Health and Justice最新文献

Background: Communicators in public safety, such as 911 telecommunicators, emergency medical dispatchers, and police and fire dispatchers, frequently deal with distressing calls, traumatic narratives, and high-stakes decisions. Despite not being physically present at crisis scenes, these experts endure psychological stress on par with first responders. This scoping review examines the prevalence and determinants of depression and suicidal ideation among public safety communicators and their co-occurrence, summarizes the occupational and personal risk factors contributing to these outcomes, and evaluates proposed mitigation strategies.

Results: The research indicates that depression is reported at elevated rates in this workforce, ranging from 8.4% to 73%, depending on the population and the sensitivity of the instrument, based on 11 quantitative studies published between 1995 and 2025. Although less studied, suicidal ideation appears to be significantly higher in this group compared to the general population. Contributing factors include indirect trauma exposure, shift work, emotional suppression, organizational neglect, and a history of trauma. The frequent co-occurrence of depression and suicidal ideation supports the Interpersonal Theory of Suicide as a relevant explanatory framework.

Conclusions: Despite accumulating evidence, research is methodologically limited due to cross-sectional designs, inconsistent screening tools, and sample homogeneity. Existing interventions, such as peer support, debriefing, and trauma-informed training, are inconsistently applied and under-evaluated. The findings highlight a pressingneed for longitudinal research, targeted interventions, and workplace reforms that take into account the unique psychological burdens associated with communicator roles. Addressing depression and suicide risk among these professionals is critical to ensuring both workforce well-being and the continued effectiveness of public safety systems.

Competency to stand trial is a legal construct in the United States whereby an individual's capacity to meaningfully and knowingly function in a legal proceeding, typically for those with mental or developmental disabilities or dementia, is questioned. The competency determination and restoration process often leads to unnecessary and excessive incarceration of those with disabilities without treatment for the underlying cause of competency concerns, often worsening health and leading to repeated incarceration. Yet, this crisis is rarely considered from a public health lens. Further, the number of individuals entangled in this legal process has risen dramatically in recent years, with 130,000 competency evaluations being conducted annually. We review what is known about this topic from legal studies, provide case studies of individuals failed by this process, and outline the responses that criminal legal systems and local and state governments have had to this crisis (e.g., increase in jails' competency beds, diversion programs). We conclude that the competency process is a public health crisis which merits both study by public health researchers and a public health response.

Background: Justice-involved individuals with opioid use disorder (OUD) face heightened relapse risks during the reentry period. While medications for opioid use disorder (MOUD) are effective, long-term recovery also depends on psychological and structural supports, including situational confidence (perceived ability to resist substance use in high-risk situations) and recovery capital (the internal and external resources that support recovery).

Methods: This cross-sectional study examined situational confidence and its association with recovery capital among 107 justice-involved adults receiving MOUD in an urban jail in Texas. Participants completed the Brief Situational Confidence Questionnaire (BSCQ) and the 10-item Brief Assessment of Recovery Capital (BARC-10). Mental health and substance use were assessed using the PHQ-9, GAD-7, AUDIT, and ASSIST. Bivariate associations were examined using chi-square and Fisher's exact tests, and a multivariable logistic regression model was used to assess factors associated with high situational confidence (BSCQ ≥ 80%).

Results: Participants had a mean age of 38.9 years (SD = 0.4); most were male (74.0%), non-Hispanic Black or other race/ethnicity (58.0%), and had a high school education or less (59.8%). A majority (66.4%) reported unstable housing in the 30 days prior to incarceration. Fewer than half (44.9%) reported high situational confidence, with a mean score of 67.6 (SD = 26.9). Higher recovery capital was strongly associated with high situational confidence (aOR = 2.66; 95% CI: 1.52-4.96). Depression (aOR = 0.36; 95% CI: 0.16-0.78), sexual minority status (aOR = 0.14; 95% CI: 0.01-0.78), and reliance on informal income-generating activities ("hustling") (aOR = 0.30; 95% CI: 0.10-1.01) were associated with lower situational confidence.

Conclusions: Recovery capital is a strong predictor of situational confidence among justice-involved individuals receiving MOUD. Interventions that enhance recovery capital, including access to employment, housing, and social support, integrate mental health care, and provide tailored support for marginalized subgroups, may improve recovery outcomes during incarceration and reentry. Brief, validated tools like the BSCQ and BARC-10 may help identify individuals at greater relapse risk and guide more targeted, equity-informed reentry planning.

Background: Justice-impacted persons aged 40 and up with substance use disorders (SUD) demonstrate increased health risks and health disparities relative to general population peers. Persons with SUD are less likely to age out of criminal behavior, appearing on criminal dockets, in jails, prisons, and under community supervision throughout the life course, with greater community-level cost burdens as they age. Justice system involvement presents health risks that compound with SUD to undermine well-being, which is amplified as people age and experience age-related health decline. Propensity for premature mortality from overdose is startlingly high for this population, highlighting demand for targeted policies to better meet the needs of this vulnerable group. To better understand justice-impacted older adults in treatment for SUD and inform policy, we examined opioid use outcomes among 357 low-income justice-impacted adults in SUD treatment in the Midwest, USA, including a natural oversampling of Black and American Indian or Alaska Native (AIAN) persons. We explored patterns among persons in their 40s, 50s, and 60s, relative to those under 40, conceptualizing life-course risk factors and using logistic regression to assess overdose, opioid use, and opioid agonist medication use.

