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Prisoners are at greater risk of developing mental health problems compared with people of a similar age and gender in the community. They are less likely to have their mental health needs recognised, are less likely to receive psychiatric help or treatment, and are at an increased risk of suicide. Prison mental health in‐reach services have been developed in the UK to address these problems. An organisational case study method was used to generate theory about the links between the aims, processes and impacts of the introduction of mental health in‐reach teams to prison contexts. Case studies were undertaken on six sites and included interviews and focus groups with in‐reach team staff, prison healthcare staff, and discipline staff. The aims of prison mental health in‐reach were related to providing an equivalent service to a Community Mental Health Team, with a primary focus on serious mental illness, but a widening role. Achievement of these aims was mediated by the organisational context, active relationship development and leadership. Overall effects were positively reported by all stakeholders. Successful development was not just a function of time in post, but also a function of the effectiveness of leadership within the in‐reach teams. The more effective teams were having a wide impact on the response to mental health problems in the prison setting

Prisoners are supposed to receive health care that is equivalent to that provided in the community. There is a high prevalence of mental ill health in prisons, and prisoners tend to have complex needs. Prison mental health care has received only limited attention until recently. The impact of the new in ‐reach teams appears to have been positive, but primary mental health care is weak across the prison estate and the vast majority of prisoners with mental health problems still receive little or no service. The development of prison mental health care has not been evidence‐based and there has been no policy implementation guidance that compares to that provided for reforms in services for the wider community. There is no model for prison mental health care and the role of the prison mental health practitioner is not well defined, nor is the health care workforce prepared for the task.

The authors’ interest in the discharge of patients with no fixed abode (NFA) arose through repeatedly seeing patients discharged back to the streets. In 2017, the Royal United Hospital (RUH) treated 155 separate individuals with NFA, making up 194 admissions. Given these numbers, the best practice according to Inclusion Health’s tiered approach to secondary care services suggests that the hospital should be providing a dedicated housing officer and a coordinated discharge pathway. As this is currently lacking, the purpose of this paper is to establish a Homeless Healthcare Team (HHT) and design a hospital protocol for the discharge of NFA patients with strong links into community support.

The literature review identified six elements that make up a successful HHT, which has provided the structure for the implementation of the authors’ model at the RUH.

Along the way, the authors have faced a number of challenges whilst attempting to transform the model into a reality, including: securing funding; allocating responsibility; balancing conflicting priorities; coordinating schedules; developing staff knowledge and challenging prejudice. The authors are now working collaboratively with invested parties from the third sector, specialist primary and secondary care health services and local government to overcome these barriers and work towards the long-term goals.

Scarce literature exists on the practicalities of attempting to set up an HHT in a District General Hospital. The authors hope that the documentation of the authors’ experience will encourage others to broaden their horizons and persist through the challenges that arise.

Diversity in boards has gained attention as a reflection of societal imbalances. The purpose of this paper is to investigate the impact of diversity in terms of both gender and nationality in management boards of small and medium-sized enterprises (SMEs) on firm performance from an upper echelons perspective. The authors also examine how board-specific characteristics influence the structural makeup of boards in gender and nationality diversity terms.

The authors focus on the UK because of its individualistic society and flexible labour market and assess 309 SMEs in the manufacturing industry over 2009–2019. A 3-stage least squares (3SLS) estimator is used to analyse the data, the Shannon index to measure board diversity, return on assets as proxy for firm performance, and owner-manager presence, board member age and tenure are the board-specific characteristics of primary interest.

Both gender and nationality diversity contribute to firm performance and represent distinct upper echelon characteristics that change the cognitive and psychological dynamics of boards. Firms with larger boards do not perform better, but diverse boards reduce the narrowing view of CEOs. Yet the presence of owner-managers, despite their performance-enhancing contribution, holds firms back from benefitting from diversity as a strategic choice.

This study extends the upper echelons theory to include board diversity as an important aspect that should become more central in upper echelon thinking when understanding firm performance. The authors’ findings suggest that theoretical developments in search of understanding firm behaviour must proceed by accounting for diversity and not simply focusing on decision-making styles.

Physical comorbidities of alcohol misuse are common and result in frequent attendance to hospitals with estimated £3.5bn annual cost to the NHS in England. The purpose of this paper is to evaluate the effect of the hospital in-reach team of the Leeds Addiction Unit (LAU) in reducing hospital service utilization in people with alcohol dependence.

This is a retrospective cohort study, with a mirror-image design. The authors included all patients who had wholly alcohol attributable admission(s) to Leeds Teaching NHS Hospitals Trust (LTHT) during a four-month period between January and April 2013 and received treatment from LAU. The primary outcome measures were changes in A and E attendance (A&E) attendances, number of hospital admissions and days spent in hospital between the three months before and after the LAU intervention.

