Mental health and spirituality of female prisoners in a women’s prison in Chile

Background The mental health of prisoners is of growing global health importance as prison populations increase exponentially. Though additional risks of mental disorder and poor mental wellbeing of prisoners are now better understood, women, especially those in low and middle income countries, and in regions outside North America and Europe are underrepresented in prison mental health studies. There is strong evidence of associations between religion and spirituality (RS) and mental health in the general population in North America and Europe. This thesis aims to measure and explain any associations between RS and depression and mental wellbeing among female prisoners in Chile. Methods An explanatory sequential mixed methods approach comprised an initial quantitative study linked to a subsequent qualitative study. In the quantitative phase, 94 randomly sampled female prisoners in Chile participated in a pooled two-stage cross-sectional survey which collected data on background, mental health and RS variables. Mental wellbeing was measured using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Self-report depression data were collected and 40 prisoners were also administered the Mini International Neuropsychiatric Interview (MINI). RS variables included: affiliation, personal importance, involvement (frequency of attending services), benefits and beliefs. The design of the qualitative phase was informed by quantitative study findings. Six prisoners who had participated in the cross-sectional survey attended one of two focus groups. Individual in-depth interviews were conducted with 3 prison chaplains and 2 health professionals from the prison health centre. Topic guides for focus groups and interviews were used to facilitate discussions on the mental health and RS of female prisoners and to elicit views on selected findings from the quantitative study. Logistical regression techniques were used to statistically test the hypothesis of no association between RS and depression and mental wellbeing. Audio-recorded qualitative data were transcribed in Spanish and analysed thematically in English. Results Of the 94 women, 11 (11.7%) reported a current professional diagnosis of depression, while major depression was confirmed in 13 (32.5%) of the 40 women assessed using the MINI. The women had a median WEMWBS score of 55 (IQR 43- 61) out of 70. Religiosity was high among the sample with 86 (91.5%) women affiliated to mainstream Christianity and 69 (73.4%) who considered RS to be personally very important. In a sample of 40 women, frequency of attendance at RS services was significantly higher in prison than during the year prior to incarceration (Wilcoxon Sign Ranks Test Z=3.1; p<0.002). No significant associations were found between depression and mental wellbeing, and the key RS variables. However, 61 (89.7%) women believed there was a connection between their mental health and spirituality. The qualitative data revealed differences within and between participant groups in understandings of mental health and RS terminology and concepts. Themes emerged around the prison determinants of mental health and the mental health effects of the female gender. Prisoners identified RS variables that influenced mental health which had not been measured in the survey. Explanations were found for the divergent survey results of the association between RS and mental health. The data showed how RS shapes prisoners’ help-seeking behaviour and attitudes to mental health care. Conclusion The association between RS and mental health among prisoners in Chile remains unclear but may differ from established patterns reported in non-prisoner populations. This a challenging area of study with an additional layer of complexity present in prison populations where there are high levels of religiosity and spirituality. Larger studies are needed to confirm the quantitative findings, while qualitative findings should lead to raised awareness of RS in the development of prison mental health strategies in accordance with the needs of a given population

Audit of Statutory Urgent Treatment at a High Security Hospital

The aim of the audit which is the subject of this article was to measure the use of statutory urgent treatment at one of England’s three high security hospitals (Rampton Hospital) against the standards set out in the Code of Practice (2008) and by the Mental Health Act Commission. Rampton Hospital is a large hospital which averaged around 400 beds during the audit period and has a catchment area of approximately one third of England. The hospital accommodates patients who suffer from a wide range of mental disorders, having directorates for mental illness, learning disability, personality disorder, women and (from 2004) ‘Dangerous and Severe Personality Disorder’. All patients are detained under the Mental Health Act 1983. It was submitted that the proper use of statutory urgent treatment is important to Rampton Hospital as an institution which accommodates patients presenting with the highest security needs owing to their risk to others

Study of Impact of COVID-19 on Mental Health and Wellbeing of Staff Working in a Forensic Mental Health Service

