Mental health of Transgender people in prison: policy issues emerging from a systematic review

Mattia MARCHI1, Ilaria CORBELLINI1, Emma VACCARI1, Gian Maria GALEAZZI1

1Department of Biomedical, Metabolic and Neural Sciences - University of Modena and Reggio Emilia, Modena, Italy

Introduction: The Authors of this presentation have co-Authored a systematic review and meta-analysis  exploring the condition of Transgender Inmates (TGI) in correctional facilities (CF), focusing on their mental health, and health service indicators of quality, such as TGI access to Gender-affirming Treatments (GAT) and their placement within the CF. This presentation will address in particular policy issues emerging from the narrative synthesis of the included studies.

Methods: Medline, Embase, Scopus, PsychInfo, and CINAHL were searched for studies on TGI in CF. Pooled Odds Ratios (ORs) with 95% confidence interval (95%CI) were estimated through inverse variance models with random-effects. A narrative synthesis of the studies was also performed.

Results: Thirteen studies were selected and four were considered in the meta-analysis, corresponding to 1255 TGI and 174314 controls. The meta-analysis showed that TGI have a higher risk of depression, post-traumatic stress disorder, and suicide attempts during detention than their controls (OR:3.07[95%CI:1.33;7.06]; OR:2.23[95%CI:1.46;3.43]; OR:2.25[95%CI:1.46;3.49], respectively). The following issues emerged from the narrative synthesis of the studies: an increased risk of harassment and victimization for TGI individuals especially when housing is based on sex assigned at birth rather than gender identity, predominantly affecting TGI women hosted in male sections  (six out of thirteen studies), limited access to GAT  worsening self-esteem and self-affirmation, and the negative impact of heteronormative and transphobic climates within CF on health disparities among TGI and other inmates, particularly concerning mental health needs and access to healthcare, including GAT (five studies).

Discussion: Collectively, these findings underscore the need for comprehensive transgender healthcare training for correctional staff. A comprehensive policy reform should be promoted to foster inclusive and supportive correctional environments and improve safety and health of TGI. Housing decisions should be made on a case-by-case basis, considering individuals' prior history of victimization and sense of safety as pivotal factors.