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BackgroundResearch has shown that 20–30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders.AimsTo estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD.MethodWe conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16–25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression.ResultsIn the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI −2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm.ConclusionsADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.

SUMMARY Mental disorders are overrepresented in the criminal justice system, and this applies equally to police custody. These environments are complex and often pressured, and the acuity of the situation, combined with underlying mental disorders, comorbid medical problems and substance misuse, can lead to behavioural disturbance and increased psychiatric risk. Police custody may also present an opportunity to identify and signpost people with mental disorders and vulnerabilities who are ordinarily hard to reach by standard health services. This article considers the purposes of mental health screening of detainees in police custody. It gives an overview of research into screening for a range of psychiatric disorders and vulnerabilities (including substance misuse and traumatic brain injury) and summarises data on deaths in and immediately following release from custody. Given the inadequacy of statutory screening procedures in some jurisdictions, the authors offer a pragmatic evidence-based protocol to guide screening for mental disorders in custody detainees.

Purpose This paper aims to examine effective diagnostic and treatment pathways for attention deficit hyperactivity disorder (ADHD) in prison settings given the high prevalence of ADHD and comorbidities in the prison population. Design/methodology/approach Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD. Findings Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD. Originality/value Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.

The treatment of vulnerable defendants by criminal justice systems or correctional systems varies within and between countries. The purpose of this paper is to examine three legal jurisdictions - New South Wales in Australia, Norway, England and Wales - to understand the extent of variation in practice within the Court systems for defendants with intellectual disabilities (ID) and/or autism spectrum conditions (ASC). \ud Two of the jurisdictions had a process for screening in place, either in police custody or at court, but this was not universally implemented across each jurisdiction. All three jurisdictions had a process for supporting vulnerable defendants through the legal system. Across the three jurisdictions, there was variation in disposal options from a mandatory care setting to hospital treatment to a custodial sentence for serious offences. This variation requires further international exploration to ensure the rights of defendants with ID or ASC are understood and safeguarded.\ud Evidence is provided by clinical experts who describe the current context within and between countries. Finally, we discuss the most challenging issues identified by authors including screening, support in Court, legal frameworks, options for disposal, implications for practice and future research directions.

The STAIR in-reach model of care for prisoners with serious mental illness focuses on screening, triage, assessment, interventions and reintegration by using the principles of assertive community treatment. An evidence base exists for the efficacy for its use in Aotearoa New Zealand. However, little is known about its adoption throughout the country. This national survey of managers of in-reach teams to all prisons (N = 19) aimed to determine the pattern of in-reach service delivery. It compared STAIR in-reach teams with other teams regarding service structure, staffing, interventions, reintegration strategies and training needs. This study signals gains made by adopting the STAIR model (multi-disciplinary team service delivery, ‘through the wire’ support and use of technologies to assist discharge planning) and potential areas of improvement (further use of psychosocial interventions and training needs). To assist national adoption of STAIR, a review is required to consider the cultural responsivity, gender-responsivity and recovery-orientated characteristics of the model.

Julian Assange is wanted by the United States so it can prosecute him for espionage and hacking. His extradition was barred on mental health grounds. That decision has been overturned. The English High Court has accepted US assurances detailing how he will be treated if transferred. Assange is seeking to appeal to the UK Supreme Court. Mental health-related issues have played a central role in his case to date, and look to continue to do so. The specific timing and effect of assurances are central to the present litigation. The Supreme Court will imminently decide on the next stage in Assange’s fight against extradition.

