A disproportionate number of women in prison have mental health problems and they are nine times more likely to die from suicide than women in the general population. They have insufficient access to help both inside where the focus has largely been on men, and outside where they often lack suitable help and support on release. For many women, improsionment is a tragedy that damages them, their families and the next generation, some of whom are born in prison, where giving birth can be particularly traumatic and potentially lethal. And men cannot be forgotten by women who are in prison, because many of them are in prison because of the actions of a man. However, it is crucial not to assume that ‘trauma’ explains all of their problems, particularly some kinds of violent behaviour. We need to keep many more women out of prison and try to help women much earlier along their life paths, long before they go to prison. Mental health care provides too little, too late. We must challenge our own stigmatising attitudes towards women in prison, support those NGOs who work tirelessly with women in the criminal justice system and advocate much more powerfully for women in prison.

This chapter seeks to provide clinicians with a better understanding of prisons and overcome many of the myths and misconceptions, with the objective of making the environment more attractive and interesting for future psychiatrists. In addition to a wide need and a rich variety of conditions, the psychiatrist in prison must contend with barriers to care such as working without a mental health act and, when a patient needs to be transferred and treated outside of prison, navigating complicated pathways to care. Mental disorder is prevalent in all prison systems. Pathways into prison may be related to general factors, specific factors such as delusions and comorbidities and complications of mental illness such as homelessness and breakdown of relationships, as well as service provision issues. The prevailing policy has been to divert prisoners in need of hospital care out of prisons. Court diversion models can focus on any point in the pathway from community to the criminal justice system. In prison, specialist mental health services are needed to address the high levels of morbidity due to self-harm, drug use, suicide and self-harm, hunger strikes and many other manifestations of developmental problems and traumatic experiences.

In solitude, as with any human experience, choice is an important driver. We know that humans, in general, like having some decision-making capability, or at least the perception of it. Positive time spent in solitude stems from the desire to be with ourselves, and we talk about how to exercise choice to be more comfortable and stronger in solitude. Simply wanting to avoid other people does not unlock its benefits and opportunities. The fact that you choose to devote your morning walk, drive to work, or shower time to solitude is what matters in building an enduring practice of everyday solitude. In this chapter, we also consider involuntary solitude, like prisoners in solitary confinement and pandemic lockdowns. This chapter also looks at what it means to have a "preference for solitude," the importance of understanding motivation in why we’re choosing time alone, and what it means to have the right framing and expectations for solitude.

Harm reduction refers to a set of strategies aimed to limit the negative consequences associated with drug use, but without requiring complete abstinence. Some harm-reduction strategies aim to reduce the risk of overdose, such as the use of naloxone rescue kits, fentanyl testing strips, and implementation of Good Samaritan laws. Other strategies lower the risk of overdose but also the likelihood of contracting infectious diseases such as HIV and hepatitis. Syringe services programs, also referred to as needle exchange programs, and supervised consumption facilities all fall under this category. Medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and naltrexone, have been proven to lower the risk of overdose, improve the likelihood of maintaining sobriety, and therefore lower rates of disease transmission. Finally, harm reduction is utilized in criminal justice system through the use of drug decriminalization, police diversion programs, and drug treatment courts.

This essay tracks the conflicts that have taken place in Ireland over a period of several centuries, examining the ways in which Shakespeare has, himself, engaged with these conflicts, and the ways in which his work has been recruited by those participating in the conflicts – on both sides. The importance of Shakespeare to the identity formation of the colonial community in Ireland is noted, and the increasing appropriation of Shakespeare by nationalists from the end of the eighteenth century onwards is registered. A particular point of focus here is the nineteenth-century nationalist militant and land-rights activist Michael Davitt. Davitt’s possession of several photographic images relating to Shakespeare is noted, as is his general acquaintance with the playwright’s work. The essay also discusses the importance of Shakespeare to later nationalists, such as Patrick Pearse, executed for leading the 1916 uprising against British rule in Ireland. That one contemporary unionist commentator unexpectedly offered a cautious celebration of Pearse’s self-sacrifice by drawing a comparison between the militant and Julius Caesar’s Brutus is a telling sign of the extent to which Shakespeare served as a kind of common cultural reference point over the course of Ireland’s fraught, conflictual history.

The significantly high prevalence of attention deficit hyperactivity disorder (ADHD) in prison populations raises the importance of assessment and treatment. Identification of prisoners for ADHD using screening tools is helpful. Those who are screened positive for ADHD can then undergo a full psychiatric assessment to confirm the diagnosis. The assessment also needs to focus on other potential comorbid mental disorders given the high prevalence of autism, intellectual disability, mental illness and personality disorders in prison/forensic population. Presence of comorbid mental disorders can also complicate the diagnostic process for ADHD. Treatment of ADHD is important given the strong evidence base for pharmacological treatment outcomes. Treatment needs to be personalised, taking into account many different factors. Stimulant or non-stimulant medications can be used, non-pharmacological interventions need to be offered alongside pharmacological treatments. Treatment of other comorbid mental disorders is equally important to achieve better outcomes. These may include pharmacological, psychological and social interventions within and when released from prison/forensic settings.

