Results

ADHD symptoms were found in 46 per cent of men and 43 per cent of women. Compared to other prisoners, the prisoners in this group were younger, less likely to be first-time offenders, less educated and ended up in disciplinary isolation more often than others. The results indicate that prisoners with ADHD traits have greater difficulty in adapting to the prison environment. 

In the self-assessment questionnaire, 40 per cent of prisoners identified characteristics of ADHD and eight per cent identified autistic traits.

Further research is needed on the suitability of different screening methods for this target group, the special support needs of neurodivergent prisoners, and the link between the characteristics of neurodivergence and psychiatric co-morbidity.

Identifying and taking into account the needs related to the characteristics of neurodivergence in individual work with prisoners and in the planning of the period of imprisonment and rehabilitation programmes is important and may have an impact on the individual’s wellbeing, safety during imprisonment and recidivism.

Nearly all prisoners had experienced physical violence at some point in their lives.

More than one in four prisoners had experienced emotional abuse during their imprisonment.

One in four prisoners reported post-traumatic symptoms, women more often than men. The prevalence of symptoms had clearly increased compared to a previous study.

Rehabilitation should be offered during imprisonment based on symptoms, not only based on offences.

In addition to actual treatment, it is important to enable corrective interactions in day-to-day situations that pay attention to traumatisation.

As trauma symptoms have increased among men, there is reason to develop trauma-conscious treatment practices aimed at men.

Eight per cent of the prisoners had experienced psychosis during their lifetime (excluding substance-induced psychosis, which 34 per cent had experienced). In addition to psychosis, almost everyone had a substance use or personality disorder, often both. 

In this group, imprisonment was most often the result of a violent offence. However, only one in ten prisoners sentenced due to a violent offence had suffered a psychosis during their lifetime.

Prisoners with psychosis are a vulnerable group with many disorders and a low level of education and reduced work ability. During their imprisonment, they are more likely to be subject to isolation measures than others.

It must be ensured that prisons do not become an inappropriate place for the placement of people with serious mental illness.

Prisoners were found to have poorer oral health than the adult Finnish population, with the exception of the condition of the periodontium.

Prisoners perceived  oral health was average or poor more often than the adult Finnish population and they reported several  oral problems, such as pain. 

Prisoners had a lot of fillings in their teeth. More than half of the participants (54%) were found to have at least one decayed tooth. One third (32%) of prisoners reported that their teeth had been injured due to violence and two out of five (42%) due to an accident. 

Any prior experiences of violence and accidents should be taken into account when facing a patient with a criminal background in oral health care. It is important to promote healthy lifestyle to protect teeth and jaw and encourage the regular use of services.

Oral health plays an extensive role in the functional capacity and social quality of life of a person with a criminal background and should be studied further.

Of the prisoners, 44 per cent had a hepatitis C infection and 13 per cent had a chronic infection.

One per cent had an HIV infection.

In prison, 34 per cent had used drugs by injecting. Two out of three of them had shared syringes and needles.

Of those using drugs by injecting, 49 per cent had started injecting in prison due to fitness doping and 10 per cent due to using narcotics.

Of the prisoners sentenced for less than two years who tested positive for hepatitis C antibodies, nine per cent had received treatment for hepatitis C.

The rate of daily smokers among prisoners is 69% (64% of male prisoners and 85% of female prisoners). 

The use of nicotine products, such as snus, was also substantially more common than in the general population on average.

In particular, male prisoners were willing to stop smoking and also reasonably confident that they would be able to do so.

The majority of prisoners who smoke had not received support for giving up smoking during their prison term.

Prisoners were exposed to tobacco smoke, especially in the cells in closed prisons.  

The goal of Finland’s Tobacco Act is that less than five per cent of the population will use tobacco and nicotine products daily in 2030. In light of the results obtained in this study, the prison population is very far from this objective.

Substance use disorders (SUD) are very common among prisoners. In this study, 87 per cent of prisoners were diagnosed with a lifetime SUD. Compared to the previous prisoner study, the prevalence of SUD has slightly increased.

Alcohol use disorder was more prevalent  in older age groups, whereas drug use disorder was more common in the younger groups. 

Approximately half of the prisoners reported amphetamine use during the 12 months before their prison term. Compared to the previous prison study, cocaine use has increased significantly. 

More half of the prisoners reported intravenous drug use during their lifetime, one in five also during their imprisonment.

Approximately 40% of prisoners reported opioid use during the 12 months before their prison term. Of those with lifetime opioid use disorder, 40% reported receiving opioid substitution treatment at some point of their lives. Only 7% of those who reported opioid use during the 12 months before their prison term had started opioid agonist treatment during their imprisonment.

Forty-four per cent of male prisoners, and 4% female prisoners had used doping agents at some point in their lives. In the general population, the corresponding figure is approximately one per cent, overall.

The youngest prisoners who injected doping agents for the first time were 15 and the oldest were 58 years old.

The most commonly used doping agents were testosterone or its derivatives and anabolic steroids.

One in two of those who had injected doping agents had been diagnosed with hepatitis C.

Employees in the prison and probation sector need additional training on fitness doping and addressing the topic.

