Treatment-resistant schizophrenia (TRS) is a challenging condition to treat for the correctional psychiatrist. Guidelines from the American Psychiatric Association indicate that the first-line pharmacotherapy for TRS is the use of the atypical antipsychotic clozapine. The use of clozapine is unique in that it requires patient adherence with weekly blood draws as a prophylactic measure against agranulocytosis and leukopenia. In the correctional setting, patients with severe and persistent schizophrenia are frequently nonadherent due to lack of insight and anemic access to health care resources, specifically as these pertain to clozapine. Therefore, an alternative treatment option would be a welcome solution for this demographic. Our literature review demonstrates a limited number of studies documenting the successful use of clozapine alternatives or combination antipsychotic therapy for treatment of TRS. In this article, we present a putative case where we believe that a combination regimen of paliperidone palmitate, oral aripiprazole, and escitalopram led to a notable mitigation of both positive and negative symptoms of psychosis in the case of an incarcerated patient with TRS, as well as an improvement in functional stability, which was conducive to housing in a less restrictive setting. A brief review of the published literature follows the report.

Older adults who are or have been incarcerated constitute a growing population in the USA. The complex health needs of this group are often inadequately addressed during incarceration and equally so when transitioning back to the community. The purpose of this paper is to discuss the literature on challenges older adults (age 50 and over) face in maintaining health and accessing social services to support health after an incarceration and to outline recommendations to address the most urgent of these needs.
This study conducted a narrative literature review to identify the complex health conditions and health services needs of incarcerated older adults in the USA and outline three primary barriers they face in accessing health care and social services during reentry.
Challenges to healthy reentry of older adults include continuity of health care; housing availability; and access to health insurance, disability and other support. The authors recommend policy changes to improve uniformity of care, development of support networks and increased funding to ensure that older adults reentering communities have access to resources necessary to safeguard their health and safety.
This review presents a broad perspective of the current literature on barriers to healthy reentry for older adults in the USA and offers valuable system, program and policy recommendations to address those barriers.

With a majority of prisoners in the United States having a history of mental illness and only half of these receiving mental health treatment, it became imperative to develop programs to assist those with mental illness to avoid repeated incarceration. The Eleventh Judicial Circuit Criminal Mental Health Project (CMHP) was developed to decrease recidivism in patients with serious mental illness (SMI). This case details how the Mental Health Offender Program (MHOP), created following the CMHP model, allows for substantial decreases in costs associated with non-violent offenders with SMI and provides wraparound services to improve their functioning and quality of life.

OBJECTIVE: This study aims to critically evaluate the Orleans Parish Prison (OPP), New Orleans, Louisiana response to Hurricane Katrina in 2005 and the Metropolitan Detention Center (MDC), Guaynabo, Puerto Rico, response to Hurricane Maria in 2017 to determine key areas for policy development.
METHODS: This study uses an interpretivist paradigm to conduct an inductive, cross-case synthesis and content analysis.
METHODS: The OPP in Katrina and the MDC in Maria; case-studies determined by similar exposure to hurricanes in the Caribbean and inmate population.
METHODS: Inmates as an intrinsically vulnerable population.
METHODS: Cross-case synthesis of the two selected case-studies comparing response to separate hurricanes.
METHODS: The ProQuest, Wiley, Scopus, Science Direct, and Google Scholar databases were used to establish a corpus of qualitative data focused on the evacuation and humane treatment of inmates. Inductive content analysis resulted in three themes which informed seven policy recommendations for enhanced correctional facility preparedness for natural and human-induced hazards.
RESULTS: The preparedness of correctional facilities remains inadequate despite significant experience during Katrina, Maria, and other disasters demonstrating a failure in isomorphic learning.
CONCLUSIONS: The theoretical contributions of this study are encapsulated in seven recommendations. Three are recommended accountability and support measures for the Bureau of Prisons (BOP) and state institutions by involving the FEMA and the Government Accountability Office (GAO). The other four are recommended improvements in EM planning for counties and municipalities.

BACKGROUND: COVID-19, caused by SARS-CoV-2, has devastated incarcerated people throughout the United States.
OBJECTIVE: The purpose of this study was to test the feasibility and acceptability of a COVID-19 Health Review for Correctional Facilities.
METHODS: The COVID-19 Health Review survey for the Department of Corrections was developed in Qualtrics to assess the following: (1) COVID-19 testing, (2) providing personal protective equipment, (3) vaccination procedures, (4) quarantine procedures, (5) COVID-19 mortality rates for inmates, (6) COVID-19 mortality rates for correctional officers and prison staff, (7) COVID-19 infection rates for inmates, (8) COVID-19 infection rates for correctional officers and prison staff, and (9) uptake of COVID-19 vaccines. The estimated time to review the Alabama State Department of Corrections COVID-19 responses on their website and complete the survey items was 45 minutes to 1 hour.
RESULTS: Of the 21 participants who completed the COVID-19 Health Review for Correctional Facilities survey, 48% (n=10) identified as female, 43% (n=9) identified as male, and 10% (n=2) identified as transgender. For race, 29% (n=6) self-identified as Black or African American, 24% (n=5) Asian, 24% (n=5) White, 5% (n=1) Pacific Islander or Native Hawaiian, and 19% (n=4) Other. In addition, 5 respondents self-identified as returning citizens. For COVID-19 review questions, the majority concluded that information on personal protective equipment was \"poor\" and \"very poor,\" information on COVID-19 testing was \"fair\" and above, information on COVID-19 death/infection rates between inmates and staff was \"good\" and \"very good,\" and information on vaccinations was \"good\" and \"very good.\" There was a significant difference observed (P=.03) between nonreturning citizens and returning citizens regarding the health grade review with respect to available information on COVID-19 infection rates.
CONCLUSIONS: COVID-19 health reviews may provide an opportunity for the public to review the COVID-19 responses in correctional settings.

During a pandemic, basic public health precautions must be taken across settings and populations. However, confinement conditions change what can be done in correctional settings. Correctional nursing (CN) care, like all nursing care, needs to be named and encoded to be recognized and used to generate data that will advance the discipline and maintain standards of care. The Omaha System is a standardized interprofessional terminology that has been used since 1992 to guide and document care. In 2019, a collaboration between the newly formed American Correctional Nurses Association and the Omaha System Community of Practice began a joint effort with other stakeholders aimed at encoding evidence-based pandemic response interventions used in CN. The resulting guidelines are included and illustrated with examples from CN practice.

This study compares staff reports of bullying among institutionalized youth with residents\' own self-reported prevalence of bullying and victimization collected in the previous study (the Self-Report Study on Bullying in Croatian Residential Care [SSBCRC]) and staff reports of reduction strategies are compared with evidence-based proposed policy solutions arising from residents\' reports. The study also compares reduction strategies used by staff with evidence-based proposed policy solutions arising from residents\' reports arising from the SSBCRC. A total of 140 staff from 20 Croatian youth facilities completed an anonymous questionnaire. The results revealed that staff estimates of the prevalence of bullying and victimization were significantly lower than resident reports. Staff were better aware of the prevalence of certain types of bullying, but they held stereotypical views of bullies and victims and had difficulties in recognizing the true times and places of bullying. Staff described their anti-bullying policies as being predominantly reactive, rather than proactive and evidence-based. It is concluded that more effort needs to be made to change the current anti-bullying policies used by staff.