Palliative care needs and experiences of people in prison: A systematic review and meta-synthesis

Background: Globally, the prison population is growing and ageing, as is the need for palliative care. Yet, little is known about how people in prison perceive palliative care provision in this setting. Aims: To identify the: (i) perceptions of palliative care provision and dying in custody by people in prison; and (ii) perceived barriers and facilitators of person-centred palliative care provision in prison. Design: A systematic review and meta-synthesis was registered and undertaken in accordance with the reporting guidelines. Data Sources: Keywords and MeSH headings encompassing (i) palliative care, end-of-life care, death; and (ii) prison; were used to search Pubmed, Medline, CINAHL, PsycINFO, Web of Science, CINCH and ProQuest Central. Articles published in English, from high income countries, and containing qualitative data exploring perceptions of people in prison of palliative care in custody were included. Findings were reporting using the ENTREQ guidelines. Findings: Of the 2193 articles identified, 12 were included. Experiences of people in prison regarding palliative care related to two themes: (1) expectations versus experiences of palliative care; and (2) prison context complicates access to and provision of palliative care. People in prison with palliative care needs want to feel safe, cared for, and acknowledged as they face an expected death. The prison environment can severely restrict access to palliative care, leaving people in prison feeling isolated and powerless. Conclusions: People in prison expect to receive high-quality palliative care, but their experiences often do not match their expectations. Numerous structural and organisational challenges complicate the provision of palliative care in prisons, limiting accessibility of care.

Vztahová vazba a copingové strategie u vězeňské populace

Objectives. The study is aimed at describing attachment and coping strategies in the prison population, and relations between these two variables were tested. Sample and setting. The sample consisted of 122 men serving middle-security sentences mainly for property crime. The attachment was determined by the Czech version of the Experiences in Close Relationships Scale, and coping strategies were measured by The Stress Coping Style Questionnaire SVF 78. Hypotheses. The prisoners’ attachment and coping strategies were expected to be different from those of the normal population. The attachment anxiety and avoidance were expected to be related to coping strategies. Statistical analyses. One sample t-test and Wilcoxon one sample test were used for analyzing the differences in scores between the prison and normal population while the Pearson correlation and linear regression were used to test relations between variables. Results. Inmates were significantly different from the normal population both in their attachment and coping strategies. They exhibited higher attachment anxiety and avoidance compared to the normative sample, fearful avoidant attachment prevailed. Prisoners demonstrated higher Play Down, Distraction from Situation, Substitutional Satisfaction, Flight Tendency, Self-accusation, and Active Avoidance, they exhibited lower Guilt Denial and Rumination. Relational avoidance correlated negatively with positive coping strategies, relational anxiety correlated positively with negative coping strategies. Limitations. The main limitation of this study is the use of a non-representative sample and the self-assessment form of the methods employed.

Punitive by negligence? The myths and reality of penal nationalism in the Czech Republic

Penal populism has repeatedly been described as influencing penal policies, with harsh penal practices presented as evidence of its influence. However, little attention has yet been paid to its role in the development of penal policies in post-authoritarian countries, which generally have large prison populations. Some minimal research has suggested that Central European countries were driven by penal nationalism following the 1989 revolutions. I examine this claim for the Czech Republic, using Garland (2013) 's framework of the five dimensions of a penal state. My analysis of political manifestoes shows that Czech politicians did not employ “law and order” rhetoric. The country's penal reforms were led by lenient penal elites. Nevertheless, a lack of analysis, coordination and sufficient funding resulted in a failure to properly identify or tackle the causes of the country's high imprisonment rate. Even though it gradually became more difficult to impose prison sentences, insufficient attention was paid to the length of the sentences Czech prisoners were serving. The large Czech prison population thus seems to be the result of state actors’ negligence, but not of penal populism nor of penal nationalism.

The Penrose hypothesis in the second half of the 20th century: investigating the relationship between psychiatric bed numbers and the prison population in England between 1960 and 2018–2019

