The humane containment of mentally disordered prisoners .

In many western countries, including New Zealand (NZ), the humane containment of mentally disordered prisoners (MOP) has became a topical issue in recent years. The current review of the literature demonstrated that there is little agreement regarding what measures are required to effectively address this somewhat complex matter and that there is a dearth of empirical research in this area, especially in NZ. The purpose of the current research was to empirically investigate this issue, within the framework of prisoners' rights in NZ, to ascertain whether there is an inherent gap between MOP's legal entitlements to mental health treatment (MHT) and the practical fulfilment of these rights. First, this was quantified by establishing an estimated base rate of clinically diagnosed MOP, and then by statistically verifying such persons’ access to MHT via an in-depth analysis of both the detection and referral process and the treatment delivery system currently in operation to service the mental health needs of prisoners at a local medium security men's prison in NZ. A randomised sample of one hundred medium security male inmates was obtained to ascertain a base rate of clinically MOP. Interviews were conducted, using the structured clinical interview for the OSM-111-R (SCIO). The results showed that 62.8% of the final sample (n=94) had a clinically diagnosed disorder and that co­ occurring disorders, especially substance use comorbidity, were prevailing issues. Analysis of the detection procedure involved a three-tiered examination; perusing the accuracy rate of detection, establishing what variables influenced a referral, and comparing these components with the referral process for rehabilitative MHT. The detection accuracy of participants with a substance use disorder was found to be significant, however, the detection rates of MOP and of participants requiring rehabilitative MHT for sexual or violent offence related issues were not found to function beyond the level of chance. Multivariate analysis revealed that visible signs of psychopathology, mental health history and atypical criminal characteristics increased the likelihood of detection. However, the majority of the MOP in this study were not detected. The examination of the treatment delivery system comprised a similar three-tiered analysis. The treatment delivery rate for MOP was not found to be statistical significant and neither was the overall delivery of rehabilitative MHT. Factors involved in treatment delivery were also explored and the findings collectively showed that the delivery of MHT for MOP primarily functioned as crisis intervention rather than humane containment. The practical implications of these research findings are discussed in relation to MOP's moral and legal entitlements to MHT and recommendations are made

Clinical differences between younger and older adults with HIV/AIDS starting antiretroviral therapy in Uganda and Zimbabwe: a secondary analysis of the DART trial

Clinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low-income African countries