Successful linkage of medical care and community services for HIV-positive offenders being released from prison

Human immunodeficiency virus (HIV) infection is more prevalent among the incarcerated than the general population. For many offenders, incarceration is the only time that they may access primary care. Project Bridge is a federally funded demonstration project that provides intensive case management for HIV-positive exoffenders being released from the Rhode Island state prison to the community. The program is based on collaboration between colocated medical and social work staff. The primary goal of the program is to increase continuity of medical care through social stabilization; it follows a harm reduction philosophy in addressing substance use. Program participants are provided with assistance in accessing a variety of medical and social services. The treatment plan may include the following: mental illness triage and referral, substance abuse assessment and treatment, appointments for HIV and other medical conditions, and referral for assistance to community programs that address basic survival needs. In the first 3 years of this program, 97 offenders were enrolled. Injection drug use was reported by 80% of those enrolled. There were 90% followed for 18 months, 7% moved out of state or died, and 3% were lost to follow-up. Reincarceration happened to 48% at least once. Of those expressing a need, 75% were linked with specialty medical care in the community, and 100% received HIV-related medical services. Of those expressing a need for substance abuse treatment, 67% were successful in keeping appointments for substance abuse treatment within the community. Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release. Ex-offenders will access HIV-related health care after release when given adequate support. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the Health Resources and Services Administration, the Special Projects of National Significance program, or other sponsors.     

Hepatitis B vaccine coverage in short and long stay prisons in Wales,UK 2013–2017 and the impact of the global vaccine shortage

Data on hepatitis B vaccination coverage across prisons in Wales 2013–2017 were analysed to describe coverage of one dose, and the full hepatitis B vaccine course for men in prison. Whilst vaccination coverage increased in both short and long stay prisons, annual coverage was consistently lower in short stay prisons compared to long-stay prisons, despite short-stay prisons delivering a higher numbers of vaccine doses. The exception of this pattern was in 2017, at a time of global vaccine shortage. The data demonstrate the need for all prisons to work together to ensure men in prison can receive the full hepatitis B vaccine course. Collaborative working will be required to recover from the vaccine shortage and to achieve higher coverage than the plateau in 2016.     

Project “For Colored Girls:” Breaking the shackles of role deprivation through prison theatre

A prison theatre workshop at Bayview Correctional Facility (BCF) in Manhattan combines improvisational techniques, play rehearsal, and performance. Ten women participate for eight weeks as cast and crew in a production of For Colored Girls Who Have Considered Suicide When the Rainbow is Enuf by African American playwright Ntozake Shange. The characters reflect different types of women in critical situations, breaking the long held silence marginalized women feel due to oppression. Written in poetic verse, scenes dramatize rites of passage, sisterhood and female sexuality, abandonment, poverty, abuse, rape, and unrequited love providing many archetypal roles that resonate with the actors and prison audience.     

服刑人员自我控制与预谋/冲动攻击的相关研究

目的:探讨服刑人员自我控制与预谋/冲动攻击之间的关系,同时发掘与自我控制相关的其他因素。方法:对206名男性服刑人员施测自我控制量表、预谋/冲动攻击量表和填写个人信息。结果:自我控制量表总分与预谋攻击呈显著负相关,与冲动性攻击没有显著相关。自我控制得分对预谋攻击有显著的预测作用。结论:服刑人员的自我控制能力越高预谋攻击行为越少,但自我控制和冲动攻击没有明显的关系。     

Medication-assisted treatment for opioid use disorders in correctional settings: An ethics review

Opioid use disorders are a pressing health concern that disproportionately impacts the United States (U.S.) correctional population. Medication-assisted treatment (MAT) is an evidence-based standard of care for opioid use disorders. Despite its availability in the community, MAT and MAT medications (buprenorphine and methadone) are largely unavailable and/or inaccessible for the treatment of opioid use disorders in U.S. prisons and jails. Given that the ethical principles have served as justification for limiting access to MAT on “moral” grounds, this article examines the implications of current correctional policies through the ethical principles of: (1) beneficence/non-maleficence; (2) distributive justice (equivalence-of-care); and (3) autonomy (informed consent). Special attention is paid to the five components of informed consent (capacity, disclosure, understanding, voluntariness, and access), as this facet has been used most often to justify policies that limit access to MAT in the past. Findings highlight that these core ethical principles support the adoption of correctional policies that include MAT. Furthermore, our findings demonstrate that autonomy is maximized during the informed consent process when MAT is available as a treatment option.     

Staff and patient perspectives on the purpose of psychotropic prescribing in prisons: care or control?

Objective

The objective was to explore perspectives on reasons for psychotropic medication use in prisons.

Method

We recruited a purposive sample of healthcare staff and patients prescribed psychotropic medicines from four East of England prisons. Participants took part in qualitative, semistructured interviews, which were recorded, transcribed and analyzed thematically.

Results

While patients and healthcare staff viewed psychotropic medicines primarily as a treatment for reducing symptoms of mental illness, they were also used as a coping strategy and to reduce insomnia. Appropriate psychotropic prescribing was also thought to contribute towards the rehabilitation agenda and helped to maintain order in prisons. Staff voiced concerns regarding possible overreliance on psychotropic medicines. However, patients perceived insufficient access to alternative, nonpharmacological forms of treatment and support in prison.

Conclusion

Psychotropic medicines are used for multiple purposes in prisons and are generally considered a useful resource. Nonetheless, further work may be needed to find the right balance between psychotropic medicines and alternative, nonpharmacological therapies.     

Predictors of Illicit Drug Use Among Prisoners

Background: The United States of America currently has the highest incarceration rate in the world, and approximately 80% of incarcerated individuals have a history of illicit drug use. Despite institutional prohibitions, drug use continues in prison, and is associated with a range of negative outcomes. Objectives: To assess the relationship between prison drug use, duration of incarceration, and a range of covariates. Results: Most participants self-reported a history of illicit drug use (77.5%). Seven percent reportedly used drugs during the previous six months of incarceration (n = 100). Participants who had been incarcerated for more than a year were less likely than those incarcerated for longer than a year to report using drugs (OR = 0.50; 95% CI = 0.26–0.98). Participants aged 37–89 were less likely than younger prisoners to use drugs (OR = 0.39; 95% CI = 0.19–0.80). Heroin users were twice as likely as nonheroin users to use drugs (OR = 2.28; 95% CI = 1.04–5.03); crack cocaine users were also twice as likely as participants with no history of crack cocaine usage to report drug use (OR = 2.53; 95% CI = 1.13–5.69). Conclusions: Correctional institutions should be used as a resource to offer evidence-based services to curb drug usage. Drug treatment programs for younger prisoners, heroin and crack cocaine users, and at the beginning of a prisoner's sentence should be considered for this population.