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Forrester A, Hopkin G. Mental health in the criminal justice system: A pathways approach to service and research design. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:207-217. [PMID: 31478274 DOI: 10.1002/cbm.2128] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Care pathway approaches were introduced into health care in the 1980s and have become standard international practice. They are now being introduced more specifically for health care in the criminal justice system. Care pathway delivery has the theoretical advantage of encouraging a whole-systems approach for health and social care within the criminal justice system, but how well is it supported by empirical evidence? AIMS The aim of this study is to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. METHOD We used an exploratory narrative method to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. The available literature was reviewed using a keyword search approach with three databases: PubMed, Medline, and Google Scholar. FINDINGS Research in this field has covered police custody, courts, prisons, and the wider community, but there is little that follows the entire career through all these elements of offender placement. Main themes in the research to date, regardless of where the research was conducted, have been counting the disorder or the need, development and evaluation of screening tools, and evaluation of clinical intervention styles. Most evidence to date is simply observational, although the possibility of conducting randomised controlled trials of interventions within parts of the criminal justice system, especially prisons, is now well established. CONCLUSIONS Access to health care while passing through the criminal justice system is essential because of the disproportionately high rates of mental disorder among offenders, and the concept of structured pathways to ensure this theoretically satisfying, but as yet empirically unsupported. Further, substantial cuts in services, generally following government economies, are largely unresearched. Considerable investment in new possibilities, driven by both pressure groups and government, tend to be informed by good will and theory rather than hard evidence and are often not evaluated even after introduction. This must change.
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Abstract
SummaryPrisons in England and Wales have reached a low point in service delivery. Despite initial improvements after National Health Service transfer in 2006, it has deteriorated since 2010, with numerous reports giving cause for concern. Improvements are now urgently required, and political courage and a revised national programme of expenditure are necessary.Declaration of interestNone.
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Bell S, Hopkin G, Forrester A. Exposure to Traumatic Events and the Experience of Burnout, Compassion Fatigue and Compassion Satisfaction among Prison Mental Health Staff: An Exploratory Survey. Issues Ment Health Nurs 2019; 40:304-309. [PMID: 30742547 DOI: 10.1080/01612840.2018.1534911] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Psychiatric morbidity is high in the prison population and prisoners with mental health problems present with complex needs. Working within the stressful prison environment and exposure to traumatic events may make prison mental health staff and correctional officers vulnerable to burnout, compassion fatigue, and reduced compassion satisfaction. This issue has not previously been explored in the prison setting. In this exploratory study, 36 mental health professionals and correctional officers were recruited from a prison in England and completed a series of questionnaires on their demographic and professional characteristics, exposure to traumatic events, support from managers and colleagues and on levels of burnout, compassion fatigue, and compassion satisfaction. Staff had high levels of exposure to traumatic events and the level of support provided by managers and colleagues was mixed. The majority of staff were not at high risk of burnout, compassion fatigue and reduced compassion satisfaction but higher levels of burnout, compassion fatigue and reduced compassion satisfaction were found to be associated with a range of factors including staff characteristics, exposure to traumatic events, and working environment. These findings should be interpreted with the small sample size and limited power in mind and larger surveys of staff working in prison mental health settings are needed to confirm these results across a wider number of sites but nonetheless this study highlights the need for providers to consider staff's exposure to traumatic events and to promote supportive working environments.
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Forrester A. The forensic intersection and the future. MEDICINE, SCIENCE, AND THE LAW 2019; 59:3. [PMID: 30852986 DOI: 10.1177/0025802419830274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Young S, Gudjonsson G, Chitsabesan P, Colley B, Farrag E, Forrester A, Hollingdale J, Kim K, Lewis A, Maginn S, Mason P, Ryan S, Smith J, Woodhouse E, Asherson P. Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus. BMC Psychiatry 2018; 18:281. [PMID: 30180832 PMCID: PMC6122636 DOI: 10.1186/s12888-018-1858-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Around 25% of prisoners meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Because ADHD is associated with increased recidivism and other functional and behavioural problems, appropriate diagnosis and treatment can be a critical intervention to improve outcomes. While ADHD is a treatable condition, best managed by a combination of medication and psychological treatments, among individuals in the criminal justice system ADHD remains both mis- and under-diagnosed and consequently inadequately treated. We aimed to identify barriers within the prison system that prevent appropriate intervention, and provide a practical approach to identify and treat incarcerated offenders with ADHD. METHODS The United Kingdom ADHD Partnership hosted a consensus meeting to discuss practical interventions for youth (< 18 years) and adult (≥18 years) offenders with ADHD. Experts at the meeting addressed prisoners' needs for effective identification, treatment, and multiagency liaison, and considered the requirement of different approaches based on age or gender. RESULTS The authors developed a consensus statement that offers practical advice to anyone working with prison populations. We identified specific barriers within the prison and criminal justice system such as the lack of adequate: staff and offender awareness of ADHD symptoms and treatments; trained mental health staff; use of appropriate screening and diagnostic tools; appropriate multimodal interventions; care management; supportive services; multiagency liaison; and preparation for prison release. Through discussion, a consensus was reached regarding prisoners' needs, effective identification, treatment and multiagency liaison and considered how this may differ for age and gender. CONCLUSIONS This practical approach based upon expert consensus will inform effective identification and treatment of offenders with ADHD. Appropriate intervention is expected to have a positive impact on the offender and society and lead to increased productivity, decreased resource utilization, and most importantly reduced rates of re-offending. Research is still needed, however, to identify optimal clinical operating models and to monitor their implementation and measure their success. Furthermore, government support will likely be required to effect change in criminal justice and mental health service policies.
