Trouble de stress post-traumatique en milieu pénitentiaire

PTSD is frequent in prison, with a lifetime prevalence of 17.8% among male inmates, and of 40.1% among female inmates. Despite those high rates, only a limited number of studies have been published about this disorder in the prison population, and PTSD is still widely underdiagnosed in jail. We conducted a review of the literature to identify the PTSD sociodemographic characteristics and specificities among incarcerated populations. Some epidemiological characteristics of PTSD are identical in both the general and the prison populations, with a higher prevalence among women than men, high rates of comorbidity with depression and anxiety disorders, and high suicide rates. PTSD after committing a violent crime seems to be common but is greatly underdiagnosed, mostly because of a lack of knowledge about this entity. The occurrence is especially high when the offender suffers from a severe mental illness at the time of the offence. Homicidal crimes are the most at risk to lead to PTSD. Every inmate should be screened for this diagnosis by psychiatrists practicing in prisons. Inmates are exposed to many traumatic events during their time in detention. Yet, little is known about the mental health consequences of imprisonment. PTSD after exposure to a traumatic event while in detention should be systematically explored, and future studies need to consider this matter. The high levels of PTSD among imprisoned people could be explained by the exposition of prisoners to repetitive traumatic events, especially during childhood, and by the multiple risk factors for PTSD found in this population. In France, screening for and treatment of PTSD in prison are insufficient. Strategies must be elaborated by the institutions created in 2019 (Centre National de Ressource et de Résilience et Centre Régionaux de Psychotraumatismes) to improve the health of inmates suffering from PTSD. Complex PTSD should also be studied in the prison population.     

The Relationship Between Severe Mental Disorders and Recidivism in a Sample of Women Released from Prison

Women are one of the fastest growing sectors of the prison population, and have different pathways into prison and differing needs during the reentry process when compared to men (Cloyes et al. J Forensic Nurs; 6:3-14, 2010b; Herrschaft et al. J Offender Rehabil; 48:463-482, 2009). Women report higher levels of mental health problems overall, and report more severe symptomatology (Cloyes et al. J Forensic Nurs; 6:3-14, 2010a; Hyde 2012; Lynch et al. 2014). The current study focuses on the role of severe mental disorders for women released from prison. Data collected from the North Carolina Division of Adult Correction and Juvenile Justice were used to analyze the specific role of severe mental disorders in women’s recidivism at eight years post-release (n?=?2311). Approximately 20% of women in this sample met the criteria for diagnosis with a severe mental disorder (SMD). Logistic regression analysis indicated that there was an association between SMDs and recidivism for this sample only (p?=?.11). Cox regression analyses indicated that women diagnosed with SMDs were 16% more likely to have recidivated at eight years post-release compared with women who were not diagnosed with an SMD (p?<?.05). Implications for the recognition, role, and treatment of SMDs during reentry are discussed.     

Availability of behavioral health treatment for women in prison

OBJECTIVES: This study examined whether women with behavioral health needs are more likely to receive treatment for these problems in prison or in the community and to what extent prison disrupts or establishes involvement in treatment for these women. METHODS: Data were collected in August 2004 as part of a population survey of female inmates in the only state correctional facility for women in New Jersey. RESULTS: A total of 908 women were surveyed. Fifty-six percent of the women surveyed reported needing behavioral health treatment before incarceration, but only 62 percent of this group reported receiving such treatment in the community. The rate at which treatment matched need within this population before incarceration varied by type of treatment needed: it was the highest (58 percent) for women who needed treatment for mental health problems, lower (52 percent) for those who needed substance abuse treatment, and lowest (44 percent) for those who needed treatment for comorbid mental health and substance abuse problems. In comparison, the rate of match between need for and receipt of treatment in prison was higher for all three types of behavioral health treatment (78 percent, 57 percent, and 65 percent, respectively). Additionally, the findings suggest that prison did not disrupt the type of behavioral health treatment that inmates had previously received in the community. CONCLUSIONS: At least in New Jersey, prison appears to improve access to behavioral health treatment among female inmates. Although this conclusion is consistent with the rehabilitation goals of incarceration, it also suggests that some women may have been able to avoid prison if treatment had been provided in the community, especially for substance-related problems.     

