Search results

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.

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.

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.

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.

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.

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.

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.

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.

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 purpose of this paper is to examine the prevalence of suicide ideation amongst a group of people who had been arrested and taken into police custody, and were then referred to a mental health service operating in the police stations.

A referred sample of 888 cases were collected over an 18-month period during 2012/2013. Clinical assessments were conducted using a template in which background information was collected (including information about their previous clinical history, substance misuse, alleged offence, any pre-identified diagnoses, and the response of the service) as part of the standard operating procedure of the service. Data were analysed using a statistical software package.

In total, 16.2 per cent (n=144) reported suicide ideation, with women being more likely to report than men. In total, 82.6 per cent of the suicide ideation sample reported a history of self-harm or a suicide attempt. Suicide ideation was also associated with certain diagnostic categories (depression, post-traumatic stress disorder and personality disorder), a history of contact with mental health services, and recent (within 24 hours) consumption of alcohol or drugs.

This evaluation adds to the limited literature in this area by describing a large sample from a real clinical service. It provides information that can assist with future service designs and it offers support for calls for a standardised health screening process, better safety arrangements for those who have recently used alcohol or drugs (within 24 hours) and integrated service delivery across healthcare domains (i.e. physical healthcare, substance use, and mental health).

The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty’s Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway.

A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted.

Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness.

The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway.

While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation.

There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway.

The purpose of this paper is to examine the role of liaison and diversion services working in the lower courts (also known as Magistrates’ courts) with regard to autism spectrum disorders (ASDs) and their assessment, in particular, the role of pre-sentence and psychiatric reports and interviews.

Current practice is described in the lower courts in the context of current legislation and procedures.

When writing reports, there is a need for expertise to offer an opinion on future risk, disposal and what needs to be in place to support people with ASDs. No assumptions should be made when reporting on the basis of an ASD diagnosis alone and each case must be assessed on its individual merits while ensuring that individual human rights are protected.

There is currently a sparse literature examining ASD in court settings. This paper seeks to clarify the current practice.

People in prisons have a high prevalence of poly-traumatisation throughout their life span. The behavioural and emotional sequalae of trauma are likely to be managed across the whole organisation. However, there is still a lack of clarity about the key components of a trauma-informed approach within the custodial context. This study aimed to gather in-depth knowledge of staff views on the components of an optimal trauma pathway in a prison and the organisational factors that influence its implementation.

The authors’ research design is qualitative, involving in-depth, semi-structured interviews with eight members of staff from different professional backgrounds at a single prison in the UK that houses sentenced and remand prisoners. Data was analysed using reflexive thematic analysis.

Three super-ordinate themes were identified within the data. Firstly, components of a trauma-informed pathway included sub-themes of asking about what has happened and knowing how to respond; providing specialist approaches; enabling residents to cope; screening and detection; and a compassionate relational approach. Secondly, organisational factors were associated with sub-themes of culture and leadership, resources and systems and processes. Thirdly, staff factors were associated with sub-themes of skills development and training, staff well-being and support and staff attitudes.

Post-traumatic stress disorder (PTSD) and complex PTSD in prisons are under-detected, and there are complex psychosocial factors within prisons that mediate the effectiveness of psychological therapies.

To the best of the authors’ knowledge, this study represents the first exploration of staff perspectives on the components of a trauma-informed pathway within custodial settings. Future directions should involve the piloting and evaluation of the components of the trauma-informed pathway, with a focus on longer-term outcomes and exploration of the organisational factors that impact on effectiveness.

Prison mental health in-reach teams (MHITs) have developed in England and Wales over the last decade. Services have been nationally reviewed, but detailed descriptions of their work have been scarce. The purpose of this paper is to describe the functions of one MHIT in a busy, ethnically diverse, male remand prison in London, UK.

Clinical and demographic data were collected for prisoners referred to the MHIT using a retrospective design over an 18-week period in 2008/2009 (n=111).

Foreign national prisoners and sentenced prisoners were significantly under-referred. Most referrals were already known to community mental health services, although around a quarter accessed services for the first time in prison. Around a third presented with self-harm/suicide risks. Substance misuse problems were common. Although the MHIT had evolved systems to promote service access, prisoner self-referrals were limited.

Foreign national prisoners require enhanced investment to improve service access. MHITs identify people with mental disorders for the first time in prisons, but better screening arrangements are needed across systems. An evaluation of multiple MHIT models could inform a wider delivery template.

One of the first ground-level evaluations of MHITs in England and Wales.

The purpose of this paper is to review the evidence on providing services to people with neurodevelopmental disorders in prisons, with a focus on those prisoners with autism spectrum disorder (ASD).

Electronic databases were used to search for literature specifically on ASD in prisons. The literature was supplemented with the authors’ experiences of carrying out research on ASD in prison.

The searches only identified four articles and therefore the broader literature on people with ASD and other developmental disorders was reviewed in relation to the prison context.

The paper highlights the current limited evidence base on prisoners with autism spectrum disorders.

The purpose of this paper is to identify neurodevelopmental disorders and difficulties (NDD) in a male prison. The study used standardised tools to carry out screening and diagnostic assessment of the attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID).

The ADHD self-report scale, 20-item autism quotient and the Learning Disability Screening Questionnaire were used to screen 240 male prisoners. Prisoners who screened positive on one or more of these scales or self-reported a diagnosis of ADHD, ASD or ID were further assessed using the diagnostic interview for ADHD in adults, adapted Autism Diagnostic Observation Schedule and the Quick Test.

Of the 87 prisoners who screened positive for NDD and were further assessed, 70 met the study’s diagnostic criteria for ADHD, ASD or ID. Most of those with NDD (51 per cent) had previously gone unrecognised and a high proportion (51 per cent) were identified through staff- or self-referral to the study.

The study demonstrated that improving awareness and providing access to skilled, standardised assessment within a male prison can result in increased recognition and identification of NDD.