Screening for serious mental illness in a correctional setting.

BACKGROUND: Serious mental illness (SMI) is more common among adults in correctional settings than in the general population. No standard exists for SMI screening across correctional settings; SMI therefore often goes undetected in these facilities. Placing individuals with unidentified SMI who are incarcerated in general population cells increases their risk for self-harming behaviors, suicide, and for being victims or perpetrators of exploitation and violence. METHODS: This article describes a quantitative, descriptive study conducted to evaluate the use of the Brief Jail Mental Health Screen (BJMHS) tool to screen for possible SMI among individuals in a jail setting. RESULTS: A total of 89 individuals who were incarcerated in one jail setting were screened either with the facility's internally developed standard medical questionnaire (SMQ) or with the BJMHS. Findings showed that 28% screened positive for possible SMI using the BJMHS as compared with only 3% using the SMQ. CONCLUSION: The BJMHS flagged a higher number of possible instances of SMI than the jail's SMQ, potentially signifying its screening superiority. Identification of SMI leads to better care for individuals who are incarcerated, and it increases safety for the individual with SMI, the greater jail population, and jail staff. Findings from this study were shared with system leadership, which has replaced other screening tools with the BJMHS in at least 250 correctional facilities throughout the US.

Using Linkage-enhancement Strategies to Bridge Treatment Gap among Inmates and Former Inmates in Correctional Settings with Inadequate Mental Health Care.

Service linkage and skill enhancement strategies were devised in Nigerian prisons with inadequate mental health resources to support the provision of psycho-legal services, including the assessments, identification, and care of inmates and former inmates with mental illness. Over the study period, 74 individuals, consisting of 64 (86.5%) males with a mean age of 33.25 (SD=11.2) years received care or psycho-legal services through these strategies. Clinically, 49% of the participants were diagnosed with schizophrenia (International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code: F20.0-9), 66.7% had first formal clinical diagnosis of mental illness, and as many as 56.1% of the participants endorsed using psychoactive substances. Most participants (73.0%) were assessed and treated within the prison's general medical services with support from a multidisciplinary team from a regional psychiatric hospital. Of the 50 psycho-legal assessments conducted, eight (10.8%) and 12 (16.2%) participants were not criminally responsible and unfit to stand trial, respectively. We included an action-plan to support the implementation of collaborative care, skill-enhancement, and linkage of services as viable strategies in correctional settings with inadequate mental health care.

Candida auris in US Correctional Facilities.

Candida auris is an emerging fungal pathogen that typically affects patients in healthcare settings. Data on C. auris cases in correctional facilities are limited but are needed to guide public health recommendations. We describe cases and challenges of providing care for 13 patients who were transferred to correctional facilities during January 2020-December 2022 after having a positive C. auris specimen. All patients had positive specimens identified while receiving inpatient care at healthcare facilities in geographic areas with high C. auris prevalence. Correctional facilities reported challenges managing patients and implementing prevention measures; those challenges varied by whether patients were housed in prison medical units or general population units. Although rarely reported, C. auris cases in persons who are incarcerated may occur, particularly in persons with known risk factors. Measures to manage cases and prevent C. auris spread in correctional facilities should address setting-specific challenges in healthcare and nonhealthcare correctional environments.

Screening for Chlamydia and Gonorrhea in Youth Correctional Facilities, Utah, USA.

We reviewed data obtained in October 2021-May 2023 from youth who reported a history of sexual activity upon admission to 1 of 12 juvenile justice facilities in Utah, USA, that offered screening for Chlamydia trachomatis and Neisseria gonorrhoeae. Urinalysis revealed C. trachomatis positivity of 10.77%, N. gonorrhoeae positivity of 1.08%, and coinfection C. trachomatis N. gonorrhoeae) of 0.90%. Prevalence of infection was similar for youths in rural and urban facilities. A total of 12.01% of those identifying as male and 14.01% of those identifying as female tested positive for C. trachomatis, N. gonorrhoeae, or coinfection. Of young adults who tested positive, 74.65% received their results while incarcerated, all of whom accepted treatment. Our research underscores the feasibility of providing prompt C. trachomatis/N. gonorrhoeae screening and treatment in juvenile correctional facilities. The pervasiveness of infection emphasizes the urgent need for early identification and treatment for C. trachomatis and N. gonorrhoeae in incarcerated youth nationwide.