Purpose There are high levels of psychiatric morbidity amongst people in prisons. In England and Wales, prisoners who present with the most acute mental health needs can be transferred to hospital urgently under part III of the Mental Health Act 1983. This project reviewed all such transfers within one region of England, with an emphasis on differences across levels of security. Design/methodology/approach Over a six-year period (2010–2016) within one region of England, 930 psychiatric referrals were received from seven male prisons. From these referrals, 173 (18.5%) secure hospital transfers were required. Diagnostic and basic demographic information were analysed, along with hospital security categorisation (high secure, medium secure, low secure, psychiatric intensive care unit and other) and total time to transfer in days. Findings There were substantial delays to urgent hospital transfer across all levels of hospital security. Prisoners were transferred to the following units: medium security (n = 98, 56.9%); psychiatric intensive care units (PICUs) (n = 34, 19.7%); low secure conditions (n = 20, 11.6%); high secure conditions (n = 12, 6.9%); other (n = 9, 5.2%). Mean transfer times were as follows: high secure = 159.6 days; other = 68.8 days; medium secure = 58.6 days; low secure = 54.8 days; and psychiatric intensive care = 16.1 days. Research limitations/implications In keeping with the wider literature in this area, transfers of prisoners to hospital were very delayed across all levels of secure psychiatric hospital care. Mean transfer times were in breach of the national 14-day timescale, although transfers to PICUs were quicker than to other units. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. Originality/value This paper extends the available literature on the topic of transferring prisoners with mental illness who require compulsory treatment. There is a small but developing literature in this area, and this paper largely confirms that delays to hospital transfer remain a serious problem in England and Wales. National work, including research and service pilots, is required to understand whether and how these transfer times might be improved. This could include different referral and transfer models as a component of service-based and pathways research or combining referral pathways across units to improve their efficacy.

More than 1000 people are forcibly removed from the UK each year through the process of extradition, so that they might stand trial or be imprisoned abroad. Over the last 10 years, 115,915 extradition requests were made using one such mechanism, the European Arrest Warrant, resulting in 15,243 arrests and 10,689 surrenders. A somewhat similar system has now been agreed post Brexit. In an increasing number of these cases, mental-health disorders are put forward in opposition to the process. This is allowed under the law. However, a number of questions necessarily arise in the area. Central to these is whether extradition law and practice appropriately and fully take these disorders into account, given the specific context. The importance of this hardly needs to be emphasised. Subjection to the criminal justice process within the UK itself is a challenging prospect for those with a mental-health disorder – indeed for all people. The prospect of facing a criminal trial or incarceration in a foreign country apart from family, support systems and familiar medical and mental-health support networks is daunting indeed.

Background\ud Prevalence studies among prisoners have found rates of 1–4% for autism spectrum disorder (ASD) or autistic traits. However, little is known about those prisoners with high levels of autistic traits.\ud \ud Aim\ud This aim of this study was to compare the mental health characteristics of prisoners with autistic traits with neurotypical prisoners not screening positive for neurodevelopmental disorders.\ud \ud Method\ud The study recruited 240 male prisoners from a London prison and screened for autism spectrum disorder using the Autism Quotient (AQ) 20 and 10, and Autism Diagnostic Observation Schedule (ADOS). The Mini International Neuropsychiatric Interview was used to assess for depression, anxiety, self-harm behavior and suicide.\ud \ud Results\ud Screening using the AQ identified 46 prisoners with significant autistic traits, with 12 meeting the diagnostic threshold for ASD using the ADOS. Those screening positive with autistic traits were significantly more likely to have thought about self-harm and suicide in the past month than neurotypical prisoners and have a comorbid mental disorder. They were also significantly more likely to report having attempted suicide during their lifetime compared to neurotypical peers at a rate of 64.9 % compared to 11.6 % for the neurotypical prisoners.\ud \ud Conclusion\ud Prisoners with elevated levels of autistic traits were more likely to report self-harm, suicidal thoughts and were more vulnerable to a range of mental disorders than neurotypical prisoners. There is a need for more evidence on the experience of autistic prisoners to inform how pathways should work to improve health outcomes through increased awareness and access to screening and subsequent diagnosis which currently prisons are currently not set up for.

