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Aging and mental illness both represent significant public health challenges for incarcerated people in the USA. The COVID-19 pandemic has further highlighted the vulnerabilities of incarcerated people because of the risks of infectious disease transmission in correctional facilities. Focusing on older adults with mental illness, this paper aims to examine efforts to decarcerate US correctional facilities during the COVID-19 pandemic and whether these approaches may lead to sustainable reforms beyond the pandemic.

A narrative literature review was conducted using numerous online resources, including PubMed, Google Scholar and LexisNexis. Search terms used included “decarceration pandemic,” “COVID-19 decarceration,” “aging mental illness decarceration,” “jails prisons decarceration,” “early release COVID-19” and “correctional decarceration pandemic,” among others. Given the rapidly changing nature of the COVID-19 pandemic, this narrative literature review included content from not only scholarly articles and federal and state government publications but also relevant media articles and policy-related reports. The authors reviewed these sources collaboratively to synthesize a review of existing evidence and opinions on these topics and generate conclusions and policy recommendations moving forward.

To mitigate the risks of COVID-19, policymakers have pursued various decarceration strategies across the USA. Some efforts have focused on reducing inflow into correctional systems, including advising police to reduce numbers of arrests and limiting use of pretrial detention. Other policies have sought to increase outflow from correctional systems, such as facilitating early release of people convicted of nonviolent offenses or those nearing the end of their sentences. Given the well-known risks of COVID-19 among older individuals, age was commonly cited as a reason for diverting or expediting release of people from incarceration. In contrast, despite their vulnerability to complications from COVID-19, people with serious mental illness (SMI), particularly those with acute treatment needs, may have been less likely in some instances to be diverted or released early from incarceration.

Although much has been written about decarceration during the COVID-19 pandemic, little attention has been paid to the relevance of these efforts for older adults with mental illness. This paper synthesizes existing proposals and evidence while drawing attention to the public health implications of aging and SMI in US correctional settings and explores opportunities for decarceration of older adults with SMI beyond the COVID-19 pandemic.

There is a dissonance between the purposes and services of the justice system compared to the needs of suicidal people or those with mental health problems. Correctional authorities are faced with sometimes difficult responsibilities when they have to incarcerate those who fall through the gaps in the social safety net. Correctional Service Canada’s (CSC) mandate is to carry out the sentences of two or more years imposed by the Court; consequently that federal authority may have more time and means than its provincial counterparts receive for inmates on remand or serving shorter sentences. CSC developed strategies for inmates with mental health problems and, specifically, an exhaustive suicide prevention program. The implementation of all the components of the mental health strategy is not completed but it is based on good planning. With respect to suicide prevention activities, these are mainly based on screening the most vulnerable inmates at the time of intake, but they cover a larger spectrum.

The purpose of this paper is to identify the psychosocial approaches that have been studied and for which positive outcomes have been reported for individuals with schizophrenia in correctional and forensic psychiatric settings.

A rapid review of the literature was undertaken. A search was conducted on MEDLINE and PsycNET electronic databases. Each identified approach was analyzed to define their types and components.

In total, 24 studies pertaining to 18 different psychosocial approaches were identified. Half of the studies used a quasi-experimental design with control group. Most frequent outcomes reported were improvements in knowledge about illness and problem solving. Seven studies reported positive outcomes related to issues more specific to this population (violence, aggression, and recidivism). Approaches associated with these studies used mainly traditional cognitive behavior therapy and cognitive remediation. The focus was on neurocognition, social cognition, social skills, emotion management and problem solving.

This rapid review may enlighten clinical settings on psychosocial approaches for which positive outcomes have been reported with individuals with schizophrenia in correctional and forensic psychiatric settings. The picture obtained supports the idea of using integrated rehabilitation approaches that cover the aforementioned intervention focuses with this population.

A significant contribution of the rapid review is based on the analysis of the psychosocial approaches identified. This process offers a closer look at the nature and content of the approaches used according to the outcomes reported.

Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a “deprivation state.” The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm.

This cross-sectional study took place at Geneva’s pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014).

Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment.

The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio – and these must be looked into further as contributors. Additionally, qualitative methods such as semi-structured interviews and focus groups could delineate the impact of overcrowding on prisoner well-being and self-harm potential.

The authors observed a significant increase in self-harm and self-strangulation/hangings over time, and overcrowding was significantly associated with self-strangulation/hangings (but not with all self-harm events). Overcrowding can impose destructive effects on the psychological and behavioral well being of inmates in prison, influencing a myriad of emotional and livelihood factors that predispose to harmful behavior.

This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

Relevant literature was searched using MEDLINE, PsycINFO and Google in addition to Arabic search engines for information. Due to the shortage of scholarly articles on the subject, we broadened our search to publications from human rights organisation and articles in the mainstream press. We estimated the total carceral population in the member countries of the Arab league at 338,500 prisoners, over 46,000 of whom could be suffering from severe mental illness. We relied on indirect indicators of mental health services such as the quality of medical care in general, accounts of prison conditions by prisoners and their families, and the abundant literature on human rights abuses. Despite a grim overall picture, we highlight signs of improvement in recent years. Psychiatrists working in Arabic prisons face a number of challenges.We comment on directions for the future in the field of correctional psychiatry in the Arab countries including from the perspective of research.

