Dr Muhammad Muhsin Ahmad Zahari  Department of Psychological MedicineFaculty of Medicine, University of Malaya            ...
ntroductionHigher rate of psychiatric illness and HIV in the prisothan in the general populationHIV infection has been a r...
Pharmacologically, anti-retroviral side effects can alsopresent as psychiatric illnessHowever, the accessibility to health...
HIV infected prisoners were less likely to beincarcerated for violent offensesStayed longer in the prisonAlso more likely ...
emographic profile                                                               HIV+                    HIV-  Characteris...
HIV+           HIV-Characteristic                                                          P                              ...
ariate and Adjusted Logistic Regression Results for Psychiatricesses Stratified by HIV Status                             ...
It is important to address mental illness in the prisonOtherwise, it will lead to social and public healthproblems for the...
Health services in the prison need to be enhancedfrom screening, diagnosis and optimal treatmentparticularly for mental il...
What are public health issues inelation to drug use Drug dependence - implementation of opioid substitution therapy (throu...
Pilot Study:Methadone Dose Matters          100-120mg                      Log Rank (Mantel-Cox):                       2 ...
TCOMES                  COUNT      Total Active       15                                Majority lost due to no family and...
What are public health issues inelation to drug abuse HIV infection - treatment for HIV (through reduction in HIV-1 RNA le...
Recidivism also high among drug-related offencesOpportunities for prison to provide interventionprogram for those who have...
Structural barriersRUCTURAL BARRIERS IU registries, with names of thoseeking treatment given to policelice harassment of p...
Structural barriersRUCTURAL BARRIERS IIug detention in name ofatmentNo medical evaluationNo right of appealForced laborNo ...
Challenges (1) Perception of the place as detention centers Assumption of the people with low ‘moral’ weakness has lesser ...
Challenges (2) Assuming prisoners just made up reason/behaviour to escape from serving punishment Lack of source of fundin...
Challenges (3) Some of them does not have home to stay Family rejection upon release Police custody – not informing us so ...
Conclusion Good prison health is important for the public health in the community Closer collaboration with or incorporati...
Social support networks, in addition to comprehensivhealthcare service are important in maintaining ex-prisoners in the co...
dr.muhsin.az@gmail.com
Challenges in delivering mental health services to plhiv in custodial settings by Muhsin Zahari
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Challenges in delivering mental health services to plhiv in custodial settings by Muhsin Zahari

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Challenges in delivering mental health services to plhiv in custodial settings by Muhsin Zahari

