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Hwang YIJ, Hampton S, Withall AL, Snoyman P, Forsyth K, Butler T. Multi-sector stakeholder consensus on tackling the complex health and social needs of the growing population of people leaving prison in older age. HEALTH & JUSTICE 2024; 12:17. [PMID: 38639865 PMCID: PMC11027373 DOI: 10.1186/s40352-024-00271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND As populations age globally, cooperation across multi-sector stakeholders is increasingly important to service older persons, particularly those with high and complex health and social needs. One such population is older people entering society after a period of incarceration in prison. The 'ageing epidemic' in prisons worldwide has caught the attention of researchers, governments and community organisations, who identify challenges in servicing this group as they re-enter the community. Challenges lie across multiple sectors, with inadequate support leading to dire consequences for public health, social welfare and recidivism. This is the first study to bring together multi-sector stakeholders from Australia to form recommendations for improving health and social outcomes for older people re-entering community after imprisonment. RESULTS A modified nominal group technique was used to produce recommendations from N = 15 key stakeholders across prison health, corrections, research, advocacy, aged care, community services, via online workshops. The importance and priority of these recommendations was validated by a broader sample of N = 44 stakeholders, using an online survey. Thirty-six recommendations for improving outcomes for this population were strongly supported. The key issues underlying the recommendations included: improved multi-stakeholder systems and services, targeted release preparation and practices that ensure continuity of care, advocacy-focused initiatives in the community, and extended funding for effective programs. CONCLUSIONS There is consensus across stakeholders on ways forward, with intervention and policy updates required at the individual, systems and community levels. These recommendations entail two important findings about this population: (1) They are a high-needs, unique, and underserved group at risk of significant health and social inequity in the community, (2) Multi-sector stakeholder cooperation will be crucial to service this growing group.
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Affiliation(s)
- Ye In Jane Hwang
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Stephen Hampton
- Justice Health & Forensic Mental Health Network, Matraville, NSW, 2036, Australia
| | - Adrienne Lee Withall
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Katrina Forsyth
- Health and Justice Research Network, University of Manchester, Manchester, M13 9PL, UK
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia
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Stoliker BE, Kerodal AG, Jewell LM, Brown K, Kent-Wilkinson A, Peacock S, O'Connell ME, Wormith JS. Older people in custody in a forensic psychiatric facility, prevalence of dementia, and community reintegration needs: an exploratory analysis. HEALTH & JUSTICE 2022; 10:3. [PMID: 35072844 PMCID: PMC8785542 DOI: 10.1186/s40352-022-00168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/11/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Across much of the developed world, the number of older people in custody has been increasing, which presents challenges for correctional systems due to the complex social, medical and mental health needs of this subgroup, especially those living with dementia. The present study therefore aimed to increase insight into the extent to which older people in custody are (a) potentially living with dementia and (b) receiving appropriate supports/services (particularly, with respect to community reintegration). RESULTS Cross-sectional data were drawn from a sample of 29 older people in custody and 20 correctional health care professionals at a regional forensic psychiatric hospital in a medium-sized Canadian city. In general, analyses revealed that: (a) scores from a modified version of the Community Screening Instrument for Dementia (CSI'D') suggest that 45% of older individuals screened positive for dementia; (b) 35% of Social Workers and 25% of Primary Nurses (i.e., RNs/RPNs) suspected that at least one older individual on their caseload has dementia, and there was adequate agreement between health staffs' perception of the presence or absence of dementia and the CSI'D' assessment; (c) varying supports/services may be required for older individuals' successful community reintegration and living; and (d) Social Workers and Primary Nurses generally lack training/education to adequately support older people in custody. CONCLUSIONS A substantial number of older people in custody may experience age-related challenges, including dementia. This necessitates the development and implementation of programming to effectively address older individuals' needs during incarceration and community reintegration and living.
