Actions taken in response to mental health screening at reception into prison

Screening for mental health problems on reception into custody has been criticised. However, there have been few studies on care pathways through custody as a result of screening identification. We aimed to identify what actions were taken as a result of screening positive for suicidal ideation and mental health problems. Case records for 2166 prisoners newly received into five prisons in England and documented contact with health care professionals in the following month were examined by hand over a four-month period. Altogether, 3% of prisoners were screened as having current suicidal ideas, of whom 30% had no contact with mental health services or risk assessment documentation. Another 21% of new receptions received psychotropic medication, for whom over 60% received no primary mental health assessment, and only 36% received psychotropic medication in prison. Care pathways need to be defined, and screening needs to be delivered as originally intended by initial screen for life-threatening matters, followed by a later, comprehensive assessment of health needs.     

Brief mental health screening of prison entrants: psychiatric history versus symptom screening for the prediction of in-prison outcomes

While prisoners are known to suffer very high rates of mental illness, evidence is often lacking to inform the development of effective approaches to prison mental health service provision, including the approach to mental health screening. In addition, research to date has been dominated by prevalence studies and little is known about the mental health needs of prisoners over time. A random sample of prison entrants was recruited from a large remand and reception prison in New South Wales, Australia (n = 707) for the completion of a brief health survey. A second survey was completed during the subsequent six months (n = 317) in order to examine the effect of timing of assessment on mental health status. Those followed up within three months (n = 182) were further included in an analysis of predictive validity comparing the performance at baseline of self-reported history of previous diagnosis versus current symptom screening for psychological distress, in predicting subsequent mental illness. When assessed over six months from prison entry, mental health status was found to vary by timing of assessment. At prison entry, self-reported history of previous diagnosis of a mental health disorder was found to be a better predictor of mental illness over three months than screening for psychological distress.     

Mental health expertise at prison reception

Although screening has become an established procedure in prison health care, some difficulties persist. In attempts to improve this, many local adaptations have been introduced, but few have been evaluated. We introduced an adaptation – mental health expertise (a Community Psychiatric Nurse, CPN) – into the reception area of a busy remand prison, and compared standard and enhanced assessment procedures over a six-month period. Referrals (n = 67) were significantly more likely to be suitable for onward caseworking by the clinical team after a CPN was introduced. The team showed little evidence of the ‘mission creep’ (where teams operating at a secondary level absorb mental health problems at a primary care level) that has been described elsewhere in the literature. Despite its limitations, this evaluation suggests that prison pathways can be improved by relatively inexpensive local initiatives, and that advancing specific mental health expertise into prison reception areas can enhance existing processes.     

Mental Health Service Recipients and Prison Work Release: How Do the Mentally Ill Fare Compared to Other Inmates in Prison Work Release Programs?

The objective of this study was to compare the success rate of the mentally ill and other inmates on prison work release within gender groups. Mentally ill (MI) men (n = 42) had a higher success rate (79%) than other men (NMI) (61%) (n = 49), but this difference only approached statistical significance (p = 0.07), and mental illness did not distinguish male success/failures in regression analyses. Mentally ill women (n = 51) had a statistically significant lower success rate (58%) than other women inmates (n = 49) (83%) on work release. The difference in rates, however, only occurred in the group of women who were currently in prison due to a parole violation, not new court commitments. Regression analysis confirmed the importance of mental illness and current commitment as a parole violator. A greater number of MI men should be allowed to participate in work release. Women with mental health issues who had prior trouble on parole may need enhanced services.     

Early detection and early intervention in prison: improving outcomes and reducing prison returns

Our aim was to investigate whether early detection was feasible in prison and whether it could improve mental health outcomes in young prisoners. A secondary aim was to explore whether it can reduce returns to prison. Between 2011 and 2014, a total of 2115 young prisoners were screened, 94 (4.4%) met criteria for ultra-high risk for psychosis and were offered an intervention, 52 actually received it. Return to prison data were sought on the 52 participants, receiving a formal intervention. Of the 52 prisoners who received an intervention, 30.8% returned to custody compared to national average reconviction rates of between 45.4 and 66.5%. Our results suggest that early detection is a feasible option in a prison setting, improving mental health outcomes and reducing returns to prison. Mental health outcomes were recorded for a sub-sample of those receiving the intervention. The results indicated statistically significant improvements on measures of depression, anxiety and psychological distress.     

