Women's experiences of prison-based mental healthcare: a systematic review of qualitative literature

Trauma Center Trauma Sensitive Yoga Intervention (TCTSY). Improving Conditions for Incarcerated Women in Latin America

Female prisoners in Latin America experience significantly higher rates of mental health issues compared to their male counterparts. The most prevalent include anxiety and stress, which stem from feelings of insecurity, perceived failure, long periods of detention, and the inability to care for their children. Furthermore, over 50% of female prisoners have been exposed to traumatic events, including physical and/or sexual violence, and report more adverse childhood experiences and higher rates of post-traumatic stress disorder (PTSD) than male prisoners. Understanding the root causes of these mental health issues is essential for developing effective interventions. Body awareness, crucial for consciousness and emotion regulation, is often compromised in individuals with PTSD, exacerbating their symptoms. Positive criminology approaches, such as yoga programs, have been shown to improve inmates' well-being and mental health by addressing these underlying issues. This commentary introduces Trauma Center Trauma Sensitive Yoga (TCTSY) as a novel intervention designed explicitly for female prisoners with PTSD. Research indicates that TCTSY provides significant physiological and psychological benefits, including reductions in negative emotional states, hostility, and overall psychological distress. Despite these benefits, TCTSY has not yet been implemented in South American prisons. Given the substantial female prison population in Chile and their critical mental health needs, introducing TCTSY in these settings presents a promising opportunity. Implementing TCTSY could significantly enhance the well-being of female prisoners and promote prosocial behavior, addressing the urgent need for effective mental health interventions in this vulnerable population.

Mental health and self-harm/suicide risk screening at prison entry over 12 months in a total population sample in New South Wales, Australia

INTRODUCTION

International research has found high rates of mental illness and self-harm/suicide among people in prison. However, existing studies are often limited by their sample selection methodology, and many do not examine mental health at prison entry specifically. In addition, with smaller samples, previous studies have lacked statistical power to robustly examine and compare subgroups.

METHOD

This study examines a total population sample of 9568 individuals entering public prisons in New South Wales, Australia over a 1-year period, and describes the prevalence of a range of mental health and self-harm/suicide risk indicators collected during routine health screening upon prison entry.

RESULTS

In total, 62% of prison entrants reported a lifetime mental health condition and 23% reported a serious mental illness. Lifetime self-harm (14%) and suicide attempts (12%) were also high. Women and First Nations people entering prison had higher prevalence of most mental health diagnoses and of previous self-harm and suicidal ideation/behaviour than men and non-First Nations people.

CONCLUSION

These results establish the scale of mental health need and self-harm/suicide risk among people entering prison, particularly among women and First Nations people. There is a clear need for investment to adequately resource prison-based mental health services to meet the needs of prison entrants, but also in interventions to prevent those with significant mental health needs from entering prison in the first place. These strategies may include targeted and preventive approaches via mental health diversion and community-based mental health services.

Indifferent minds, broken system: a critical examination of mental health care provision for Spain's incarcerated population with serious mental illnesses

Background

Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI).

Objective

To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment.

Methods

Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision.

Results

In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings.

Conclusions

Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.

Seeking Safety for women in incarceration: a systematic review

PURPOSE

Seeking Safety is an evidence-based treatment for individuals with comorbid posttraumatic stress disorder and substance use disorder. This treatment shows promise to address the unique, unmet needs of women in prison. The current systematic literature review aims to highlight several critical gaps in research on Seeking Safety in forensic settings that need to be filled before Seeking Safety can be implemented in a widespread manner.

METHODS

PsycINFO, PubMed and Google scholar databases were used to identify studies that were published in English, included women in forensic settings, and incorporated Seeking Safety treatment. A total of seven studies met review criteria. The quality of studies was assessed with the mixed methods appraisal tool.

RESULTS

High risk of contamination, inclusion of small, predominantly White samples, high attrition rates, need for dose-response testing, and lack of follow-up data currently limit the ability to assess the efficacy of Seeking Safety in forensic settings. In addition, there is a lack of research on Seeking Safety's ability to reduce symptoms of substance use disorder for incarcerated women and further cultural adaptation may be needed.