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Bowen K, Jarrett M, Stahl D, Forrester A, Valmaggia L. The relationship between exposure to adverse life events in childhood and adolescent years and subsequent adult psychopathology in 49,163 adult prisoners: A systematic review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Patel R, Harvey J, Forrester A. Systemic limitations in the delivery of mental health care in prisons in England. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 60:17-25. [PMID: 30217326 DOI: 10.1016/j.ijlp.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 05/17/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
There is a high prevalence of mental health need in prisons, much of which is currently unmet. Although considerable research has identified and described this mental health need, there has been limited research focussed on reviewing the delivery of mental health care in prisons. This study uses content analysis to review 36 unannounced prison inspection reports in England to establish whether mental health care was provided to an appropriate standard, and whether it is equivalent to services that are provided in the wider community. The analysis identified four main categories, each of which had further sub-categories: managing the process; staffing; range of services; and quality of service. Numerous concerns were identified, including: delays to service access; lack of appropriate interventions; low staffing levels; limited specialist support; and limited access to supervision, training and reflective practice. Despite these difficulties, many teams had adopted open referral systems to improve service access, had good working relationships and were thought to be providing care of good quality. The delivery of mental health care within prisons is still not equivalent to that which is provided in the community, and this study has identified a number of areas for further improvement.
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Forrester A, Till A, Simpson A, Shaw J. Mental illness and the provision of mental health services in prisons. Br Med Bull 2018; 127:101-109. [PMID: 30124765 DOI: 10.1093/bmb/ldy027] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 07/19/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Around 11 million people are held in prisons internationally, and criminal justice systems are overburdened with a high prevalence of multiple psychiatric disorders. In England and Wales over 200 000 people enter prisons each year, and in many cases, this facilitates their first contact with mental health services. SOURCES OF DATA Research, evaluations, government reports and independent reviews. AREAS OF AGREEMENT Screening, Triage, Assessment, Intervention and Re-integration (STAIR) are necessary components of prison mental health provision, offering an opportunity to improve the wellbeing of a complex population. AREAS OF CONTROVERSY There are serious problems with service provision across many parts of the world, with human rights abuses occurring in some States. Screening and service delivery models still require substantial development. In England and Wales, self-harm, self-inflicted deaths and violence are increasing. GROWING POINTS Introducing comprehensive mental health models throughout prisons would offer a massive public health initiative, providing new services for the socially disadvantaged. A rights-based framework would be useful in ensuring systemic improvements, especially in low and middle-income countries. AREAS TIMELY FOR DEVELOPING RESEARCH Mechanisms for screening and triage, specific interventions across a broad range of conditions, and practical re-integration models, should be submitted to research across international sites.
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Cooper J, Jarrett M, Forrester A, di Forti M, Murray RM, Huddy V, Roberts A, Phillip P, Campbell C, Byrne M, McGuire P, Craig T, Valmaggia L. Substance use and at-risk mental state for psychosis in 2102 prisoners: the case for early detection and early intervention in prison. Early Interv Psychiatry 2018; 12:400-409. [PMID: 27136461 DOI: 10.1111/eip.12343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/06/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
AIM Prisoners exhibit high rates of substance use and mental health problems. In the present study, we sought to gain a detailed understanding of substance use amongst young prisoners to inform early detection and early intervention strategies in a prison setting. METHODS This is a cross-sectional study of 2102 prisoners who were screened by the London Early Detection and Prevention in Prison Team (LEAP). Data on the use of substances were collected including age of first use, recent use, duration of use and poly-drug use. The Prodromal Questionnaire - Brief Version was used to screen for the at-risk mental state. RESULTS We found high rates of lifetime and recent use and low age of first use of a number of substances. We also found strong associations between substance use and screening positive for an at-risk mental state. Logistic regression analysis confirmed that use of any drug in the last year, poly-drug and early use, as well as heavy alcohol use, were related to an increased risk of screening positive. CONCLUSIONS Substance use in the prison population is not only widespread and heavy but is also strongly linked with a higher risk of developing mental health problems. The need for early detection and early intervention in prison is discussed.
