The purpose of this paper is to analyse the historical development and current challenges of professional training for prison service staff in the Czech Republic. This study focuses on the transition from a repressive system under communism to a democratic approach emphasising human rights, ethics and professionalisation. It aims to assess the effectiveness of the current training programmes and their alignment with international standards, highlighting their impact on safety, recidivism reduction and prisoner re-socialisation. The findings aim to inform policymakers and practitioners about the importance of continuous investment in education and professional development for sustainable improvements in the prison system. The authors focused on the basic professional training of prison service workers. Specifically, 247 people. Through the questionnaire, the authors investigated the reflection of the education itself and its benefit for the participants. This research reveals that the professional training of prison service staff significantly enhances their preparedness, ethical standards and ability to manage crisis situations. Participants acknowledged the high quality of teaching materials and the dedication of instructors. Humanities subjects, such as law and ethics, were found challenging but essential. Well-trained staff contribute to improved prison safety and reduced recidivism. This study emphasises the necessity of ongoing education, collaboration with academic experts and modern training tools. Moreover, the findings highlight the importance of tailoring training programmes to meet the evolving needs of diverse prisoner groups and the societal demand for rehabilitation. This study primarily relied on questionnaire-based data from participants in basic professional training courses, which may introduce subjective bias and limited scope. This research focused on the Czech Republic's prison system, and findings may not be directly generalisable to other contexts. Further studies could benefit from longitudinal data collection, in-depth qualitative interviews and comparative analyses across different countries. The implications emphasise the need for more comprehensive evaluation frameworks to ensure that training programmes are continuously updated in line with emerging challenges, such as increasing prisoner diversity and evolving security risks, thereby enhancing the global relevance of these findings. Implementing this study's recommendations can improve the overall quality and effectiveness of prison service training. Regular updates to curricula, inclusion of modern technologies and collaboration with external experts can address the evolving needs of the prison environment. Enhanced training in crisis management, ethics and human rights will better equip staff for real-life challenges. In addition, targeted specialisation programmes can help address the specific needs of prisoner subgroups, including those with mental disorders or cultural differences. These practical changes will contribute to safer prisons, better re-socialisation outcomes and increased public trust in the prison system. By improving the quality of prison staff training, this study supports broader societal goals of reducing recidivism and promoting the successful reintegration of former prisoners. Enhanced training fosters a more humane and ethical approach to incarceration, reducing stigma and fostering public understanding of rehabilitation's value. Addressing social exclusion through effective prisoner re-socialisation directly benefits communities by reducing crime rates and improving social cohesion. The findings also underline the importance of public-private partnerships and community involvement in supporting re-entry programmes, thus contributing to a more inclusive and equitable society. This paper offers a comprehensive analysis of the transformation of prison service training in the Czech Republic, highlighting the shift from a repressive to a rehabilitative approach. Its originality lies in combining historical, sociological and practical perspectives to assess training effectiveness. By focusing on ethical education, modern pedagogical methods and international standards, this study provides valuable insights for policymakers and practitioners aiming to enhance prison systems. The findings contribute to the global discourse on prison reform by showcasing how investment in education and professional development can lead to safer prisons and more effective reintegration of prisoners into society.
The purpose of this study is to fill the research gap that exists with respect to availability of research on correctional facilities in India, which restricts one's ability to comprehend the prison environment and recidivism from the perspective of the inmates. By examining inmates' perception of their environment within correctional facilities, researchers and policymakers can identify specific aspects of the prison climate that may contribute to increased risks of reoffending. This understanding would not only help to improve prison conditions and encourage humane treatment, but it is also essential to support the inmates in their efforts to find and retain employment, achieve self-sufficiency and personal growth. It is also necessary to encourage the inmates to participate in a variety of therapeutic and prison programmes both inside and outside of prison to help them reintegrate into the community. The present research investigated the association between negative perceptions of prison climate and the heightened probability of recidivism among a sample of 37 adult women convicts incarcerated in Tihar Prisons, Delhi. Data were obtained by administering CSS-M Hindi version and PCQ Hindi version to the convicts in person in the prison premises. Furthermore, the collected data were subjected to Pearson's product moment correlation coefficient to analyse the correlation between the probability of recidivism and the dimensions of prison climate. Results suggested that negative perceptions of relationships in prison (staff-inmate relationship, inmate-inmate relationship), safety, facilities (cell conditions, food quality, etc.), meaningful activities (recreation, education, yard time, etc.) and autonomy in prison were inversely associated with a higher probability of recidivism. The results from the current study demonstrated that recognising and taking cognisance of the inmates' perceptions of prison environment on their well-being and their probability of recidivism is crucial for the successful implementation of interventions and policies within correctional systems. The sample size procured for the research was relatively small, as the number of available women convicts in Tihar Prison at the time of the research was limited, making it difficult to generalise the findings. In addition, this investigation included solely women convicts, while undertrials and detenues were excluded, and thus does not represent all the individuals in conflict with the law. The findings of the current investigation allow for the formulation of potential policy recommendations for improving the prison climate, which in turn might consequently impact future criminality. Policymakers may use these findings when developing policies that foster a rehabilitative prison environment, as it can help in reducing the incidence of recidivism. This study is unprecedented in its approach, especially with respect to the Indian context, as it sheds light on the relatively understudied association between the variables of perceived prison climate and the probability of recidivism among women convicts in India. The findings of this study add to the current body of research indicating that subjective experience and perception of prison climate have a substantial influence on the likelihood of recidivism.