Moving prison health promotion along: towards an integrative framework for action to develop health promotion and tackle the social determinants of health

The majority of prisoners are drawn from deprived circumstances with a range of health and social needs. The current focus within ‘prison health’ does not, and cannot, given its predominant medical model, adequately address the current health and well-being needs of offenders. Adopting a social model of health is more likely to address the wide range of health issues faced by offenders and thus lead to better rehabilitation outcomes. At the same time, broader action at governmental level is required to address the social determinants of health (poverty, unemployment and educational attainment) that marginalise populations and increase the likelihood of criminal activities. Within prison, there is more that can be done to promote prisoners’ health if a move away from a solely curative, medical model is facilitated, towards a preventive perspective designed to promote positive health. Here, we use the Ottawa Charter for health promotion to frame public health and health promotion within prisons and to set out a challenging agenda that would make health a priority for everyone, not just ‘health’ staff, within the prison setting. A series of outcomes under each of the five action areas of the Charter offers a plan of action, showing how each can improve health. We also go further than the Ottawa Charter, to comment on how the values of emancipatory health promotion need to permeate prison health discourse, along with the concept of salutogenesis.     

Sociodemographic,Clinical, and Therapeutic Aspects of Penitentiary Psychiatric Consultation: Toward Integration Into the General Mental Health Services

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.     

Screening for mental disorder using the UK national offender assessment system

Probation officers have large caseloads with high levels of psychiatric morbidity but receive minimal training in recognising/managing mental health problems. In the UK, there is no national screening procedure for mental illness among offenders that is considered effective. This study’s aim was to develop a screening system for mental/personality disorders using the Offender Assessment System. Seven screens for mental disorder were developed using items from assessments on 574 prisoners: alcohol misuse, drug dependence, antisocial personality disorder, psychopathy, learning difficulties, psychosis and severe mood disturbance. Internal validation showed that the screens performed well across accuracy estimates. Prevalence of mental disorders identified with the screens in test and validation samples was similar. However, the psychopathy and severe mood disturbance screens may be more effective in screening for true negatives. The screens are an economical method for prioritising mental health needs of the UK prison and probation population using routinely collected data.     

The psychometric properties of a psychosis screen in a correctional setting

Many people who go to gaol are mentally ill. Remandees, prisoner receptions or people in jails have a substantially higher rate of severe mental disorder than other prisoners and the general population. There are no completely satisfactory ways to screen for psychosis and few existing screening questionnaires are available for use in correctional establishments. The Screening Instrument for Psychosis (PS) was developed in the context of the Australian Mental Health Survey: Study of Low Prevalence Disorders. It can help indicate whether a person should be referred to mental health professional for a diagnostic evaluation and possible treatment and/or diversion. We trialled the PS in a high security remand and reception centre. Measures of validity and reliability are reported.     

Stability of life-time psychiatric diagnoses among offenders in community and prison settings

The dearth of studies investigating diagnostic stability among offenders, and diagnostic stability being important from the patient’s mental health perspective, as well as from a public health, training and research standpoint, highlights the need to evaluate lifetime stability of ICD-10 psychiatric diagnoses for offenders in community and prison settings. A case-linkage design linked a two-year population-based cohort of male-sentenced prisoners with a state-wide psychiatric register (23,742 psychiatric consultations). Four measures of diagnostic stability were calculated for each setting as well as across settings, for all offenders who received at least two psychiatric diagnoses. Temporal consistency was moderate for schizophrenia spectrum disorders and low for affective, anxiety and personality disorders, and was higher in prison setting than community settings. Diagnostic instability highlights that the course of mental illness and clinical features among offenders may genuinely vary over time, across community and prison settings and may lead to complexities regarding psychiatric care for this population     

