Perceptions of vaccine safety and hesitancy among incarcerated adults and correctional staff in the rural midwest.

Objectives: This project assessed vaccine hesitancy among staff and incarcerated adults in one rural medium-security prison in the Midwestern United States and identified differences in hesitancy across sociodemographic and work-related variables. Methods: 610 prison staff and people incarcerated completed a cross-sectional survey in May 2021. The vaccine hesitancy scale (VHS) identified perceived risk and confidence in vaccination. A single item assessed whether people typically follow public health protocols in the prison. A combination of analyses was utilized, including ANOVA, Chi-Square, and Pearson's correlation. Results: Vaccine hesitancy was moderate to high for both populations. Incarcerated people had more confidence in vaccination than staff; differences did not reach statistical significance. Incarcerated people had statistically significantly higher perceptions of risk compared to staff. Both populations reported doing their best to follow public health protocols. For both populations, vaccine hesitancy varied by education and veteran status. Among staff, hesitancy varied by gender and political beliefs. For people incarcerated, it varied by pre-incarceration income and visit frequency. Conclusions: Results support the need for public health policy and procedural interventions to reduce hesitancy towards vaccination in correctional settings.

Decarceration of older adults with mental illness in the USA - beyond the COVID-19 pandemic.

PURPOSE: Aging and mental illness both represent significant public health challenges for incarcerated people in the USA. The COVID-19 pandemic has further highlighted the vulnerabilities of incarcerated people because of the risks of infectious disease transmission in correctional facilities. Focusing on older adults with mental illness, this paper aims to examine efforts to decarcerate US correctional facilities during the COVID-19 pandemic and whether these approaches may lead to sustainable reforms beyond the pandemic. DESIGN/METHODOLOGY/APPROACH: A narrative literature review was conducted using numerous online resources, including PubMed, Google Scholar and LexisNexis. Search terms used included "decarceration pandemic," "COVID-19 decarceration," "aging mental illness decarceration," "jails prisons decarceration," "early release COVID-19" and "correctional decarceration pandemic," among others. Given the rapidly changing nature of the COVID-19 pandemic, this narrative literature review included content from not only scholarly articles and federal and state government publications but also relevant media articles and policy-related reports. The authors reviewed these sources collaboratively to synthesize a review of existing evidence and opinions on these topics and generate conclusions and policy recommendations moving forward. FINDINGS: To mitigate the risks of COVID-19, policymakers have pursued various decarceration strategies across the USA. Some efforts have focused on reducing inflow into correctional systems, including advising police to reduce numbers of arrests and limiting use of pretrial detention. Other policies have sought to increase outflow from correctional systems, such as facilitating early release of people convicted of nonviolent offenses or those nearing the end of their sentences. Given the well-known risks of COVID-19 among older individuals, age was commonly cited as a reason for diverting or expediting release of people from incarceration. In contrast, despite their vulnerability to complications from COVID-19, people with serious mental illness (SMI), particularly those with acute treatment needs, may have been less likely in some instances to be diverted or released early from incarceration. ORIGINALITY/VALUE: Although much has been written about decarceration during the COVID-19 pandemic, little attention has been paid to the relevance of these efforts for older adults with mental illness. This paper synthesizes existing proposals and evidence while drawing attention to the public health implications of aging and SMI in US correctional settings and explores opportunities for decarceration of older adults with SMI beyond the COVID-19 pandemic.

Behavioral Health Services Following Release From Jail: A Widening Racial Disparity Gap

Black and Native people continue to be grossly overrepresented in jails at 592 and 401, respectively, per 100000 people compared with White people, who are incarcerated at a rate of 187 per 100 000.1 HEALTH AND MENTAL HEALTH IN JAILS Jails concentrate people with highly infectious and chronic diseases and untreated mental illness and substance use problems, which contributes to the health inequities in the communities to which they return.2 We see this today more than ever, with jails being vectors for spreading COVID-19.3 People spend an average of 25 days in jail1;these short stays can disrupt established mental health care and bring infectious disease home to people's families and neighbors. Hedden et al. suggest several solutions, including the application of critical race theory to policy and practice in the criminal-legal and behavioral health fields, authentic leadership that mirrors affected populations, and culturally responsive interventions to address systemic and individual barriers. Policy reform and the development and testing of interventions that work for people of color with SMI who enter orare at risk for entering the criminal-legal system are essential in closing the gap between need and service utilization in this critical postincarceration period.