Personality assessment inventory (PAI) in forensic and correctional settings: A comprehensive review.

As Forensic Psychology continues to expand as an independent field, professionals regularly resort to psychological assessment tools to assess people involved within the justice system. The Personality Assessment Inventory (PAI) is a 344-item, self-report inventory that aims to provide meaningful information for diagnosis and clinical decision-making, specifically relating to psychopathology, personality, and psychosocial environment. Its applicability in forensic settings has been increasingly recognized on account of its benefits in comparison to other self-report inventories (e.g., MMPI-2, MCMI-III), since it includes scales that are relevant to forensic settings (e.g., violence risk levels, psychopathy, substance abuse), and the existence of profile distortion indicators is useful when dealing with highly defensive and/or malingering populations. The goal of this paper is to conduct a thorough review of the PAI's utility in forensic settings, by focusing on the relevant forensic constructs assessed by the PAI (e.g., personality disorders, psychosis, substance abuse, aggression, recidivism risk, and response distortion), as well as its application to offender and inmate populations, intimate partner violence contexts, family law cases, and forensic professionals. Overall, the PAI continues to gather international recognition and its relevance and usefulness in forensic settings is generally accepted and acknowledged.

Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story.

BACKGROUND: International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. AIMS: The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. METHODS: This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. RESULTS: Adults with IDD were over-represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co-occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. CONCLUSIONS: Establishing a population-based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement.

Transitional community adherence support for people leaving incarceration in South Africa: a pragmatic, open-label, randomised controlled trial.

BACKGROUND: People released from correctional facilities face multifactorial barriers to continuing HIV treatment. We hypothesised that barriers faced in the first 6 months of community re-entry would be decreased by a multilevel group-based and peer-led intervention, the Transitional Community Adherence Club (TCAC). METHODS: We did a pragmatic, open-label, individually randomised controlled trial in five correctional facilities in Gauteng, South Africa. Participants aged 18 years and older and receiving antiretroviral therapy (ART) in correctional facilities were enrolled before release and randomly assigned (1:2) to either passive referral (usual care) or TCACs. TCACs followed a 12-session curriculum over 6 months and were facilitated by trained peer and social workers. Participants were followed up by telephone and in person to assess the primary outcome: post-release enrolment in HIV treatment services at 6 months from the date of release. We did an intention-to-treat analysis to determine the effectiveness of TCACs compared with usual care. The trial was registered with the South African National Clinical Trials Register (DOH-27-0419-605) and ClinicalTrials.gov (NCT03340428). This study is completed and is listed as such on ClinicalTrials.gov. FINDINGS: From March 1, to Dec 13, 2019, we screened 222 individuals and enrolled 176 participants who were randomly assigned 1:2 to the usual care group (n=59) or TCACs (n=117). 175 participants were included in the final analysis. In the usual care group, 21 (36%) of 59 participants had enrolled in HIV treatment services at 6 months, compared with 71 (61%) of 116 in the TCAC group (risk ratio 1·7, 95% CI 1·2-2·5; p=0·0010). No adverse events were reported. INTERPRETATION: We found strong evidence that a differentiated service delivery model with curriculum and peer support designed specifically to address the needs of people with HIV returning from incarceration improved the primary outcome of enrolment in HIV treatment services. Our approach is a reasonable model to build further HIV treatment continuity interventions for individuals in the criminal justice system in South Africa and elsewhere. FUNDING: National Institute of Mental Health.

"We're Not Patients. We're Inmates": Older Black Women's Experience of Aging, Health, and Illness During and After Incarceration.