This study aims to examine how prison experience, perceived social support, and education are related to mental health distress among Brazilian inmates. A cross-sectional study was conducted with 242 male (M age = 31.84 years, SD = 8.29) prisoners from three facilities in Brazil's Central-West region. Mental health distress was assessed using the self-reporting questionnaire (SRQ-20), which captures anxiety, depression and somatic complaints. The scale of experience (SEP) in prison evaluates inmates' subjective experiences related to the prison environment, such as sense of safety, whereas the social support perception (EPSUS-A) scale measures perceived emotional and instrumental support from family, friends and others. Inmates reported moderate levels of mental health distress (M = 9.11, SD = 5.35), prison experience (M = 41.98, SD = 9.93) and social support (M = 45.25, SD = 21.55). Correlations showed that prison experience was positively related to perceived social support (r = 0.43, p < .001) and negatively related to mental health distress (r = -0.16, p = .024). In a multiple regression model, sociodemographic variables accounted for 15% of the variance in mental health distress (p = .07). After adding the main predictors, the final model accounted for 26% of the variance (p = 0.003). Prison experience was a significant predictor of fewer mental health symptoms (β = -0.223, p = .01). This study relied on self-report measures, which may be subject to social desirability and underreporting of symptoms. The cross-sectional design limits causal interpretations, and the sample included only male inmates from one region in Brazil, reducing generalizability. First, correctional staff should be trained to promote safer, more respectful environments, as positive prison experiences were linked to better mental health. Second, while strengthening social support networks is a practical step, future research should also focus on developing better tools to assess mental health among inmates, ensuring more accurate identification and intervention. First, the study highlights the importance of improving prison environments, as positive experiences in prison were linked to better mental health outcomes. Second, it suggests that enhancing inmates' access to social support could reduce psychological distress. Together, these findings emphasize the need for correctional policies focused on fostering support within prisons to promote inmate well-being and successful reintegration into society. Results highlight prison experience as a protective and malleable factor, suggesting targets for mental health interventions in prisons.
The literature on prison officers highlights the mental health effects of the COVID-19 pandemic on prison staff. However, there is limited knowledge about how the pandemic affected prison officers' mental health in the global south. To fill this void, this study aims to assess the impact of COVID-19 on the mental well-being of prison officers in a developing country. An online survey of 553 prison officers from 12 prison facilities in Ghana between August and December 2020 to examine their psychological and mental well-being during the COVID-19 pandemic. Culturally sensitive measures of mental well-being were utilised. Over 50% of prison officers reported a wide range of psychological well-being issues such as depression, sleep disturbances, general anxiety and specific anxieties relating to contracting the virus and fears of infecting their families. Whilst 75% of prison officers indicated their need for psychological support, 61% preferred off-site psychological support, including telephone and online platforms (Zoom and WhatsApp) over face-to-face psychological support at work. Group differences were also found among prison officers based on gender and whether suspected cases of COVID-19 were reported at the prison they worked. The findings underscore the need for carefully curated mental health interventions for prison officers that consider the working culture of officers' work.
