Suicide in Older Prisoners in Germany

As in many countries, the numbers of older prisoners are rising in Germany, but scientific information on this group is scarce. For the current study, a survey was used that included all prison suicides in Germany between the years of 2000 and 2013. Suicide rates of the elderly prisoners exceeded the suicide rates of the general population and the same age group. We observed a continuous decrease in the suicide rate of elderly prisoners. When compared to the younger suicide victims in prison, significantly more elderly suicide victims were: female, of German nationality, remand prisoners, or serving a life sentence. In Germany, elderly prisoners are a vulnerable subpopulation of the prison population. Higher suicide rates than in the same age group in the general population indicate unmet needs regarding mental disorders and their specific treatment

Loneliness and social isolation among the older person in a Swiss secure institution: a qualitative study

Background A pandemic of loneliness is hitting the aging population. As COVID19 forced us to isolate ourselves, we are in a better position to understand consequences of social distancing. The recent literature showed that older incarcerated adults are particularly at risk of health-related complications due to isolation in the prison environment, reducing their social capital. Mental and physical health can be severely affected by loneliness and social isolation, especially in prison. Methods Our qualitative study investigates the view of older persons deprieved of their liberty on loneliness and social isolation pertaining to their mental health. We interviewed 57 older participants, including imprisoned individuals and forensic patients, following a semi-structured interview guide. During the data management and data analysis process, we excluded 7 interviews which were of poorer quality. Thereafter, we analyzed the remainders following a thematic approach. Results Most interviewees experience loneliness following lack of significant human relationships in prison. Making friends appears to be a challenge for all the participants, because, for one thing, they do not find people with similar interests. Also, secure institution setting aggravates isolation due to the restrictions of movement placed such as rules concerning movement between floors, hindering intimate relationship, and separation between friends. Moreover, contact with prison personnel is limited and lack social capital (e.g. trust). Conclusion To our knowledge, this study is one of the first to present incarcerated persons’ perspective on loneliness, social isolation and poor social capital in the Swiss prison setting. These has been reported to cause health problems both somatic and psychological. Our participants experience these deleterious factors in detention. As prisons have the possibility to become a health-promoting environment through connectedness, friendship, and trust promotion, stakeholders need to better their social capital

Suicide of prison convicts – risk factors and theoretical models

Suicid u zatvoru predstavlja jedan od vodećih uzroka smrti osu đenih, sa stopom od dva do devet puta viša nego u opštoj populaciji. Reč je o multidimenzionalnom problemu koji zahteva sistematski postavljene preventivne odgovore i posvećenost preventivnim aktivnostima na ra zličitim nivoima. Kako konačnom izvršenju suicida može prethoditi sadejstvo mno gih faktora rizika socio-demografske, psihosocijalne, institucionalne, psihijatrijske i kriminološke prirode, ovaj fenomen se može razumeti kroz integrativni pristup, uvažavajući postojeće teorijske modele u tri osnovna domena: penološkom, kroz „Model deprivacija“, „Model unosa“ i Kombinovani model; sociološkom, kroz primenu Dirkemovog modela suicidalnosti na zatvorski kontekst; i psihološkom, kroz Interpersonalnu teoriju, Teoriju stresa i Teoriju reaktivne agresivnosti. Cilj rada jeste pregled razmera problema suicidalnosti osuđenih kroz povezivanje faktora rizika različitim teorijskim modelima koji objašnjavaju etiologiju suicida u zatvoru. U radu se koriste analiza i sinteza teorijskih i empirijskih nalaza kroz proučavanje relevantne literature u različitim naučnim izvorima podatakaSuicide in prison represents one of the leading causes of death among inmates, with a rate two to nine times higher than in the general population. This is a multidimensional problem that requires systematically established preventive responses and dedication to preventive activities at different levels. Since many risk factors of socio-demographic, psychosocial, in stitutional, psychiatric, and criminological nature can precede the act of committing suicide, this phenomenon can be understood through an integrative approach through, existing theoretical models covering three domains: the penological domain, through the “Deprivation Model”, “Importation Model”, and Combined Model; the sociological domain, through the application of Durkheim’s model of suicidality to the prison context; and the psychological domain, through Interpersonal Theory, Theory of Stress, and Theory of Reactive Aggressiveness. The aim of this paper is to review the scope of the problem of suicide among inmates by linking risk factors to different theoretical models that explain the etiology of suicide in prison. The paper uses analysis and synthesis of theoretical and empirical findings through the study of relevant literature from different scientific data source