A Call for Help: Women Offenders' Reflections on Trauma Care

Female prisoners have extensive trauma histories and complex treatment needs that contribute to their criminality, yet trauma screening and treatment is not widespread in prisons. This article examines qualitative data gathered from face-to-face interviews with 31 female offenders in Canadian prisons. Using a grounded theory approach we demonstrate an unmet need for trauma-specific services for female offenders. These services go beyond trauma-informed practice and treat the psychological and behavioral sequelae of trauma exposure (e.g., mental illness and addictions) to facilitate recovery. The findings suggest that women in prison want and need specific treatment for trauma exposure. Integrating trauma-specific services involves a cultural shift within the prison environment that might be achieved by positioning trauma within the risk–need–responsivity model as an additional risk factor for criminality. Although counter to the public health perspective that trauma is a health concern, it is a way to ensure that trauma becomes part of the battery of care in corrections so that the needs of traumatized women are addressed while they are in custody. This was a unique opportunity to learn about what women would like to help deal with their experiences of trauma.     

Mentally ill offenders in prison: the Belgian case

According to the EUPRIS-study on mental health in prisons (2007), available data on mental disorders in prison are scarce. Therefore, this study aims at summarizing and discussing the available knowledge on incarcerated mentally ill offenders concerning: (1) the screening and assessment for detecting mental health; (2) the psychiatric expertise in order to evaluate the mental status; and (3) the development and provision of forensic psychiatric treatment and care. These findings will be applied to the current situation in Belgium, which is a particularly interesting case. Belgium is currently facing difficulties concerning a large population of interned mentally ill offenders residing in correctional establishments.Implications with regard to the penal code, general or mental health legislation, screening, assessment, and treatment could deliver interesting viewpoints on how this problem could be tackled more effectively. Therefore, the findings will be discussed with reference to the international scientific and policy debate, focusing on ethical implications.     

Sexual offenders with serious mental illness: prevention, risk, and clinical concerns

Individuals with serious and persistent mental illness who have also engaged in illegal sexual behavior present a unique challenge for our legal and clinical systems. Frequently, these individuals may engage in problematic sexual behaviors which result in hospitalization rather than incarceration, and an overburdened and resource-deficient public community mental health system is ill-equipped to address the seriousness of these sexual behaviors. We have a rather limited understanding of how prevention programs, intervention strategies, and risk assessment would work with this population. Here we evaluate data from a sample of 245 inpatient psychiatric sexual offenders in a forensic mental health setting and compare these with what information has already been presented in some of the literature. Through an examination of seriously mentally ill sexual offenders and their clinical presentation, legal history, and risk management concerns, we illustrate a variety of tertiary prevention needs. Future directions in the area of prevention and risk management for seriously mentally ill sexual offenders are also discussed.     

How do psychiatric patients on prison healthcare centres differ from inpatients in secure psychiatric inpatient units?

Abstract

Mentally ill prisoners have consistently been highlighted as a group with complex needs. However, it is not clear what these needs are, how effective prison health services are in meeting the needs of this vulnerable group, and whether there would be any benefit to transferring them to psychiatric facilities. This study compared the characteristics and needs of mentally ill patients in prison healthcare centres (HCC prisoners) with patients in forensic medium secure psychiatric units (MSU inpatients) in the UK. HCC prisoners and MSU inpatients were in fact very similar. Where they did differ, though, was that MSU inpatients were significantly more likely to be of non-white ethnicity, diagnosed with psychotic or substance use disorders, and have recorded histories of drug misuse. HCC prisoners and MSU inpatients reported the same number of needs overall, according to the CANFOR-S (Camberwell Assessment of Need Forensic Short Version), but HCC prisoners reported significantly higher levels of unmet need. The need for transfer to alternative services was common in both groups, with bottlenecks evident at all levels. The high level of unmet need reported in the HCC prison sample is of particular clinical concern and highlights the need for improved assessment and treatment services in this setting.     