Results: Significant differences in opioid use by age were observed, with older persons less likely to report opioid prescription misuse or illicit opioid use. Differences were not significant once controlling for user preferences, race/ethnicity, gender, family, childhood, and life course experiences. Overdose history was also significantly less likely for the 40 and older SUD patient, though this was no longer significant when controlling for demographic covariates. Opioid agonist medication use did not significantly differ by age.

Conclusions: Justice-involved patients aged 40 and up in SUD treatment were less likely to have experienced overdose or report opioid use, relative to their younger peers, but this variation dissipated when considering demographic, family and/or life course factors. Targeted treatment services for gender and racial minorities may be beneficial for patients 40 and up. We identify preference for one substance, versus two, as protective against overdose and opioid use among older persons who use drugs.

Background: Harm reduction is a public health approach that emphasizes strategies to reduce the negative consequences of drug use. Rising overdose deaths in the United States have prompted integration of harm reduction strategies within criminal-legal systems (CLS), which have historically emphasized deterrence. However, the scope and nature of these strategies across the CLS remain poorly understood.

Methods: We conducted a scoping review, in accordance with PRISMA guidelines, to identify harm reduction strategies targeting illicit drug use that have been implemented within CLS settings in the United States. We searched seven databases for peer-reviewed articles published in the last 10 years. Eligible articles reported on implementation of a harm reduction strategy focused on reaching PWUD in a CLS setting. Using the Sequential Intercept Model as a guiding framework, we mapped strategies to law enforcement, initial detention/court hearings, jails and courts, reentry, and community corrections settings. We used DistillerSR to screen articles and abstract data.

Results: From 455 records, 99 articles met inclusion criteria, representing 51 discrete instances of harm reduction strategy implementation. Implementation was most common in custody settings (e.g., jails and courts) and frequently included initiation of medication for opioid use disorder, naloxone distribution, and CLS referral/diversion. Fewer instances of implementation were documented in early stage or community-based settings. CLS staff were directly involved in delivering over 75% of the harm reduction strategies, and one-third included partnerships with non-CLS government agencies. Nearly one-third of the strategies were implemented as part of research studies.

Conclusions: Harm reduction strategies have increasingly been integrated into CLS, though unevenly and often with a narrow clinical focus. Expanding harm reduction within CLS will require broader definitions, system-level buy-in, and efforts to align practice with public health evidence.

Background: Non-custodial judicial treatment orders aim to reduce recidivism for justice-involved people with drug and/or alcohol use problems, but health and well-being impacts are not understood. We conducted the first qualitative evidence synthesis to explore the perceived impacts on health and well-being of treatment orders and the perceived barriers and facilitators to implementation from the perspectives of justice-involved adults, their family members/significant others, and staff delivering/ mandating the treatment.

Design: We searched 14 bibliographic databases (31/10/2023-07/11/2023) and conducted supplementary searches to identify qualitative evidence. Two reviewers appraised methodological limitations using CASP and assessed confidence in review findings using GRADE-CERQual. We used framework synthesis to synthesise evidence. We integrated synthesised findings with results of a complementary quantitative review investigating health and well-being effects of treatment orders.

Results: We synthesised 25 studies (29 reports); 22/29 reports had moderate or high methodological limitations. Most studies (n = 20) focused on USA drug courts; none focused on alcohol interventions. Only three studies had health and well-being as their main focus. No studies involved family members. Only one study reported a theory of how treatment orders might impact health. GRADE-CERQual assessments of 13 findings were high (n = 7/13), moderate (n = 4/13), or low (n = 2/13) confidence. Justice-involved adults perceived treatment orders to reduce mortality/morbidity risk, improve sense of self and coping with emotions, to result in feeling healthier, but also to exacerbate trauma and increase stress. Coerced treatment was perceived to interfere with "therapeutic change," nonetheless it was often perceived to reduce, cease and/or stabilise illicit drug use. Justice-involved adults' challenging life circumstances were an important barrier to reducing/ ceasing substance use. Abstinence-based approaches were common but abstinence may be unrealistic. Intervention effectiveness trials rarely measured relational outcomes of importance to justice-involved adults e.g., impacts on their children, or health outcomes.

Conclusions: High-quality qualitative studies are urgently needed on the health impacts of diverse treatments orders. Treatment orders should emphasise harm-reduction treatment approaches and address participants' healthcare and social needs. Theories of how treatment orders work are needed. Unintended negative health consequences of treatment orders must be researched. Future trials should measure and report health and relational outcomes. Study protocol registration: [CRD42023484923]. The National Institute for Health and Care Research (NIHR) Evidence Synthesis Programme (Grant: NIHR153425, project number NIHR162046) funded this study.

Opioid-related fatalities in U.S. correctional facilities present a critical criminal justice and health challenge. This study examines predictors of drug- and opioid-related deaths among incarcerated individuals nationwide. In the main models, younger age increases overdose risk, females face higher odds of drug-related death than males, and shorter stays are linked to all drug-related deaths, while longer stays are associated with opioid fatalities. Geographic disparities emerge, with small metro and micropolitan areas showing higher drug death rates and large fringe metros showing significantly lower opioid death rates. Medium-security facilities and greater spatial distance from public transportation access points predict higher rates for both outcomes. Subgroup analyses reveal that conviction status predicts elevated drug-related mortality only among males and among individuals held longer than 17 days. Notably, over one-third of opioid-related deaths and more than half of other drug deaths occur within 24 h of incarceration, underscoring acute early-stage vulnerability. Findings reveal distinct and overlapping predictors shaped by both rehabilitative and punitive factors, informing policies and interventions to reduce overdose fatalities in jails.