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Forrester A, Henderson C, Wilson S, Cumming I, Spyrou M, Parrott J. A suitable waiting room? Hospital transfer outcomes and delays from two London prisons. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.108.022780] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo describe a group of prisoners who required transfer to mental health units from two London prisons. Data were collected from prison clinical records.ResultsOverall, 149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services. the aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at £6.759 million.Clinical ImplicationsBoth prisons manage a large number of prisoners with untreated psychosis. While in prison, they save the NHS considerable sums of money, but transfer delays prevent timely treatment and could now be legally challenged.
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Abstract
SummaryPrisons have high levels of psychiatric morbidity and function as mental illness recognition centres. Their healthcare wings are not hospitals and timely transfers to hospital are often unavailable. The United Nations' right to the highest attainable standard of health is assessed according to whether healthcare services are available, accessible, acceptable and of good quality (AAAQ). It is proposed that the AAAQ framework goes beyond the principle of equivalence of care and provides a more sophisticated measure for exploring prison healthcare.
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Wilson S, Chiu K, Parrott J, Forrester A. Postcode lottery? Hospital transfers from one London prison and responsible catchment area. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.109.025239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo consider the link between responsible commissioner and delayed prison transfers. All hospital transfers from one London prison in 2006 were audited and reviewed by the prisoner's borough of origin.ResultsOverall, 80 prisoners were transferred from the audited prison to a National Health Service (NHS) facility in 2006: 26% had to wait for more than 1 month for assessment by the receiving hospital unit and 24% had to wait longer than 3 months to be transferred. These 80 individuals were the responsibility of 16 different primary care trusts. Of the delayed transfer cases (n=19), the services commissioned by three primary care trusts were responsible for the delays.Clinical implicationsThere are significant differences in performance between different primary care trusts related to hospital transfers of prisoners, with most hospitals able to admit urgent cases within 3 months. This suggests that a postcode lottery operates for prisoners requiring hospital transfer. Data from prison services may be useful in monitoring and improving the performance of local NHS services.
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Chaplin E, McCarthy J, Underwood L, Forrester A, Hayward H, Sabet J, Mills R, Young S, Asherson P, Murphy D. Characteristics of prisoners with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:1185-1195. [PMID: 29154489 DOI: 10.1111/jir.12441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 07/31/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Previous studies have found high rates of intellectual disabilities (ID) in prison. However, little is understood about prisoners with ID. This study aimed to identify prisoners with ID and compare their characteristics with prisoners without neurodevelopmental disorders with regard to demographic profile, mental health, suicide risk and offences. METHOD This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ID and mental disorder. RESULTS The study identified 18 prisoners as having ID. Participants with ID were less likely to be from a black or minority ethnic background, be over 35 years of age or have any qualifications. They were more likely to have been single, homeless or unemployed before coming into prison. Prisoners with ID were significantly more likely to have mental health problems and 25% had thought about suicide in the last month and 63% had attempted suicide in the past. Prisoners with ID were also more likely to be housed in the vulnerable prisoners' wing and significantly more likely to have committed robbery than other prisoners. CONCLUSIONS The findings confirm the presence of significant numbers of people with ID with high levels of mental illness in a male prison. Services across the CJS are required for this group, specifically, there is a need for raised awareness among those working in prison about ID and improved skills to recognise offenders with ID and address major gaps in current healthcare provision in prison.
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Brooker CGD, Forrester A. Prison mental health in-reach teams in England: the care programme approach and sexual abuse/violence. Br J Psychiatry 2017; 211:337-338. [PMID: 29196391 DOI: 10.1192/bjp.bp.117.200428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 11/23/2022]
Abstract
Prison mental health in-reach teams have doubled in size over the past decade and case-loads have reduced. Since 2010 it has been mandatory for keyworkers to ask whether prisoners with serious mental illness being treated under the care programme approach have experienced sexual or physical abuse. This is known as routine enquiry and should take place for these prisoners but NHS England, the commissioners, do not audit this activity. It is time to review current interventions and their associated outcomes.
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Chaplin E, McCarthy J, Forrester A. Defendants with autism spectrum disorders: what is the role of court liaison and diversion? ADVANCES IN AUTISM 2017. [DOI: 10.1108/aia-08-2017-0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
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.
Design/methodology/approach
Current practice is described in the lower courts in the context of current legislation and procedures.
Findings
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.
Originality/value
There is currently a sparse literature examining ASD in court settings. This paper seeks to clarify the current practice.