  1. 1. Dr Muhammad Muhsin Ahmad Zahari Department of Psychological MedicineFaculty of Medicine, University of Malaya dr.muhsin.az@gmail.com
  2. 2. ntroductionHigher rate of psychiatric illness and HIV in the prisothan in the general populationHIV infection has been a risk factor for psychiatricillnessHIV spreading to the brain can also affect centralnervous systemAlso via psychosocial adversity
  3. 3. Pharmacologically, anti-retroviral side effects can alsopresent as psychiatric illnessHowever, the accessibility to healthcare service is verylimited
  4. 4. HIV infected prisoners were less likely to beincarcerated for violent offensesStayed longer in the prisonAlso more likely to have substance use disorders,including polysubstance usersIn developing countries, more likely to be IVDU
  5. 5. emographic profile HIV+ HIV- Characteristic P (n=200) (n=200) Median age* 37 (31-43) 33 (27-42) <0.01 Ethnicity* <0.01 Malay 138 (69.0) 122 (61.0) Chinese 27 (13.5) 28 (14.0) Indian 35 (17.5) 29 (14.5) Other 0 21 (10.5) Religion (Muslim) 146 (73.0) 143 (71.9) 0.997 Married* 132 (66.0) 107 (53.5) <0.01 Education level 0.298 1: Primary or below 54 (27.0) 56 (28.0) 2: Incomplete secondary 80 (40.0) 79 (39.5) 3: Complete sec or higher 66 (33.0) 65 (32.5) Employed at incarceration 75 (37.5) 84 (42.0) 0.358 Income below 500RM (poverty) 24 (12.0) 25 (12.5) 0.700pted from Muhsin et al. Psychiatric and Substance Abuse Co-Morbidity Among HIV Seropositive and HIV Seronegative Prisoners in MJ Drug & Alcohol Abuse, 36:31–38, 2010
  6. 6. HIV+ HIV-Characteristic P (n=200) (n=200)History of transfusion 26 (13.1) 19 (9.5) 0.260History of IDU* 188 (94.5) 53 (26.5) <0.01Median duration of HIV diagnosis inmonths (IQR) 48 (12-96) -Median cumulative lifetime-years inprison* 47 (24.5-90) 17 (4.5-59.5) <0.01Substance-related diagnosis* 198 (99.0) 133 (66.5) <0.01 Opioid use* 196 (98.0) 111 (55.5) <0.01 Amphetamine use* 88 (44.0) 59 (29.5) <0.01 Cannibis use* 125 (62.5) 75 (37.5) <0.01 Sedative use* 45 (22.5) 9 (4.5) <0.01Polysubstance diagnosis* 157 (78.5) 84 (42.0) <0.01Alcohol-related diagnosis 35 (17.5) 32 (16.0) 0.688History of psychiatric visit prior toincarceration 20 (10.0) 14 (7.0) 0.282History of psychiatric visit duringincarceration 3 (1.5) 4 (2.0) 0.703
  7. 7. ariate and Adjusted Logistic Regression Results for Psychiatricesses Stratified by HIV Status Odds Ratio (95% Adjusted OddsPsychiatric disorder (n) HIV+ (200) HIV- (200) CI) Ratio (95% CI)Any psychiatric disorder (165) 88 (44.0) 77 (38.5) 1.26 (0.84-1.87) 1.52 (0.83-2.76) Any non-substance-induced 73 (36.5) 66 (33.0) 1.17 (0.77-1.76) 1.91 (1.02-3.56)* psychiatric disorder (139) Substance-induced psychiatric 22 (11.0) 15 (7.5) 1.54 (0.77-3.04) 0.86 (0.34-2.20) disorder (37)Mood disorder (68) 36 (18.0) 32 (16.0) 1.15 (0.68-1.94) 1.42 (0.69-2.95) Bipolar disorder (17) 5 (2.5) 12 (6.0) 0.40 (0.14-1.16) 0.55 (0.12-2.41) Major Depression (51) 31 (15.5) 20 (10.0) 1.65 (0.91-3.01) 1.76 (0.79-3.96)Psychotic disorder (34) 23 (11.5) 11 (5.5) 2.23 (1.06-4.72)* 1.49 (0.71-3.62)Adjustment disorder (38) 17 (8.5) 21 (10.5) 0.79 (0.40-1.55) 1.80 (0.70-4.68)Anxiety disorder (15) 7 (3.5) 8 (4.0) 0.87 (0.31-2.45) 1.12 (0.21-5.98)ted from Muhsin et al. Psychiatric and Substance Abuse Co-Morbidity Among HIV Seropositive and HIV Seronegative Prisoners in MaDrug & Alcohol Abuse, 36:31–38, 2010
  8. 8. It is important to address mental illness in the prisonOtherwise, it will lead to social and public healthproblems for the futureIdeally, it should be a clear policy to divert the mostmentally ill away from prisons
  9. 9. Health services in the prison need to be enhancedfrom screening, diagnosis and optimal treatmentparticularly for mental illness including addiction andalso, infectious diseases such as HIV, Hep C
  10. 10. What are public health issues inelation to drug use Drug dependence - implementation of opioid substitution therapy (through reducing HIV risk behaviors) in community settings independently reduces morbidity and mortality . Methadone maintenance treatment (MMT) is effectiv for both relapse prevention and facilitating access to and retention in care in community settings.
  11. 11. Pilot Study:Methadone Dose Matters 100-120mg Log Rank (Mantel-Cox): 2 Χ = (1, 27) 7.60, p < .01 Breslow (Gen Wilcoxon): 2 Χ = (1, 27) 7.45, p < .01 <80mg Tarone-Ware: 2 Χ = (1, 27) 7.69, p < .01
  12. 12. TCOMES COUNT Total Active 15 Majority lost due to no family and no placeeath in the community 1 to stay. PCO 1Death in the prison 2 Lost upon release 61 month after release 31 month after release 2TAL 30
  13. 13. What are public health issues inelation to drug abuse HIV infection - treatment for HIV (through reduction in HIV-1 RNA levels) Hepatitis C – in prison 20 times higher than in the community This is closely related to IVDU IDU – IVDU inmates are 8 times more likely to get HCV in prison IDU inmates are 24 times more likely to have HCV than non-IVDU inmates TB
  14. 14. Recidivism also high among drug-related offencesOpportunities for prison to provide interventionprogram for those who have high risk behaviour
  15. 15. Structural barriersRUCTURAL BARRIERS IU registries, with names of thoseeking treatment given to policelice harassment of patients andovidersovider harassmentArrests and fear chill (Ukraine), painprescription (all countries), and opendiscussion (Russia)carceration and tx interruptionsNo OST (or ARV) in pre-trial detentionNo OST and little ARV in prison Ukraine: 1 in 10 HIV+ prisoners treated Malaysia: 1 in 15 HIV+ prisoners treated Russia: food shortages, medication shortages, unsanitary conditions
  16. 16. Structural barriersRUCTURAL BARRIERS IIug detention in name ofatmentNo medical evaluationNo right of appealForced laborNo treatmentNo effectiveness
  17. 17. Challenges (1) Perception of the place as detention centers Assumption of the people with low ‘moral’ weakness has lesser ‘humane value’ – Patients vs prisoners Perception –’Punishment not only in term of restriction of individual freedom and physical suffering but also should be deprived from comprehensive healthcare service’ Knowledge on medical related issues – e.g. addiction, mental health, epilepsy, infectious diseases
  18. 18. Challenges (2) Assuming prisoners just made up reason/behaviour to escape from serving punishment Lack of source of funding – lower financial allocation Lack of trained medical personnel Now moving towards rehabilitation where elements o healthcare will facilitate any forms of rehabilitation
  19. 19. Challenges (3) Some of them does not have home to stay Family rejection upon release Police custody – not informing us so subject left untreated Multi agencies coordination
  20. 20. Conclusion Good prison health is important for the public health in the community Closer collaboration with or incorporation into the ke healthcare provider in delivering health service to prisoners will help to improve the quality of health provided to prisoners
  21. 21. Social support networks, in addition to comprehensivhealthcare service are important in maintaining ex-prisoners in the communityPrison staff need to be made aware of the importanceof health issues among prisoners
  22. 22. dr.muhsin.az@gmail.com

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