Anja Dirkzwager’s research while affiliated with Vrije Universiteit Amsterdam and other places

Background Worldwide, the prevalence of mental health problems in prison populations is higher than in the general population. While prisons may provide opportunities to address mental health problems, the prison setting can also include obstacles to the actual delivery of interventions, such as mental health care staff deficiencies. A brief scalable psychological intervention such as the World Health Organization’s (WHO) Problem Management Plus (PM +) intervention, which is delivered by trained non-specialists, could be valuable in addressing common mental health problems in the prison setting. The primary aim of the study is to evaluate the feasibility and acceptability of PM + , adapted for use in Dutch remand prisons. The secondary aim is to examine barriers and facilitators for scaling up the adapted version of PM + in the Dutch prison setting. Method This single-blind pilot randomised controlled trial (RCT) will compare individual PM + with care-as-usual (PM + /CAU) to CAU only. Dutch-speaking remand prisoners (18 years or older; N = 60) who report an elevated level of psychological distress (K10 ≥ 16) will be included. The feasibility of the intervention will be reviewed using different measures such as recruitment success, intervention retention, protocol adherence, number of serious adverse events, and stakeholders' views. Participants will be assessed for self-reported anxiety, depression, self-identified problems, vulnerability for suicide and self-harm behaviour and post-traumatic stress disorder (PTSD) symptoms at baseline, one-week post-intervention and three-month follow-up. The pilot RCT will be followed by a process evaluation. For the process evaluation, stakeholders will be interviewed (N = 25), including 1) RCT participants, 2) PM + helpers, supervisors and trainers, 3) prison professionals, and 4) family members & friends of RCT participants. Data of the process evaluation will be analysed using reflexive thematic analysis. Discussion This pilot RCT will be the first to study the potential of WHO-developed scalable interventions aimed at reducing mental health problems within (Dutch) prisons. Results from this study could subsequently inform a potential full-powered RCT. Trial registration This trial is registered on ClinicalTrials.gov (number NCT05927987) on 13/06/2023.

Instead of focusing on the transition to work as an indicator of social integration after imprisonment, this study approaches reintegration as a process. The labour market paths of Dutch men were mapped using the number and type of transitions, their duration and order in the first four post-prison years. To identify seven clusters with diverse labour market paths, a distinction was made between various active labour market statuses (in school, employed) and passive labour market statuses (regular benefits, disability benefits, no formal income, detained). Characteristic of most clusters is that individuals experienced few transitions during the follow-up and spent little time in employment or in prison. These findings raise the question whether popular definitions of successful reintegration after imprisonment are realistic and point towards alternative definitions.

Background Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes. Methods This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis). Discussion We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release. Trial registration ClinicalTrials.govNCT05842330. Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.

In this paper, we study what factors contribute to the extent that detained individuals (a) perceive their time in detention as severe and (b) perceive their treatment by prison staff as procedurally just. More specifically, the aim of the study is to examine the antecedents of subjective severity of detention (SSD) and perceived procedural justice (PPJ) with the aim to identify individual and situational characteristics that contribute to such perceptions. Our analyses were based on data from the Prison Project (n = 1430), which includes detailed information on measures of SSD, and PPJ among Dutch males held in Dutch penitentiary institutions. Based on their SSD and PPJ scores, detained individuals were classified as belonging to one of four subgroups (reference group, high SSD, high PPJ, or high both). Using a large set of background variables, we found that older age, a less elaborate criminal history, no daily drug use before arrest, not having experienced any victimization by prison staff, and the personality traits of neuroticism, conscientiousness, and agreeableness were the most relevant antecedents for “high both” subgroup membership.

This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees’ encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement.

Mensen met een slechte lichamelijke en geestelijke gezondheid zijn oververtegenwoordigd in de gevangenispopulatie. Onduidelijk is of die gezondheidsproblemen er al waren voor de detentie, of juist in de gevangenis zijn ontstaan of verergerd. In een gematcht cohortonderzoek op basis van Nivel Zorgregistraties Eerste Lijn en gevangenisgegevens is de gezondheid van gedetineerden in het jaar voor en het jaar na hun detentie vergeleken met die van niet-gedetineerden. Gedetineerden bleken al voor hun detentie relatief vaak psychische en sociale problemen te hebben. De gevangenschap zelf veranderde daar niet veel aan. (Ex-)gedetineerden blijven een kwetsbare patiëntengroep die ook buiten de gevangenis extra aandacht behoeft.

Background: A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. Objective: The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. Methods: PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. Results: PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. Conclusions: PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population. International registered report identifier (irrid): DERR1-10.2196/35182.

BACKGROUND A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. OBJECTIVE The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. METHODS PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. RESULTS PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. CONCLUSIONS PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/35182

Recent scholarship suggests that detention may have differential effects depending on situational factors. This longitudinal study tests an integrative theoretical framework with the aim to identify the conditions under which detention deters from subsequent rule-violating behavior. We examined whether the effects of experienced sanction severity on subsequent misconduct/reoffending behavior are dependent on procedural justice perceptions among Dutch adults in detention (n = 763 and n = 765). The deterrent effect of sanction severity on misconduct was dependent on procedural justice. Increased sanction severity only deterred from subsequent misconduct when treatment was perceived as procedurally neutral to just. For individuals that were detained for the first time, a similar interaction effect was observed for their reoffending behavior. The results support the added value of integrating deterrence theory with situational characteristics (i.e., procedural justice) to explain sanctioning effects and suggest that correctional staffs’ relationships with individuals in detention can contribute to order in prison and beyond.

Procedural justice in the criminal justice chain It has been proposed that when people perceive their treatment by criminal justice actors as more procedurally just, they will be more likely to comply with the law. Existing research mainly focused on the police or the judge. This longitudinal study examined how prisoners experienced their treatment by five different criminal justice actors using data from the Prison Project. The prisoners were most positive about the procedurally fair treatment by their lawyer and least positive about the treatment by the police. Additionally, the perceived treatment by the police was associated with the treatment by other actors at subsequent moments.