Attention-deficit/hyperactivity disorder (ADHD) is associated with a range of adverse outcomes. One of many potential adverse trajectories for those with ADHD is involvement in criminal offending. Meta-analyses have reported increased prevalence rates of ADHD in youth and adult offender populations. The prevalence of comorbid disorders in offender populations is common, but this appears to be increased in those with ADHD, which in turn complicates diagnosis and treatment. This chapter outlines the prevalence of ADHD in offender populations and considers gender and cultural effects. The relationship between ADHD and criminal offending is discussed, including the onset and type of offending, recidivism, progress within institutional establishments, comorbidity and long-term consequences. theoretical frameworks for understanding the association between ADHD and criminal offending are also considered. The chapter also highlights the economic consequences of ADHD within offender populations and more broadly within society. We consider system barriers and practical strategies that may be implemented to identify and meet the needs of offenders with ADHD.

Violence is more common in prisons than in the community. Mental disorders are over-represented in this population, and are associated with an even higher risk of perpetrating or becoming a victim of prison violence. Violence in this environment has unique characteristics, strongly influenced by gangs and an illicit economy. This chapter reviews the causes and management of prison violence, and the role of the mental health clinician in the assessment and management of violence in prison relating to mental disorder. The early impact of COVID-19 on prison violence is described.

Chapter 3 rejects the previous characterisation by Godfrey Anstruther of the period from 1559 to 1655 as a hundred ’homeless’ years, to see how a few Englishmen joined Dominican houses on the continent and how some of these returned to work on the English mission where they frequently resided in their family homes. It notes the public apostasy of friars who lacked the support of an organised mission, and how attempts were made in the latter part of the period to put a stronger organisation in place.

In early 1959, Kanyama Chiume escaped arrest during the Nyasaland Emergency. Chapter 4 follows him in his period of exile, focusing on two pamphlets he wrote in London. These pamphlets provide a way to assess the limits of the newly internationalised global anticolonial world of the late 1950s for this regional-generational cohort. These activists honed their vision of publicity and of the party publicity officer by drawing on the regional specificities of the late colonial state in East and Central Africa. Gender and form were of critical importance to this vision. This cohort joined the conversation around colonial violence in the context of the Algerian War of Independence, discussing ideas about permits, police and imprisonment in and beyond the region, in correspondence, conferences and publications. Charting the development of their ideas about totalitarianism at this apparent turning point helps to explain why the UN was largely out of reach, why activists continued to formulate their critiques in terms that echoed the early 1950s and why they increasingly doubted the efficacy and legitimacy of world public opinion.

In response to the radicalization of the late 1960s, many governments turned to repression. With so many of their comrades behind bars, radicals in the North Atlantic decided to pay closer attention to prisoners, promote civil rights, build alliances with progressives, rebrand themselves as defenders of liberty. At the same time that activists were reconsidering their revolutionary priorities, the United States reoriented its war in Vietnam by using the issue of the POWs to reframe American intervention as a fight for humanitarian principles. Antiwar radicals in the United States and France responded by focusing on political dissidents in South Vietnam. Drawing on their experiences with prison organizing, they connected their newfound concern with civil liberties to antiwar activism, calling for the liberation of political prisoners in South Vietnam. Despite their new focus on rights, anti-imperialist radicals still thought in Leninist terms, framing their internationalism around the problematic of the right of nations to self-determination. Yet in arguing that South Vietnam violated civil rights, anti-imperialist solidarity increasingly took the form of criticizing the internal affairs of a sovereign state, which brought radicals close to competing visions of internationalism like human rights. While most radicals never agreed on a single radical rights discourse, and did not convert to human rights in the early 1970s, their new collective attention to rights, along with alliances with groups such as Amnesty International, shifted the political terrain in a way allowed a rival approach to global change to attract new audiences. In so doing, anti-imperialists lent legitimacy to a competing form of internationalism that shared the progressive aspirations of anti-imperialism but rejected nationalism in favor of human rights.

A director who has facilitated Shakespeare programmes in prisons for fifteen years in conversation with a former prisoner who served eighteen years and who participated in four of those programmes. The authors explore the ways in which performative Shakespeare programmes fill a niche otherwise unoccupied in the prison system – a recreational programme that offers opportunities for collaboration, growth and the development of empathic and communication skills that are not constrained by a deficit-based and outcome-oriented pedagogy. The programme offers models of camaraderie and support that are not ‘in opposition to’ other groups, and promotes collaborative over individual achievement. The development of intrinsic motivation is a key component in functioning as a free citizen, but is actively discouraged by the correctional system. Prison Shakespeare programmes develop these skills in addition to offering a practical critique to the model of ‘toughness’ promoted by the prisoners’ own cultural milieu. The chapter speaks to the value of recreation for its own sake, and how it can be a vital component in both education and rehabilitation precisely because it does not set out to do either.