Effects of Personality Disorder and Impulsivity on Emotional Adaptations in Prison Among Women Offenders

The present study sought to better understand the influence of personality disorders and impulsivity on women??s ability to adapt to incarceration. We analyzed the influence of personality disorders as screened with the Structured Clinical Interview for Personality Disorders, and impulsivity as assessed with the Barratt Impulsivity Scale on depression and anxiety, sleeping problems, and feeling afraid of being attacked in prison among a large sample of women incarcerated in a Virginia prison. Results from regression models indicated that schizotypal, borderline, avoidant and dependent personality disorders and cognitive impulsivity were significant predictors of symptoms of anxiety and depression net of demographic covariates. Women possessing a diagnosis of paranoid personality disorder were at increased odds of having difficulty sleeping in prison and borderline, dependent, and paranoid personality disorder were at increased odds of experiencing fear in prison. Women who had been in prison before were significantly less likely to experience these problems. Implications of study findings for policies and practices involving women offenders are discussed.     

Les idéations suicidaires chez les nouveaux arrivants en maison d’arrêt

Suicide in prison is in increase for several years and participates in a major problem of public health. The number of suicide in prison arises mainly during first moment of incarceration, in particular under fifteen days. Eighty percent of the subjects who attempt to commit suicide or commit suicide express such ideas months before. So the expression of suicidal ideations is a risk factor of suicide and their detection is crucial. This study has investigated suicidal risks in prisoners with the assessment of the rate of suicidal ideation as well as their link with risk factors such as depressive disorders, individual factors or life's event's life, etc. Participants were recruited from all-male adults, who just arrived in prison since one week in prison of Hauts-de-Seine, Nanterre, France. One hundred prisoners able to read and fill in the scales in autonomy way were evaluated from March to June 2007 using a structured interview, Beck Depression inventory (BDI), Scale of suicidal ideation by Beck (SSI) and a short version of Mini International Neuropsychiatric Interview (MINI). The SSI assesses precisely the presence of suicidal ideations and suicidal risk as well as its severity and the score gives some information on the severity of the suicidal risk. The BDI assesses the presence of depressive symptoms as well as the severity of depression according to a classification: Light, medium or severe depression. Eleven out of 100 prisoners have suicidal ideations in SSI. They are not connected significantly to the incarceration (χ² = 3.52, P = 0.05). The scores go from 3 to 27 (the maximum score for this scale is 36) and the medium score is 8.81: four people have scores around the medium score, four people have a score smaller than 5, three people have a score higher than 9. The group of prisoners who have suicidal ideations (n = 11) was compared with the group of prisoners without suicidal ideations (n = 89). Suicidal ideations are in link with the severity of depression in BDI (χ² = 12.53, P < 0.001) but not with its presence only: Prisoners who have suicidal ideations have a medium score of depression higher than prisoners who have not suicidal ideations (16.45 against 6.01, the maximum score for this scale is 39). Ninety-one percent of prisoners who have suicidal ideations suffer from medium or severe depression against 35 % of prisoners without suicidal ideations. Nevertheless, the difference is not significant if we compare the two groups with all types of depression-light, medium or severe (χ² = 2.74, P < 0.05). Moreover anxious and psychotics symptoms, in particular hallucinations in MINI are linked significantly with suicidal ideation (anxiety: χ² = 22.62, P = 0.00001; psychosis: χ² = 6.639, P = 0.01; hallucinations: χ² = 12.8, P = 0.001). Significant risk factors for suicidal ideation in prisoners are life's event such as personal suicidal attempt (χ² = 25.58, P < 0.000001) and substance use history (χ² = 7.76, P < 0.01) and the lack of family support (χ² = 8.7, P < 0.01). It is not the case for suicidal attempt in family (χ² = 1.663, P < 0.05) and a recent death (χ² = 1.24, P < 0.015). Prisoners, who are more than 35 years old, are married, have children and are in prison for murder(s) or rape(s) have significantly more suicidal ideations. Some prisoners who have not suicidal ideation in the SSI have a suicidal risk in the MINI. So we can think these ideas are under-expressed in the SSI because prisoners can feel uncomfortable to express such ideas. Moreover there is more than the half of prisoners who present some signs of depression in BDI for less than one third of prisoners in MINI: Depression can be over-expressed in BDI, what explain it is the severity of depression which is in link with suicidal ideations and no only its presence because a lot of prisoners (with or without suicidal ideations) seem to have a depression with the assessment of BDI. The results must be used with care because the population of the study is quite small, in particular for prisoners who have suicidal ideations. Furthermore it is very heterogeneous and judging origins of the link between suicidal ideations and risk factors is very difficult. In conclusion, these results cannot be generalised to the whole prison; they are specifics to this place of research. Symptoms of depression, anxiety and psychosis as well as personal history of suicidal attempt, substance use and a lack of family support are risk factors for suicidal ideations in prisoners. The precocious detection of suicidal ideation and risk factors would prevent from suicide and reduce the risks.     