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Roberts A, Onwumere J, Forrester A, Huddy V, Byrne M, Campbell C, Jarrett M, Phillip P, Valmaggia L. Family intervention in a prison environment: A systematic literature review. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2017; 27:326-340. [PMID: 27104884 DOI: 10.1002/cbm.2001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/03/2015] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The prison population in England and Wales is approximately 85,000, and elevated rates of mental health difficulties have been reported among the prisoners. Despite frequent recommendations for family interventions to optimise prisoner outcomes, the evidence for its use and impact in prison remain unclear. AIM The aim of the study is to conduct a systematic review of published literature on family interventions in prisons. METHODS Embase, PsychINFO and Medline were searched using terms for family interventions and for prisoners or young offenders. No limit was imposed on study design, but, for inclusion, we required that papers were written in English and published in peer-reviewed journals. RESULTS Nine hundred eighty-three titles were retrieved. Twenty-two met criteria for inclusion. Three were case studies, 12 were descriptive, 6 were quasi-experimental and one was a randomised controlled trial. Interventions and study methods were too heterogeneous for meta-analysis. All studies gave positive conclusions about family interventions, but empirical data on effectiveness were slight. CONCLUSIONS Consistency in findings across the wide-ranging studies suggested that family therapies may indeed be helpful for prisoners and their families, so further research is warranted. The fact that a randomised controlled trial proved feasible should encourage researchers to seek more robust data and to determine which form of intervention is effective and in which circumstances. It would also be useful to develop an improved understanding of mechanisms of change. Copyright © 2016 John Wiley & Sons, Ltd.
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Huddy V, Kitchenham N, Roberts A, Jarrett M, Phillip P, Forrester A, Campbell C, Byrne M, Valmaggia L. Self-report and behavioural measures of impulsivity as predictors of impulsive behaviour and psychopathology in male prisoners. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Samele C, Forrester A, Bertram M. An evaluation of an employment pilot to support forensic mental health service users into work and vocational activities. J Ment Health 2017; 27:45-51. [PMID: 28084839 DOI: 10.1080/09638237.2016.1276527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Few employment programmes exist to support forensic service users with severe mental health problems and a criminal history. Little is known about how best to achieve this. The Employment and Social Inclusion Project (ESIP) was developed and piloted to support forensic service users into employment and vocational activities. AIMS This pilot service evaluation aimed to assess the number of service users who secured employment/vocational activities and explored services users' and staff experiences. METHOD Quantitative data were collected to record the characteristics of participating service users and how many secured employment and engaged in vocational activities. Eighteen qualitative interviews were conducted with service users and staff. RESULTS Fifty-seven service users engaged with the project, most were men (93.0%) and previously employed (82.5%). Four service users (7.0%) secured paid competitive employment. Eight (14.0%) gained other paid employment. Tailored one-to-one support to increase skills and build confidence was an important feature of the project. Creation of a painting and decorating programme offered training and paid/flexible work. CONCLUSIONS This exploratory project achieved some success in assisting forensic service users into paid employment. Further research to identify what works well for this important group will be of great value.
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Slade K, Samele C, Valmaggia L, Forrester A. Pathways through the criminal justice system for prisoners with acute and serious mental illness. J Forensic Leg Med 2016; 44:162-168. [PMID: 27810587 DOI: 10.1016/j.jflm.2016.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/17/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate pathways through the criminal justice system for 63 prisoners under the care of prison mental health services. RESULTS A small number (3%) were acutely mentally ill at prison reception, which may reflect the successful operation of liaison and diversion services at earlier stages in the pathway. However, a third (33%) went onto display acute symptoms at later stages. Cases displaying suicide risk at arrest, with a history of in-patient care, were at increased risk of acute deterioration in the first weeks of imprisonment, with a general absence of health assessments for these cases prior to their imprisonment. Inconsistencies in the transfer of mental health information to health files may result in at-risk cases being overlooked, and a lack of standardisation at the court stage results in difficulties determining onward service provision and outcomes. CONCLUSIONS Greater consistency in access to pre-prison health services in the criminal justice system is needed, especially for those with preexisting vulnerabilities, and it may have a role in preventing subsequent deterioration. A single system for health information flow across the whole pathway would be beneficial.
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Jarrett M, Jamieson-Craig TK, Forrester A, McGuire P, Badger S, Fusar-Poli P, Byrne M, Williams P, Valmaggia LR. Prison and Community Populations at Ultra-High Risk of Psychosis: Differences and Challenges for Service Provision. Psychiatr Serv 2016; 67:990-5. [PMID: 27032664 DOI: 10.1176/appi.ps.201500355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of the study was to explore the feasibility of expanding a community service for early detection of psychosis into a local London prison for men in the United Kingdom. METHODS All new receptions to a local prison for men in South London were approached for routine screening. Those who met criteria for being at ultra-high-risk of psychosis were compared with a help-seeking sample from the community who met the same criteria. Clinical and sociodemographic characteristics were compared to determine whether the prison and community populations had similar profiles and mental health needs. RESULTS Of 891 prisoners screened, 44 (5%) met criteria for being at ultra-high risk of psychosis. The community sample consisted of 42 participants. Compared with the community group, prison participants had lower scores on almost all symptom measures, were less likely to have remained in school and completed exams, and were more likely to be in short-term accommodations and to be of black race-ethnicity. Lifetime use of illicit drugs was similar between the groups, but recent use was much higher in the prison group. CONCLUSIONS Expanding community services into custodial settings should take into account the different environment and needs of the prisoner population. Specifically, early detection and intervention services should target a broad range of mental health problems rather than psychosis alone.
