The Rikers Island Hot Spotters: Defining the Needs of the Most Frequently Incarcerated

We used "hot spotting" to characterize the persons most frequently admitted to the New York City jail system in 2013.

We used our Correctional Health Services electronic health record to identify 800 patients admitted in 2013 who returned most since November 2008. We compared them to a randomly selected control group of 800 others admitted in 2013, by using descriptive statistics and cross-tabulations, including data through December 2014.

The frequently incarcerated individuals had a median of 21 incarcerations (median duration 11 days), representing 18 713 admissions and $129 million in custody and health costs versus $38 million for the controls. The frequently incarcerated were: 

• significantly older (42 vs 35 years), 
• and more likely to have serious mental illness (19% vs 8.5%) 
• and homelessness (51.5% vs 14.7%) in their record. 
• Significant substance use was highly prevalent (96.9% vs 55.6%). 
• Most top criminal charges (88.7%) for the frequently incarcerated were misdemeanors; assault charges were less common (2.8% vs 10.4%). 

Frequently incarcerated persons have chronic mental health and substance use problems, their charges are generally minor, and incarceration is costly. Tailored supportive housing is likely to be less costly and improve outcomes.

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By: MacDonald R1, Kaba F1, Rosner Z1, Vise A1, Weiss D1, Brittner M1, Skerker M1, Dickey N1, Venters H1.

• 1All of the authors are with the New York City Department of Health and Mental Hygiene, Bureau of Correctional Health Services, Queens, NY.

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County-Level Heat Maps of Prison Capacity and Latino Inmate County of Origin

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Percentage of inmates visited by distance and race/ethnicity

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Predicted Likelihood of Prison Visitation by Economic Disadvantage

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Number U.S. Adults on Probation, 1980-2013

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U.S. Adult Community Supervision Rate, 1980-2013

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Association Between Number of Psychiatric Disorders and Violent Reoffending in Male Released Prisoners

Error bars are 95% CIs.

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By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.

• 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.

Probability of Violent Reoffending by Sex, Time After Release, and Psychiatric Disorder Status

Error bars are 95% CIs.

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By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.

• 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.

Psychiatric Disorders & Violent Reoffending: A National Cohort Study of Convicted Prisoners in Sweden

Reoffending and presence of psychiatric disorders are common in prisoners worldwide. However, whether psychiatric disorders are risk factors for reoffending is still unknown. We aimed to examine the association between psychiatric disorders, including substance use disorder, and violent reoffending.

We did a longitudinal cohort study of 47 326 prisoners who were imprisoned since Jan 1, 2000, and released before Dec 31, 2009, in Sweden. We obtained data for diagnosed psychiatric disorders from both inpatient and outpatient registers, and sociodemographic and criminological factors from other population-based registers...

Diagnosed psychiatric disorders were associated with an increased hazard of violent reoffending in male and female prisoners, and these associations were independent of measured sociodemographic and criminological factors, and, in men, remained substantial after adjustment for unmeasured familial factors. However, findings differed between individual diagnoses and sex. We found some evidence of stronger effects on violent reoffending of alcohol and drug use disorders and bipolar disorder than of other psychiatric disorders. Alcohol use disorder seemed to have a greater effect in women than in men. The overall effects of psychiatric disorders did not differ with severity of crime. The hazard of violent reoffending increased in a stepwise way with the number of diagnosed psychiatric disorders. Assuming causality, up to 20% of violent reoffending in men and 40% in women was attributable to the diagnosed psychiatric disorders that we investigated.

Certain psychiatric disorders are associated with a substantially increased hazard of violent reoffending. Because these disorders are prevalent and mostly treatable, improvements to prison mental health services could counteract the cycle of reoffending and improve both public health and safety. National violence prevention strategies should consider the role of prison health.

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By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.

• 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
• 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.

Recidivism among Licensed-Released Prisoners Who Participated in the EM Program in Israel

Toward the end of 2006, a pilot program was launched in Israel wherein licensed-released prisoners were put under electronic monitoring (EM). In addition to EM, the pilot program, operated by the Prisoners' Rehabilitation Authority, provides programs of occupational supervision and personal therapy and is designed to allow for early release of those prisoners who, without increased supervision, would have been found unsuitable for early release. 

The aim of this study was to ascertain whether participation in the EM program among licensed-released prisoners in Israel might bring about lessened recidivism. For that matter, rates of arrests and incarceration were examined during a follow-up period of up to 4 years, among the entirety of licensed-released prisoners participating in the EM program between the years 2007 and 2009 (n = 155). 

To compare recidivism rates, a control group was assembled from among the entirety of released prisoners who were found unsuitable for early release in judicial conditions, and had therefore served the full term of their incarceration, to be released between the years 2005 and 2006 (a period of time during which an EM program was not yet operated among licensed-released prisoners in Israel). 

Study findings clearly show that while among the control group, 42% of released prisoners were re-incarcerated, at the end of a 4-year follow-up period, only 15% among the study group had returned to prison. 