Background NHS Psychiatric beds comprise mental illness and intellectual disability beds. Penrose hypothesised that the number of psychiatric in-patients was inversely related to prison population size. Aims To ascertain whether the Penrose hypothesis held true in England between 1960 and 2018–2019. Method A time-series analysis explored the association between total prison population and NHS psychiatric beds; this was also tested for the male and female prison populations, using non-psychiatric beds as a comparator. Associations were explored with time lags of up to 20 years. Linear regression was conducted to estimate the size of the effect of bed closures. Results NHS psychiatric beds decreased 93% and the prison population increased 208%. A strong (r =−0.96) and highly significant negative correlation between these changes was found. Annual reduction in psychiatric bed numbers was associated with an increase in prison population, strongest at a lag of 10 years. The closure of mental illness and intellectual disability beds was associated with increases in female prisoners 10 years later. The only significant explanatory variable for the increase in male prison population was intellectual disability bed reduction. Conclusions The Penrose hypothesis held true between 1960 and 2018–2019 in England: psychiatric bed closures were associated with increases in prison population up to 10 years later. For every 100 psychiatric beds closed, there were 36 more prisoners 10 years later: 3 more female prisoners and 33 more male prisoners. Our results suggest that the dramatic increase in the female prison population may relate to the closure of NHS beds.

The COVID-19 pandemic amplified long-standing racial disparities in the United States criminal justice system

During the first year of the COVID-19 pandemic, the number of incarcerated people in the United States decreased by at least 16%---the largest, fastest reduction in prison population in American history. Using an original dataset curated from public sources on prison demographics across all 50 states and the District of Columbia, we show that incarcerated white people benefited disproportionately from this decrease in the U.S. prison population, and the fraction of incarcerated Black and Latino people sharply increased. This pattern deviates from a decade-long trend before 2020 and the onset of COVID-19, during which the proportion of incarcerated Black people was declining. Using case studies of select states, we explore and quantify mechanisms that could explain these disparities: temporary court closures that led to fewer prison admissions, changes in the frequency of police interactions, and state-level prison release policies that sought to de-densify congregate settings. These findings illuminate how systemic racism pervades juridical and penal institutions and is the engine of mass incarceration in America.

Epidemiological, clinical and imaging characteristics of female prisoners with definite COVID-19 in a prison in the southwest, Iran, 2020

Purpose Prisoners are at greater risk of infectious diseases compared to the general population. While imprisoned, it is often difficult to observe Coronavirus 2019 (COVID-19) prevention strategies such as social distancing. To the authors’ knowledge, no study has been conducted worldwide to examine the condition of female prisoners with COVID-19. Therefore, this study aims to investigate the epidemiological, clinical and imaging characteristics of prisoners with COVID-19 in Ahvaz Women’s Prison (southwest, Iran). Design/methodology/approach The data for this descriptive cross-sectional study was collected using a checklist including epidemiological information, clinical symptoms, X-ray and computed tomography scan findings of the chest, underlying diseases and the final status of all female prisoners whose COVID-19 test was positive. Findings This study included 139 female prisoners with COVID-19 with a mean age of 37.19 ± 12.67 years. The most common underlying diseases were hypertension (14.4%), obesity (10.8%) and chronic obstructive pulmonary disease (9.4%). The most common symptoms at the onset of the disease were myalgia (59.0%), cough (41.0%) and dyspnea (37.4%). The most common radiological symptoms were ground-glass opacity (12.9%) and atelectasis (7.2%). In terms of extension of involvement, both lungs were involved in 8.6% of patients. In terms of zonal involvement, the lower lobes were more involved (8.6%). In terms of involvement position, the most common was sub-pleural (10.1%). None of the patients died. Originality/value Because the incidence, morbidity and mortality rate of COVID-19 in the prison population are likely to differ from those of the public. This study sought to investigate the situation of prisoners with COVID-19 in Ahvaz Prison, Khuzestan Province. To the best of the authors’ knowledge, this is the first worldwide study in this regard in women’s prisons.

Challenges facing a Māori prison education leader

Māori are severely over-represented in the prison population of Aotearoa New Zealand, making up over half of all prisoners, despite being only about 15% of the national population. These Māori statistics are well-known, and support racist perceptions of Māori in general. There is substantial literature on Māori imprisonment in Criminology and related fields, but it mostly focuses on ‘fixing’ the prisoner. Prison education is a neglected topic in extant educational research. Little research exists on the experiences of those who work in prisons, and little or none about the experiences of Māori prison educators. Prison education focuses on changing behaviours that lead to offending and helping prisoners to gain work and life skills. But security concerns and managing the prison population take precedence and restrict the availability and priority given to education. The recent Hōkai Rangi strategy has generated enthusiasm, but has yet to translate into positive results.