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Affiliation(s)
- Bryce E Stoliker
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5A5, Canada.
| | - Ashmini G Kerodal
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5A5, Canada
| | - Lisa M Jewell
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5A5, Canada
| | - Kelsey Brown
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5A5, Canada
| | - Arlene Kent-Wilkinson
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5A5, Canada
| | - J Stephen Wormith
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5A5, Canada
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Merkt H, Wangmo T, Pageau F, Liebrenz M, Devaud Cornaz C, Elger B. Court-Mandated Patients' Perspectives on the Psychotherapist's Dual Loyalty Conflict - Between Ally and Enemy. Front Psychol 2021; 11:592638. [PMID: 33488459 PMCID: PMC7815763 DOI: 10.3389/fpsyg.2020.592638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/01/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. METHODS This qualitative interview study investigates patients' perceptions of their therapists' dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. RESULTS We first present the patients' perceptions of their treating psychotherapist's dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants' reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: (1) respecting the patient's pace and perceived coercion; (2) patient health needs to be first priority; (3) clarity in roles and responsibilities; and (4) the art of communication - between transparency and unchecked information sharing. DISCUSSION Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists' characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist' characteristics promoting a trustful relationship in correctional settings.
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Affiliation(s)
- Helene Merkt
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Félix Pageau
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Corinne Devaud Cornaz
- Unité Thérapeutique, Centre de Psychiatrie Forensique, Réseau Fribourgeois de Santé Mentale, Fribourg, Switzerland
| | - Bernice Elger
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Barry LC, Coman E, Wakefield D, Trestman RL, Conwell Y, Steffens DC. Functional disability, depression, and suicidal ideation in older prisoners. J Affect Disord 2020; 266:366-373. [PMID: 32056900 PMCID: PMC7103559 DOI: 10.1016/j.jad.2020.01.156] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/26/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The population of older prisoners (age ≥50), a group with high suicide rates, is growing. We sought to explore the associations among functional disability, depression, and suicidal ideation (SI) among older prisoners, focusing on the mediating role of depression. METHODS Study participants were 220 sentenced male inmates age ≥50 who were incarcerated in 8 prisons. Face-to-face interviews were conducted following consent. Functional disability was assessed objectively, using the Short Physical Performance Battery (SPPB), and via self-report by asking participants their level of difficulty climbing stairs and completing activities necessary for daily living in prison (PADLS) such as standing in line for medications. The PHQ-9 and the Geriatric Suicide Ideation Scale assessed depressive symptoms and SI, respectively. Data were analyzed using linear regression models and causal mediation models. RESULTS Participants were racially diverse and ranged from age 50 to 79 years. Whereas each functional disability measure was significantly associated with depressive symptoms, difficulty climbing stairs and PADL disability, but not SPPB score, were independently associated with SI. Depressive symptoms mediated the relationship between functional disability, assessed both objectively and via self-report, and SI. LIMITATIONS Cross-sectional study design; possible under-sampling of participants with depressive symptoms and SI. CONCLUSIONS Our findings have implications for suicide prevention in older prisoners. As this population continues to grow, prevention efforts should target those with depression, including but not limited to those with functional disability. Furthermore, assessing functional disability may offer a means of identifying those who should be screened for depression and suicidal ideation.
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Affiliation(s)
- Lisa C Barry
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT 06030-5215, US; University of Connecticut Health Center, UConn Center on Aging, Farmington, CT 06030-5215, US.
| | - Emil Coman
- University of Connecticut Health Center, Health Disparities Institute, Farmington, CT 06030-7030, US
| | - Dorothy Wakefield
- University of Connecticut Health Center, UConn Center on Aging, Farmington, CT 06030-5215, US
| | - Robert L Trestman
- Virginia Tech Carilion School of Medicine, Department of Psychiatry, Roanoke, VA 24016, US
| | - Yeates Conwell
- Yeates Conwell, MD, University of Rochester School of Medicine, Rochester, NY 14627, US
| | - David C Steffens
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT 06030-5215, US
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Barry LC, Adams KB, Zaugg D, Noujaim D. Health-care needs of older women prisoners: Perspectives of the health-care workers who care for them. J Women Aging 2019; 32:183-202. [PMID: 30943874 DOI: 10.1080/08952841.2019.1593771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The proportion of older incarcerated women is growing, yet little is known regarding their health-care needs. Using focus group methodology, this study sought to elucidate the unique health-care needs of older women prisoners through the perspectives of correctional health-care providers. Three organizing themes emerged regarding the health of older women prisoners: (a) the meaning of being "older" in the prison setting; (b) challenges impacting correctional health-care workers' care delivery; and (c) unmet health-care-related needs. Correctional health-care workers' insights can provide guidance regarding how to optimize the health of the increasing population of older women prisoners.