BACKGROUND AND OBJECTIVES: The incarcerated population is growing older and by the year 2030, more than one third of people incarcerated in the United States will be over the age of 55. This population shift will have a profound impact on correctional health care systems as older incarcerated people often have multiple chronic illnesses and correctional institutions were not designed with aging and disability in mind. Black women experience greater burdens of comorbid conditions and are disproportionately represented among incarcerated women. RESEARCH DESIGN AND METHODS: We utilized Black Feminist Epistemological Methodology to explore the intersection of aging, chronic illness, and mass incarceration via in-depth interviews with 13 formerly incarcerated older Black women. RESULTS: First, participants described needing to prove themselves to be trustworthy prior to becoming ill in order to be believed and granted access to care when they report symptoms. Next, participants report being treated, not as patients, but as "inmates." The punitive nature of prison health care disrupted the patient-provider relationship and complicated the ability of patients to maintain autonomy in health care interactions. Finally, I describe how carceral health extends beyond the walls of both the clinic and the institution. DISCUSSION AND IMPLICATIONS: For older Black women, medical care and decision making inside prisons occur within a punitive context, which presents unique barriers when seeking care. Their experiences of health and illness while incarcerated may continue to influence if and how they seek care as they age in the community and thus must be interrogated when discussing aging in the Black community.

The Association Between Prior Mental Health Service Utilization and Risk of Recidivism among Incarcerated Ontario Residents.

BACKGROUND: There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use. METHODS: We conducted a population-based cohort study linking individuals held in provincial correctional institutions in 2010 to health administrative databases. Prior MHA service use was assigned hierarchically in order of hospitalization, emergency department visit and outpatient visit. We followed up individuals post-release for up to 5 years for the first occurrence of recidivism and MHA hospitalization, emergency department visit and outpatient visit. We use Cox-proportional hazards models to examine the association between prior MHA service use and each outcome adjusting for prior correctional involvement and demographic characteristics. RESULTS: Among a sample consisting of 45,890 individuals, we found that prior MHA service use was moderately associated with recidivism (hazard ratio (HR): 1.20-1.50, all P < 0.001), with secondary analyses finding larger associations for addiction service use (HR range: 1.34-1.54, all P < 0.001) than for mental health service use (HR range: 1.09-1.18, all P < 0.001). We found high levels of post-release MHA hospitalization and low levels of outpatient MHA care relative to need even among individuals with prior MHA hospitalization. DISCUSSION: Despite a high risk of recidivism and acute MHA utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.

Enhancing the Focus: How Does Parental Incarceration Fit into the Overall Picture of Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs)?

Despite the five million children in the U.S. with an incarcerated parent, there is limited research on risk and protective factors for this population. We analyzed data from the National Survey for Children's Health (2018) to: (1) examine associations among parental incarceration and other adverse childhood experiences (ACEs), (2) characterize the association between parental incarceration and youth mental health outcomes, (3) examine differences in positive childhood experiences (PCEs; collective socialization, community engagement, neighborhood amenities, and family problem solving) by parental incarceration status, (4) examine whether PCEs were protective against mental health problems and if there was an interaction with parental incarceration status, and (5) examine the interaction between PCEs, parental incarceration, and ACEs on mental health problems. Results revealed that children with incarcerated parents had higher odds of experiencing other ACEs, higher odds of having mental health problems, and experienced fewer PCEs compared to children without incarcerated parents. Further, although PCEs were associated with a lower odds of mental health problems for both children with and without incarcerated parents, they did not mitigate the negative impact of parental incarceration on mental health outcomes. While PCEs attenuated the association between ACEs and mental health, parental incarceration status did not significantly moderate the interaction. These results highlight vulnerabilities and potential protective factors for children with incarcerated parents and have important implications for the development of multilevel intervention strategies that seek to promote resilience and reduce risk for this population.

The impact of COVID-19 on opioid toxicity deaths for people who experience incarceration compared to the general population in Ontario: A whole population data linkage study.