During the four-month period, there were 1,711 wholly alcohol attributable admissions related to 1,145 patients. LAU saw 265 patients out of them 49 who had wholly alcohol attributable admissions engaged in treatment with LAU. Of those who engaged 33 (67.3 per cent) had fewer A&E attendances, 34 (69.4 per cent) had fewer admissions and 39 (80 per cent) spent fewer days in hospital in the three months after compared to three months before. There was a significant reduction in total number of hospital admissions (78 vs 41, mean=1.56 vs 0.82, p<0.001) and days spent in hospital (490 vs 146, mean=9.8 vs 2.92, p<0.001).

This mirror-image study suggests that an alcohol hospital in-reach team could be effective in reducing acute hospital service utilization by engaging with the frequent attenders with alcohol misuse complications.

The purpose of this paper is to report on a three‐year contract to provide learning disability in‐reach to young offenders serving a sentence of Imprisonment for Public Protection (IPP) at HMYOI Aylesbury.

A whole population sample (n=75) was obtained between December 2009 and July 2011, where all had received an assessment of intellectual functioning using either the in‐reach screening protocol, consisting of the Kaufman Brief Intelligence Test – Version 2 (KBIT‐2) and four background questions, the Wechsler Abbreviated Scale of Intelligence (WASI) or the Wechsler Adult Intelligence Scale (WAIS).

It was found that 5.5 per cent of the population had a standard score of less than 70 (significant impairment) and a further 18.6 per cent fell between 70 and 79 (borderline range). The mean standard score of the KBIT‐2 (85.8) was consistent with previous studies of prison populations. The background had a significant but weak association with the KBIT‐2 scores, but lacked sufficient specificity.

Further research is required if these findings are to be generalised to the wider prison population.

Systematic screening for learning disability can be of clinical benefit in identifying the needs of young offenders, which is the first step to addressing these needs.

A number of publications by the Department of Health, the Home Office and third sector organisations have identified the need for services for offenders with a learning disability. In‐reach provision to prisons is still in its infancy and, currently, no gold standard exists for screening tools.

Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while emergency healthcare use is high (Mathie, 2012; Homeless Link, 2014). Duration of admission has been estimated to be three times longer for homeless patients who often experience poor hospital discharge arrangements (Mathie, 2012; Homeless Link, 2014). This reflects ongoing and unaddressed care and housing needs (Blackburn et al., 2017). The paper aims to discuss these issues.

This paper reveals how GPs employed in secondary care, as part of Pathway teams, support improved health and housing outcomes and safe transfer of care into community services. It draws on published literature on role of GPs in working with excluded groups, personal experience of working as a GP in secondary care, structured interviews with Pathway GPs and routine data collected by the team to highlight key outcomes.

The expertise of GPs is highlighted and includes holistic assessment, management of multimorbidity or “tri-morbidity” – the combination of addictions problems, mental illness and physical health (Homeless Link, 2014; Stringfellow et al., 2015) and research and teaching.

The role of the GP in the care of patients with complex needs is more visible in primary care. This paper demonstrates some of the ways in which in-reach GPs play an important role in the care of multiply excluded groups attending and admitted to secondary care settings.

The purpose of this paper is to explore the conversation activities of design teams to negotiate task conflict and reach consensus.

Four case studies were conducted to analyse the conversation activities that teams use in the course of design projects.

The conversation activities that teams used to negotiate conflict and bring about consensus were identified. These conversation activities are associated with collaboration, communication and social skills enabling teams to engage in the high level of information exchange and negotiation that is required to manage task conflict. How they were used to negotiate conflict and help reach consensus is also discussed.

The findings from this research are based on a small number of participants; hence, it cannot be generalised without further study with larger groups. However, the questions this paper has raised can be generalised to other design tasks and groups.

The findings have implications for the management of design teams and teams working on complex unstructured problems both in industry and education. They highlight how conflict can be constructively managed to bring about consensus that integrates the knowledge and perspective of all team members.

The benefits of task conflict have been disputed in the literature. This research has identified the conversation activities that facilitate the constructive management of task conflict to bring about consensus that integrates the perspectives and knowledge of a team.

Approximately 90% of prisoners experience mental health problems, substance misuse problems or both. However, prison reception screening tools are not always effective in enabling staff to identify mentally disordered prisoners. Therefore, to ensure that these individuals get access to appropriate care, custodial staff should be trained in recognising the signs and symptoms of mental health disorders, and in effectively working with these individuals. This paper charts the pilot implementation of a mental health awareness workbook designed for use in custodial settings across England. It examines the variety of approaches adopted to implement the workbook, staff views on the usefulness of the workbook, and barriers to implementation encountered in each area. Recommendations made for best practice in delivering the workbook in other areas suggest a need for changes to its format, but also that time should be ring‐fenced for staff to participate in this training, in groups led by experts such as in‐reach team members.

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.