The Course of Psychiatric Symptoms During Remand Imprisonment

• Author: Oscar Bloem,Robbert-Jan Verkes,Erik Bulten
• DOI: http://doi.org/10.1177/0306624X211058956
• Published date: 01 May 2023
• Date: 01 May 2023
• Subject Matter: Articles

https://doi.org/10.1177/0306624X211058956

International Journal of

Offender Therapy and

Comparative Criminology

2023, Vol. 67(6-7) 720 –735

© The Author(s) 2021

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sagepub.com/journals-permissions

DOI: 10.1177/0306624X211058956

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Article

The Course of Psychiatric

Symptoms During Remand

Imprisonment

Oscar Bloem1, Robbert-Jan Verkes2,

and Erik Bulten3

Abstract

Imprisonment may pose a risk for unintended effects such as deterioration of

psychiatric symptoms. Therefore, it is pivotal to understand the relation between

imprisonment and the course of psychiatric symptoms, but previous studies are

inconclusive. The current study followed up the psychiatric symptoms of newly

admitted remand prisoners to one Dutch remand prison using the Brief Psychiatric

Rating Scale (BPRS) and also studied possible related pre-existing variables. On average

we found an overall slight—yet clinically marginal—improvement of psychiatric, in

particular affective symptoms. One in three prisoners deteriorated and prisoners with

psychotic disorders less often deteriorated. Other variables were not related. Overall,

psychiatric symptoms remain stable over time during early remand imprisonment

independent of most psychiatric disorders. The context in the Dutch prison studied

appears to be adequately organized in terms of handling psychiatric stability, but we

notice that prison contexts may vary to a large extend.

Keywords

prison, psychiatric symptoms, psychiatric disorders, follow up, prisoner

Introduction

Although the mental health of prisoners received increased attention in the past

decades, the impact of imprisonment (either in jail or prison) on mental health prob-

lems of prisoners with psychiatric disorders is barely studied in a longitudinal design.

1Custodial Institutions Agency, Ministry of Security and Justice, Amsterdam, The Netherlands

2Radboud University Medical Centre, Nijmegen, The Netherlands

3Pompe Foundation, Nijmegen, The Netherlands

Corresponding Author:

Oscar Bloem, Custodial Institutions Agency, Ministry of Security and Justice, Vlieterweg 14-A, 3925 GB

Scherpenzeel, Amsterdam, The Netherlands.

Email: o.bloem@alumni.maastrichtuniversity.nl

1058956IJOXXX10.1177/0306624X211058956International Journal of Offender Therapy and Comparative CriminologyBloem et al.

research-article2021

Bloem et al. 721

Imprisonment severely deprives ones autonomy and provides a challenging context to

adapt to, in particular during the first weeks (Walker et al., 2014). On itself, this may

give rise to unintended mental health problems, especially in prisoners with a history

of psychiatric problems. To understand the course of mental health during the first

phase of imprisonment and the factors related to mental health change, is therefore

pivotal for adequate triage and treatment to prevent unintended negative effects of

imprisonment, specifically from a human rights point of view. Furthermore there is an

association between mental health problems and behavioral problems within a prison

context, such as misconduct or suicidal behavior in prison (Favril et al., 2019; Fazel

et al., 2008; Felson et al., 2012; Schenk & Fremouw, 2012). Next to this, mental health

and substance related problems may also increase the risk of reoffending after release

from jail or prison (Baillargeon et al., 2009; Blank Wilson et al., 2014). This empha-

sizes the importance to understand the development of mental health within a prison

context. It should be noted that prison contexts may vary largely between and even

within countries, depending on governmental policy and finances, building setup,

quality of prison staff and mental healthcare services among other things.

Compared to the general population, prisoners suffer more often from psychiatric

disorders, including substance use disorders and personality disorders (Baranyi

et al., 2019; Bebbington et al., 2017; Fazel & Danesh, 2002; Fazel & Seewald, 2012;

Gottfried & Christopher, 2017). In a general (high income country) prison popula-

tion, elevated psychiatric symptoms1 are specifically reported at admission of

imprisonment (Dirkzwager & Nieuwbeerta, 2018; Gonçalves et al., 2016; Walker

et al., 2014). Concerning the presence of psychiatric disorders—not the level of

symptoms per se—low- and middle-income countries report higher prevalence of

psychiatric disorders at prison intake than later on during imprisonment (Baranyi

et al., 2019). Although the relation between current mental health problems and the

presence of a psychiatric disorder is also presented in a prison context, it is not

always clear in what way the presence of a psychiatric disorder relates to the course

of presented symptoms within this context. Whereby, again, it should be noted that

also this context may vary largely.

Prior Research on the Course of Mental Health During Imprisonment

The few studies on this subject come from high-income countries and describe an

average positive mental health change in a general prisoner population during the

first period of imprisonment (Dirkzwager & Nieuwbeerta, 2018; Gonçalves et al.,

2016; Walker et al., 2014). However, explanations to understand this overall posi-

tive change, are inconclusive (Dirkzwager & Nieuwbeerta, 2018; Gonçalves et al.,

2016; Walker et al., 2014). Furthermore, risk factors for deterioration of mental

health appear unexplored. A complex interplay between psychiatric, pre-existing

individual (socio-economic) and prison characteristics is considered to relate to

mental health during imprisonment. This interplay is also debated in terms of

importation and deprivation factors in relation to adaptation to (long-term) impris-

onment (Dhami et al., 2007).