This study explored the impact of COVID-19 on the mental health and wellbeing and trust support of Tees Esk and Wear Valleys (TEWV) NHS forensic staff using an online google survey during the second wave of the pandemic. Survey respondents were a voluntary cross-sectional sample of 246 TEWV staff working in the forensic directorate staff; this included males (n = 60, 24.5%); with the majority of staff aged between 36–50 years (n = 99, 40.2%) and 50 years or older (n = 80, 32.5%). The results showed that staff working at home and on the front line were both affected by depression, stress and anxiety. Those most at risk were younger staff members. We concluded that the mental health and well-being of staff working should be a priority. It is important to consider targeted support that should be aimed at younger staff members to provide an open culture enabling for those who want support to have readily available signposted resources. Staff working in different settings may have experienced a different impact of COVID-19 on their mental health and wellbeing, and whilst some interventions might be successfully applied across the service, it would be beneficial to understand the unique needs of staff working in specific settings

Mental health in prisons in Latin America: The effects of COVID-19

Latin America is a vast region of the world. In 2022, it is estimated that nearly 620 million people live in 33 countries spanning almost 20 million km2 across North, South and Central America, and the Caribbean.1 These countries are united by their common historic cultural origins.2 It is estimated that Spanish is spoken by 400 million, and Portuguese by 200 million people in the region.2 Quechua is the most widely spoken indigenous language in the region, with around 8 million speakers; smaller numbers speak around 560 other indigenous languages such as Mayan, Guarani, and Nahuatl.2,3 The region was described as having a total gross domestic product (GDP) of almost 4.7 trillion US dollars in 2020, with substantial contributions from the four largest economies—Brazil, Mexico, Argentina, and Chile.4,5 However, Latin American countries are mainly considered developing nations.

Interventions for female drug-using offenders (Review)

Kumar KM,

Mental health intervention research in Latin American correctional settings: A scoping review

Background: The Latin American prison population has grown faster than anywhere else globally over the past two decades, reaching a total of 1.7 million people at any given time. However, research on mental health prevention and treatment interventions in Latin American prisons remains scarce. Aims: This study aimed to systematically review and synthesize research on prison mental health interventions conducted in the region. Methods: We used a two-stage scoping review design guided by the JBI Manual for Evidence Synthesis. Searches took place in December 2021 in nine databases using descriptors and synonyms. First, all prison mental health research in Latin America was retained. Secondly, using title and abstract screening, all research possibly related to interventions was retained for full text evaluation. Studies reporting interventions were assessed by country, language, institution, population, intervention type, intervention focus and outcomes. Results: N = 34 studies were included in this review. These were 13 case reports, seven expert consensus papers and 14 quantitative studies (four randomized controlled trials, nine cohort studies, one quasi-experimental study). Fourteen interventions were targeted at promoting prosocial behavior, seven studies each aimed to improve mental health and to treat substance use disorders. Six studies involved the treatment of sexual offending behavior, and 3 focused on reducing criminal recidivism. Psychoeducation (n = 12) and motivational interviewing (n = 5) were the most frequent intervention types studied. Promising data from trials showed that anger management, depression, substance use and reoffending could be successfully addressed through interventions. Conclusions: Implementation and effectiveness research of mental health interventions in Latin American prisons is scarce. Addressing mental health, substance use and prosocial behavior outcomes should be considered in future research. There is a particular dearth of controlled trials describing quantifiable outcomes

Six nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations

This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted

Pharmacological interventions for drug-using offenders : an update to a systematic review and meta-analysis

This updated systematic review assesses the effects of pharmacological interventions for drug-using offenders. Methods Systematic review protocols and conventions of the Cochrane Collaboration were followed to identify eligible studies. Studies were pooled in a meta-analysis to assess the impact of pharmacological interventions on drug use and criminal activity. An economic appraisal was conducted. Results The search strategies identified 22 studies containing 4372 participants. Meta-analyses revealed a small statistically significant mean difference favouring pharmacological interventions relative to psychological interventions in reducing drug use and criminal activity. When comparing the drugs to one another there were no significant differences between those included (methadone versus buprenorphine, naltrexone and cyclazocine). Conclusion Overall, the findings of this review suggest that methadone and naltrexone may have some impact on reducing drug use and reincarceration. Individual pharmacological drugs had differing (generally non-significant) effects. One study identified serious adverse events. Three studies reported cost and consequences information sufficient to conduct a full economic analysis but this was not comprehensive enough to be able to make judgements across all treatment options. Full economic analyses should be encouraged. The study findings were limited mainly to male adult offenders