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Hopkin G, Samele C, Singh K, Craig T, Valmaggia L, Forrester A. Prison Mental Health In-reach: The Effect of Open Referral Pathways. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2016; 24:152-158. [PMID: 31983946 PMCID: PMC6818432 DOI: 10.1080/13218719.2016.1197813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In England and Wales, mental health in-reach teams manage high levels of mental disorder in prisons, but problems with reception screening and referral triage have been identified. As one potential solution, we examined the effect of an open referral pathway upon one in-reach team by evaluating its referrals and caseload across two time periods (in 2008 and 2011). There was a doubling of team referrals (from 101 to 203) with significantly improved identification of people with no mental health history. There was further evidence for a lowering of thresholds for referral and assessment, an approach that can be seen as helpful within a system that is known to under-identify mental health problems. Despite limitations, this evaluation offers some evidence for the effectiveness of open referral systems. It also raises questions about the potential effects of liaison and diversion services that are presently being piloted for national introduction.
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Underwood L, McCarthy J, Chaplin E, Forrester A, Mills R, Murphy D. Autism spectrum disorder traits among prisoners. ADVANCES IN AUTISM 2016. [DOI: 10.1108/aia-11-2015-0023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to determine the extent of autism spectrum disorder (ASD) traits among prisoners. The authors tested the hypotheses that ASD traits would: be continuously distributed among prisoners; be unrecognised by prison staff; and predict whether a prisoner met diagnostic criteria for ASD.
Design/methodology/approach
– ASD traits were measured among 240 prisoners in a male prison in London, UK using the 20-item Autism Quotient (AQ-20). Further diagnostic assessment was carried out using the Autism Diagnostic Observation Schedule. Results were compared with ASD data from the 2007 Psychiatric Morbidity Survey.
Findings
– There were 39 participants with an AQ-20 score=10; indicating significant autistic traits. The distribution of ASD traits among participants appeared to be normal and was not significantly higher than the rate found in a population-based sample from England.
Originality/value
– Few studies have explored ASD traits among prisoners. The authors identified high levels of unrecognised ASD traits among a group of male prisoners, many of whom went on to meet diagnostic criteria for ASD. The study highlights the need for specialist assessment within the criminal justice system for individuals with neurodevelopmental disorders including ASD. The authors discuss the process of carrying out an ASD assessment project in a prison.
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Samele C, Forrester A, Urquía N, Hopkin G. Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:589-96. [PMID: 26846126 PMCID: PMC4823327 DOI: 10.1007/s00127-016-1170-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/17/2015] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services. METHOD A purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified. RESULTS Twenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners. CONCLUSIONS The prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.
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McCarthy J, Chaplin E, Underwood L, Forrester A, Hayward H, Sabet J, Young S, Asherson P, Mills R, Murphy D. Characteristics of prisoners with neurodevelopmental disorders and difficulties. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:201-6. [PMID: 26486964 DOI: 10.1111/jir.12237] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/22/2015] [Accepted: 09/17/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Previous studies have found high rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) within the criminal justice system (CJS). However, little is understood about prisoners with neurodevelopmental disorders and difficulties (NDD) or their needs. This study aimed to identify prisoners with NDD and compare their characteristics with prisoners without NDD on a range of socio-demographic and social functioning measures. METHOD This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ADHD, ASD and ID. RESULTS The study identified 87 prisoners who screened positive for one or more type of NDD. Participants with NDD were significantly younger and more likely to be single [(odds ratio) OR = 2.1], homeless (OR = 3.4) or unemployed (OR = 2.6) before they came into prison. They also had poorer educational achievements that those without NDD. Over 80% of those with NDD had a previous conviction or imprisonment. CONCLUSIONS The findings confirm the presence of significant numbers of people with NDD in a male prison. Services across the CJS are required for this group; specifically, there is a need for raised awareness among those working in the CJS to improve the recognition of offenders with NDD. Services in the community need to work with individuals with NDD who are at risk of offending, targeting those who are homeless, unemployed and have poor employment opportunities.