Women in prison face profound challenges, including high rates of trauma and gender inequalities. This paper aims to explore the barriers to delivering effective psychotherapy in these settings and the importance of approaches tailored to women's specific needs. A case study is presented of "Clare", a white, British woman in her early 30s, with diagnoses of autism and severe depression, serving a life sentence for murder in a women's prison in England. The intervention combined cognitive behavioural therapy with systemic working delivered within a National Health Service commissioned service. Outcomes were assessed using the Clinical Outcomes in Routine Evaluation and Problem Behaviour Checklist, supported by qualitative reflections on therapeutic resources, strengths and limitations. The intervention produced significant improvements suggesting partial support for the therapeutic approach. The case highlights the therapeutic potential of collaborative and tailored interventions, while recognising the challenges related to gender, trauma, autism and the constraints of the prison environment. Additional complexities were noted in the context of COVID-19 and social isolation. This case study offers in-depth clinical insight but is limited by its single-subject design and lack of post-discharge follow-up data. The absence of longitudinal outcome measures restricts conclusions about the sustainability of change. Further research is needed to explore adapted therapeutic models for individuals with complex trauma and co-occurring neurodivergence in forensic settings. Ethical challenges surrounding consent, particularly posthumously, highlight the importance of developing clearer publication frameworks for clinical learning. Future studies could strengthen the evidence base by combining individual case data with service-level evaluations of trauma-informed approaches in secure environments. This paper illustrates how trauma-informed psychological therapy, adapted for neurodivergent needs, can be delivered safely and effectively within a high-security women's prison. It highlights the value of flexible, relationship-based work supported by robust supervision and multi-agency collaboration. The case emphasises the importance of formulation-driven approaches, staff training and managing systemic barriers such as restricted access, risk procedures and limited specialist services. Clinicians working in secure settings may draw on this example to inform safe and ethical trauma work, particularly when navigating complex presentations, co-occurring diagnoses and environments that often compound psychological distress. This case highlights the impact of social inequalities, institutional trauma and system-induced distress on women in prison, particularly those with neurodivergent needs. It raises important questions about access to psychological care in secure settings, the potential for re-traumatisation and the risks of exclusion from therapy. The work reinforces the need for equity in mental health provision for marginalised groups, especially those affected by intersecting vulnerabilities. Sharing this anonymised account may help inform service development, promote more compassionate care and advocate for change within carceral systems that often neglect the psychological needs of those most affected by adversity. This case study contributes to the limited literature on trauma-focused psychotherapy with women in prison. It illustrates how adapted, evidence-informed interventions can promote recovery in an often-overlooked client group, offering insights into the intersectionality of trauma, gender and imprisonment.
This paper aims to investigate some key health issues among incarcerated women in Bangladesh. It seeks to identify the magnitude and nature of menstrual health problems, violence victimization and mental health issues in this population and to explore the prison context and available health infrastructure for addressing these health problems. The study employs a mixed-method cross-sectional design and covers four purposively selected prisons in Bangladesh. The sample includes incarcerated women aged 18 years and above, who were either convicted or under trial and had been imprisoned for at least eight months (n = 281). Menstrual health problems such as pain during menstruation (53%), excessive bleeding (40%) and irregular periods (32%), and inadequate hygiene practices such as changing menstrual absorbent less than three times a day (50%) were widespread among the incarcerated women. Violence in the last six months was highly prevalent in this population with 54% reporting psychological, 21% - physical and 5% - sexual violence. Help-seeking for violence was extremely low (0-12%). The risk of clinical depression was universal (98%) in this sample. Around 7% engaged in self-harm, and 1% attempted suicide during imprisonment. Poor living conditions compounded the overall vulnerability of the women. The prison health care was not equipped to address these problems. The burden of menstrual health problems, violence victimization and mental health issues were disproportionately higher among women living in prisons in Bangladesh. To the best of the authors' knowledge, this study is one of the first to document the magnitude and nature of key health problems of women who are living in prisons in Bangladesh. The findings highlight huge service gaps in addressing these problems highlighting the urgent need for prison health reform for women.