Réflexion sur les fondements du débat et des critiques actuels sur l'expertise psychiatrique pénale

As in a number of industrialized countries, the penal psychiatric expertise knows important a faintness: reduction in the number of the experts, not renewal of the old experts, blamed of the quality of the expertises… The reduction in penal irresponsibilities is also underlined and put in connection with the increase in the mental patients in the prison. All occurs as if the penal psychiatric expertise did not play anymore its part of regulator between hospital and prison. These observations are analyzed through the history of the penal irresponsibility and the evolution of the hospital institution.     

<Emphasis Type="Italic">Tarasoff</Emphasis> Duties in Prisons: Community Standards With Certain Twists

Because inmates’ actions are restricted by incarceration, Tarasoff duties in prisons have certain unique aspects. There are two broad situations: (1) when the potential victim is located within the prison community; and (2) when the potential victim is located outside of prison. Although responsibilities vary widely from state to state, this paper discusses general principles of exercising Tarasoff duties in prison settings. In addition to duties to protect potential victims, correctional mental-health professionals have an ethical duty to protect patient confidentiality. Professionals should chose Tarasoff options that protect confidentiality to the fullest extent possible, and prisoners should be informed of situations where confidentiality does not exist. A caveat is that no Tarasoff statutes can be relied upon to offer tort protection to correctional clinicians until they have been tested in appellate courts.     

L’acte et son énigme. Entre l’indicible et l’innommable

Contiguous with social spaces, the prison is invested with a degree of secrecy. However, those who are incarcerated tolerate the space, which imprisons them with difficulty, insofar as this place, which punishes them, does not allow them to approach an act where the significance escapes. The act, which led them to this place, identifies them, more than it interrogates the “acting out of the act”, which is profoundly enigmatic and rarely questioned. The legal procedures fix behaviors by a ruling, which is hardly suitable for clarifying acts, which inhibit the significance. Based on clinical situations, we have attempted to conduct investigations concerning the act, defining the role, which the psychologist, orientated by psychoanalysis, must have in the individual work that he maintains with the prisoners. Far from numbing the significance, the aim is to articulate the statements with the contradictions, which compose them, to let an aborted word appear under appropriate discourse; the one which touches on the unspeakable. Taken literally, the significant point of the act is revealed to be less expressible than it had seemed and allows a glimpse of unsuspected areas.     

Extending borders of knowledge: gendered pathways to prison in Thailand for international cross border drug trafficking

Few researchers have concerned themselves with qualitative gender-comparative studies of women’s and men’s prison trajectories – particularly appraisals relating to international cross border drug trafficking (ICBDT). Using life history interviews with prisoners incarcerated in three regions of Thailand, we describe, examine and compare the features of women’s and men’s pathways to prison for ICBDT. Overall, the findings point to both similarities and divergences in experiences by gender. Three pathways to prison emerged for both women and men: (1) ‘deviant’ lifestyle, (2) economic familial provisioning and (3) inexperience and deception. However, gendered variance was found within these pathways; an additional woman-only trajectory, the romantic susceptibility pathway, was also identified.     

Lifetime use of mental health and substance abuse treatment services by incarcerated women felons

OBJECTIVE: This study examined the lifetime use of alcohol, drug, and mental health treatment services by recently incarcerated women prison inmates. METHODS: A total of 805 women entering a North Carolina prison for new felony charges in 1991 and 1992 were interviewed in person shortly after incarceration. The women were assessed for psychiatric disorders and lifetime use of substance abuse and mental health treatment services. Rates of service use were analyzed by inmate characteristics and were compared with rates for a sample of women in the community in North Carolina. RESULTS: The majority of women inmates reported a history of using substance abuse services or mental health services or both. Those with psychiatric disorders and prison recidivists were the most likely to have used such services. Rates of service use were substantially higher for the inmates than for the women in the community, even when the effects of having a psychiatric or substance use disorder were controlled for. CONCLUSIONS: Many of the incarcerated women in the study met lifetime criteria for alcohol, drug, and mental health disorders that were significantly related to their use of substance abuse and mental health treatment services. The majority of the inmates met criteria for a current disorder despite past treatment. Further research is needed to help in developing programs to reduce women inmates' alcohol, drug, and mental health problems.     