The purpose of this paper is to discuss five domains impacted by the transformation of correctional mental health care in the USA: public health, public safety, legal obligations, fiscal responsibility and ethical standards, as well as critical issues such as administrative segregation, suicide prevention and reentry planning.

In the last four decades, the USA has seen a sizable growth in its criminal justice system and corrections population. It has also seen reductions in civil and community-based mental health care. Persons with mental disabilities have come to represent a highly disproportional segment of the corrections population. The paper discusses the implications and underlying causes of these developments as well as recent responses to them.

This set of circumstances is starting to change the mission of correctional health services from crisis intervention and suicide prevention to include preparation for the inmate's almost inevitable return to the community.

Such changes have led to further developments in correctional mental health care, in particular, policy designed to treat mental illness, reduce its destructive outcomes such as suicide, and facilitate successful reentry into the community in attempts to reduce recidivism and improve clinical outcomes. Mental health care professionals working within corrections have likewise faced ethical challenges in effectuating treatment.

This article reviews the international literature of the last two decades on self‐injurious behaviour in prisons and jails and introduces the risk factors associated with this behaviour. Studies from a variety of countries investigated different samples (e.g. in jails or prisons; female or male inmates). We only chose those studies using a control group of inmates without self‐injurious behaviour. The findings on potential risk factors for self‐injurious behaviour are largely contradictory because of the differences in sample selection and dependent variables (deliberate self‐harm without suicidal intent vs. suicide attempts). We also discuss some methodological problems in predicting self‐injurious behaviour.

This study aims to determine the prevalence of insomnia as well as its association with the quality of life of the inmates in a Nigerian prison. Prisoners are a disadvantaged group of people whose needs are often unmet. Many authors have focussed on investigating the prevalence and pattern of psychiatric morbidity, as well as substance use among prisoners. However, sleep disorders, which can predispose or precipitate psychiatric disorders, have been largely neglected in research. The relationship between insomnia and quality of life (QoL) among the general population has been documented but similar investigations have yet to be conducted among the prisoner population.

This was a cross-sectional study with 300 male prisoners at the Ibara prison, Abeokuta, Nigeria who were not diagnosed with depressive, generalized anxiety or post-traumatic stress disorders. Each respondent was interviewed with a sociodemographic proforma, Insomnia module of the Schedule for Clinical Assessment in Neuropsychiatry and the brief World Health Organisation Quality of Life questionnaire.

About half of the respondents (45.7%) met diagnostic criteria for insomnia. A diagnosis of insomnia and some sleep-related variables were significantly associated with QoL.

All the possible correlates of insomnia could not be investigated. Further research should be conducted to identify more correlates and investigate the impact of insomnia on prisoners’ lives.

Improvement of prison climate (relationships in prison, safety and order, contact with the outside world, facilities, meaningful activities and autonomy) may mitigate insomnia among prisoners. Prison psychiatry in Nigerian correctional centres should be made a priority.

The findings have brought to light the need to address the current social welfare system in place for Nigerian correctional centres.

The study provided information on the prevalence of insomnia and poor QoL among prisoners in a Nigerian correctional facility.

South America is a heterogeneous continent, with diverse prison realities. Its prison population is estimated at 600,000 inmates, of whom 10,000 are declared insane. Physical and mental health care supplied to the inmates is precarious and preventive programs in progress are rare. The authors’ comment on the Roman Law tradition and describe the situation in Brazil and Argentina, from the point of view of their legal backgrounds. They also consider the kind of mental health resources found and the types of treatment offered, mainly in Forensic Psychiatric Hospitals. Their conclusion emphasizes the need to improve the conditions of penitentiaries in South America, which, because of their deficiencies, often violate the human rights of prisoners.

People living with opioid use disorder (OUD) disproportionately encounter the criminal justice system. Although incarcerated individuals with OUD face higher risk for withdrawals, relapses and overdoses, most jails fail to offer comprehensive medications for OUD (MOUD), including recovery support services and transition of care to a community provider. The purpose of this paper is to describe the development and implementation of a comprehensive MOUD program at a large county jail system in Maricopa County, Arizona.

The authors used the Sequential Intercept Model (SIM) to develop a community-based, multi-organizational program for incarcerated individuals with OUD. The SIM is a mapping process of the criminal justice system and was applied in Maricopa County, Arizona to identify gaps in services and strengthen resources at each key intercept. The program applies an integrated care framework that is person-centered and incorporates medical, behavioral and social services to improve population health.

Stakeholders worked collaboratively to develop a multi-point program for incarcerated individuals with OUD that includes an integrated care service with brief screening, MOUD and treatment; a residential treatment program; peer support; community provider referrals; and a court diversion program. Recovery support specialists provide education, support and care coordination between correctional and community health services.

OUD is a common problem in many correctional health centers. However, many jails do not provide a comprehensive approach to connect incarcerated individuals with OUD treatment. The Maricopa County, Arizona jail system opioid treatment program is unique because of the ongoing support from recovery support specialists during and after incarceration.