CONCLUSION

Seeking Safety has the potential to address the underlying causes of incarceration for justice-involved women, but additional research addressing these identified gaps is needed to facilitate more widespread implementation.

Mental Disorders Among Mothers in Contact with the Criminal Justice System: A Scoping Review and Meta-analysis

This scoping review critically assessed evidence regarding mental disorders among mothers involved with the criminal justice system (CJS) and provided pooled prevalence rates of mental disorders. In total, 27 studies were included in the review, with 23 studies from the United States of America and 26 focused on incarcerated mothers. The findings supported the evidence on substantial burden of mental disorders, among CJS-involved mothers. Several factors contributing to mental disorders were identified, including history of abuse/incarceration/mental illness, a greater number of pregnancies, child-rearing responsibilities, less contact with children, and poor social support, which were organised using a socioecological model. However, significant gaps in the current evidence base were apparent, including inconsistencies in methodologies and outcomes assessed and a lack of large, longitudinal studies. The study highlights the importance of high-quality longitudinal research to extend knowledge around causal pathways between different risk or protective factors and mental disorders among CJS-involved mothers.

Nursing in a prison context: A focused mapping review and synthesis of international nursing literature

AIM

To provide a snapshot of the extent to which nursing and the prison context features in non-specialist/generic nursing journals.

DESIGN

Focused mapping review and synthesis.

METHODS

Relevant articles were examined for the extent to which they featured nursing and the prison context. A descriptive and contextual analysis of the data was carried out to provide a topography and synthesis of the key trends identified.

DATA SOURCES

Articles meeting criteria for nursing and the prison context in relevant non-specialized, generic nursing journals (n = 7) from January 2018 to December 2022.

RESULTS

Four thousand, nine hundred and twelve (n = 4912) articles were published during the review period of which (n = 14) met inclusion criteria. The key trends identified are presented under three headings: taking an advocacy approach for better health and well-being, examining self-determination and autonomy in prison populations and nursing in the prison context.

CONCLUSION

Nursing and the prison context features in non-specialized and generic nursing journals but sparsely and infrequently. There is a need for greater visibility of nursing and the prison context in nursing journals to help reduce stigma and marginalization of those working and those detained in prison.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

Nurses working in prison environments often manage extremely complex care needs. It is necessary to feature all nursing care environments in nursing journals so as to increase visibility and to act as a source of education for all. IMPACT (WHAT PROBLEM DID THE STUDY ADDRESS? MAIN FINDINGS? WHERE/WHOM WILL THE RESEARCH HAVE IMPACT ON): The findings of this review will have impact on all nurses engaged in practice and research as it highlights the extent to which nursing in a prison context is featured in non-specialized nursing journals and also speaks to the challenges faced by those working and detained in prison.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. This was a review of existing literature.

General and reproductive healthcare experiences of formerly incarcerated women in the United States: a qualitative study

PURPOSE

The US prison population has recently reached an all-time high, with women representing the fastest growing subpopulation. Correctional health-care system in the USA remains fragmented and nonuniform in practice, particularly in women's health care, with poor transitions between incarceration and release. This study aims to examine the qualitative health-care experiences of women while incarcerated and their transition into the community health-care setting. Additionally, this study also examined the experiences of a subset of women who were pregnant while incarcerated.

DESIGN/METHODOLOGY/APPROACH

After obtaining institutional review board approval, adult, English-speaking women with a history of incarceration within the past 10 years were interviewed using a semi-structured interview tool. Interview transcripts were analyzed using inductive content analysis.

FINDINGS

The authors completed 21 full interviews and identified six themes that were both the most significant and most novel: "feeling stigmatized and insignificant," "care as punishment," "delay in care," "exceptions to the rule," "fragmentation of care" and "obstetric trauma and resilience."

ORIGINALITY/VALUE

Women face numerous barriers and hardships when accessing basic and reproductive health-care services while incarcerated. This hardship is particularly challenging for women with substance use disorders. The authors were able to describe for the first time, partially through their own words, novel challenges described by women interacting with incarceration health care. Community providers should understand these barriers and challenges so as to effectively reengage women in care upon release and improve the health-care status of this historically marginalized group.