Risk factors for suicide in prisons : an updated systematic review and meta-analysis

Background Rates of suicide among people in prison are elevated compared with people of similar age and sex who are living in the community. Improving assessments and interventions to reduce suicide risk requires updated evidence on risk factors. We aimed to examine risk factors associated with suicide in prisoners. Methods We did an updated systematic review and meta-analysis of risk factors for suicide among people in prison. We searched five biblographic databases for articles published between Jan 1, 2006, and Aug 13, 2020, and one database for articles published between Jan 1, 1973, and Aug 13, 2020. Eligible studies reported risk factors in individuals who died by suicide while in prison and in controls from the general prison population. Two reviewers independently extracted data for each study using a standardised form. We calculated random-effects pooled odds ratios (ORs) for the association of suicide with demographical, clinical, criminological, and institutional risk factors, and investigated heterogeneity using subgroup and meta-regression analyses. This systematic review is registered with PROSPERO, CRD42020137979. Findings We identified 8041 records through our searches, and used 77 eligible studies from 27 countries, including 35 351 suicides, in the main analysis. The strongest clinical factors associated with suicide were suicidal ideation during the current period in prison (OR 15·2, 95% CI 8·5–27·0), a history of attempted suicide (OR 8·2, 4·4–15·3), and current psychiatric diagnosis (OR 6·4, 3·6–11·1). Institutional factors associated with suicide included occupation of a single cell (OR 6·8, 2·3–19·8) and having no social visits (OR 1·9, 1·5–2·4). Criminological factors included remand status (OR 3·6, 3·1–4·1), serving a life sentence (OR 2·4, 1·3–4·6), and being convicted of a violent offence, in particular homicide (OR 3·1, 2·2–4·2). Interpretation Several modifiable risk factors, such as psychiatric diagnosis, suicidal ideation during the current period in prison, and single-cell occupancy, are associated with suicide among people in prison. Preventive interventions should target these risk factors and include improved access to evidence-based mental health care. Understanding other factors associated with suicide might improve risk stratification and resource allocation in prison services. Funding Wellcome Trust, National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley

The Relationship between Age and Suicidal Thoughts and Attempted Suicide among Prisoners

Background Suicide is a major problem across the lifespan, yet rates are highest among middle-aged and older adults; a trend which remains relatively stable across varying sociological settings, including prisons. Despite this understanding, there is limited knowledge on the nature of suicidal thoughts and attempts among older prisoners, especially with respect to how they compare to younger counterparts. The present study aimed to increase insight into the relationship between age and suicidal thoughts and attempted suicide among prisoners, with particular focus on factors that may explain age-based variability. Results Cross-sectional data were drawn from a nationally representative sample of 18,185 prisoners housed within 326 prisons across the United States. In general, analyses revealed that: (a) attempted suicide was more commonly reported among younger prisoners, while suicidal ideation was more commonly reported among older prisoners; (b) the relationship between age and probability of reporting suicidal thoughts and behavior is curvilinear; (c) younger and older prisoners exhibit somewhat differing predictive patterns of suicidal thoughts and behavior (e.g., physical illness is directly associated with suicidal history for younger prisoners, whereas the effect of physical illness on suicidal history for older prisoners is mediated by depression). Conclusions There is evidence to suggest that suicidal thoughts and behavior may manifest differently for younger and older prisoners, with differing patterns of risk. More research is needed on age-based variability in suicidal thoughts and attempted suicide among prisoners, as well as those factors that might explain this variability. Importantly, future research must continue to investigate the nature of suicidal thoughts and behavior among older prisoners

Psychosocial factors in prisoner suicide in European prisons: A systematic review and meta-Analysis