Criminal justice liaison and diversion services identify people with mental health needs and ensure they receive appropriate support. We describe a 25-year period of one such service that deals with a population of 864,540 in South East London that was set up in 1991. We used data from three time periods. A diagnosis of a mental illness was recorded in 70.0–80.3% of court liaison and diversion referrals. The proportion receiving a hospital order declined from 15.4% in 1991/1992 to 1.1% in 2015/2016; 54/199 (27.1%) of referrals to the police liaison and diversion service were detained in hospital. Although the service is designed to support any individual with a mental health issue, these results suggest that it has dealt mainly with people who have severe mental illness. Further research is required to understand how best to benefit a wider range of people with mental health issues who attend the lower (Magistrates’) courts, and whether screening for mental disorders can be applied in liaison and diversion settings to aid the implementation of national policy. We also need to understand how disposal decisions are made, and which are most effective.

The relationship between immigration and terrorism is an important public policy concern. Using bilateral migration data for 170 countries from 1990 to 2015, we estimate the relationship between levels of immigration and terrorism using an instrumental variables (IV) strategy based on the decades prior stocks of immigrants in destination countries. We specifically investigate rates of immigration from Muslim majority countries and countries involved in armed conflicts. We find no relationship between immigration and terrorism, whether measured by the number of attacks or victims, in destination countries.

Foreign national prisoners include people who are subject to criminal proceedings and have been deprived of their liberty in a state in which they are neither a national nor a resident. In the United Kingdom, they constitute approximately 10,000 individuals and represent around 12% of the total prison population. Significant health disparity exists within the general prison population compared to society at large and foreign national prisoners suffer even higher rates of both physical and mental health disorders. The impact of detention; extradition, deportation and administrative removal legislation; and mental health service provision for foreign national prisoners is discussed. The right to health encompasses access to appropriate healthcare independent of legal status and like all human rights, extends to foreign national prisoners. Change is required and the provision of equivalent care for foreign national prisoners requires global attention.

There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies.

Approximately 1000 persons are extradited from the UK every year. While this number may lessen on account of Brexit, it is clear that hundreds of individuals will be forcibly removed from the UK, both nationals and non-nationals, to stand trial or be imprisoned abroad. The UK has a duty to take due cognisance of the mental health of requested persons in coming to decisions to extradite. Whilst Julian Assange’s extradition has been barred on account of his mental health, there is no certainty that that decision will stand. While there is undoubtedly a need for research into the interplay of mental health disorders and extradition, this may be a time for root and branch reconsideration of the law and related practice itself. Cooperation between relevant mental health professionals in various countries is one such area that could be enhanced. This could add weight to assurances given by the requesting state and may increase the likelihood that they are adhered to. Related to this, consequences in the event of non-compliance could be agreed between countries, including the potential return of the individual in certain circumstances. As extradition law and practice stand, these important issues are not addressed.

