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Purpose The purpose of this paper is to assess the impact of short-term incarceration on antiretroviral therapy (ART) adherence, virologic suppression, and engagement and retention in community care post-release. Design/methodology/approach A retrospective chart review of patients who attended the human immunodeficiency virus (HIV) Outreach Clinic at a Canadian remand center between September 2007 and December 2011 was carried out. Data extraction included CD4 lymphocyte count, HIV viral load, ART prescription refills, and community engagement and retention during and one-year pre- and post-incarceration. Findings Outpatient engagement increased by 23 percent (p=0.01), as did ART adherence (55.2-70.7 percent, p=0.01), following incarceration. Retention into community care did not significantly improve following incarceration (22.4 percent pre-incarceration to 25.9 percent post-release, p=0.8). There was a trend toward improved virologic suppression (less than 40 copies/ml; 50-77.8 percent (p=0.08)) during incarceration and 70. 4 percent sustained this one-year post-incarceration (p=0.70). Originality/value The impact of short-term incarceration in a Canadian context of universal health coverage has not been previously reported and could have significant implications in optimizing HIV patient outcomes given the large number of HIV-positive patients cycling through short-term remand centers.

Purpose – While research often elaborates on outcomes of youth remand more broadly, the specific impact that remand has on indigenous young people can be overlooked, particularly in Australia. The paper aims to discuss these issues. Design/methodology/approach – This paper analyses interview data gathered from eight individual service providers from six community youth organisations in a city in Queensland, Australia. Findings – Participants reported the specific effects of remand for indigenous young people and their families, noting especially the negative impact on the young people’s emotional, social and psychological development. Originality/value – Results strongly suggest there is a blurring of the welfare and justice systems inherent within remand processes with indigenous young people, with remand employed so frequently that it has itself become a form of social support.

Purpose – The purpose of this paper is to explore prison drug injecting prevalence, identify any changes in injecting prevalence and practice during imprisonment and explore views on prison needle exchange. Design/methodology/approach – An empirical prospective cohort survey conducted between 2006 and 2008. The study involved a random sample of 267 remand and sentenced prisoners from a large male category B prison in England where no prison needle exchange operates. Questionnaires were administered with prisoners on reception and, where possible, at one, three and six months during their sentence. Findings – In total, 64 per cent were injecting until admission into prison. The majority intended to stop injecting in prison (93 per cent), almost a quarter due to the lack of needle exchange (23 per cent). Yet when hypothetically asked if they would continue injecting in prison if needle exchange was freely available, a third of participants (33 per cent) believed that they would. Injecting cessation happened on prison entry and appeared to be maintained during the sentence. Research limitations/implications – Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of needle exchange programmes (NEPs) not being provided in the UK prison setting. Practical implications – Not providing sterile needles may increase risks associated with injecting for prisoners who continue to inject. However, providing such equipment may prolong injecting for other prisoners who currently cease injecting on account of NEPs not being provided in the UK prison setting. Originality/value – This survey is the first to question specifically regarding the timing of injecting cessation amongst male prisoners and explore alongside intention to inject should needle exchange facilities be provided in prison.

Purpose – Prison mental health in-reach teams (MHITs) have developed in England and Wales over the last decade. Services have been nationally reviewed, but detailed descriptions of their work have been scarce. The purpose of this paper is to describe the functions of one MHIT in a busy, ethnically diverse, male remand prison in London, UK. Design/methodology/approach – Clinical and demographic data were collected for prisoners referred to the MHIT using a retrospective design over an 18-week period in 2008/2009 (n=111). Findings – Foreign national prisoners and sentenced prisoners were significantly under-referred. Most referrals were already known to community mental health services, although around a quarter accessed services for the first time in prison. Around a third presented with self-harm/suicide risks. Substance misuse problems were common. Although the MHIT had evolved systems to promote service access, prisoner self-referrals were limited. Practical implications – Foreign national prisoners require enhanced investment to improve service access. MHITs identify people with mental disorders for the first time in prisons, but better screening arrangements are needed across systems. An evaluation of multiple MHIT models could inform a wider delivery template. Originality/value – One of the first ground-level evaluations of MHITs in England and Wales.