Incarceration is associated with significant health burdens. Prisoners suffer disproportionately from chronic diseases, mental disorders, and substance use disorders. While primary care in prisons is usually provided regularly and sometimes even faster than outside, care for more complex treatment needs is often limited to few facilities. Structural deficits include restricted freedom of physician choice, limited specialist access, separation from the regular health system, and gaps at the transitions from incarceration to release.Despite the principle of equivalence, prison healthcare often fails to meet the standards of the statutory health insurance (in German: Krankenversicherung [GKV]). International recommendations call for the inclusion of prisoners in the GKV as well as for a transfer of healthcare responsibility from ministries of justice to ministries of health.Particularly challenging is the treatment of individuals with substance use disorders: access to evidence-based therapies is inconsistent and varies greatly from region to region. Smoking cessation and psychosocial support are also inadequate. Nutrition is also often unbalanced, while sports and physical activities are often inadequately implemented.To date, a comprehensive interdisciplinary healthcare strategy aligned with the "Healthy Prisons" approach is largely absent in Germany. The Baden-Württemberg model featuring health reporting, telemedicine approaches, age-appropriate care, and quality circles, could serve as a nationwide example. A paradigm shift is required from institution-centered care toward participatory, preventive health promotion that involves both prisoners and staff. Freiheitsentzug geht mit erheblichen gesundheitlichen Belastungen einher: Gefangene leiden überdurchschnittlich oft an chronischen oder psychischen Erkrankungen und Suchtproblemen. Während die Primärversorgung in den Anstalten meist regelmäßig und teils sogar schneller als außerhalb gewährleistet ist, bleibt die Versorgung komplexerer Behandlungsbedarfe häufig auf wenige Justizvollzugskrankenhäuser beschränkt. Strukturelle Defizite bestehen in der eingeschränkten freien Arztwahl, der limitierten spezialärztlichen Versorgung, der Trennung vom regulären Gesundheitssystem sowie in Versorgungslücken an den Übergängen zwischen Haft und Freiheit.Trotz des Äquivalenzprinzips entspricht die intramurale Gesundheitsversorgung häufig nicht dem Standard der gesetzlichen Krankenversicherung (GKV). Eine Einbeziehung von Gefangenen in die GKV sowie eine Verantwortungsübertragung auf Gesundheitsministerien werden international empfohlen und könnten die Versorgung verbessern.Besonders kritisch ist die Versorgung von Menschen mit Substanzgebrauchsstörungen: Zugang zu evidenzbasierter Therapie ist lückenhaft und regional sehr unterschiedlich. Auch Tabakentwöhnung und psychosoziale Hilfen sind unzureichend vorhanden. Auch Ernährung ist häufig unausgewogen, während Sport- und Bewegungsangebote bislang ungenutzt bleiben.Ein interdisziplinäres Versorgungskonzept im Sinne des „Healthy-Prisons“-Ansatzes fehlt bislang weitgehend. Das baden-württembergische Modell mit Gesundheitsberichterstattung, telemedizinischen Ansätzen, altersgerechter Versorgung und Qualitätszirkeln könnte bundesweit als Vorbild dienen. Notwendig ist ein Paradigmenwechsel von der anstaltszentrierten Fürsorge hin zu partizipativer, präventiver Gesundheitsförderung, die sowohl Gefangene als auch Bedienstete einbezieht.
This study aims to determine the prevalence of selected modifiable risk factors of cardiovascular diseases (CVDs) among male prisoners in Karachi. This cross-sectional study was conducted on a convenience sample of 400 male prisoners aged between 30 and 60 years at Central Jail Karachi in December 2024. Information on risk factors of CVDs was obtained using a modified World Health Organization (WHO) STEPS questionnaire. Data were analyzed using SPSS version 20. Logistic regression was performed to identify determinants of CVD risk factors, including smoking status, disturbed sleep and raised blood pressure, overweight and obesity. Almost all participants had no moderate to vigorous physical activity (97.5%), no fruit intake (93.0%) and vegetable intake of less than three times per week (91.0%). Around one-third had raised blood pressure (38.5%), were current smokers (35.5%) and were overweight or obese (32.8%). Older age showed positive association with raised blood pressure. Education was positively associated with smoking and being overweight/obese. With reference to prisoners who had spent one to five years in jail, those who had spent six years or more were significantly less likely to have disturbed sleep. The study reveals a high prevalence of risk factors of CVDs among prisoners, making them highly vulnerable to encounter cardiovascular events. The findings emphasize the urgent need for prison reforms, including improving access to healthy food choices, reducing access to tobacco products and engaging prisoners in physical activity, offering intermittent screening and provision of treatment support when required. The findings emphasize the critical need to introduce reforms in jails which include improving access to healthy food choices, reducing access to tobacco products, engaging prisoners in physical activity, offering intermittent screening and provision of treatment support if required. The findings will help to improve healthy lifestyles in prisons in a developing country setting. The study presents the prevalence of modifiable risk factors in the biggest prison of Karachi which addresses an important public health gap focusing on the underprivileged and overlooked population of society. Use of a validated tool enhances reliability and validity to the findings of the research.