More research data is needed on the use of doping agents and the motives underlying their use to make users’ voices heard when planning treatment practices.

Problem gambling was more common among prisoners than in the general population, even though prisoners gambled less often. 

Of the participants, 13 per cent met the criteria for a probable problem gambling.

Problem gambling was most common among prisoners incarcerated for theft or property crime as their principal offence.

Problem gambling causes serious financial problems and debt.

The identification and treatment of problem gambling must not be overlooked in the treatment of different mental health challenges and other addictions. The available therapeutic tools should also be applied among the prison population.

Alexithymia refers to a difficulty in identifying and processing emotions.

One in five prisoners is alexithymic, which is about twice the prevalence compared to the general population.

Female prisoners have the same levels of alexithymia as male prisoners, although in general population, alexithymia is considerably more common in men.

In addition to discussion-based methods, different types of functional and experiential forms of interventions should be considered in the rehabilitation.

Resilience refers to the capacity to adapt to and recover from adversities.

On average, resilience among prisoners was lower than among the general population. Half of male prisoners and three out of five female prisoners had especially low resilience. 

Compared to other prisoners, those with low resilience were more likely to have problems related to work ability and somatic health, and they served shorter sentences.

Low resilience appears to be associated with extensive coping problems: the criminal activities of prisoners with low resilience may arise from chaotic and uncontrolled everyday life compared to systematic and serious offending.

Resilience can be strengthened during imprisonment, e.g. by treating mental health problems and traumas, strengthening personal agency and providing environmental support for stability. 

Up to 60% of younger offenders have problems with speech production and/or comprehension related to a developmental language disorder (DLD).

Overall, Finnish prisoners performed well in the tasks related to linguistic skills in the Wattu study. 

However, prisoners aged under 30 who performed below average performed significantly more poorly in producing animal words and learning word lists compared to prisoners aged over 30.

The results obtained from the individual and concise tasks do not correspond to an extensive assessment based on tools that measure several linguistic areas.

Speech-language therapy can be used to assess and train prisoners’ speech, language and communication skills. Supporting communication skills allows prisoners to gain more benefits from programmes during incarceration and cope better in interactive situations.

Prisoners have less trust in other people than the rest of the population. Prisoners who have been incarcerated longer have less trust than first-time offenders. 

Prisoners are less satisfied with life than the rest of the population. 

Loneliness varies among prisoners. Female prisoners are less lonely than men. 

Prisoners are more likely to receive help and support from informal parties than from official service providers. Women feel more often supported by prison workers than men. 

Upon their release, prisoners face an uncertain situation from the perspectives of housing, livelihood and interpersonal relationships.

The experience of social inclusion among prisoners was clearly weaker compared to the general adult population. However, the prisoners’ experience of social inclusion was somewhat stronger than expected.

Female prisoners had a stronger experience of social inclusion compared to male prisoners.

There were no statistically significant differences in the level of the experience of social inclusion when examining prison-specific background variables.

Work ability emerged as most strongly associated with the experience of social inclusion.

Future studies should examine how prisoners’ health and particularly mental health and functional capacity and work ability are associated with their experience of social inclusion.

Long-term illnesses and the usage of health services are more common among prisoners compared to the Finnish population.

Around one in four of the Wattu IV respondents are heavy users of health services.

The prisoners who had undergone a forensic psychiatric examination stand out based on their greater need for both mental and somatic treatment. It is well-founded to refer the offenders ending up in prison instead of in care facilities as forensic psychiatric prisoners.

Health problems and the usage of health services are prevalent in female prisoners.

Comprehensive intervention for the heavy usage of health services is possible during imprisonment.

Prison conditions may in themselves increase aggression and violence.

Prisoners feel that means such as physical activity, discussion assistance and creative activity-based approaches reduce their feelings of aggression. 

The services offered in the prisons respond fairly well to the suggestions made by the prisoners, but there are differences between prisons in the services provided.

Prisoners should be provided with sufficient opportunities to discuss their aggressive behaviour with prison staff and prison health care staff. 

The need for spaces where prisoners can retreat, the possibility of spending time alone and sufficiently diverse opportunities for physical activity should be taken into consideration in prison planning.

The prisoner’s voice is a valuable addition when looking for ways to carry out better prison and probation work. By involving prisoners, it is possible to find new ideas for services.

Seventy-five per cent of male and 86% of female participants came to prison from outside the working life. The share of those unemployed before their imprisonment was 64 per cent of men and 69 per cent of women.

Two-thirds of men (62%) and just over half of the women (55%) assessed their work ability to be good.

Compared to the previous prisoner study, in which the corresponding share was over 80 per cent, the ratio has declined.

According to the assessment conducted by the study nurse, in every third case, reduced work ability could be restored through rehabilitation.

Factors reducing work ability of people with prison background appear to include at least characteristics of ADHD, a psychotic disease, poor oral health, low resilience, poor linguistic skills, loneliness and lack of experience of social inclusion.

The prison term can be used as a valuable period for observing and assessing the functional work ability of persons otherwise outside the workforce as well as evaluating obstacles to their employment possibilities.