By Christina Emilian, Noura Al-Juffali, Seena Fazel

Prison populations have been increasing worldwide. Previous studies suggest that there is a high burden of psychiatric morbidity in people in prison, but, to our knowledge, the last published meta-analysis of prevalence is more than a decade old. We aimed to describe the pooled prevalence of depression, psychosis, bipolar disorder, and schizophrenia spectrum disorders for people who are incarcerated. Methods In this updated systematic review and meta-analysis, we searched six databases and grey literature published from database inception until Aug 8, 2024, with no language or geographical restrictions. We included primary quantitative studies that reported the prevalence of depression and psychotic disorders in the unselected prison population, based their diagnoses on clinical examination or from interviews and by the use of validated diagnostic instruments, met standardised criteria of the ICD or the Diagnostic and Statistical Manual of Mental Disorders for the diagnoses, and provided pooled prevalences for psychosis in the previous 6 months and clinical depression in the previous 2 weeks to 1 month. We excluded studies that used selected samples or were only qualitative. We investigated bipolar and schizophrenia spectrum disorders as separate diagnostic subcategories. We synthesised studies using random-effects meta-analysis and explored heterogeneity with meta-regression and subgroup analyses. The protocol is registered with PROSPERO, CRD42022378568. Findings We identified 131 publications reporting the prevalence of mental illness in 58838 people in prison in 43 countries. We estimated that the prevalence of depression was 12·8% (95% CI 11·1–14·6) and for any psychosis was 4·1% (3·6–4·7). For diagnostic subcategories, we found that the prevalence of bipolar disorder was 1·7% (1·0–2·6) and schizophrenia spectrum disorders was 3·6% (1·3–7·1). Between-study heterogeneity was substantial for these estimates (I² 69–97%) with few explanations. However, subgroup analyses revealed that people in prison in lowincome and middle-income countries had higher prevalences for depression (16·7% [95% CI 13·6–20·0]) than in high-income countries (10·8% [9·0–13·0]), and that, for people with psychosis who are incarcerated, psychiatrists were less likely to diagnose (3·5% [2·8–4·3]) than were non-psychiatrists (4·7% [3·9–5·5]). Interpretation Our study indicates that the prevalence of severe mental illness in people who are incarcerated worldwide is considerable. Meeting the treatment needs of people in prison who have mental ill health remains an ongoing challenge for public mental health. More evidence on how to improve the assessment, treatment, and linkage to services on release, which will require more research-friendly prison services, is now needed.

Lancet Public Health 2025; 10:, pages 97–110

By UK Ministry of Justice

A summary of what happened to the prison population between 1993 and 2020 and the major factors contributing to the changes.

London: Ministry of Justice, 2020. 18p.

By Marta Nelson, Samuel Feineh and Maris Mapolski

One hundred years from now, we may look back at the United States’s overreliance on punishment and its progeny—mass incarceration—with the kind of abhorrence that we now hold for internment camps for Japanese Americans and Jim Crow laws. Or, if we never curb our reliance on jails and prisons for public safety, we may be in the same place then as we are today….This report posits that maintaining our system of mass incarceration will not bring people in the United States the safety and justice they deserve, while dismantling it in favor of a narrowly tailored sentencing response to unlawful behavior can produce more safety, repair harm, and reduce incarceration by close to 80 percent, according to modeling on the federal system. In this report, the Vera Institute of Justice (Vera) addresses a main driver of mass incarceration: our sentencing system, or what happens to people after they have gone through the criminal legal system and are convicted of a crime

New York: Vera Institute of Justice, 2023. 81p.

