COVID-related disruptions and adaptations to prison-based mental health and substance use services: a narrative review.

PURPOSE: Public health experts and advocates have long raised concerns about the pandemic preparedness of prison systems worldwide - an issue that became increasingly salient at the start of the COVID-19 pandemic. People in prison experience poorer health outcomes compared to the general population, making timely access to adequate health services in prison critical for their health and wellbeing. This study aims to identify the extent of the literature on initial changes in mental health and substance use services for people in prison during the COVID-19 pandemic, summarize and synthesize the findings and identify areas in need of further study. DESIGN/METHODOLOGY/APPROACH: The authors conducted a review of the academic literature published internationally in English between 2019 and December 1, 2020 to describe the disruptions and adaptations to mental health and substance use services in prisons during the onset of the COVID-19 pandemic. FINDINGS: The authors found that mental health and substance use services in prisons around the world were widely disrupted due to the COVID-19 pandemic - predominantly consisting of the complete suspension of services, discontinuation of transfers to off-site treatment sites and limitations on service capacity. Adaptations ranged from virtual service delivery and changes to treatment dispensation processes to information sessions on overdose prevention. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first review to examine the nature and extent of the literature on delivery of mental health and substance use services in prisons during the COVID-19 pandemic.

Indigenous Cultural Safety Trainings for Healthcare Professionals Working in Ontario, Canada: Context and Considerations for Healthcare Institutions.

Background: Racism and discrimination are realities faced by Indigenous peoples navigating the healthcare system in Canada. Countless experiences of injustice, prejudice, and maltreatment calls for systemic action to redress professional practices of health care professionals and staff alike. Research points to Indigenous cultural safety training in healthcare systems to educate, train, and provide non-Indigenous trainees the necessary skills and knowledge to work with and alongside Indigenous peoples using cultural safe practices grounded in respect and empathy. Objective: We aim to inform the development and delivery of Indigenous cultural safety training within and across healthcare settings in the Canadian context, through repository of Indigenous cultural safety training examples, toolkits, and evaluations. Methods: An environmental scan of both gray (government and organization-issued) and academic literature is employed, following protocols developed by Shahid and Turin (2018). Synthesis: Indigenous cultural safety training and toolkits are collected and described according to similar and distinct characteristics and highlighting promising Indigenous cultural safety training practices for adoption by healthcare institutions and personnel. Gaps of the analysis are described, providing direction for future research. Final recommendations based on overall findings including key areas for consideration in Indigenous cultural safety training development and delivery. Conclusion: The findings uncover the potential of Indigenous cultural safety training to improve healthcare experiences of all Indigenous Peoples. With the information, healthcare institutions, professionals, researchers, and volunteers will be well equipped to support and promote their Indigenous cultural safety training development and delivery.

Sex differences in pre-incarceration mental illness, substance use, injury and sexually transmitted infections and health service utilization: a longitudinal linkage study of people serving federal sentences in Ontario.

BACKGROUND: People who experience incarceration have poorer health than the general population. Yet, we know little about the health and health service utilization of people during the critical period prior to their incarceration, relative to during incarceration and post-release. In this study, we conducted a longitudinal cohort study of 39,498 adults in Ontario, Canada between January 1, 2002, and December 31, 2011 using linked administrative health and correctional data to describe mental illness, substance use, injury, sexually transmitted infections and health service utilization of men and women in federal prisons in the 3 years prior to their incarceration, compared to a matched group. RESULTS: We found that, in the 3-year period prior to their incarceration, men (n = 6,134) and women (n = 449) experiencing their first federal sentence had poorer health across all indicators examined (e.g., psychosis, drug/alcohol use, and self-harm) and higher outpatient psychiatric and emergency department visits, compared with the matched group. Women in the pre-incarceration group exhibited a higher prevalence of self-harm and substance use, relative to women in the matched comparison group and higher relative prevalence to that of men in the pre-incarceration group, compared to their matched counterparts. CONCLUSIONS: Disparities in health and health service utilization are gendered and exist prior to incarceration. The gendered nature of these findings, specifically the significantly higher prevalence of poor health among women across several indicators, necessitates a focus on the social and systemic factors that contribute to these disparities. Gender-responsive and trauma-informed primary, secondary, and tertiary prevention strategies, alongside transformative approaches to justice should be considered in addressing the health needs of men and women who experience incarceration.

"These Issues Aren't Separate": The Relationship Among Being Indigenous, Motherhood, and the Criminal Justice System.

In using an approach encompassing intersectionality and interconnectedness, we highlight how the experiences of Indigenous mothers and mother figures in contact with the law are a result of various historical and contemporary events. We highlight a need for a wholistic approach to eliminate the overrepresentation of Indigenous Peoples, including parents, in the criminal justice system. There is a lack of research and discussion on Indigenous women and their experience with the justice system and by using an Indigenous lens, we can explore the establishment of culturally safe resources and care wherein gender inclusivity is prioritized. Our team of researchers and advocates intends for this article to contribute and spark dialogue on Indigenous Peoples, particularly mothers and mother figures and their interactions with the justice system. Although this article mainly focuses on federal programs and policies in Canada, insights on the barriers to care can be applied into policy and practice across multiple settler states.

