Damian Sendler, M.D. – The World Health Organization (WHO) declared a COVID-19 pandemic in March 2020. This year, there have been over 127 million confirmed cases of SARS-CoV-2 worldwide, with over 2.5 million deaths as of March 31st, 2020. 2 More than 11 million people around the world are in prison at any given time. Overcrowding, poor ventilation, and often unsanitary conditions, combined with subpar healthcare, make this population particularly vulnerable to COVID-19. There are multiple points of entry for COVID-19 because of frequent staff turnover and the movement of inmates in and out of and between prisons. There are four to five
Damian Jacob Sendler: Chronic diseases, such as diabetes and hypertension, pose a significant risk to imprisoned individuals. As a result, people from black and minority ethnic groups are more likely to be diagnosed with cancer, which has a negative impact on their health. 5 6 Therefore, it is clear that imprisoned people are at a high risk of developing severe COVID-19, which is likely to result in significant stress and anxiety for this population. To make matters worse, prisons’ infection prevention and control procedures prioritize limiting inmate-to-inmate and visitor-to-outsider contact. 13–16 All visits have been cancelled, and the amount of time that prisoners are allowed to spend outside their cells has been restricted. As a result, prisoners are spending up to 23 hours a day in their cells. This isolation could be compared to solitary confinement,15 which has been shown to have a negative effect on a person’s mental health. 17 18 It’s also worth noting that imprisoned people have a high rate of mental health and substance abuse issues. 7 There is also a high prevalence of mental health conditions among prison staff.
Dr. Sendler: For both prison staff and inmates, we conducted a literature review focusing on the effects of COVID-19 on mental health. The review’s goal was to find out how the COVID-19 pandemic affects inmates’ and prison staff’s mental health in a comprehensive way. Our research also included summarizing and analyzing the findings and pointing out where there were still holes in the evidence.
Infection control measures have severely restricted the movement of many prisoners. A practice that has negative connotations in prison because it is perceived as being similar to punitive solitary confinement is the isolation of those with symptoms and positive test results who are new to the prison or who are vulnerable to severe infection. 35–43, 47–70, 73–78 Many were concerned that isolation could lead to an increase in mental health conditions, such as anger, depression, psychosis, self-harm, and suicide, as well as an increase in self-harm.
The distinction between isolation and solitary confinement is critical in this context.
Seclusion is defined as being held for more than 22 hours a day without “meaningful human contact” in solitary confinement. 86 Penal institutions use it to punish inmates for misbehavior, but it can also be used to keep them safe from harm. In most prisons, keeping inmates in isolation separate from the rest of the population is done to prevent the spread of disease. Mental health resources such as television, tablet computers, and radios, along with reading materials and ways to contact family members should be available to all prisoners. They should also have access to health care providers and be kept informed about the length of time they will need to be isolated. 73 13 Inmates may be reluctant to report symptoms unless the purpose of their isolation is clearly defined. Ninety-three
Regardless of the COVID-19 classification, many prisons have severely restricted inmate movement.
Combined with social distancing measures, this can mean spending up to 23 hours a day in an 8 x 6 foot cell. 63 74 75 59 In contrast, Penal Reform International recommends avoiding blanket isolation measures or imposing them ‘only for the time required to conduct a more individualised and independent medical assessment’ if necessary. 58
There have been a number of activities that have been and not replaced with recommended socially distant activities.
This could have a negative impact on one’s mental well-being. 74 81 Since the number of staff members on site is restricted to minimize the risk of infection, there are fewer activities available at facilities such as gyms. 63 While in-cell activities like exercise, mindfulness and puzzles can be used to keep patients occupied, they’re not the only options. 975 88.
This means that trials and court hearings will be postponed and that incarcerated people will be held in remand for longer periods of time, resulting in additional stress.