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Hopkin G, Samele C, Singh K, Forrester A. Letter to the editor: Transferring London's acutely mentally ill prisoners to hospital. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2016; 26:76-78. [PMID: 26786192 DOI: 10.1002/cbm.1992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
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Forrester A, Till A, Senior J, Shaw J. Competitive tendering and offender health services. Lancet Psychiatry 2015; 2:859-61. [PMID: 26462209 DOI: 10.1016/s2215-0366(15)00414-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/22/2015] [Accepted: 08/24/2015] [Indexed: 11/26/2022]
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79
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McCarthy J, Underwood L, Hayward H, Chaplin E, Forrester A, Mills R, Murphy D. Autism Spectrum Disorder and Mental Health Problems Among Prisoners. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30674-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sen P, Exworthy T, Forrester A. Mental health care for foreign national prisoners in England and Wales. J Ment Health 2014; 23:333-9. [DOI: 10.3109/09638237.2014.951480] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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81
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Forrester A. Forensic psychiatry: out of mind, out of sight. Lancet Psychiatry 2014; 1:266. [PMID: 26360857 DOI: 10.1016/s2215-0366(14)70369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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82
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Forrester A, MacLennan F, Slade K, Brown P, Exworthy T. Improving access to psychological therapies in prisons. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2014; 24:163-168. [PMID: 25042836 DOI: 10.1002/cbm.1898] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 10/19/2013] [Accepted: 11/05/2013] [Indexed: 06/03/2023]
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Mudathikundan F, Chao O, Forrester A. Mental health and fitness to plead proposals in England and Wales. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:135-141. [PMID: 24268448 DOI: 10.1016/j.ijlp.2013.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Proposals to reform fitness to plead legislation have been published by the Law Commission in England and Wales; they include a new test of decision making capacity and a new psychiatric test that has yet to be fully developed. Although proposals have met with some support, there have also been detractors. The history of fitness to plead is reviewed and current case law (including the 1836 Pritchard criteria) is examined. Although existing arrangements have been criticised, this may be attributable to inconsistent practical application, rather than inherent conceptual flaws. The Pritchard test has largely stood the test of time and has emerged relatively unscathed. Fitness to plead is not a medical construct, but rather a legal entity and any new test would be likely to introduce its own difficulties. A capacity based assessment could enhance debate and disagreement and increase court time in many cases, presenting new resource implications with questionable benefit. As the existing Pritchard criteria, amended by case law, already include a five limb test that closely resembles a capacity assessment (ability to plead to the indictment, to understand the course of the proceedings, to instruct a lawyer, to challenge a juror and to understand the evidence) and given the difficulties in introducing a functional test format in other jurisdictions, the Law Commission's proposals should now be set aside, perhaps for another day: reconsideration may be possible some decades hence, pending enhanced scientific developments within psychiatry and better understanding of the mind.
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Till A, Forrester A, Exworthy T. The development of equivalence as a mechanism to improve prison healthcare. J R Soc Med 2014; 107:179-182. [PMID: 24566935 DOI: 10.1177/0141076814523949] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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86
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Hwang H, Forrester A, Lansey K. Decentralized Water Reuse: Regional Water Supply System Resilience Benefits. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.proeng.2014.02.093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Srivastava S, Forrester A, Davies S, Nadkarni R. Developing criminal justice liaison and diversion services: research priorities and international learning. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2013; 23:315-20. [PMID: 24311445 DOI: 10.1002/cbm.1888] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 08/06/2013] [Indexed: 05/26/2023]
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Ganapathy K, Wilkins M, Forrester A, Lemiere S, Cserep T, McMullin P, Jones RC. QX‐like infectious bronchitis virus isolated from proventriculitis in commercial broilers in England. VETERINARY RECORD CASE REPORTS 2013. [DOI: 10.1136/vetreccr.101005rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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89
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Warwick D, Dewbury K, Forrester A. Intermittent pneumatic compression. A comparison of femoral vein velocity with five different devices. INT ANGIOL 2013; 32:404-409. [PMID: 23822943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Different mechanical devices for thromboprophylaxis have different flow characteristics. A new device (Vadoplex) has been developed to provide a short impulse around the calf, a concept derived from the efficacy of foot impulse technology. New devices should be compared with existing devices to establish whether it has a comparable ability to augment venous velocity. Objectives of the study were to compare the venous velocity induced by the Vadoplex with established intermittent pneumatic calf and leg compressors (Covidien and Huntleigh). METHODS The venous velocity was established in ten healthy volunteers with standardised Duplex ultraonography of the common femoral vein. Measurements were taken at rest and on standing, with each device inactive and active. RESULTS The Vadoplex induced an increased femoral venous velocity at least as enhanced as established calf and full leg sleeves. CONCLUSION Calf impulse technology is an alternative to other systems in enhancing femoral vein blood flow, itself a surrogate for assumed thromboprophylactic effect.
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Forrester A, Exworthy T, Chao O, Slade K, Parrott J. Influencing the care pathway for prisoners with acute mental illness. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2013; 23:217-226. [PMID: 23839927 DOI: 10.1002/cbm.1870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Despite improved mental health services in prisons in England and Wales, there are often delays in transferring acutely mentally ill prisoners to hospital, particularly in the London area. AIM To establish whether clinical pathway interventions can reduce such transfer delays. METHODS Two clinical pathway interventions - one based in a medium secure forensic hospital and the other in a remand prison (pre-trial/sentence) - were independently introduced to manage referrals of prisoners with acute mental illness in London, UK. Time taken to transfer to hospital was measured for each and compared with the best available estimates for time to transfer prior to the new pathways. RESULTS Both interventions produced significant reductions in prison to hospital transfer times. CONCLUSIONS/IMPLICATIONS FOR PRACTISE The nature of the projects precluded ideal research design, but despite small sample sizes, provision of modestly funded small but dedicated elements of service to target the specified problem of transfer to hospital delays showed a significant advantage for such provision, whether hospital or prison based, psychiatrist or nurse led. Further research is now required to examine the whole pathway. More secure psychiatric beds may be required, at least in the short term, to support diversion policies and enable compliance with national policy directive, and to establish whether redesigned pathways can enhance treatment and behavioural outcomes for acutely mentally ill prisoners on a larger scale.