Background: 20-30% of prisoners meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms but effects in prisoners are uncertain due to high rates of comorbid mental health and substance use disorders. We therefore estimated the efficacy of a first line medication recommended by the National Institute for Health and Care Excellence (NICE) for ADHD, Osmotic Release Oral System methylphenidate (OROS-methylphenidate), in reducing ADHD symptoms in young adult prisoners with ADHD. Methods: An 8-week parallel arm, double-blind, randomised, placebo-controlled trial of OROS-methylphenidate versus placebo in 200 male prisoners from two young offender prisons in Southeast England and Scotland. Participants aged 16-25, met DSM-5 ADHD criteria. Randomisation to OROS-methylphenidate (n=101) or placebo (n=99) was stratified by prison. Trial medication was titrated for five weeks against symptom reduction and adverse effects to a maximum daily dose of 72 mg, followed by stable dose for three weeks. Primary outcome was ADHD symptoms at 8-weeks using the investigator rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcome measures included emotional dysregulation, mind-wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression. Trial registration: EudraCT Number 2015-004271-78; ISRCTN16827947. Database lock 27 th August 2019 Findings: Mean CAARS-O at 8 weeks in the OROS-methylphenidate arm was estimated to be reduced by 0.57 points relative to the Placebo arm (95% CI: -2.41 to 3.56) and non-significant. The responder rate, defined as a 20% reduction in CAARS-O scores was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm difference were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm. Interpretation: The study finds that ADHD symptoms did not respond to treatment for ADHD in young adult prisoners and does not support routine treatment with OROS-methylphenidate in this population. This does not exclude treatment in those with severe symptoms who may require treatment in prison. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multimodal treatments, and preventative interventions in the community. Trial Registration: Trial registration: EudraCT Number 2015-004271-78; ISRCTN16827947. Funding: Efficacy and Mechanism Evaluation (EME) programme (project ref: 14/23/17). Janssen Pharmaceutical Company supplied Concerta XL. Declaration of Interest: Philip Asherson reports grants and personal fees from Janssen-Cilag Ltd (High Wycombe, UK), Medice (Iserlohn, Germany), Shire/Takeda Pharmaceutical Company Ltd (Tokyo, Japan) and Flynn Pharma Ltd (Stevenage, UK); non-financial support and grants from QbTech AB (Stockholm, Sweden); personal fees from Novartis International AG (Basel, Switzerland) and Eli Lilly and Company (Indianapolis, IN, USA); and grants from Vifor Pharma Group (Villars-sur-Glâne, Switzerland), GW Pharmaceuticals (Cambridge, UK) and QbTech AB, outside the submitted work. Ylva Ginsberg has received royalties, speaker fees, reimbursement for travel costs and/or collaborated in research with Shire, Medscape [www.medscape.com/ (accessed 5 January 2021)] and Studentlitteratur AB (Lund, Sweden). Susan Young is director of Psychology Innovations Ltd (London, UK), which has received fees from Shire/Takeda, and has received fees for training in attention deficit hyperactivity disorder (ADHD) assessment tools and psychological interventions. She is a consultant at the Cognitive Centre of Canada and has received fees from the sale of psychological treatment programmes; she is also president of the UK ADHD Partnership, which received unrestricted educational grants from Shire/Takeda. Stephen Lawrie has received personal fees and research income from Janssen-Cilag, as well as personal fees from Sunovion Pharmaceuticals Inc. (Marlborough, MA, USA), in connection with work on schizophrenia (i.e., outside the submitted work). John Strang conducted research studies with the study medication being provided by the relevant pharmaceutical companies, and King’s College London has received payment of consultancy fees or honoraria for such work. However, this work does not apply to the study of ADHD nor to the type of treatment (methylphenidate). Ulrich Muller-Sedgwick received honoraria for being on an advisory board and/or speaking/delivering training for the UK Adult ADHD Network, British Association for Psychopharmacology, Takeda, Sosei Heptares (London, UK), Eli Lilly and Company, and Flynn/Medice. Ethical Approval: Ethical approval was obtained from the East of England, Essex, Research Ethics committee (ref: 16/EE/0117). Research and Development approvals were obtained from Oxleas NHS Foundation Trust and NHS Forth Valley (Ref: FV908), and additional approvals were given by HM Prison & Probation Services (England) and the Scottish Prison Service.

