Incarceration and Wellbeing - Comprehensive Notes

Incarceration and Wellbeing

Mental Health in Prison Populations

  • Outline (Durie, 2004): Key factors impacting wellbeing include:

    • Mental Health
    • Trauma
    • Social Interactions
    • Cultural Support
    • Sleep
    • Nutrition
    • Education
    • Prison Environment
    • Assaults/Death

  • New Zealand (Brinded et al., 2001):

    • Common mental health issues: PTSD, major depressive disorder, and substance abuse, affecting both sexes.

  • Scandinavia (Bukten et al., 2024): A study across Norway, Denmark, and Sweden (2010-2019) reveals the prevalence of mental health disorders among incarcerated individuals.

    • Norway (n=50,861):
      • Substance use disorders: 44.0% (n=22,392)
      • Psychosis or schizophrenia: 5.5% (n=2,811)
      • Affective disorder:
        • Bipolar disorder: 3.1% (n=1,559)
        • Depressive disorder: 17.5% (n=8,911)
      • Anxiety disorder: 9.2% (n=4,696)
      • Stress-related disorder: 17.1% (n=8,722)
      • Dissocial personality disorder: 2.6% (n=1,310)
      • Borderline personality disorder: 2.7% (n=1,373)
      • ADHD: 11.9% (n=6,028)
      • Comorbid SUD and other mental health disorder: 29.0% (n=14,769)
    • Denmark (n=45,532):
      • Substance use disorders: 39.9% (n=18,177)
      • Psychosis or schizophrenia: 7.6% (n=3,483)
      • Bipolar disorder: 1.5% (n=668)
      • Depressive disorder: 8.1% (n=3,668)
      • Stress-related disorder: 14.4% (n=6,576)
      • Dissocial personality disorder: 2.3% (n=1,051)
      • Borderline personality disorder: 1.9% (n=853)
      • ADHD: 9.3% (n=4,247)
      • Comorbid SUD and other mental health disorder: 23.1% (n=10,520)
    • Sweden (n=23,114):
      • Substance use disorders: 39.1% (n=9,029)
      • Psychosis or schizophrenia: 3.6% (n=821)
      • Bipolar disorder: 1.8% (n=424)
      • Depressive disorder: 10.5% (n=2,436)
      • Stress-related disorder: 8.8% (n=2,029)
      • Dissocial personality disorder: 2.1% (n=483)
      • Borderline personality disorder: 1.2% (n=282)
      • ADHD: 11.8% (n=2,732)
      • Comorbid SUD and other mental health disorder: 21.7% (n=5,024)

  • Trends (Bukten et al., 2024): Over a 9-year period, the prevalence of mental health disorders in Scandinavian prisons is increasing, potentially correlated with rising prison populations.

Healthcare in New Zealand Prisons (Ara Poutama)

  • Primary Health Care: Includes GP services, nursing, basic dentistry, and some disability support.
  • Health Centers: Each prison has a health center staffed with registered nurses, contracted doctors, and dentists.
  • Secondary and Tertiary Care: Provided by local District Health Boards (DHB), similar to the general public.
  • Initial Assessment: Health needs, including mental health, are assessed upon arrival. Acute and ongoing care is provided (e.g., nicotine replacement therapy).

Mental Health Care in New Zealand Prisons

  • Providers: General practitioners (GPs), local Regional Forensic Mental Health Services (DHB), ACC (Accident Compensation Corporation), and Special Treatment Units.

  • GP Role: GPs are the first point of contact.

  • DHB Specialists: Handle more severe cases requiring specialist treatment.

  • ACC: Addresses trauma-related mental health issues.

  • Special Treatment Units: Designed for individuals with violent, sexual, or drug-related offenses. These units may include woman-specific therapeutic communities that meet specific requirements.

  • Longitudinal Studies: Needed to understand the development and persistence of mental health problems among incarcerated individuals, whether pre-existing or developed during imprisonment.

Childhood Trauma Prevalence

  • Te Hiwi et al. (in preparation): Study on attendees of Ara Poutama Special Treatment Units for Violent Offending (N = 423).
    • Almost all participants in the sample had experienced childhood trauma. Important as shows ability to follow treatment.

Impact of Childhood Traumatic Experiences on Treatment Outcomes

  • Te Hiwi et al. (in preparation): Research on the impact of childhood trauma on treatment outcomes in NZ Special Treatment Units (STUs).
    • Individuals who did not complete treatment experienced more diverse types of childhood traumas.
    • Completion of the program is correlated with the number of childhood traumas and negative adversities; a higher number of traumas increases the likelihood of non-engagement and program incompletion.
    • The group completing treatment exhibited the lowest recidivism rates compared to other groups.