In total, there are 1012 instances of this. For both the prisoner’s own well-being and that of his loved ones, a lack of communication can lead to increased anxiety. 69 Infants and children should be given special consideration when deciding on visits, according to the European Centre for Disease Prevention and Control. 14 Although in-person visits had been suspended in the US by early April 2020, some women in UK prisons hadn’t seen their children in two months by May 2020. 59
Due to the fact that visits are used as a means of smuggling drugs into prisons, cutting down on visits has the added benefit of decreasing drug availability and use.
Damian Sendler
Opioid substitutes are in high demand, perhaps because they can alleviate withdrawal symptoms. Item Numbers: 36-57 Prison staff and healthcare workers may have been put under additional stress due to an increase in the number of inmates who are absconding.
It’s critical to keep in touch with loved ones and friends. This has been accomplished in part by increasing telephone access. Letters, video calls, and a prison voicemail service are among the other options. However, these methods are not implemented or effective in all prisons due to a variety of policies and resources at each facility. 62, 76, 77, and So, only half of the prisons in England and Wales have access to secure phone handsets. 75 As a result, those who are most likely to harm themselves or take their own lives are the least likely to benefit from support networks. To put it another way:
Staff and inmates alike need to be able to communicate effectively. Imprisoned people have low levels of health and education literacy, which, when combined with the strict control of information within prisons, can lead to the spread of misunderstandings and misinformation. 80 Communication with inmates about protocol changes must be regular and clear. A total of 31 43 69 85 The Royal College of General Practitioners’ guidelines for managing COVID-19 in prisons place an emphasis on effective communication.
Regular services have been reduced or eliminated in many places due to infection risk despite widespread belief that the mental health burden will increase.
The following numbers represent the total number of participants: 54 Psychiatric and psychological care is widely believed to be essential, which is why this finding is shocking. Ten twelve thirty-three sixty-two seventy-two Inmates will have access to online counseling tools and telepsychiatry as part of the new adaptations. To put it another way: A number of states in the United States were urged to waive licensing requirements in order to increase the use of telepsychiatry.
Mental health services have been rationalized, and articles have called for better triaging to ensure imprisoned people with the highest risk of harming themselves or others, aggression, and a refusal to eat are prioritized.
As many as ninety-seven Risk assessment and personal protective equipment are critical for the few in-person mental health appointments that do occur. 71 41 Several articles detailed the changes and improvements made to existing systems and processes in order to allow people incarcerated to continue their drug treatment. When it came to treating opioid agonists, depot buprenorphine was the first line of defense in one prison (OAT).
Damian Jacob Sendler
To begin with, they’ll be in an unfamiliar place with a lot of cultural shifts, which can cause a lot of stress. 65 68 Imprisoned people often lack financial and social capital, have lower educational attainment, and are more likely to become homeless, all of which are more difficult to overcome with current restrictions. 68 98 99 105 0 With limited options for new housing arrangements and difficulties in obtaining a police protective order if necessary, those who return to difficult family situations are at risk for domestic violence. 68 & 89 As a second issue, many of the community services on which recently released prisoners had relied have been cut, altered or discontinued. OAT is a critical area that requires careful planning. OAT services are now available via telemedicine in some areas, but inmates must be provided with technology and an internet connection in order to use this service after they are released from prison. One hundred and sixty-one
Liaising with community services for follow-up is difficult when dealing with these additional complexities and the rapid rate of decarceration.
Damian Jacob Markiewicz Sendler: Those who work in prisons have suffered psychologically as a result of the epidemic. The number of prison staff absences in England and Wales has doubled. 75 employees are suffering from stress and exhaustion as a result of working with fewer people. A total of nine 62 80 Inmates’ mental health will suffer as a result of a shrinking labor force. 9 75 Having fewer staff members means fewer opportunities to support inmates and less time to monitor those at high risk of self-harm or suicide.
More than anything, fear of COVID-19 has had a negative impact on inmates’ mental health, which is exacerbated by the regime changes that have been implemented to reduce infection risks. The main issues are social exclusion and isolation, the cessation of prison visits, and the reduction or discontinuation of mental health services, to name a few. Inmates’ mental health risks can be effectively assessed via telephone and video calls, telepsychiatry, and socially distant in-person mental health appointments, which can all help alleviate some of these consequences. Other options include providing individual and communal socially distant activities, communicating clearly with prisoners, and decarceration.