Prisons are associated with poor health outcomes for incarcerated people and correctional staff. Efforts to remedy harmful prison conditions typically focus on litigation, legislation and administrative policy changes; however, implementing these top-down mandates is often impeded by cultural barriers among prison staff. The purpose of this study was to evaluate a novel intervention grounded in public health and international correctional principles, to educate and motivate frontline prison staff to lead culture change initiatives in US prisons. Guided by an implementation science framework, researchers administered surveys and conducted semi-structured interviews with three cohorts of participants in the Amend Ambassadors Program. This study included a total of 37 participants: 28 US prison staff from four US states (Oregon, California, North Dakota and Washington) and 9 prison staff from Norway. The objectives were to assess the implementation of the program and its impacts based on the experiences of those who participated. Results suggest that the Ambassadors program succeeded in its educational objectives, and provided participants with knowledge, skills and motivation to lead culture change projects in the prison systems where they work. Participants responded favorably to the pedagogical components of the program, and most reported improvements in their perceived levels of job satisfaction, overall well-being and inspiration to advance culture change efforts, as a result of their participation in the program. The Amend Ambassadors program is a novel approach to educating and inspiring correctional professionals to mobilize "ground up" culture change initiatives focused on improving human dignity and health promotion. This formative evaluation provides new insights into the potential for interventions that combine international immersion, health promotion and experiential learning components for fostering leadership and reducing cultural resistance to prison reform among prison workforces.
There is insufficient data on the oral health of those incarcerated in Ireland and oral health is generally poorer in people in prison. The purpose of this study is to investigate and describe the oral health needs of people in prison, patterns of dental care and the outcomes of dental services in Irish prisons. A retrospective chart review of patient dental records was undertaken from a sample across Ireland. Outcomes included the presence of active decay, reasons for initial presentation and patterns of service use. The sample totalled 389 incarcerated persons. Fewer than 40% of this population had full dental charting completed. More than 40% of prisoners had active and untreated dental decay noted whilst addressing their presenting complaint. For 44.7% it was not possible to make any determination in relation to other oral health needs. The most common reason for initially accessing prison dental services was emergency presentation for pain or infection. The low proportion of prisoners with full dental charting is an important finding in itself, and reflects some of the challenges of providing dental care in prisons. The recording of dental data is an important part of patient care. Incarcerated people are at high risk for oral diseases and demand for dental services frequently exceeds availability. More research is needed to establish and reduce the dental disease burden of people in prison, and how a reorientation towards preventative dentistry could be achieved in this population.
The medical care of prisoners in the German correctional system has traditionally taken place within a parallel structure, characterized by specific actors, regulations, and conditions. In light of the serious challenges in recruiting medical personnel for correctional facilities, cooperation with the public health system is becoming increasingly important. This is evident, for example, in the growing reliance on private (specialist) physicians and in the establishment of specially secured hospital rooms for the inpatient treatment of prisoners in public hospitals.International frameworks such as the European Convention on Human Rights (ECHR), the European Prison Rules (EPR), and the Nelson Mandela Rules, as well as the reports of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), also contribute to aligning healthcare in prisons with societal standards. Nevertheless, the generally poor health status of many inmates requires special efforts to achieve a standard of care equivalent to that of the public health system.This article first provides an overview of the legal foundations of medical care in correctional facilities. It then explains in more detail the duties and responsibilities of prison physicians, describes the care structures and various medical specialties involved, and concludes by emphasizing the importance of a qualified, comprehensive assessment of deficiencies in prison healthcare. Die medizinische Betreuung von Gefangenen im deutschen Strafvollzug findet traditionell in einem Parallelsystem mit speziellen Akteuren, Vorschriften und Rahmenbedingungen statt. Insbesondere angesichts der gravierenden Probleme der Personalgewinnung für den medizinischen Dienst der Vollzugsanstalten gewinnt die Kooperation mit dem öffentlichen Gesundheitswesen zunehmend an Bedeutung. Die zeigt sich beispielsweise im verstärkten Rückgriff auf niedergelassene (Fach‑)Ärzte oder in der Einrichtung besonders gesicherter Patientenzimmer bei stationären Behandlungen von Gefangenen in öffentlichen Krankenhäusern.Zur Orientierung der Gesundheitsbetreuung in Haft an gesellschaftliche Standards tragen auch internationale Regelwerke wie die Europäische Menschenrechtskonvention (EMRK), die European Prison Rules (EPR) oder die Nelson Mandela Rules sowie die Berichte des European Committee for the Prevention of Torture and Inhuman or Degrading Treatmentor Punishment (CPT) bei. Der insgesamt schlechte gesundheitliche Status vieler Strafgefangener verlangt dennoch besondere Anstrengungen, um ein Versorgungsniveau zu erreichen, welches dem öffentlichen Gesundheitssystem entspricht.Dieser Artikel bietet zunächst einen Überblick über die rechtlichen Grundlagen der medizinischen Versorgung im Strafvollzug. Anschließend werden die Mitwirkungspflichten und Verantwortlichkeiten des Anstaltsarztes näher erläutert sowie die Versorgungsstrukturen und die verschiedenen medizinischen Fachbereiche beschrieben. Die Wichtigkeit einer qualifizierten, flächendeckenden Bestandsaufnahme von Defiziten der Gefängnismedizin wird abschließend hervorgehoben.