BACKGROUND: To inform preparedness and population health action, we need to understand the effects of COVID-19 on health inequities. In this study, we assess the impact of COVID-19 on opioid toxicity deaths among people who experience incarceration compared to others in the general population in Ontario, Canada. METHODS: We conducted a retrospective cohort study for the period of January 1, 2015 to December 31, 2020. We accessed and linked coronial data on all opioid toxicity deaths in Ontario with correctional data for people aged 18 years and older who were incarcerated in a provincial correctional facility. We used data from the Statistics Canada Census to calculate whole population rates. We used an interrupted time series design and segmented regression to assess for change in the level or rate of increase in deaths due to opioid toxicity coinciding with the COVID-19 pandemic. We compared the impact of COVID-19 on the opioid toxicity death rates for people exposed and not exposed to incarceration. RESULTS: Rates of opioid toxicity death increased with a linear positive slope in both persons exposed to incarceration and those not exposed over the study period. The start of COVID-19 measures coincided with a marked upward shift in the trend lines with modification of the effect of COVID-19 by both sex and exposure to incarceration. For persons exposed to incarceration, the risk ratio (RR) was 1.50 (95%CI 1.35-1.69) for males and 1.21 (95%CI 1.06-1.42) for females, and for persons not exposed to incarceration, the RR was 1.25 (95%CI 1.13-1.38) for males and not significant for females. CONCLUSIONS: COVID-19 substantially exacerbated the risk of opioid toxicity death, impacting males and females who experienced incarceration more than those who had not, with an immediate stepwise increase in risk but no change in the rate of increase of risk over time. Public health work, including pandemic preparedness, should consider the specific needs and circumstances of people who experience incarceration.

Incarceration of Youths in an Adult Correctional Facility and Risk of Premature Death.

Importance: Youths incarcerated in adult correctional facilities are exposed to a variety of adverse circumstances that could diminish psychological and physical health, potentially leading to early mortality. Objective: To evaluate whether being incarcerated in an adult correctional facility as a youth was associated with mortality between 18 and 39 years of age. Design, Setting, and Participants: This cohort study relied on longitudinal data collected from 1997 to 2019 as part of the National Longitudinal Survey of Youth-1997, a nationally representative sample of 8984 individuals born in the United States between January 1, 1980, and December 1, 1984. The data analyzed for the current study were derived from annual interviews between 1997 and 2011 and interviews every other year from 2013 to 2019 (19 interviews in total). Participants were limited to respondents aged 17 years or younger during the 1997 interview and alive during their 18th birthday (8951 individuals; >99% of the original sample). Statistical analysis was performed from November 2022 to May 2023. Intervention: Incarceration in an adult correctional facility before the age of 18 years compared with being arrested before the age of 18 years or never arrested or incarcerated before the age of 18 years. Main Outcomes and Measures: The main outcome for the study was age at mortality between 18 and 39 years of age. Results: The sample of 8951 individuals included 4582 male participants (51%), 61 American Indian or Alaska Native participants (1%), 157 Asian participants (2%), 2438 Black participants (27%), 1895 Hispanic participants (21%), 1065 participants of other race (12%), and 5233 White participants (59%). A total of 225 participants (3%) died during the study period, with a mean (SD) age at death of 27.7 (5.9) years. Incarceration in an adult correctional facility before the age of 18 years was associated with an increased risk of earlier mortality between 18 and 39 years of age compared with individuals who were never arrested or incarcerated before the age of 18 years (time ratio, 0.67; 95% CI, 0.47-0.95). Being arrested before the age of 18 years was associated with an increased risk of earlier mortality between 18 and 39 years of age when compared with individuals who were never arrested or incarcerated before the age of 18 years (time ratio, 0.82; 95% CI, 0.73-0.93). Conclusions and Relevance: In this cohort study of 8951 youths, the survival model suggested that being incarcerated in an adult correctional facility may be associated with an increased risk of early mortality between 18 and 39 years of age.

What is Known About Reproductive Autonomy Among Justice-Involved Black Women?: A Scoping Review.

OBJECTIVE: There are approximately 231,000 women detained daily within the nation's jail and prison systems with women of color making up nearly half of those experiencing incarceration. The purpose of this scoping review was to synthesize the literature on the reproductive autonomy of Black women influenced by incarceration, using the three tenets of reproductive justice. METHODS: We searched PubMed, CINAHL, SocINDEX, and PsycINFO for research related to reproductive justice written in English and published in the United States from 1980 to 2022. A review of 440 article titles and abstracts yielded 32 articles for full-text review; nine articles met inclusion. RESULTS: Eight addressed Tenet 1; five mentioned Tenet 2; none addressed Tenet 3. Recognition of the influence of incarceration on the reproductive autonomy of Black women is limited. CONCLUSION: The findings from this review suggest a need to address (a) reproductive choice, (b) support goals, and (c) support of justice-involved Black women.