By Marcelo F. Aebi and Yuji Z. Hashimoto

The main findings of the SPACE II 2021 report are presented in a separate booklet (Probation and Prisons in Europe, 2021: Key Findings of the SPACE reports), which includes analyses of the data collected and comparisons with the main results of the SPACE I 2021 report on prison populations. This section only provides a snapshot of the situation regarding the use probation in Europe. ➢ The participation rate in the SPACE II 2021 Survey was satisfactory: 48 out of the 52 countries or administrative entities of the 47 Council of Europe Member States answered the questionnaire. ➢ Probation agencies are usually placed under the authority of the National Ministry of Justice. In ten countries/administrative entities, the Ministry of Justice is neither responsible nor co-responsible for their functioning. ➢ Probation agencies are independent from the Prison Administrations in 26 countries/administrative entities, while in 15 there is a shared prison and probation administration. ➢ 25 of the 48 probation agencies which provided data use the person as the counting unit. Seven probation agencies do not use the person as the counting unit for neither stock nor flow, two do not use the person for flow and 12 use it partially, most often only for the total stock and the total flow. ➢ Stock of probationers: On 31 January 2021, there were 1 773 556 persons under the supervision of the 32 probation agencies that provided data on this item and use the person as the counting unit for their stock. The absolute number of persons on probation is much higher than in 2019 because the Russian Federation provided data for SPACE II 2021 but not for SPACE II 2020. ➢ Flow of entries to probation: During the year 2020, 1 860 352 were placed under the supervision of the 29 probation agencies which provided data on this item and use the person as the counting unit for their flow of entries. ➢ Flow of exits from probation: During the year 2020, 1 700 528 persons ceased to be under the supervision of the 29 probation agencies which provided data on this item and use the person as the counting unit for their flow of exits. ➢ Non-custodial sanctions and measures are seldom used as an alternative to pre-trial detention; only 14% of the probation population on 31 January 2021 corresponds to persons placed under supervision before trial in the 18 probation agencies which provided data on this item and use the person as the counting unit for their stock of probationers. ➢ On 31 January 2021, among the 28 probation agencies which provided figures on female probation clients and use the person as the counting unit, women represented 11% of the total probation population. ➢ Among the 20 probation agencies that provided figures on foreigners and use the person as the counting unit, foreigners represented 13% of the total probation population. ➢ Among the 20 probation agencies that provided figures on minors and use the person as the counting unit, minors represented 4.8% of the total probation population. ➢ Among the 27 probation agencies that provided figures on total stock and total staff and use the person as the counting unit, there are around 38 probationers for each probation staff member, but that ratio varies considerably across countries. ➢ Among the 32 probation agencies that provided figures on total staff and pre-sentence reports, there are around six (6) pre-sentence reports produced for each probation staff member across Europe. ➢ In 40 jurisdictions, probation is used for all of the major categories of criminal offences specified (against persons, against property, drug offences, road traffic offences).

Strasbourg: Council of Europe & University of Lausanne, 2022 . 149p.

By Kevin R. Reitz, Edward E. Rhine, Allegra Lukac, and Melanie Griffith

“Indeterminacy” is the product of uncertainty, after a judge has pronounced a prison sentence, about later official decisions that will influence the actual time served by the defendant. The uncertainty extends over many future decisions, such as good-time awards or forfeitures by prison officials and release or release-denial decisions by parole boards. To the extent these later decision patterns are unpredictable, the judge’s sentence is “indeterminate” on the day of sentencing. When prison sentences are highly indeterminate, many months or years of time-to-be-served can be unforeseeable in individual cases. The mechanics of indeterminacy in prison sentencing vary enormously from state to state, and are not well understood. In many states, time-served policy is largely administered at the “back end” of the sentencing system. If prison policy is aimed toward retribution or public safety, it is back-end officials who ultimately choose how best to achieve those goals. This raises critical questions of whether they are well-positioned to be stewards of the public interest, and whether their procedures are adequate to the task. Such questions are especially urgent in a nation with high incarceration rates. In most American jurisdictions, however, back-end decisionmaking about prison-sentence length has low visibility and is unglamorous. Very few people pay serious attention to its workings. From a systemic perspective, indeterminacy can be seen as the field of play in which back-end officials with time-served discretion exercise their powers. The larger the field—the greater the degree of indeterminacy—the greater the whole-system impact of back-end decisions. Indeterminacy builds up cumulative effects over hundreds and thousands of cases. In systems with high degrees of indeterminacy, a substantial amount of control over prison population size is located at the back end of the system. In many states, back-end officials have more to say about prison numbers than sentencing courts. Yet few people are aware of this.

Minneapolis, MN: Robina Institute of Criminal Law and Criminal Justice, University of Minnesota, 2022. 145p.