AimsWhilst the majority of age groups are seeing a decline in numbers in prison custody, the older male population continues to rise year on year. This unexpected trend has led researchers to investigate the needs of this particular cohort in more detail and start to question if the prison estate is able to care for the specific needs of the ageing population. This primary research specifically, looks to investigate what relationship, if any knowledge and attitudes to dementia have on how the confidence in practice levels of non-healthcare prison staffMethodsThis research, in a specific, applied context considers the relationship between attitudes toward the prison estate alongside knowledge and attitudes toward dementia in general and the potential relationship these may have on confidence levels. To do this, the research scored individuals’ responses against the dementia knowledge assessment scale, attitudes to the prison estate and general attitudes toward dementia. These three independent variables were measured both overall and individually against individual confidence in practices scores. 50 individuals participated with differing roles and length of service in the prison estateResultsThe results of the study found that the overall model was significant. Of the three independent variables, it was found that positive attitudes to dementia were the most influential predictor of confidence. Knowledge of the condition and attitudes to the prison estate, the second and third independent variable however were not significant predictors of confidence in practice levels. Overall, the results indicate that there is a relationship between knowledge, attitudes, and confidence in delivery of dementia care in the prison estate as an overall model.ConclusionThe main objective of this study was to determine the knowledge and attitudes to dementia of non-healthcare prison staff and if that knowledge and those attitudes had an impact on confidence in practice levels. It could be argued that this research has fulfilled its primary aim, reporting that knowledge about and attitudes toward dementia scores are a significant predictor of knowledge of the condition in non-healthcare-based staff.

Background\udInternationally, there is evidence of high rates of mental disorders amongst police custody detainees but this literature is limited, and there has been little research into the unmet needs of police detainees in the UK, or elsewhere. Such research could support better focussed interventions for improving health and recidivism outcomes.\ud\udAim\udTo examine psychiatric and developmental morbidity amongst police detainees, and ascertain differences in need between morbidity categories.\ud\udMethod\udWe used a cross-sectional study design and interviewed a 40% sample of people entering police custody in one South London police station over a 2-week period. A series of standardised measures was administered to screen for the presence of mental illness, general health and social care needs.\ud\udResults\udA cohort of 134 people was generated, of whom nearly one-third (39, 29%) had current mental illness (major depression and/or psychosis); more had a lifetime diagnosis (54, 40%). Just under a fifth met the threshold for post-traumatic stress disorder (11, 8%). Clinically relevant alcohol or daily cannabis use affected about one quarter of the sample. Twenty-one percent (or 28) screened positive for personality disorder, 11% (or 15) for attention deficit hyperactivity disorder and 4% (6) for intellectual disability. Nearly one-fifth (24, 18%) were at risk for suicide. Those with psychosis, and those deemed at risk for suicide, had the highest levels of unmet need and, indeed, overall need. The most frequent unmet need was for accommodation.\ud\udConclusion\udOur findings not only confirm high rates of mental health problems amongst police detainees but also demonstrate their high risk of suicide and high levels of unmet need, especially as regards accommodation. This underscores the need to provide mental health services in police stations, to help identify and resolve these issues at this early stage in the criminal justice system. Extending accommodation capacity to help some arrestees may help to save lives and interrupt cycling through the criminal justice system.

Introduction: Homelessness has risen across high-income countries in the last decade, and in the United Kingdom, there has been a drastic increase in people living on the streets. Due to these increases, policy responses from public services are required to address the needs of this group. The risk factors for homelessness and conditions that this group live in mean they are at elevated risk of both mental health problems and contact with the criminal justice system. Despite this, there is little previous research on the homeless in police custody. Methods: Our study used a matched sample of homeless ( n = 77) and non-homeless (n = 77) individuals to examine whether there were different needs across this group and whether the responses of a criminal justice mental health service differ for this group. This study is a secondary data analysis of a more extensive study. Results: Homeless and non-homeless detainees referred to the mental health service were broadly similar. However, differences in some variables show that homeless detainees had higher rates and frequency of substance misuse as well as some suggestion of more acute immediate need. Onward referrals were lower for homeless people, and it is not clear why this is the case. In addition, for those referred contact with services over time was reduced compared to the non-homeless group. Discussion: Our findings indicate that mental health services in police custody may need adaptations to ensure homeless individuals’ higher level of need is addressed and that they receive appropriate care both during and after detention. Further quantitative and qualitative research is needed to confirm why responses differ and to assess what can be done to address this issue.