The purpose of this study is to investigate the prevalence of chronic illness, multimorbidity, mental illness and comorbidity among older adults incarcerated in a Mid-South state prison system. This study used a cross-sectional descriptive design, gathering data through face-to-face interviews with older adults (n = 499) incarcerated in five state prisons in Kentucky. Uncovered was a substantial prevalence of chronic diseases and mental health disorders among older adults incarcerated in a Mid-South state prison system. Specifically, hypertension was reported by 65.5% of the participants, arthritis by 52.3% and diabetes by 23%. In terms of mental health, significant findings included that 34% of the older adult population scored above the threshold for major depression, and over one-third met the criteria for post-traumatic stress disorder. Constrained by its cross-sectional design, the study may not reflect changes in chronic and mental health conditions over time. The predominantly white demographic of the Kentucky state prison system limits the generalizability of findings to more racially diverse populations. Findings highlight the need for integrated health-care models within prison systems to address the complex, coexisting chronic and mental health conditions among older inmates. These findings illuminate the substantial social implications of inadequate health care for aging incarcerated persons, revealing a pressing public health issue within correctional facilities. The study highlights the often-overlooked demographic of older adults within the correctional system, particularly within a specific geographical region of the Mid-South, which is known for its higher disease prevalence. It contributes valuable insights into the multimorbidity and comorbidity of chronic and mental health conditions among incarcerated older adults.
Psychometric screening tools for persons in penitentiary centers (PPC) are key to assessing their mental health needs, given the shortage of both time and mental health personnel. Depression and anxiety are among the most prevalent mental health problems in PPC. Inadequate diagnosis can lead to increased symptom severity and even suicide. Therefore, validating instruments to assess depression and anxiety in PPC populations is essential to reduce the risk of misdiagnosis and its consequences. A cross-sectional study was conducted to evaluate the reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) in 272 men (>18 years old) deprived of liberty in a penitentiary center in Mexico. Both exploratory and confirmatory factor analyses were performed. Concurrent and discriminant validity were assessed using the depression and anxiety scales of the International Statistical Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11) Primary Health Care (PHC). Receiver Operating Characteristic curves were plotted to determine the best cut-off points in both instruments. Both the PHQ-9 and GAD-7 showed items that were representative of their underlying constructs and supported the original one-factor structure, with satisfactory goodness-of-fit indices in both exploratory and confirmatory analyses. Both instruments exhibited good internal consistency in the sample of Mexican men incarcerated in penitentiary centers (α = 0.87 and α = 0.89, respectively). Furthermore, both scales showed strong correlations with the ICD-11 PHC depression and anxiety scales, along with adequate sensitivity, specificity, false positive, and false negative rates, resulting in a low misclassification rate. The PHQ-9 and GAD-7 can be used to briefly and reliably assess depression and anxiety among male PPC in Mexico City and in populations with similar institutional and sociodemographic conditions Given the specific characteristics of PPC populations across different countries, it remains necessary to continue testing these instruments in underrepresented populations to ensure the development of reliable and valid tools that help identify potentially confusing items and minimize diagnostic errors.
Literature on drug recovery programs has mostly emanated from the West, and there is a dearth of literature on drug treatment from a gender perspective. This study aims to contribute to these gaps by examining gender differences in the impact of drug counseling programs for drug offenders in the Philippines. This study consisted of 246 persons incarcerated for drug use who participated in a drug counseling program as part of their plea-bargaining agreement. Participants came from 19 jail facilities in six regions in the Philippines. The Katatagan, Kalusugan at Damayan ng Komunidad (resilience, health and care in community) for persons deprived of liberty program consisted of drug recovery, life skills and family modules. The sessions were facilitated by trained jail personnel who delivered the program in small groups, conducted once a week for up to six months. The study used a cohort design and administered pre- and post-test surveys before and after the program. Structural equation modeling was used to test the program's theory of change. As hypothesized, the active ingredients (recovery skills, life skills and family support) were positively associated with psychological well-being, perceived quality of life and intent not to use. The active ingredients were negatively associated with substance use disorder symptoms. Analysis of variance revealed the interaction between time and gender for recovery skills, life skills, family support, well-being, intent to refuse and substance use disorder symptoms. The program had a greater effect size among female participants compared to males. The cohort design does not allow for causal generalizations on the impact of the program. Future studies using randomized control trials and longitudinal designs post incarceration are needed for more robust conclusions on the impact of the program. In addition, the program was created primarily to treat drug use and does not include those involved in drug distribution or manufacturing. More research is needed to address this population and identify appropriate interventions to avoid recidivism. Majority of those incarcerated in the Philippines are because of drug charges. The study is the first in the Philippine prison setting examining gender differences in outcomes of a drug rehabilitation program. It suggests the viability of implementing a treatment program for persons who use drugs in detention facilities. In many countries, drug use is treated as crime. However, more than punishment, the study suggests the viability of reformation in detention facilities. These can potentially prevent recidivism and provide individuals the skills they need to achieve greater quality of life after incarceration. The study validated the importance of recovery skills, life skills and family support in the rehabilitation of drug offenders. Significant gender differences in the impact of the program highlight the importance of using a gender lens in implementing and evaluating drug recovery programs in jails.