Effraction d’un cadre psychothérapique en milieu carcéral et décompensation psychotique

The objective of our study is to prevent pathological outcomes of the institutional abuse in a prison facility, which can trigger a psychotic breakdown of inmate patients, by enhancing a healthy communication between penitentiary staff and medical team despite the fact that they both adopt two opposite approach of inmates. In France, since 1994, public health institution took in charge medical and psychological penitentiary follow-up through Counseling and Ambulatory Care Units (UCSA). Composed of a multi-field team (psychiatrists, psychologists, medical staff), those care units have to constantly deal with security and normative issues specific to the prison facility. Usually, it is difficult to keep the psychotherapy setting safe from external “attacks” inflicted by penitentiary staff. Moreover, admitting UCSA within prison walls raises the eternal conflicting issue between two opposite logics: punishment (related to guilt) and treatment (related to illness and suffering). Whereas, UCSA staff perceives inmates as patients (to be cured), penitentiary staff perceives them as “cons” or out-laws (to be punished). The daily confrontation of such opposing logics not only affects the quality of communication between health team and penitentiary staff, but it also triggers acting-outs which put to the test the feasibility of psychotherapy in a prison setting mainly with mentally vulnerable inmate patients. Our method is based upon a case study of an inmate patient, C., who suffered a psychotic break down as a consequence to the unannounced renovation of the office dedicated to his psychotherapeutic sessions. Though, it is true that C., a former addict, had already a psychotic predisposition, his encounter with the intrusive and arbitrary authority of the penitentiary institution triggered his mental breakdown while undergoing psychotherapy. The result of our study emphasizes upon the necessity to establish a true communication between the medical team and the penitentiary staff and a mutual understanding of the value of their professional task in order to contain any conflict issues or misjudgment that may affect the progress of the most vulnerable inmate patients. Our study concludes to the importance of a complementary, cooperative, comprehensive and balanced approach of mental health problems in a prison facility through continuous training courses and discussions involving both penitentiary staff and medical teams whose roles, despite their differences, revolve around the same goal: the social and mental rehabilitation of inmates.     

1324 prison suicides in 10 countries in South America: incidence,relative risks,and ecological factors

Purpose

Although suicide rates of prison populations and incidence factors have been reported for high-income countries, data from low- and middle-income regions are lacking. The purpose of the study was to estimate suicide rates among prison populations in South America, to examine prison-related factors, and to compare suicide rates between prison and general populations.

Methods

In this observational study, we collected the numbers of suicides in prison, rates of prison occupancy, and incarceration rates from primary sources in South America between 2000 and 2017. We compared suicide rates among prisoners with incidence rates in the general populations by calculating incidence rate ratios. We assessed the effect of gender, year, incarceration rates and occupancy on suicide rates in the prison populations using regression analyses.

Results

There were 1324 suicides reported during 4,437,591 person years of imprisonment between 2000 and 2017 in 10 South American countries. The mean suicide rate was 40 (95% CI 16–65) per 100,000 person years for male and female genders combined. The pooled incidence rate ratio of suicide between prison and general populations was 3.9 (95% CI 3.1–5.1) for both genders combined, 2.4 (95% CI 1.9–3.1) for men and a higher ratio in women (13.5, 95% CI 6.9–26.9). High occupancies of prisons were associated with lower incidence of suicide (β = − 58, 95% CI − 108.5 to − 7.1).

Conclusions

Suicides during imprisonment in South America are an important public health problem. Suicide prevention strategies need to target prison populations.

     

Prevalence of psychiatric disorders among sentenced prisoners in a medium security prison in Ghana: Implications for mental health assessment and service

Background

Extant literature has shown that there is a higher prevalence of mental disorders among prisoners compared to the general population. These findings have, however, mostly been from high-income and westernised cultures. In Ghana, little is known about the extent of psychiatric disorders among prisoners, as is consistent with the dearth of scholarly work in low and middle-income countries.

Aims

Our aim was to determine the prevalence of common mental disorders among sentenced prisoners in the second largest prison in Ghana.

Methods

A cross-sectional survey research design was used in one prison. The Mini International Neuro-Psychiatric Interview questionnaire was used to collect data from men and women serving prison sentences who volunteered for the study. Socio-demographic characteristics and criminal history data were collected using a questionnaire designed by the researchers.