监狱精神病罪犯问题及法律规制

对精神健康问题的关注程度标志着一个国家文明程度的提升,相应地对精神病人的刑事处遇政策也体现了一个国家刑事法治的发达水平,目前,监狱精神病犯人数有所增加,对这些特殊人群的关爱和保障要尽快提上议事日程,应当结合监狱的具体实际,建立罪犯服刑能力鉴定机制,强化“司法审查关”;构建强制治疗程序,发挥其防卫社会、治疗疾病和保障人权的功能;在监狱系统设立专门的精神病医院或监区,以维护监狱安全和保障罪犯权利。     

Social support among releasing men prisoners with lifetime trauma experiences

High rates of lifetime trauma experiences exist among men incarcerated in US state and federal prisons. Because lifetime trauma experiences have been linked to problematic behavioral and psychiatric outcomes for incarcerated populations, trauma-informed interventions could improve post-release well-being of releasing men prisoners with trauma histories. Social support has consistently been found to have a positive impact on trauma-related outcomes in non-incarcerated populations. Therefore, it is reasonable to hypothesize that social support may be an important intervention component for releasing men prisoners with trauma experiences; yet, the relationship between trauma experiences, psychiatric and behavioral factors, and social support has received almost no attention in research with men prisoners. Using a probability sample of 165 soon-to-be-released men, the present study examined differences in certain demographic, criminal justice history, mental health, substance abuse, and social support (type, quality, amount, and source) variables between releasing men prisoners with and without lifetime trauma experiences. Results indicate that men with trauma histories had more negative social support experiences and fewer positive social support resources before prison than their counterparts. Men with trauma histories also had more lifetime experiences with mental health and substance use problems. On further investigation of the subsample of men with trauma histories, those who were older, had substance use disorders, and histories of mental health problems anticipated fewer post-release social support resources. Study findings underscore the nuances of social support for men prisoners with trauma experiences and point to implications for future directions in targeted trauma-informed intervention development for releasing men prisoners.     

Prevalence of mental disorders and deliberate self-harm in Greek male prisoners

The aim of this survey was to determine the prevalence of current and lifetime mental disorder and deliberate self-harm among male prisoners in Greece. The subjects were 80 randomly selected remanded and sentenced prisoners in a Greek prison. They were assessed for mental disorder including suicidality and substance misuse using the Mini International Neuropsychiatric Interview (MINI). We also collected information regarding contact with psychiatric services, previous deliberate self-harm as well as physical health and conducted a brief assessment of their intellectual functioning. Mental disorder was diagnosed in 63 (78.7%) prisoners. The main diagnoses were: anxiety disorder, 30 (37.5%); major depression, 22 (27.5%); antisocial personality disorder, 30 (37.5%); alcohol dependence, 21 (26.3%) and opiate dependence 22 (27.5%) and schizophrenic or bipolar disorder 9 (11.2%). Deliberate self-harm prior to and during imprisonment was reported by 15% and 2.5% of prisoners, respectively, and 12 prisoners (15%) had IQ below 75. This survey identified a significant level of need for specialist mental health services in prison. Further studies are required to assess the specific needs of those patients who are too unwell to remain in prison, the need for specific treatments for substance misuse and improved assessment/treatment of common psychiatric disorders.     

Prevalence of Criminal Thinking among State Prison Inmates with Serious Mental Illness

To examine the prevalence of criminal thinking in mentally disordered offenders, incarcerated male (n = 265) and female (n = 149) offenders completed measures of psychiatric functioning and criminal thinking. Results indicated 92% of the participants were diagnosed with a serious mental illness, and mentally disordered offenders produced criminal thinking scores on the Psychological Inventory of Criminal Thinking Styles (PICTS) and Criminal Sentiments Scale-Modified (CSS-M) similar to that of non-mentally ill offenders. Collectively, results indicated the clinical presentation of mentally disordered offenders is similar to that of psychiatric patients and criminals. Implications are discussed with specific focus on the need for mental health professionals to treat co-occurring issues of mental illness and criminality in correctional mental health treatment programs.