El material complementario está disponible en https://doi.org/10.5093/apj2022a13En el presente artículo se identifican las variables más influyentes de la conducta suicida de presos en prisiones europeas. Para ello se realizó una búsqueda bibliográfica desde 2010 en las bases de datos de Web of Science (Colección Principal), Scopus, Psicodoc y la plataforma ProQuest (PsycExtra, Psychology Database, PsycArticle, Criminology Collection y Psy- cINFO), seleccionando artículos y revisiones, con muestras de reclusos adultos con conductas suicidas. Se excluyeron artículos con muestras de menores, no reclusos y en cárceles no europeas. Los resultados obtenidos con 8,468 reclusos describen el historial previo como el factor de riesgo de suicidio más relevante, siendo el apoyo familiar el factor protec- tor más relevante. Se observa insuficiente investigación sobre la influencia del sexo en la conducta suicida, así como una escasez de estudios con suficiente muestra reclusa de los diferentes países europeos.In this article, the most influential variables of suicidal behaviour in prisons in Europe are identified. To this end, a literature search was conducted from 2010 in the databases of Web of Science (Core Collection), Scopus, Psicodoc and the ProQuest platform (PsycExtra, Psychology Database, PsycArticle, Criminology Collection, and PsycINFO), selecting articles and reviews, with samples of adult inmates with suicidal behaviour. Articles with samples of juveniles, non-prisoners and non-European prisons were excluded. The results obtained with 8,468 inmates describe prior history as the most relevant risk factor for suicide, with family support being the most relevant protective factor. There is insufficient research on the influence of gender on suicidal behaviour, as well as a scarcity of studies with a sufficient sample of inmates from different European countries

Mortalitet osuđenih tokom izvršenja kazne zatvora

Право на живот представља једно од основних људских и природних права, које је признато бројним декларацијама и документима, а његови најважнији облици заштите су међународноправни, уставни и кривичноправни. Међутим ово право није усмерено само на слободне људе, већ и на особе лишене слободе. Како се у затвору често говори као о установи у којој су присутни недовољно добри санитарни услови, болести, депривације, лоше одржавање установе, пренасељеност, која може довести и до смањења контроле од стране особља, може доћи и до повећања насилних инцидената који за последицу могу имати смрт. Морталитет особа лишених слободе најчешће настаје као последица природних болести, самоубистава, убистава али и поступања страже. Предмет овог рада је морталитет осуђених и отпуштених током и након извршења казне затвора, док су циљеви и задаци рада упознавање са етиолошким и феноменолошким карактеристикама морталитета осуђених у затвору али и бивших осуђених које могу да укажу на правац осмишљавања и примене превентивних мера, ради редукције и елиминације предметног проблема.The right to life is one of the fundamental human and natural rights, recognized by numerous declarations and documents and its most important form of protection is the criminal law. However, this right is not limited solely to free people, but also those deprived of their liberty. As the prison is often referred to as an institution with insufficient sanitary conditions, presence of illness, deprivation, poor maintenance of the institution, overcrowding, which can lead to a decrease in control by staff, there may be an increase in violent incidents that can result in death. The mortality rate in people deprived of liberty most often occurs as a consequence of natural diseases, suicides, murders, but also the actions of guards. The subject of this paper is the mortality rate of convicts and the released during and after serving a prison sentence, while the objectives and tasks of the paper comprise recognition of the etiological and phenomenological characteristics of the mortality rate of convicts in prison and former convicts, which may indicate the direction of the design and implementation of preventive measures to reduce and eliminate the subject in question