Results

Five hundred prisoners participated. Nearly half (246, 49.8%) had at least one psychiatric disorder. The most prevalent disorders were major depression and a range of anxiety disorders (145, 29%, 132, 26% respectively). A smaller proportion recorded high scores on the antisocial personality disorder scale (13%); just 50 (10%) reported using substances in the 12 months before interview, but this is a minimum estimate of such problems as many were already in prison during that time. None of these prisoners, regardless of disorder, had been screened, diagnosed, or treated in prison.

Conclusions

This study contributes to the gap in scholarly literature in low- and middle-income countries on psychiatric disorders in the prison population. It will be important to explore further the extent to which the internationally recognised screening tools used led to under-estimation of psychiatric disorders. The findings are of immediate practical importance nationally as they highlight the need to implement reforms anticipated by the new mental health legislation of 2012 and strategies for interagency working to improve health services and their uptake in the criminal justice system.

     

Pilot study of treatment for major depression among women prisoners with substance use disorder

This study, the largest randomized controlled trial of treatment for major depressive disorder (MDD) in an incarcerated population to date, wave-randomized 38 incarcerated women (6 waves) with MDD who were attending prison substance use treatment to adjunctive group interpersonal psychotherapy (IPT) for MDD or to an attention-matched control condition. Intent-to-treat analyses found that IPT participants had significantly lower depressive symptoms at the end of 8 weeks of in-prison treatment than did control participants. Control participants improved later, after prison release. IPT's rapid effect on MDD within prison may reduce serious in-prison consequences of MDD.     

Successfully Treating Aggression in Mentally Ill Prison Inmates

The population of prison inmates in the United States is rapidly growing; in 1994 it was estimated that 1.7 million Americans were incarcerated. Changes in the complexion of the prison population highlight the need for successful mental health interventions for special populations. Specifically, increasing numbers of women, middle aged inmates, physically ill inmates, and inmates with severe mental illness have challenged an already taxed system. Many inmates have complex pathology in which substance abuse, psychosis, affective disorders, personality disorders and medical illnesses play overlapping roles. One of the most challenging aspects of care involves management of inmates who are aggressive to themselves or others. This article discusses the approach to managing inmates with aggressive behavior and complex mental health issues. Specific diagnoses are discussed as are the general approaches best used to assess new onset violent behavior in a mentally ill prison inmate.     

Parcours de soins et expertises psychiatriques pré-sentencielles : une étude descriptive au centre pénitentiaire de Château-Thierry

ContextThe high prevalence of psychiatric disorders among people in prison is well documented, and several hypotheses have been proposed to explain this overrepresentation. In France, the decrease in the number of people found by the judge to be not criminally responsible on account of mental disorder after a psychiatric expertise could play a crucial role. The Château-Thierry prison is a high-security correctional facility where prisoners whose integration into a “standard” prison is complicated because of behavioural problems, reside. We conducted the first study to describe the judicial and healthcare trajectories of people incarcerated in this facility.MethodAll the people incarcerated in the Château-Thierry prison between May and September 2019 were included in this cross-sectional study. In addition to sociodemographic characteristics, data on the psychiatric care before and during incarceration as well as information on the judicial and prison history were collected. We also analyzed all the pre-sentencing psychiatric reports in order to collect the degree of discernment determined by the psychiatrist expert for each included individual.ResultsSixty-eight (97%) of the 70 people detained at the Château-Thierry prison during the study period were included and 92 pre-sentencing psychiatric reports were analyzed. The population studied was exclusively male, with an average age of 40 years, low socio-economic status and frequent criminal history (79%). About half of them (46%) had already been hospitalized in a psychiatric community hospital prior to incarceration, and 79% have been hospitalized in a psychiatric facility during their incarceration. Disciplinary sanctions were frequent (72%) as well as convictions for offenses committed while in prison (57%). When at least one pre-sentencing psychiatric report was carried out (29 persons had a single psychiatric forensic evaluation and 27 ones had multiple evaluations), at least one psychiatric expert had concluded to a diminished (but not lack of) criminal responsibility in almost half of the cases (44%).ConclusionThis study shows the extent to which people incarcerated in the Château-Thierry prison are affected by psychiatric disorders. It also highlights the difficulties of coping with the prison environment for people suffering from psychiatric disorders. Finally, it raises the question of the lack of diversion programs for the individuals in France with mental health problems whose responsibility has been considered as full or diminished.