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Slade K, Forrester A. Measuring IPDE-SQ personality disorder prevalence in pre-sentence and early-stage prison populations, with sub-type estimates. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:207-212. [PMID: 23627987 DOI: 10.1016/j.ijlp.2013.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Understanding the prevalence and type of personality disorder within prison systems allows for the effective targeting of resources to implement strategies to alleviate symptoms, manage behaviour and attempt to reduce re-offending. This study aimed to determine the prevalence of personality disorder (PD) traits within a local urban high-turnover adult male prison with a remand/recently sentenced population in London, UK. The International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ) self-administered questionnaire (ICD-10 version) was completed by 283 prisoners (42% completion rate). 77% of respondents reached the threshold for one or more PDs. The most common PD types were Paranoid PD (44.5%), Anankastic PD (40.3%), Schizoid PD (35%) and Dissocial PD (25.8%). These results confirm and extend existing knowledge regarding the prevalence of PD in prison populations into a high-turnover, urban, remand population. The stark comparison with community samples indicates that a more equitable standard of service delivery within the criminal justice system, focussing on preventive and early intervention services, is now required.
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Forrester A, Exworthy T, Olumoroti O, Sessay M, Parrott J, Spencer SJ, Whyte S. Variations in prison mental health services in England and Wales. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2013; 36:326-332. [PMID: 23669592 DOI: 10.1016/j.ijlp.2013.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In responding to high levels of psychiatric morbidity amongst prisoners and recognising earlier poor quality prison mental health care, prison mental health in-reach teams have been established in England and Wales over the last decade. They are mostly provided by the National Health Service (NHS), which provides the majority of UK healthcare services. Over the same period, the prison population has grown to record levels, such that prisons in England and Wales now contain almost 90,000 of the world's overall prison population of over 10 million people (roughly the size of Paris or Istanbul). This study provides an overview of mental health in-reach services in prisons in England and Wales, including variations between them, through a telephone survey of senior staff in all prisons and young offender institutions in England and Wales. 73% of prisons took part; of them 13% had no in-reach team at all (usually low security establishments) and the majority of services were run by NHS teams, usually according to a generic community mental health team (CMHT) model rather than other specialist models. Team size was unrelated to prison size. Each nurse covered around 500 prisoners, each doctor over 3700. Many provided few or no healthcare cells and 24-h psychiatric cover (including on-call cover) was uncommon. Despite developments in recent years, mental health in-reach services still fall short of community equivalence and there is wide variation in service arrangements that cannot be explained by prison size or function. The aim of community equivalence has not yet been reached in prison healthcare and a more sophisticated measure of service improvement and standardisation would now be useful to drive and monitor future development.
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Forrester A, Chu HC, Williams GA. Exact solution for vortex dynamics in temperature quenches of two-dimensional superfluids. PHYSICAL REVIEW LETTERS 2013; 110:165303. [PMID: 23679613 DOI: 10.1103/physrevlett.110.165303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Indexed: 06/02/2023]
Abstract
An exact analytic solution for the dynamics of vortex pairs is obtained for rapid temperature quenches of a superfluid film starting from the line of critical points below the critical temperature T(KT). An approximate solution for quenches at and above above T(KT) provides insights into the origin of logarithmic transients in the vortex decay, and is in general agreement with recent simulations of the quenched XY model. These results confirm that there is no "creation" of vortices whose density increases with the quench rate as predicted by the Kibble-Zurek theory but only monotonic decay of the thermal vortices already present at the initial temperature.