PurposeAlcohol misuse is internationally recognised as a major public health problem. The link between alcohol and crime is strong and offenders have a higher prevalence of alcohol problems when compared with the general population. Alcohol‐related crime is estimated to cost the Scottish economy over £700 m per annum. The purpose of this paper is to measure the nature and prevalence of Alcohol Use Disorders (AUDs) in adult male prisoners on remand in a prison in Scotland.Design/methodology/approachUsing the Alcohol Use Disorders Identification Test (AUDIT) screening tool, all new remand prisoners were screened over a two week period.FindingsPrevalence of alcohol problems within the sample was high: 73 per cent of the sample was identified with an AUD, with 43 per cent with scores indicating possible alcohol dependence.Originality/valueThis is the first study to focus solely on a remand prisoner population and the results show high levels of need. The criminal justice setting is ideally placed to identify and treat alcohol problems in this hard to reach population.

Insomnia is a problem commonly identified by remand prisoners who also have a concurrent dual diagnosis of substance misuse and mental health problems. Historically, sleep problems in prison have been treated with either hypnotics or benzodiazepines but these cause adverse side effects and are often misused. Valerian teabags were introduced in 2004 but their efficacy was untested within the prison setting. The aim of this study was to establish whether Valerian teabags improve subjective sleep quality for men with sleep disturbance and dual diagnosis in a remand prison setting within a 14‐day period. The findings show that herbal alternatives appear to improve sleep quality for prisoners with complex needs.

Studies of prison suicides have consistently reported higher numbers of deaths for men than women. However it is not clear whether male or female prisoners have higher rates of self‐inflicted deaths proportionate to their population. This paper explores the number, rate and patterns of self‐inflicted deaths of women in prison over the last ten years (1992‐2001) compared with death rates for male prisoners and identifies from 13 case studies possible precipitating factors and implications for prevention.The female prison population increased by 237% over the period 1992 to 2001, from an average annual figure of 1,577 to 3,739. During the same period there were 33 self‐inflicted deaths: an increase from one death in 1993/94 to a peak of eight in 2000. Just over half (51%) of the women were unsentenced/on remand; 14 (43%) had an open F2052SH at the time of death, compared with 28% of all self‐inflicted deaths in the general prison population between 1997‐2001, and nine were known to have self‐ harmed previously (27%).Of the 13 case studies, all but one had recently used illicit drugs. Many had shown disturbed and difficult behaviour throughout their short time in custody, including non‐compliance with medication for mental health problems and behaviour resulting in adjudications. The women all had multiple problems in the days and weeks prior to their deaths, including withdrawal from drugs, lack of contact with families, bereavement and relationship problems within the prison. However more than two thirds had recently been relocated, often against their wishes or to accommodation they found less acceptable.

Over the last decade many ‘diversion from custody’ schemes have been established and there is evidence of their effectiveness in reducing the number of mentally disordered offenders inappropriately remanded in custody. In North Wales there has been pressure to establish such a scheme but it is not clearwhether models developed in large urban areas are applicable to the problems of a rural community.This paper describes a study of male prisoners remanded in custody from North Wales during a four month period to identify need for such a service. In four months 298 prisoners were remanded from North Wales. Only seven courts remanded more than 16 (equivalent to one remand per week); the busiest court remanded 83, equivalent to five per week.In total, 42 prisoners reported a history of mental disorder; records were available on 28 of these, of whom ten were considered to have a mental disorder requiring admission.Only a small number of individuals in this study required diversion from custody (approximately one per week), but in those cases there was significant unmet need. The conclusion was that an effective diversion scheme would have to be able to provide a service to numerous and widely spread courts, most with a low level of activity.

Describes the author’s visit to The Netherlands while in receipt of a Winston Churchill Travelling Fellowship to study drug education. Reports on a visit of a group of 12‐year‐old schoolchildren to a remand prison in Amsterdam, where they met a heroin addict. This scheme is run by the Amsterdam police authorities as part of their drug education programme. Concludes that, although the scheme is unusual, it could make a valuable contribution to a health education programme.

The first privatized penal establishment was commissioned in early April 1992, The Wolds Remand Prison, Humberside. In April 1993 it is proposed to restructure HM Prison Service as a government agency, rather than a government department. These policies are not new. In fact it is a repeat of history, and the Prison Service will be established as a dual system, as it was prior to the 1877 Prisons Act. Government accountability and control may be removed from the Home Office. A privatized prison may be run in the name of its shareholders, and not in the name of Her Majesty The Queen – hence the title of this article. Argues that privatization will not decrease overcrowding, but encourage it, along with potential corruption.