Challenges in the mental health care of older incarcerated persons

Background: The number of older incarcerated adults has exponentially risen within the past two decades. Even though they still represent a minority amongst the general prison population, they require vast amount of resources from prison mental health services. Their health needs are higher compared to the general population and to younger incarcerated adults. At the same time, we lack detailed knowledge on their needs and the applicability of current interventions to this particular subgroup. We therefore systematically explored their mental health needs profile with a specific focus on substance use issues. Moreover, a major limitation in the integration of literature on older incarcerated adults is the missing shared definition of this age group. For this reason, we assessed the problems of defining the older population and compared current understandings and arguments provided to support these choices. In addition, in the Swiss prison context, the number of older adults mandated to psychotherapeutic treatment has risen the most drastically. The overall goal of these court-mandated treatment orders is to reduce risk of recidivism by treating mental health disorders that stand in direct connection with the crime committed. Such interventions come with specific challenges due to aspects such as the coercive and restrictive nature of prison environment, the involuntary admission to psychotherapeutic treatment, as well as the therapist’s dual role to care and control. To date, we lack research exploring these factors on psychotherapeutic interventions, which could support mental health professionals in integrating these challenges into their clinical practice. This thesis therefore investigated the experiences of older incarcerated adults and mental health professionals with court-mandated treatment orders to explore current challenges and shortcomings in the delivery of psychotherapeutic and psychiatric treatment. Methods: Systematic reviews of current literature were performed with the aim to investigate prevalence rates of mental health disorders with a specific focus on substance use issues as well as to shed light into current ways of defining this older age group, arguments used to support this choice, and the empirical evidence to back these definitions. This research project further used a mixed-methods approach, collecting qualitative and quantitative data from incarcerated persons as well as mental health professionals working in Swiss and Canadian correctional contexts. Quantitative data collection mainly encompassed data extraction from medical records. Additionally, pilot studies for the applicability of the routine outcome measure HoNOS-secure, the screening tool PHQ-9, and the structural diagnostic interview MINI were conducted. For qualitative data collection, semi-structured interviews were performed with older incarcerated adults receiving mental health care as well as mental health professionals working with patients who offended. Results: Systematic review methodology revealed that definitions of the older age group vary and hamper the integration of already limited research. Based on our findings, we suggest the use of age 50 as cut-off to define the older age group for research and health care planning on national levels. Additionally, we confirmed the high rates of mental health disorders amongst this subgroup with psychiatric diagnoses of cognitive issues, alcohol misuse, and affective disorders being relatively more common in comparison to younger incarcerated adults. Qualitative interviews showed that patients and mental health professionals likewise struggled with integrating the involvement of the justice system into their psychotherapeutic work. In particular, limits to confidentiality needed to be handled transparently. Patients accepted mental health professionals sharing information with judicial authorities, as long as their private details were protected that were of no relevance to authorities’ decision-making. Additionally, when mental health professionals accomplished to emphasize their caring role over their controlling responsibilities, patients reported beneficial treatment experiences. This was achieved by a supportive and respectful attitude that aimed at promoting the patient’s well-being and progress in life. Therapists needed to master the balancing act between responding to patient’s individual needs within the predefined framework of mandated interventions. When therapist managed to respond to these personal needs, relief from psychological burden and therefore positive effects from treatment participation motivated them to remain and engage in therapy. This psychological burden frequently originated in their difficulties in dealing with deprivation of freedom, harshness of prison environments, as well as accepting and understanding their crimes committed and their psychiatric diagnoses. Last, external pressures imposed by judicial authorities strongly affect patients’ experiences with psychotherapeutic treatment. Predefined goals and authorities’ decision-making currently lacks clarity and transparency. To augment patients’ motivation to participate in treatment, the application of these external motivators should be used more favorably. Discussion: This research project contributes to much-needed research on mental health of older incarcerated adults and their experiences with court-mandated interventions. We confirmed high prevalence rates of older incarcerated persons’ mental health issues and outlined current definitions applied to this subgroup. This to advance a shared understanding of this population to facilitate the integration of available literature. Further, we showed that the involvement of the justice system substantially affects psychotherapeutic processes. We confirmed previous assumptions that the way MHPs integrate coercion and control in their clinical work, alters patients experiences with psychotherapy. We outline some pressing shortcomings of current treatment delivery and propose some strategies in alleviating the negative impact of external pressures. By this, we can potentially enhance patient motivation and alliance quality to improve clinical and criminal outcomes of incarcerated persons mandated to treatment. By increasing the effectiveness of such court-mandated treatments, we consequently not only enhance well-being of the individual patient but concurrently increase public’s safety