Purpose\ud\udThis study examined the characteristics of men in prison who have a history of both self‐harm and violence (known as dual harm) and the extent to which demographic and criminogenic factors, in‐prison incidents, and self‐harm method could differentiate men who dual harm.\udMethods\ud\udOfficial prison sample data were examined for the period April 2010 to November 2017 (n = 965). Regression analysis of all custodial incidents, demographic and offending information, and imprisonment experience, was undertaken.\udResults\ud\udSelf‐harm was associated with violence in prison, representing a 3.5‐fold risk of violence compared with men who did not self‐harm, after controlling for time in prison, age, and index offence. 60% of men who harmed themselves also engaged in custodial violence, while 32% who were violent also had a self‐harm event. After controlling for age at first incident, 11% of the sample had custodial history of dual harm and they accounted for 56% of all recorded custodial incidents. They had a high probability of property damage and fire setting in prison and spent 40% longer in custody. Men who dual harmed used a greater variety of self‐harm methods, with increased use of lethal methods.\udConclusion\ud\udDual harm is prevalent, particularly among those who harm themselves in prison. Men who dual harm contribute excessively to the overall incident burden in prison and demonstrate behavioural variability and risk regarding both violence and self‐harm. The findings challenge the usual distinctive management responses or that self‐harm or violence is solely the responsibility of health or justice, with greater integration required.

The forward enstrophy cascade in two-dimensional quantum turbulence in a superfluid film connected to a thermal bath is investigated using a Fokker-Planck equation based on Kosterlitz-Thouless renormalization. The steady-state cascade is formed by injecting vortex pairs of large initial separation at a constant rate. They diffuse with a constant flux to smaller scales, finally annihilating when reaching the core size. The energy spectrum varies as $k^{-3}$, similar to the spectrum known for 2D classical-fluid enstrophy cascades. The dynamics of the cascade can also be studied, and for the case of a sharply peaked initial vortex-pair distribution, it takes about four eddy turnover times for the system to evolve to the decaying $k^{-3}$ cascade, in agreement with recent computer simulations. These insights into the nature of the cascade also allow a better understanding of the phase-ordering process of temperature-quenched 2D superfluids, where the decay of the vorticity is found to proceed via the turbulent cascade. This connection with turbulence may be a fundamental characteristic of phase-ordering in general., Comment: 5 pages, 4 figures. arXiv admin note: text overlap with arXiv:1411.5080

To what extent does immigration affect the economic institutions in destination countries? While there is much evidence that economic institutions in developed nations are either unaffected or improved after immigration, there is little evidence of how immigration affects the economic institutions of developing countries that typically have weaker institutions. Using the Synthetic Control Method, this study estimates a significant and long-lasting positive effect on Jordanian economic institutions from the surge of refugees from the First Gulf War. The surge of refugees to Jordan in 1990–1991 was massive, equal to 10 percent of Jordan’s population in 1990. Importantly, these refugees were able to have a large and direct impact on Jordanian economic institutions because they could work, live, and vote immediately upon entry due to a quirk in Jordanian law. The refugee surge was the main mechanism by which Jordan’s economic institutions improved in the decades that followed.

The prevalence of personality disorder is very high among criminal justice (correctional) populations, yet our understanding of this condition as it arises in police custody is presently limited. Although healthcare screening has a well-described role within criminal justice settings, including police custody, specific screening for personality disorders has hardly been considered. Yet such screening is broadly in keeping with the aims of liaison and diversion services and the general healthcare principle of early identification, has the potential to inform future care pathways and ameliorate risk and could in some cases inform future sentencing arrangements including community alternatives. Therefore, there is a need for research to consider the design and implementation of a suitable screening tool for application as early as possible in the criminal justice pathway, either as a stand-alone instrument, or as part of a wider package of healthcare screens. It will be important to consider the feasibility of any such design, given environmental and time limitations within police custody and the high levels of substance misuse, with issues relating to intoxication and withdrawal.