra attention to taking sufficient time when treating MUPS patients, taking the problems seriously, and involving them in treatment decisions.

Not Just Any Job Will Do: A Study on Employment Characteristics and Recidivism Risks After Release.

Ex-prisoners' recidivism risks are high. Several theories state that employment can reduce these risks but emphasize that the protective role of employment is conditional on job qualities (work intensity, job duration, etc.). Longitudinal research on the role of employment in ex-prisoners' recidivism patterns is scarce, and most existing work used a simplistic employment measure (i.e., employed vs. unemployed), leaving the topic of job quality underexplored. This study examines the association between employment characteristics and recidivism among Dutch ex-prisoners. Using longitudinal data of the Prison Project ( n = 714), we found that not just any job, but particularly stable employment and jobs with a higher occupational level could help reduce crime rates among these high-risk offenders. Many ex-prisoners face a human capital deficit that complicates the guidance to high-quality jobs. It might, however, be possible to help place ex-prisoners in stable employment.

Treatment Readiness as a Determinant of Treatment Participation in a Prison-Based Rehabilitation Program: An Exploratory Study.

The current study had three aims. First, it measured treatment readiness among offenders who entered the Prevention of Recidivism program. This is a prison-based rehabilitation program in the Netherlands that aims to lower re-offending rates among offenders with a prison sentence of at least for months and that is carried out during the final months of incarceration. Second, the study evaluated whether treatment readiness was associated with treatment participation. Third, the study examined whether treatment readiness measured with a validated instrument predicted treatment participation above and beyond a clinical assessment of treatment readiness, currently used as a criterion to include offenders in rehabilitation programs. To address these aims, data were used from the fourth wave of a research project studying the effects of imprisonment on the life of detainees in the Netherlands. Results indicated that treatment readiness as measured with a validated instrument was a significant predictor of treatment participation. Also, the current study showed that treatment readiness measured with a validated instrument improved the prediction of treatment participation above and beyond a clinical assessment of treatment readiness. Outcomes were discussed in light of study limitations and implications.