Prison inmates with major psychiatric disorders are more likely than those without to have had previous incarcerations. The authors recommend expanding interventions to reduce recidivism among mentally ill inmates. They discuss the potential benefits of continuity of care reentry programs to help mentally ill inmates connect with community-based mental health programs at the time of their release, as well as a greater role for mental health courts and other diversion strategies.

Objectives-Advanced care planning (ACP) is a process that includes discrete steps of contemplation, discussions, and documentation. Whereas prior studies have assessed barriers to single ACP steps, this study explored barriers to multiple ACP steps and identified common barrier themes that impede older adults from engaging in the process as a whole. Design-Descriptive study Setting-San Francisco County, General Medicine clinicParticipants-143 English/Spanish-speakers, aged ≥50 years (mean 61), enrolled in an advance directive preference study.Measurement-Six months after reviewing two advance directives, self-reported ACP engagement and barriers to each ACP step were measured with both open-and closed-ended questions using quantitative and qualitative (thematic content) analyses.Results-Forty percent of participants did not contemplate ACP, 46% did not discuss with family/friends, 80% did not discuss with their doctor, and 90% did not document ACP wishes. Six barrier themes emerged: perceiving ACP as irrelevant (84%); personal barriers (53%); relationship concerns (46%); information needs (36%); health encounter time constraints (29%), and problems with advance directives (29%). Some barriers were endorsed at all steps (e.g., perceiving ACP as irrelevant). Others were endorsed at individual steps (e.g., relationship concerns for family/friend discussions, time constraints for doctor discussions, and problems with advance directives for documentation).

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An exponential rise in the number of older prisoners is creating new and costly challenges for the criminal justice system, state economies, and communities to which older former prisoners return. We convened a meeting of 29 national experts in correctional health care, academic medicine, nursing, and civil rights to identify knowledge gaps and to propose a policy agenda to improve the care of older prisoners. The group identified 9 priority areas to be addressed: definition of the older prisoner, correctional staff training, definition of functional impairment in prison, recognition and assessment of dementia, recognition of the special needs of older women prisoners, geriatric housing units, issues for older adults upon release, medical early release, and prison-based palliative medicine programs.