This study aims to explore the nutritional adequacy of food served in Lebanese prisons. A mixed-method approach, using both qualitative and quantitative instruments, was used. Diet plans provided by Roumieh Central Prison in 2019 and 2021 were analyzed using Nutritionist Pro™ software for a comprehensive nutritional assessment. Additionally, articles pertaining to food and nutrition policy within Lebanese prison law were carefully reviewed and compared to international standards and findings from other countries. The findings of this study reveal significant gaps in both the nutritional quality and quantity of various nutrients in the food provided to inmates. This study is limited to diet plans from one central prison and may not fully represent the nutritional situation across all Lebanese prisons. The findings underscore the need for reform in the nutrition policy within Lebanese prison law, advocating for a more nutritious diet that considers the quantity, quality, macronutrient and micronutrient content and food choices that reflect the needs and dietary habits of all prisoners, including migrants and refugees. This research highlights opportunities for improvement in the food provision system within Lebanese prisons. This study provides evidence for health experts and policymakers to advocate for and implement changes in nutrition policy to ensure the overall well-being of inmates. Ensuring adequate nutrition for prisoners, a marginalized population, aligns with international human rights standards and contributes to their overall well-being. Addressing the dietary needs of all prisoners, including migrants and refugees, promotes inclusivity and equity within the prison system. This research provides an original analysis of the nutritional adequacy of food in Lebanese prisons, comparing it to both national policy and international standards and highlighting the nutritional needs of a diverse prison population.
This study aims to examine associations between history of incarceration (HOI) and two oral health outcomes (tooth loss and dental care utilization) among older adults with diabetes, as well as identify factors that may mediate these associations. The authors used self-report data from the 2012 and 2014 waves of the Health and Retirement Study (a population-based study of adults aged >50 in the USA) to evaluate associations between HOI and the two oral health outcomes, controlling for demographics. HOI was associated with greater odds of permanent tooth loss (OR = 1.43, 95% CI = 1.08-1.90) and reduced odds of dental care utilization in the past two years (OR = 0.70, 95% CI = 0.53-0.92). After adjusting for social support and perceived provider mistrust, the association remained but was attenuated (direct effect = -0.310, p = 0.030). Further, 11% of the total effect was explained by the mediators, with social support accounting for 74% of the indirect effect, and perceived provider mistrust accounting for the remaining 26%. Findings are limited by the study design. This cross-sectional study had data that was collected at one point in time. Thus, long-term follow-up could not occur. Additionally, the HRS does not differentiate between prison and jail, and health disparities tend to differ between jail and prison. Evidence from this study was preliminary and correlational, and longitudinal work should be conducted. There are disparities in oral health indicators among those with diabetes based on HOI. Future research should identify barriers to oral health diabetes management in prison and test potential interventions to improve diabetes management following release from prison. To the best of the authors' knowledge, this study is the first to provide evidence of oral health disparities among older adults with diabetes with a history of incarceration. No study has yet investigated these important health markers in individuals with a history of incarceration. This is important for future intervention to improve healthcare in the justice system.
Evidence to support approaches to reducing self-harm (SH) and suicide in prison settings is lacking, despite increased risk in these settings. This study aims to describe a pilot trial of a health service-improvement initiative intended to provide a structured framework to support mental health clinicians in assessing and managing risk of SH /suicide in a prison setting. The authors examined all clinically reported SH incidents in a prison mental health unit over a three-year period. In the third year, the authors piloted a novel intervention, the Suicide/Self-Harm, Legal, Individual, Psychiatric, Safety Plan (SLIPS) framework, aimed at reducing SH and suicide behaviours. Routinely recorded data from clinical notes were used to examine both incidents of SH as well as reported thoughts of SH. No statistically significant reduction in the number of SH incidents was observed. An increase in patients reporting thoughts of SH to staff was seen in the post-SLIPS period, potentially reflecting an improvement in patient-staff engagement. Implementation of the intervention was challenging, with just under 20% of individuals in the unit receiving an SLIP assessment or safety plan. This study focused on a unique population of patients in a prison mental health screening unit and used a novel structured professional judgement approach to developing a framework for supporting clinicians to undertake the difficult job of assessing and managing SH and suicide risk in prison.