These findings can be explained by combining the Social Control theory and the Self-Control theory which consider the period of time under EM program and the occupational and familial integration tools for reducing criminal connections and enhancing pro-social behavior.

Via: http://ht.ly/S78hx

By: Shoham E1, Yehosha-Stern S2, Efodi R3.

• 1Ashkelon Academic College, Israel 
• 2Ashkelon Academic College, Israel.
• 3Prisoners Rehabilitation Authority, Jerusalem, Israel.

Symptomatic Exposures among California Inmates 2011-2013

Prisoners have a high prevalence of substance misuse and abuse, but few studies have examined symptomatic exposures among incarcerated populations. We sought to further characterize the nature of these exposures among this population using the California Poison Control System data. Keyword searches identified inmate cases in 2011-2013 for patients 20+ years old exposed to a single substance and taken to hospital from jail, prison, or police custody. 

Comparisons were made with non-inmate cases during the same period, using similar limitations. Body stuffers and body packers were analyzed as a subgroup. Seven hundred four inmate cases were compared to 106,260 non-inmate cases. Inmates were more likely to be younger, male, and to have engaged in drug misuse or abuse. They most commonly ingested methamphetamine, heroin, acetaminophen, and anticonvulsants. Inmates were more likely to receive activated charcoal, whole bowel irrigation, undergo endotracheal intubation, and to experience a major clinical outcome or death. 

When body stuffers and packers were removed, clinical findings were similar, though the odds of a major outcome or death became statistically non-significant. Body stuffers and body packers primarily used methamphetamine and heroin, and compared with other inmates had significantly higher odds of both adverse clinical effects and poor outcome. 

This large series provides a profile of symptomatic exposures among inmates, a little-studied population. The potential for high morbidity among body stuffers and packers suggests that a high index of suspicion of such ingestions be maintained when evaluating patients prior to incarceration.

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By: Butterfield M1, Al-Abri S, Huntington S, Carlson T, Geller RJ, Olson KR.
1Department of Internal Medicine, Tulane University Medical Center, New Orleans, LA, USA

Local Jail Inmates, 1980 - 2013

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State and Federal Prisoners: 1980 - 2013

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Total Correctional Population in U.S.

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Intensive Vipassana Meditation Practice: An Intervention with Promise for Traumatized Prisoners

The United States has the highest rate of incarceration in the world. According to the Bureau of Justice Statistics, 2,266,800 adults were incarcerated in U.S. federal and state prisons and county jails at year-end 2010 – about 0.7% of the resident adult population. Childhood trauma increases the likelihood of criminal justice involvement in adulthood (Wolf & Shi, 2010). A high percentage of prisoners are survivors of childhood abuse and other traumas before they are imprisoned (Wallace, Connor, & Dass-Brailsford, 2011), and prisons are notoriously violent and traumatic places for inmates. In a survey of inmates in Midwestern prisons, 54% of men and 28% of women reported having been raped in their current facility (Struckman-Johnson & Struckman-Johnson, 2000). In short, prisons are veritable warehouses of traumatized adults.

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Patterns of Inhalant Use among Incarcerated Youth

Below: Plot of Polyinhalant Use Classes.

Note. (1) Airplane or model glue; (2) Anesthetic gases; (3) Freon; (4) Gas from whipping cream cans; (5) Butane; (6) "White-out" or another correction fluid; (7) Air Freshener; (8) Nail polish; (9) Nail polish remover; (10) Whippets; (11) Spray paint; (12) Gases from computer "duster" sprays; (13) Permanent markers; (14) Gasoline.

Inhalant use is especially prevalent among antisocial youth and can have serious health consequences. However, the extant literature has not investigated how use of various inhalants may co-occur among incarcerated youth. This study begins to address this gap in the literature by using latent class analyses to form distinct typologies of inhalant use. Study participants were residents (N = 723) of 27 Missouri Division of Youth Services facilities. Interviews assessed psychiatric symptoms, antisocial traits, delinquency, trauma, suicidality, and substance use behaviors. The mean age of the mostly male, ethnically diverse sample was 15.5 (S.D. = 1.2) years old. The study revealed the following classes of inhalant use: (1) severe polyinhalant use; (2) moderate polyinhalant use; (3) gas and permanent marker use; and (4) low-use. Compared to the low-use class, members of the severe polyinhalant use class had experienced more than double the rate of head injuries, the highest rates of traumatic experiences, and the highest rates of mental illness diagnoses. The gas and markers class had the highest rate of reporting hearing voices, followed by the severe polyinhalant use class, and the moderate polyinhalant use class. Results of this study underscore the need to address the high rate of head injuries and mental health diagnoses that contribute to severe polyinhalant use.

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Profiles of a Childhood Spent in Prison - Anisha Walker

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Profiles of a Childhood Spent in Prison - William Skinner

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Profiles of a Childhood Spent in Prison - Nick Martinez

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Profiles of a Childhood Spent in Prison - Perry Johnson

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