Indigenous Cultural Safety Training for Applied Health, Social Work, and Education Professionals: A PRISMA Scoping Review.

Anti-Indigenous racism is a widespread social problem in health and education systems in English-speaking colonized countries. Cultural safety training (CST) is often promoted as a key strategy to address this problem, yet little evidence exists on how CST is operationalized and evaluated in health and education systems. This scoping review sought to broadly synthesize the academic literature on how CST programs are developed, implemented, and evaluated in the applied health, social work and education fields in Canada, United States, Australia, and New Zealand. MEDLINE, EMBASE, CINAHL, ERIC, and ASSIA were searched for articles published between 1996 and 2020. The Joanna Briggs Institute's three-step search strategy and PRISMA extension for scoping reviews were adopted, with 134 articles included. CST programs have grown significantly in the health, social work, and education fields in the last three decades, and they vary significantly in their objectives, modalities, timelines, and how they are evaluated. The involvement of Indigenous peoples in CST programs is common, but their roles are rarely specified. Indigenous groups must be intentionally and meaningfully engaged throughout the entire duration of research and practice. Cultural safety and various related concepts should be careful considered and applied for the relevant context.

Education in uncertainty: Academic life as Indigenous health scholars during COVID-19.

As the COVID-19 crisis continues to develop, communities around the world find themselves living in new and uncertain times. School and university closures are significantly disrupting the lives of students, educators and researchers alike. With the sudden shift to online learning platforms, the limitations on research projects and the lack of standardised policies and procedures, many concerns arise surrounding the unequal impacts of this crisis. This article brings together diverse perspectives on the effects of COVID-19 on post-secondary life for students and scholars engaged in the field of Indigenous health research. The authors reflect on how this time has impacted them as a graduating student, incoming PhD student, junior faculty member and mid-career faculty member respectively. Their experiences of teaching and learning at a large, research-intensive university in Toronto, Canada have been profoundly transformed, and will continue to change the way they work, research and interact at the graduate level. Working with Indigenous communities and organisations requires relationship building, collaboration and ceremony. In these unprecedented times, scholars cannot simply continue "business as usual". They must adapt everything, including how they teach, learn and work with Indigenous peoples, who are particularly vulnerable to this pandemic. Reflecting on the impacts that have already occurred and those that are still likely to come, the authors discuss what changes may need to be made in academia to support diverse actors within their scholarly community. They suggest changes to their scholarship with Indigenous communities in Canada to help them continue to work in a respectful, reciprocal and culturally appropriate way.

L'éducation dans des temps incertains : la vie universitaire pour les chercheurs dans le domaine de la santé des autochtones à l'heure de la COVID-19 ­ La crise de la COVID-19, qui continue de prendre de l'ampleur, plonge des communautés du monde entier dans des périodes inédites et incertaines. Les fermetures d'écoles et d'universités perturbent considérablement la vie des étudiants au même titre que celle des éducateurs et des chercheurs. Le brusque passage aux plateformes d'apprentissage en ligne, les restrictions imposées aux projets de recherche et l'absence de politiques et de procédés standardisés ont fait apparaître des préoccupations concernant l'impact hétérogène de la crise en cours. Cet article réunit différents points de vue sur les effets qu'a la COVID-19 sur la vie des étudiants de troisième cycle et des chercheurs dans le domaine de la recherche sur la santé des autochtones. Les auteures se penchent sur la façon dont cette période a impacté leur existence respectivement en tant qu'étudiante en fin de deuxième cycle, future doctorante et membres du corps professoral en début et en milieu de carrière ; une période qui a profondément marqué leur expérience de l'enseignement et de l'apprentissage dans une université centrée sur la recherche dans la ville canadienne de Toronto, et qui continuera à transformer leur façon de travailler, de faire de la recherche et d'interagir au niveau de l'enseignement supérieur. Travailler avec des communautés et organisations autochtones exige de construire des relations et de collaborer avec elles, et de respecter leurs usages. En cette période sans précédent, les universitaires ne peuvent pas faire comme si de rien n'était. Ils doivent tout adapter, y compris leur façon d'enseigner, d'apprendre et de travailler avec les peuples autochtones, particulièrement vulnérables face à cette pandémie. Dans une réflexion sur les conséquences qui se sont déjà fait sentir et sur celles probablement à venir, les auteures se penchent sur les changements susceptibles de devenir indispensables dans la sphère universitaire pour soutenir différents acteurs de leur communauté scientifique. Elles proposent des changements à leur travail avec les communautés autochtones au Canada pour les aider à continuer à opérer dans le respect et la réciprocité, et de façon adaptée sur le plan culturel.