BackgroundHigh levels of psychiatric morbidity in prisoners have been documented in many countries, but it is not known whether rates of mental illness have been increasing over time or whether the prevalence differs between low–middle-income countries compared with high-income ones.AimsTo systematically review prevalence studies for psychotic illness and major depression in prisoners, provide summary estimates and investigate sources of heterogeneity between studies using meta-regression.MethodStudies from 1966 to 2010 were identified using ten bibliographic indexes and reference lists. Inclusion criteria were unselected prison samples and that clinical examination or semi-structured instruments were used to make DSM or ICD diagnoses of the relevant disorders.ResultsWe identified 109 samples including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models, and we found a pooled prevalence of psychosis of 3.6% (95% CI 3.1–4.2) in male prisoners and 3.9% (95% CI 2.7–5.0) in female prisoners. There were high levels of heterogeneity, some of which was explained by studies in low–middle-income countries reporting higher prevalences of psychosis (5.5%, 95% CI 4.2–6.8;P=0.035 on meta-regression). The pooled prevalence of major depression was 10.2% (95% CI 8.8–11.7) in male prisoners and 14.1% (95% CI 10.2–18.1) in female prisoners. The prevalence of these disorders did not appear to be increasing over time, apart from depression in the USA (P=0.008).ConclusionsHigh levels of psychiatric morbidity are consistently reported in prisoners from many countries over four decades. Further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and examine trends over time within nations with large prison populations.

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An actuarial risk assessment instrument can be considered valid if independent investigations using novel samples can replicate the findings of the instrument's development study. In order for a study to qualify as a replication, it has to adhere to the methodological protocol of the development study with respect to key design characteristics, as well as ensuring that manual-recommended guidelines of test administration have been followed. A systematic search was conducted to identify predictive validity studies (N = 84) on three commonly used actuarial instruments: the Violence Risk Appraisal Guide (VRAG), the Sex Offender Risk Appraisal Guide (SORAG), and the Static-99. Sample (sex, age, criminal history) and design (follow-up, attrition, recidivism) characteristics, as well as markers of assessment integrity (scoring reliability, item omissions, prorating procedure), were extracted from 84 studies comprising 108 samples. None of the replications matched the development study of the instrument they were attempting to cross-validate with respect to key sample and design characteristics. Furthermore none of the replications strictly followed the manual-recommended guidelines for the instruments' administration. Additional replication studies that follow the methodological protocols outlined in actuarial instruments' development studies are needed before claims of generalizability can be made.

The role of psychosocial and structural occupational factors in mental health service provision has broadly been researched. However, less is known about the influence of employees’ occupational factors on inmates in correctional treatment settings that mostly seek to apply a milieu-therapeutic approach. Therefore, the present study investigated the relationships between occupational factors (job satisfaction, self-efficacy, and the functionality of the organizational structure) and prison climate, the number of staff members’ sick days as well as inmates’ treatment motivation. Employees (n = 76) of three different correctional treatment units in Berlin, Germany, rated several occupational factors as well as prison climate. At the same time, treatment motivation of n = 232 inmates was assessed. Results showed that higher ratings of prison climate were associated with higher levels of team climate, job satisfaction and the functionality of the organizational structure, but not with self-efficacy and sick days. There was no significant relationship between occupational factors and the perceived safety on the treatment unit. Inmates’ treatment motivation was correlated with all aggregated occupational factors and with average sick days of staff members. Outcomes of this study strongly emphasize the importance of a positive social climate in correctional treatment units for occupational factors of prison staff but also positive treatment outcomes for inmates. Also, in the light of these results, consequences for daily work routine and organizational structure of prisons are discussed.

La valoración del riesgo de violencia es un requisito fundamental en la toma de decisiones profesionales que implican prevenir, intervenir o informar sobre la conducta de las personas. El uso de herramientas estructuradas mejora la precisión de las evaluaciones basadas en el juicio clínico en contextos psiquiátricos, penitenciarios y jurídicos. Este estudio presenta resultados de la primera encuesta sobre el uso de herramientas de evaluación del riesgo de violencia y sobre su utilidad percibida en España. Las escalas de psicopatía (PCL-R y PCL:SV) y el HCR-20 encabezaron la lista de las herramientas más usadas tanto por elección personal como por requisito institucional. Se ofrecen datos novedosos sobre las prácticas profesionales de evaluación del riesgo de violencia que pueden orientar a los profesionales que desempeñan su tarea en contextos sanitarios, correccionales y forenses, donde los instrumentos estructurados son frecuentemente usados para asistirlos en la toma de<br />decisiones.

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In the present study, we examined the effects of implementing the suicide risk screening instrument SIRAS in a pre-trial detention facility for men in Berlin. Within a period of 3 months, all newly arriving prisoners were screened (n = 611) by social workers or prison officers. Cases of elevated suicide risk were immediately referred to a psychologist or medical staff the same day. Follow-up over a 6-month period showed that 14% of all incoming prisoners were classified as high-risk individuals. These individuals received significantly more psychological and psychiatric treatment and were significantly more likely to be accommodated in crisis intervention rooms and emergency community accommodation (shared prison cells). In addition, it was found that despite the increased amount of treatment in the high-risk group, the number of specific measures did not increase significantly compared to the pre-implementation phase (N = 1,510).

Purpose. Relapse prevention is an important goal in correctional settings. Although there is strong evidence for the effectiveness of certain treatment programs for juvenile offenders, those for adults lack such evidence. This study evaluated the effectiveness of a risk-need-responsivity (RNR)-based intervention.Methods. A quasi-experimental, observational study design and cox regression analysis were used to compare treated violent and sexual offenders (n = 171) with untreated offenders (n = 241).Results. Both groups were observed for an average of 7.9 years. Recidivism rates of treated offenders (11.7%, n = 20) were similar to those of control offenders (15.8%, n = 38; p = .25). When controlling for confounding variables, the hazard of recidivism in the treatment group was 5.2% lower than that in the control group. Subdividing the treatment group resulted in lower hazard ratios for offenders still in therapy when released and offenders cancelling therapy. However, none of the group differences was statistically significant. Conclusion.Our results show that control and RNR-based treatment groups had comparable recidivism rates with a trend towards a positive treatment effect, especially for people in outpatient treatment. However, criminal history, age at the start of followup, and actuarial risk of recidivism were significantly associated with recidivism. Future research needs to apply elaborate methodological approaches to detect robust treatment effects and consider different criteria of treatment effectiveness. Furthermore, the influence of prison climate, motivational factors, intervention quality, and factors supporting the success of outpatient treatment should be considered in future studies of larger offender samples.