Prison Safety

  • Assault Trends:
    • Serious assaults remain relatively stable over time.
    • Non-injury assaults increased but have declined more recently.
  • Factors Influencing Assaults: Increased tension, reduced staffing levels (leading to less freedom and access to resources), and overpopulation.

Deaths in Prisons (Aotearoa New Zealand)

  • Data includes natural and unnatural deaths for men and women.
  • Unnatural deaths may result from assaults or suicide.

Nutrition's Role

  • Meta-Ethnographic Analysis (Woods-Brown et al., 2023): Across 11 countries. Food in prison serves as a mechanism for:
    • Power dynamics, punishment, and resistance/agency.
    • Cultural identity and social relationships (prison foodways).
  • Systematic Review (Poulter et al., 2024): Effects of supplements on prison populations show mixed findings with small effect sizes for behavioral and mental health outcomes.
  • RCT on Omega-3 Supplements (Choy, 2023): Showed a reduction in behavioral problems.
  • Practical Implications: Food is utilized for trading and managing social hierarchies, social identity, and status within prisons. The cost of supplements and small effect sizes can hinder implementation.

Sleep and Aggression (Van Veen et al., 2021)

  • Aggressive Behaviors Measured: Irritability, hostility, externalizing behaviors, physical aggression, and anger.
  • Meta-Analysis: Examined correlations between sleep quality and aggression, revealing a consistent effect: poor sleep quality is related to aggression.
  • Prefrontal Cortex Impact: Poor sleep quality affects prefrontal cortex functioning, which is crucial for executive planning and emotional control.
  • Ethical Considerations: Studies ethically measure aggression (e.g., provoking aggression through tasks that measure verbal aggression rather than physical).

Sleep, Serotonin, and the HPA Axis

  • Sleep affects serotonin levels, influencing aggression.
  • HPA Axis (Cortisol/Stress Hormones): Sleep affects cortisol stress hormones. Studies in adults with aggression show HPA axis activity differs.

Sleep Quality and Prosocial Behavior

  • Barker et al. (2016): Lower sleep quality (not quantity) is associated with:
    • Lower prosocial attribution tendencies.
    • Higher levels of reactive and proactive aggression.
  • Vogler et al. (2014): Good sleep duration and quality correlate with better psychosocial adjustment, including less rumination and aggressiveness.
  • Environmental Factors: Lighting conditions (lights on/off at night) can contribute to aggression.

Social Connections

  • Distance to Home (Edgemont & Clay-Warner, 2019): Greater distance from home is related to depressive symptoms.
  • Lack of Control (MCLennan et al., 2025): The lack of control over their situation leads to withdrawing and isolating, staying connected to the outside world is a particular issue, especially for older people in prison.
  • Cell Placement (Stephenson et al, 2025): Single cell placement, frequent changes of cellmates and cells increase the risk of self-harm.
  • Social Density (Carmel, 2025): Higher social density is correlated with more violent assaults.
  • Gang Relationships: Can substitute for external relationships and help build social connections within prison.

Occupational and Education Programs

  • Occupational Therapy (Berardi et al., 2024): Reduces recidivism and aids in social and work reintegration.
  • Meta-Analysis (Ellison et al., 2017):
    • Education in prison reduces the recidivism rate by approximately 1/3.
    • Education in prison increases the chance of employment by 24% (Duwe & Clark, 2014).
  • Secondary Degree: Obtaining a secondary degree in prison reduces likelihood of recidivism and leads to a post-release job.

Culturally Sensitive Programs

  • Systematic Review (Perdacher et al., 2019): North American studies suggest culturally based interventions have high acceptability and potential for increased recovery from trauma, reduced alcohol-related problems, and lower reoffending.
  • Australian Study (Shepherd et al., 2017): Cultural engagement is related to less distress in challenging situations in prison.
  • Religious Activities (Mowen et al., 2017): Support for religious activities after release may have a positive effect on recidivism.

Biodiversity, Air Pollution, and Wellbeing

  • Moran et al., 2024: Examined the relationship between greenspace and prisoners' wellbeing. Found a relationship between greenspace in prison vicinity and closeset area around it is related to less self harm
    • Lack of green space and higher air pollution increase the likelihood of self-harm and prisoner attacks.
  • Limitations: Studies are correlational rather than causal, making it difficult to determine if improving these variables will directly fix the other. Longitudinal studies are needed to assess recidivism and the outcomes of these variables.

Summary

  • Prisons are social constructs and social entities.
  • Imprisonment can affect physical, psychological, and social wellbeing.
  • Prison environments, education, and care can have a positive impact.
  • Prison characteristics might interfere with rehabilitation goals.
  • Problems of current state of research.