Mental and Physical Health Problems as Conditions of Ex-Prisoner Re-Entry
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Health Care during Imprisonment
Interviewee (I): I actually came here [to the therapeutic ward] under duress, because I did not agree to the therapy myself, because I did not want to. The psychologist referred me to the penitentiary court, they stated in article 117 that I must go to treatment, because I have a problem, I’m addicted, right? I denied it (…) I did nothing, I didn’t participate [in therapy]. I fucked this whole thing. I stood by my own, that I have no problem with drugs, that I can handle it. (…) They are sick, they want to put some disease in my head. Which I don’t really have. (…) So, when I was here on the ward, I endured drugs. My brother used to visit me from freedom to see me, he brought me heroin, amphetamines, needles, syringes. <adult male, recidivist>
I: When they are in the transition room, they go through this withdrawal period and then they end up in the [support] group and that’s it. And later, if an addiction is diagnosed (…) he may go to a correctional facility in Białystok, and that is that. There are simply no specialists at the shelter who would do it properly. <counselor, juvenile facility>
I: You cannot even ask for a visit to the doctor, because the waiting time is 3 weeks, for an antibiotic—4 months. So, either you will manage to heal yourself or—as I had it—the disease will spread to the whole body, because I have a [skin disease] and I needed such a specific medicine (…) and I got to the doctor after 4 months. It was during this time that it developed all over my skin, everywhere. <adult male, 1st time prisoner>
I: Doctors disregard us (…) Healthcare here is at a zero level. Polopyrine here is [a cure] for everything. The girl from my cell got it, for example, for inflammation of the peritoneum. <adult female, 1st time prisoner>
I: It’s horrific here… You can die here. When I was in [Name of the prison], a girl arrived (…) from this prison. And she had in her papers that she simulated a heart defect, because that was what the local doctors said, so they didn’t accept her there either. And she died on the same night she arrived. <adult female, 1st time prisoner>
Researcher (R): And what is your favorite way of spending your time in prison?
Interviewee (I): I used to go to a psychiatrist to prescribe me sleeping pills. Because my thoughts are so weird. [The doctor] didn’t ask about it, he did not research, he just would rewrite the prescription. Sometimes I collected these [pills] from others so I could sleep all the time. <adult male, recidivist>
I: They [inmates from a hostile subculture group] beat me up so much that they took me unconscious to the [prison] hospital. (…) I will never forget this. They did something to my leg, it started to crush me (…) but when I wanted to go to the doctor they said I was simulating, because the leg is not swollen. However the pain was horrendous. I could not put my foot gently or even rest without pain. When I finally went to the doctor I had a fever of 40 degrees. <adult male, recidivist>
I: Especially mental health protection is a big problem, because someone calculated up there that the cost was 12–13 thousand [PLN]. The salary of a psychiatrist is quite a lot and they dismissed a psychiatrist treating prisoners. They offered him a lump sum and he refused as the rates were ridiculous. And the problem of the situation of people with disorders leaving prisons emerged. They then go outside and pose a threat to themselves and others. <Prison Service informer>
I: Boys very often come to the facility with a diagnosis of a personality disorder, while the literature says that personality is formed until the age of 18–19, so a boy may reveal features only, this personality may only develop, but it irritates me when I see a diagnosis of a borderline personality disorder in a 15-year-old. Often, psychiatrists write a personality disorder, yet they combine it with ADHD and the matter is over the top. (…) And they usually already have labels attached to their documents. <psychologist, juvenile facility>
R: Why did you cut your hands?
