HIV+ inmates and mental illness: Description and implications for release planning

Background: Little is known about HIV+ inmates with mental illnesses (MI) and their post-release needs. The aims of this study were to determine: 1) proportion of MI in a HIV+ prison population; 2) differences between MI and non-MI HIV+ inmates; 3) if significant association exist between MI and community needs or coping self-efficacy.

Methods: Quantitative interviews of 101 soon-to-be-released HIV+ inmates and qualitative interviews with a 24 inmate subset were completed. MI was determined using CES-D. Bivariate analyses examined differences between MI and non-MI inmates. Logistic regression examined if MI was associated with having more pre-incarceration needs, more post-release needs, and lower coping self-efficacy. Qualitative analyses explored differences in conceptualization and plans for post-release between MI and non-MI inmates.

Results: Clinically significant CES-D scores were found for 51% of the sample, with half of these having no chart documentation of MI. MI was significantly associated with going without healthcare to meet basic needs and needing housing pre-incarceration. MI was significantly associated with post-release need for housing, transportation, medication adherence assistance, emergency medical care, and lowered coping self-efficacy. Qualitative interviews revealed MI inmates had less clearly conceptualized release plans and were more likely to express concerns about post-release coping and survival.

Conclusions: Findings indicate >50% of HIV+ inmates have MI, with half of these unidentified. MI inmates have more unmet needs pre-incarceration, more needs upon release, and lower ability to cope with these challenges. Release planning should include identifying HIV+ MI inmates and addressing their elevated community needs and lowered self-efficacy.