There are indications that the pandemic has had a significant impact on the mental health of those who reside or work in prisons. Isolation poses a significant threat to inmates’ mental health while they are incarcerated. It’s well known that solitary confinement has negative psychological effects, and research shows that even five years after being released, the risk of death is increased. 108 Even if the causes of isolation differ, the effects on one’s mental health are almost certainly the same. Visitors, on the other hand, have been shown to have a positive effect on the well-being of inmates and reduce recidivism rates. 109 Mental health may also be affected by preventing visits. There is a wide-ranging and possibly long-lasting impact on mental health from quarantine, according to a quick review of the psychological impact on the wider community. 110 Longer quarantines have a more severe effect, and restricting one’s freedom is more stressful and can have longer-term effects on one’s mental health. 110
Mental health may be harmed as a result of a lack of access to health care. Since the pandemic began, health care services in many countries have grown rapidly thanks to the widespread use of telemedicine. 111 In prisons, however, concerns have been raised about the lack of equity and access to technology. Fifty of the 117 prisons in the United Kingdom had poor internet connectivity at the start of the pandemic, even in high-income countries like the United States. 112 It is imperative to address mental health issues as the pandemic continues to grow in recognition. Riots in prisons in Brazil, Colombia, Italy, and the United States have been linked to the mental health issues, and they show that solutions must be found right away.
COVID-19’s discussion of mental health in prisons lacks solid evidence. Understanding the impact of COVID-19 and the implemented regime changes is an urgent necessity in light of the vulnerabilities of prisoners’ physical and mental health. When mass decarceration occurs, prisons become places of transition, and the unaddressed mental health impact will have repercussions throughout society. As the pandemic spreads, the prison system in England and Wales is currently evaluating feedback from inmates and staff in order to better manage safety and mental health.
There are a lot of great things about this review. A scoping review of mental health in prisons during the pandemic is the first of its kind. In addition, by following a methodical approach, the relevant literature and evidence gaps were comprehensively identified, with clear implications for future research and policy. In spite of this, the findings are not conclusive because of the poor quality of articles included.
In order to gain a better understanding of the mental health impact of prisons, as well as to identify effective interventions, more research is needed. We must also look into the effects of decarceration. Newly released prisoners face a particularly high mortality rate due to drug overdoses. 114 Because drug-related sentences are one of the most frequently commuted,68 104 it is critical to examine how best to maintain continuity of care upon release. It’s noteworthy that little research has been done on female prison staff or inmates, and this needs to be addressed as well.
Damien Sendler: Inmates and employees in prisons should have their mental health taken into account. In-cell activities and the expansion of electronic communications are needed to allow inmates to communicate with health care providers and family members, as well as to allow courts to operate remotely in order to prevent a backlog of trials in prison. Inmates and prison staff must be informed of the public health measures in place so they can anticipate what to expect. In order to protect prisoners’ human rights, these measures must be kept to a minimum while still allowing for infection control. Vulnerable people are identified and monitored, services are maintained and health needs are addressed by healthcare workers. There are issues with releasing a large number of people into the community, and these people require adequate protection, such as appropriate housing and connections to health care services.. We need strong leadership and collaboration across prison systems, non-governmental organizations, and healthcare and social care partners to implement all of these initiatives.
As a result of infection control measures as well as fear of COVID-19, the impact of COVID-19 on inmates’ mental health and prison staff’s mental health is likely to be significant. Despite their importance, these must be minimized and strategies to maintain mental health implemented in conjunction with them. For example, the WHO warned in March 2020 that ‘people in prisons and other places of detention are not only at greater risk of contracting the virus COVID-19, but they are also at greater risk of human rights violations’. Action and research are urgently needed to address the negative mental health consequences of the pandemic on those who live and work in correctional facilities given the evidence so far and because this pandemic is far from over.