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Affiliation(s)
- Lisa C Barry
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA.,Department of Psychiatry, UConn School of Medicine, Farmington, Connecticut, USA
| | - Kathryn B Adams
- Department of Psychiatry, UConn School of Medicine, Farmington, Connecticut, USA
| | - Danielle Zaugg
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
| | - Deborah Noujaim
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
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Smoyer AB, Madera JE, Blankenship KM. Older Adults' Lived Experience of Incarceration. JOURNAL OF OFFENDER REHABILITATION 2019; 58:220-239. [PMID: 31680760 PMCID: PMC6823991 DOI: 10.1080/10509674.2019.1582574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Amy B Smoyer
- Department of Social Work, Southern Connecticut State University, 101 Farnham Ave, #108, New Haven, CT 06515
| | | | - Kim M Blankenship
- Department of Sociology, American University, 4400 Massachusetts Ave, NW, Washington DC, 20016-8072 (USA), ,
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Barry LC, Steffens DC, Covinsky KE, Conwell Y, Li Y, Byers AL. Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning From Prison to Community in Later Life. Am J Geriatr Psychiatry 2018; 26:1165-1174. [PMID: 30146371 PMCID: PMC6425485 DOI: 10.1016/j.jagp.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The number of individuals transitioning from correctional facilities to community in later life (age ≥50 ) is increasing. We sought to determine if later-life prison release is a risk factor for suicidal behavior and death by accidental injury, including drug overdose. DESIGN Retrospective cohort study. SETTING U.S. Department of Veterans Affairs and Medicare healthcare systems, 2012-2014. PARTICIPANTS Veterans age ≥50 released from correctional facilities (N = 7,671 re-entry veterans) and those never incarcerated (N = 7,671). METHODS Dates of suicide attempt and cause-specific mortality defined using the National Suicide Prevention Applications Network and the National Suicide Data Repository, respectively. RESULTS Later-life prison release was associated with increased risk of suicide attempt (599.7 versus 134.7 per 100,000 per year; adjusted hazard ratio [HR] 3.45; 95% confidence interval [CI] 2.24-5.32; p < 0.001, Wald χ2 = 31.58, degrees of freedom [df] = 1), death by drug overdose (121.7 versus 43.5; adjusted HR 3.45; 95% CI 1.37-8.73; p = 0.009, Wald χ2 = 6.86, df = 1), and other accidental injury (126.0 versus 39.1; adjusted HR 3.13; 95% CI 1.28-7.69; p = 0.013, Wald χ2 = 6.25, df = 1), adjusting for homelessness, traumatic brain injury, medical and psychiatric conditions, and accounting for competing risk of other deaths. Suicide mortality rates were observed as nonsignificant between re-entry veterans and those never incarcerated (30.4 versus 17.4, respectively; adjusted HR 2.40; 95% CI 0.51-11.24; p = 0.266, Wald χ2 = 1.23, df = 1). CONCLUSION Older re-entry veterans are at considerable risk of attempting suicide and dying by drug overdose or other accidental injury. This study highlights importance of prevention and intervention efforts targeting later-life prison-to-community care transitions.