Vitamin D deficiency is a global concern, disproportionately affecting vulnerable populations, including prisoners. Vitamin D was found to be protective against Covid-19 during the pandemic. As a response, Nottinghamshire Healthcare NHS Foundation Trust implemented a vitamin D supplementation policy across three prison health-care settings in the UK. The purpose of this study was to assess the overall impact of this policy on supplementation rates and Vitamin D deficiency. This pragmatic cross-sectional study retrospectively evaluated the impact of the vitamin D supplementation policy on supplementation uptake and deficiency rates. Vitamin D deficiency was defined as less than 50 nmol/L. Cross-sectional data were collected from 768 prisoners for periods of two years before and two years after introduction of the policy. Overall supplementation rates were lower after the policy introduction (43%, n = 330 versus 35%, n = 270; McNemar's χ2, p = 0.004). However, there was increased uptake among previously untreated individuals - 40% (n = 175) of those previously untreated (n = 438) received supplementation after policy implementation. There was an overall reduction in vitamin D deficiency from 71% to 55% after policy introduction (χ2 = 12.3, Cramer's V = 0.13, p < 0.001). Mean vitamin D levels increased from 41.3 nmol/L to 50.3 nmol/L. In a small subsample (n = 23) in whom vitamin D levels were available before and after the policy, paired sample analysis showed significant mean vitamin D level increase (p < 0.001). An exploratory analysis using binary logistic regression suggested the specific prison location and pre-existing vitamin D deficiency as significant predictors of deficiency post-policy. The findings highlight the potential effectiveness of a simple, population-wide supplementation strategy in reducing vitamin D deficiency within prisons. Future research should use prospective designs and explore factors influencing supplementation adherence and long-term health outcomes, toward developing the most effective strategies.
Although empirical support for the International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD-11) distinction between posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) is growing, research into the ICD-11 CPTSD model in prison staff is lacking. This study used latent profile analysis (LPA) to (a) determine if there are distinct groups of trauma-exposed prison governors (i.e., "wardens" in the United States and Canada) who have symptom profiles consistent with the distinction between PTSD and CPTSD and (b) identify predictors and posttraumatic maladaptive beliefs associated with the latent profiles. Trauma-exposed prison governors (N = 385) completed the International Trauma Questionnaire (ITQ) and a measure of traumatic life events. LPA was used to extract profiles using the six ITQ symptom clusters and revealed four profiles: CPTSD (8.4%), PTSD (14.4%), disturbances in self-organization (DSO; 11.0%), and low symptoms (66.3%). Membership in the CPTSD and DSO profiles was associated with cumulative traumatization, odds ratios (OR) = 1.42 and OR = 1.26, respectively, and poorer health, OR = 2.84 and OR = 1.64, respectively, relative to the low symptom profile, and membership in the PTSD profile was associated with younger age, OR = 0.91, relative to the low symptom profile. The CPTSD profile showed the highest level of posttraumatic maladaptive beliefs. This study yields empirical support for the ICD-11 CPTSD model in prison staff. The results provide additional support for the validity of ITQ measurement of PTSD and CPTSD.
Australia has seen the emergence of Clinical Ethics Support Services (CESS) across health care settings over recent decades, with the exception of prison health services which can present inherent complex ethical challenges. The purpose of this paper is a descriptive report of the implementation of a CESS in a prison health service. A literature review was done to inform the implementation of a CESS by a prison health service. Different CESS delivery models were considered and expert advice obtained from an external clinical bioethicist. A Clinical Ethics Advisory Panel (CEAP) was established and accepted referrals between October 2022 and October 2024. A preliminary review of referrals was conducted to consider whether the CEAP was achieving its objectives. The CEAP was implemented with a membership that comprised clinical and nonclinical representatives. The CEAP received seven referrals over 24 months from staff of the organization. Six out of seven (86%) referrals involved a clinical operational issue. One referral (14%) involved an individual clinical scenario in addition to a clinical operational issue. All referrals were initiated by senior medical management. The CEAP has had a beneficial role in supporting staff with responsibility for ethical decision making in a prison health service. CESS can potentially provide an important source of support for frontline clinical staff and clinical management but requires further evaluation. The implementation of a CESS in a prison health context is rarely described in the literature.