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Ganapathy K, Wilkins M, Forrester A, Lemiere S, Cserep T, McMullin P, Jones RC. QX-like infectious bronchitis virus isolated from cases of proventriculitis in commercial broilers in England. Vet Rec 2012; 171:597. [DOI: 10.1136/vr.101005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jarrett M, Craig T, Parrott J, Forrester A, Winton-Brown T, Maguire H, McGuire P, Valmaggia L. Identifying men at ultra high risk of psychosis in a prison population. Schizophr Res 2012; 136:1-6. [PMID: 22330178 DOI: 10.1016/j.schres.2012.01.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/05/2012] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of psychotic disorders among prisoners is relatively high. We sought to investigate the prevalence of men who have a very high risk of developing psychosis in a prison population. METHODS The Prodromal Questionnaire - Brief Version (Loewy, Pearson, Vinogradov, Bearden and Cannon, 2011), was used to screen newly-arrived prisoners in a London prison for features associated with an increased risk of psychosis. Concurrent validity was evaluated using the Comprehensive Assessment for At Risk Mental State (Yung et al., 2005). RESULTS 750 prisoners were screened and 301 were underwent further clinical assessment. 5% the total number of those screened met diagnostic criteria for the ARMS and 3% had recently developed a first episode of psychosis. Using endorsement of items that also caused distress, the PQ-B predicted an ARMS or a psychotic disorder with 90% sensitivity and 44% specificity. CONCLUSIONS The PQ-B is effective in identifying people who are vulnerable to developing psychosis in a prison population.
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Exworthy T, Samele C, Urquía N, Forrester A. Asserting prisoners' right to health: progressing beyond equivalence. Psychiatr Serv 2012; 63:270-5. [PMID: 22388532 DOI: 10.1176/appi.ps.201100256] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The concept of the "right to health," regardless of a person's legal status, is a guiding force in establishing adequate standards of health care for all, including prisoners with mental illness. Prison health care in the United States, however, often falls below acceptable minimum standards. In the United Kingdom, the notion of equivalence has been the main driving force in improving prison mental health care. Although improvements have been made over the past ten years, demand for services continues to outstrip supply, as in the U.S. prison system. In both prison systems, prisoners often present with complex and multiple needs, much greater than those found in community samples. Even mental health care equivalent to that provided in the community falls significantly short of what is required. Further improvements to prison health care, therefore, remain a priority, and a more suitable model needs to be established and implemented. The authors propose an assertive application of a person's right to health with a well-defined framework for health care that is available, accessible, acceptable, and of good quality (AAAQ). The authors explore how the AAAQ framework can move beyond minimal or equivalent standards to deal with complex prison structures, meet health care needs, and measure progress more effectively. The AAAQ framework could lead to more equitable standards of health care that can be applied to international settings.
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Black G, Forrester A, Wilks M, Riaz M, Maguire H, Carlin P. Using initiative to provide clinical intervention groups in prison: a process evaluation. Int Rev Psychiatry 2011; 23:70-6. [PMID: 21338301 DOI: 10.3109/09540261.2010.544293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We present a process evaluation of a new anger control intervention within an urban remand prison in London, UK. An anger control group was created and run as an extension of the prison in-reach healthcare team, in order to meet the needs of prisoners. We evaluate the aims of the intervention, therapeutic methodology, administrative process, and post-intervention outcomes. We report change in anger scores (State Trait Anger Expression Inventory; STAXI-II), showing how a service of this type might deliver important benefits. Through the use of a focus group with the clinicians who ran the service, we have reflected on this process to inform the evaluation. We conclude that anger management may have a useful role in remand prisons, not just for violent offenders, but as part of a wider public health agenda. Resources for new prison healthcare groups are scarce, particularly in urban remand prisons, and clinicians may have to collaborate with other teams to provide a range of interventions. Following the expressed needs of the prisoner population promotes a strong uptake of clients. Prison health services operate within a complex and environment which restricts healthcare teams' ability to run groups. We provide recommendations on overcoming potential barriers to care.
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Forrester A, Graham M, Williams F, Reynolds N. The aryl hydrocarbon receptor in human keratinocytes: Relevance to chloracne. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Forrester A, Chiu K, Dove S, Parrott J. Prison health-care wings: psychiatry's forgotten frontier? CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2010; 20:51-61. [PMID: 20104472 DOI: 10.1002/cbm.753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND There is worldwide evidence of high rates of mental disorder among prisoners, with significant co-morbidity. In England and Wales, mental health services have been introduced from the National Health Service to meet the need, but prison health-care wings have hardly been evaluated. AIMS/HYPOTHESES To conduct a service evaluation of the health-care wing of a busy London remand (pre-trial) prison and examine the prevalence and range of mental health problems, including previously unrecognised psychosis. METHODS Service-use data were collected from prison medical records over a 20-week period in 2006-2007, and basic descriptive statistics were generated. RESULTS Eighty-eight prisoners were admitted (4.4 per week). Most suffered from psychosis, a third of whom were not previously known to services. Eleven men were so ill that they required emergency compulsory treatment in the prison under Common Law before hospital transfer could take place. Over a quarter of the men required hospital transfer. Problem behaviours while on the prison health-care wing were common. CONCLUSIONS AND IMPLICATIONS Prison health-care wings operate front-line mental illness triaging and recognition functions and also provide care for complex individuals who display behavioural disturbance. Services are not equivalent to those in hospitals, nor the community, but instead reflect the needs of the prison in which they are situated. There is a recognised failure to divert at earlier points in the criminal justice pathway, which may be a consequence of national failure to fund services properly. Hospital treatment is often delayed.
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