I: Because I had such a period, because of various problems… For example, my mother turned against me when she was with her boyfriend, it was also because of this. <female, juvenile facility>
R: I noticed that this [cutting hands] is probably such a fashion. One day, only one girl has her arms cut, another one it’s several…
I: Because some [girls] are so cool and all. I know this one… she thinks it’s cool and that she likes to cut her hands, because it looks fancy. And she had such a cut, ugly, I wouldn’t be able to cut it this way to make it look asymmetrical somehow. <psychologist, juvenile facility>
I: I told myself that I would not be held responsible and that I would not be in prison for so many years… I would cut my wrists as soon as I step into detention. After they locked me up, I slashed my veins on the second day. I was lying in this bed, I took out the artery (…) About three hours I was bleeding out (…) I was getting cold, I was getting hot, I started to sweat (…) I reached out for cigarettes and lost consciousness. <adult male, recidivist>
I: When I got imprisoned (…) I had so many eschars [caused by self-injecting with heroin] that they had nowhere to insert the needle… legs and hands (…) They had to put cannulas in my neck (…) [With three other people] I took a kilo of mephedrone and almost a kilo of heroin over the span of three months. It scares me terribly and I thank God that I am actually in prison. <adult male, recidivist>
3.2. Health Issues as Barriers to Re-Entry
I: The fact that [a prisoner] was serving a sentence does not mean that he does not come back [to the therapy ward]. He does. I am working in a substitutive therapy unit, i.e., where an addicted patient takes methadone. He comes back anyway. Despite our efforts. So my activity is mainly limited to helping him find himself in the society, again and again. <psychotherapist, prison therapy ward>
I: One thing is worth noting: the fact that they do not have access to drugs in the facility does not mean that they are already clean. They declare that as soon as they leave, they will “pull in their nose”. <psychotherapist, juvenile facility>
I: I was waiting for this day of departure, you know it! (…) And the closer to this exit, the more I was overwhelmed … Well, to put it so brutally, I had terrible poops. I didn’t want this previous life anymore, but I was afraid. <adult male, ex-prisoner, recidivist>
I: Most often, these people go to the same places, to the same people (…) with their old habits (…) while in statistics about 70% of crimes [are those committed] under the influence of alcohol. (…) Human pro-health behaviors outside prison are absolutely crucial if you don’t want to come back here. But when funds run out, you have to find a way to get them, and under the influence of alcohol it is easier not to worry that the crime will be exposed. This is most often the case of robberies and the circle is closed. <counselor, adult male prison facility>
I: (…) so I‘m leaving prison. I lost my apartment [while serving a 15-year sentence], I don’t have anywhere to go. I got, I think, 150 PLN, which is actually a maximum for what they give you (…) I got some clothes there, but you can probably imagine their quality (…) So where will I sleep? I spend the first night at my friend’s, the second at another’s apartment. And that’s it. That’s the help you receive. And now, how do you survive? Even if you tried I don’t know how hard, you won’t be able to live on. <adult male, ex-prisoner, recidivist>
I: There was a boy who came out of here, mentally ill, came out of here and stood in the gate and didn’t know what to do with himself. Then he started walking across the field, into the trees and back to the gate. He didn’t know where to go, what to do. The ambulance had to come, and they asked what was wrong with him. They took him to the counselor, and the counselor just said that the boy was mentally ill. So they took him to the hospital. <adult male, recidivist>
I: Prisoners after larger sentences, such as few years old, I think they are more closed and withdrawn (…) They are often so damaged and so personality disturbed after being released from prison that they need a longer, deeper, and more intense work on themselves. <prison psychologist>
I: Access to free psychological care is crucial (…) so that in a difficult, mutagenic situation of relapse, this person could quickly contact a specialist who would help him and prevent a mishap (…) or relapse. As far as I know, the waiting period for a psychological consultation under the National Health Fund is about 12 months and 2–3 months to see a psychiatrist. (…) Some of them can afford private medical advice but most are unable to pay for such benefits, it’s difficult to find a job and cope with the life outside prison, and even more so in paying for medical advice, which is not the cheapest. <prison psychologist>
I: Let’s be clear about this. Depriving someone of physical freedom is violence. (…) A person who experiences violence learns to miss it. These people miss this system. These mechanisms are like hypocrisy in any addiction. A man will subconsciously do everything to get there once again. <therapist>
I: Why can’t I find a job? I tried, I really tried (…) but now I’m constantly unemployed. (…) when I went to the a commission [for assessing the degree of disability], they told me “You speak rather well, you hear a little, you are capable, you can go to work”. Really? I am? So why doesn’t anyone want to hire me? <adult male, ex-prisoner>
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Pękala-Wojciechowska, A.; Kacprzak, A.; Pękala, K.; Chomczyńska, M.; Chomczyński, P.; Marczak, M.; Kozłowski, R.; Timler, D.; Lipert, A.; Ogonowska, A.; et al. Mental and Physical Health Problems as Conditions of Ex-Prisoner Re-Entry. Int. J. Environ. Res. Public Health 2021, 18, 7642. https://doi.org/10.3390/ijerph18147642
Pękala-Wojciechowska A, Kacprzak A, Pękala K, Chomczyńska M, Chomczyński P, Marczak M, Kozłowski R, Timler D, Lipert A, Ogonowska A, et al. Mental and Physical Health Problems as Conditions of Ex-Prisoner Re-Entry. International Journal of Environmental Research and Public Health. 2021; 18(14):7642. https://doi.org/10.3390/ijerph18147642
Chicago/Turabian StylePękala-Wojciechowska, Anna, Andrzej Kacprzak, Krzysztof Pękala, Marta Chomczyńska, Piotr Chomczyński, Michał Marczak, Remigiusz Kozłowski, Dariusz Timler, Anna Lipert, Agnieszka Ogonowska, and et al. 2021. "Mental and Physical Health Problems as Conditions of Ex-Prisoner Re-Entry" International Journal of Environmental Research and Public Health 18, no. 14: 7642. https://doi.org/10.3390/ijerph18147642