The Watchman

<p>Over the course of the last five years, the female prison population in New Zealand has risen more than 56%. As these numbers remain exponentially increasing, the ability to uphold successful facilitation for each and every inmate is weakening. This is largely a result of poor and incorrect implementation of criminal rehabilitation schemes. Upon release, confusion, fear, and the sheer overwhelm of exposure to the culture contained within modern day society gives appeal to recidivism, and leads to the escalation of the prison population crisis. In response to this escalating crisis — advancing the search for alternative means of successful criminal rehabilitation — this research explores the enablement of architecture to have a rehabilitative function within a prison environment, as well as the reduction of recidivism through didactic architectural experience. This research proposes that the decommissioned Mount Crawford Prison in Wellington New Zealand can be redesigned to test this opportunity. As a research site, it can be used to test how design can enhance the rehabilitation process of a prisoner in the cultural transition from incarceration to society. The research approach integrates Michel Foucault’s theory “Of Other Spaces” to address the first principle objective of this research investigation, and develop architecture that encourages prison inhabitants to reinterpret dystopian experience through the lens of heterotopia; Cathy Ganoe’s theory “Design as Narrative: A theory of inhabiting space” to address the second principle objective of this research investigation, and develop architecture that establishes a spatial experiential narrative about a person’s transforming interpretation of their surroundings; Daniel Merritt Hewett’s theory “Architecture and the Productive Implications of Pause” to address the third principle objective of this research investigation, as a means of establishing strategic points of pause along the journey of the spatial experiential narrative, that enable enhanced understanding of heterotopia. Kalervo Oberg’s theory of culture shock is also integrated as a means of developing an understanding of the cultural transition from incarceration to liberation.</p>

The Watchman

<p>Over the course of the last five years, the female prison population in New Zealand has risen more than 56%. As these numbers remain exponentially increasing, the ability to uphold successful facilitation for each and every inmate is weakening. This is largely a result of poor and incorrect implementation of criminal rehabilitation schemes. Upon release, confusion, fear, and the sheer overwhelm of exposure to the culture contained within modern day society gives appeal to recidivism, and leads to the escalation of the prison population crisis. In response to this escalating crisis — advancing the search for alternative means of successful criminal rehabilitation — this research explores the enablement of architecture to have a rehabilitative function within a prison environment, as well as the reduction of recidivism through didactic architectural experience. This research proposes that the decommissioned Mount Crawford Prison in Wellington New Zealand can be redesigned to test this opportunity. As a research site, it can be used to test how design can enhance the rehabilitation process of a prisoner in the cultural transition from incarceration to society. The research approach integrates Michel Foucault’s theory “Of Other Spaces” to address the first principle objective of this research investigation, and develop architecture that encourages prison inhabitants to reinterpret dystopian experience through the lens of heterotopia; Cathy Ganoe’s theory “Design as Narrative: A theory of inhabiting space” to address the second principle objective of this research investigation, and develop architecture that establishes a spatial experiential narrative about a person’s transforming interpretation of their surroundings; Daniel Merritt Hewett’s theory “Architecture and the Productive Implications of Pause” to address the third principle objective of this research investigation, as a means of establishing strategic points of pause along the journey of the spatial experiential narrative, that enable enhanced understanding of heterotopia. Kalervo Oberg’s theory of culture shock is also integrated as a means of developing an understanding of the cultural transition from incarceration to liberation.</p>

Missed Opportunities for Compassion: A Call to Action for Incarcerated Individuals Denied Compassionate Release

In 2016, a total of 4,117 state and federal prisoners died in publicly or privately operated prisons. Each year from 2001 to 2016, an average of 88% of deaths in state prisons were due to natural causes, with more than half of those due to cancer, heart disease or liver disease, conditions for which non-incarcerated citizens often benefit from palliative care and hospice. Prisoners age 55 and older are the fastest-growing segment of the population residing in prisons, as well as those with the highest mortality rate. Compassionate release of seriously ill prisoners became a matter of federal statute in 1984 and has currently been adopted by the majority of U.S. prison jurisdictions. The spirit of the mandate is based on the idea that catastrophic health conditions ie terminal illness affect the four principles of incarceration: retribution, rehabilitation, deterrence, and incapacitation. Concerned about an aging prison population, overcrowded facilities, and soaring costs, many policy makers are calling for a wider use of compassionate release for persons with terminal illness as well as broader prison reform. The prognosticating criteria of compassionate release guidelines are clinically flawed, and the application and procedural barriers are prohibitive. In this paper we review cases of patients who qualified for compassionate release but had their applications denied. We will discuss the urgent need for access to quality palliative medicine for incarcerated persons with advanced illness and call healthcare providers to action with the aim of reducing suffering and promoting social justice for those in need.