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Affiliation(s)
- Lisa C Barry
- Department of Psychiatry, UCONN Health, Farmington, CT; UCONN Center on Aging, Farmington, CT.
| | | | - Kenneth E Covinsky
- San Francisco VA Health Care System, San Francisco, CA; Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY
| | - Yixia Li
- San Francisco VA Health Care System, San Francisco, CA; Northern California Institute for Research and Education, San Francisco, CA
| | - Amy L Byers
- San Francisco VA Health Care System, San Francisco, CA; Department of Psychiatry, University of California, San Francisco, San Francisco, CA
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Barry LC, Wakefield DB, Trestman RL, Conwell Y. Disability in prison activities of daily living and likelihood of depression and suicidal ideation in older prisoners. Int J Geriatr Psychiatry 2017; 32:1141-1149. [PMID: 27650475 PMCID: PMC7864224 DOI: 10.1002/gps.4578] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The study objective was to determine if disability in activities of daily living specific to prison, prison activities of daily living (PADLs), is associated with depression and severity of suicidal ideation (SI) in older prisoners, a rapidly growing population at high risk of suicide. METHODS Cross-sectional design using data from a study of prisoners age ≥50 years (N = 167). Depression was operationalized as a score of ≥15 on the 9-item Physician Health Questionnaire (PHQ-9). SI severity was assessed using the Geriatric Suicide Ideation Scale (GSIS). Participants were considered to have PADL disability if they reported any of the following as "very difficult" or "cannot do:" dropping to the floor for alarms, climbing on/off the top bunk, hearing orders, walking while wearing handcuffs, standing in line for medications, and walking to chow. Associations were examined with bivariate tests and with multivariable logistic and linear regression models, and the interaction term gender × PADL disability was tested. RESULTS PADL disability was associated with depression and SI severity. There was no main effect of gender on either depression or SI, yet the association between PADL disability and depression was considerably stronger in male than in female older prisoners. CONCLUSIONS Identifying older prisoners who have difficulty performing PADLs may help distinguish prisoners who may also be likely to be depressed or experience more severe SI. Furthermore, the association between PADL disability and depression may be particularly salient in older male prisoners. Longitudinal studies are needed as causal inferences are limited by the cross-sectional design. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lisa C. Barry
- University of Connecticut Health Center, UConn Center on Aging, Farmington, CT, USA
| | - Dorothy B. Wakefield
- University of Connecticut Health Center, Center for Public Health and Health Policy, Farmington, CT, USA
| | - Robert L. Trestman
- Correctional Managed Health Care, University of Connecticut Health Center, Farmington, CT, USA
| | - Yeates Conwell
- University of Rochester School of Medicine, Rochester, NY, USA
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Psick Z, Simon J, Brown R, Ahalt C. Older and incarcerated: policy implications of aging prison populations. Int J Prison Health 2017; 13:57-63. [PMID: 28299972 PMCID: PMC5812446 DOI: 10.1108/ijph-09-2016-0053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to explore the policy Implications of aging prison populations. Design/methodology/approach An examination of the worldwide aging trend in prison and its implications for correctional policy, including an examination of population aging in California prisons as a case example of needed reform. Findings Prison populations worldwide are aging at an unprecedented rate, and age-related medical costs have had serious consequences for jurisdictions struggling to respond to the changes. These trends are accompanied by a growing body of evidence that old age is strongly correlated with desistance from criminal behavior, suggesting an opportunity to at least partially address the challenges of an aging prison population through early release from prison for appropriate persons. Originality/value Some policies do exist that aim to reduce the number of older, chronically ill or disabled and dying people in prison, but they have not achieved that goal on a sufficient scale. An examination of the situation in California shows that recognizing how the healthcare needs of incarcerated people change as they age - and how aging and aging-related health changes often decrease an older person's likelihood of repeat offense - is critical to achieving effective and efficient policies and practices aimed at adequately caring for this population and reducing their numbers in prisons when appropriate.
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Affiliation(s)
- Zachary Psick
- Department of Sociology, University of California , Davis, Davis, California, USA
| | - Jonathan Simon
- University of California, Berkeley , Berkeley, California, USA
| | - Rebecca Brown
- Division of Medicine, Department of Geriatrics, University of California, San Francisco , San Francisco, USA
| | - Cyrus Ahalt
- University of California, San Francisco , San Francisco, California, USA
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