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Gerth J, Endrass J, Weber M, Graf M, Singh JP, Rossegger A. Exploring the mental healthcare needs of Swiss pre-trial detainees: A pilot investigation of an on-site psychiatric day clinic. Front Psychiatry 2022; 13:924861. [PMID: 35928770 PMCID: PMC9345322 DOI: 10.3389/fpsyt.2022.924861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Research has established that justice-involved individuals experience significant mental health problems. However, mental healthcare in correctional settings is often not sufficiently accessible to meet the demand. Hence, to improve the availability of mental healthcare services, especially for pre-trial detainees, the first Swiss on-site psychiatric day clinic (PDC) was established in 2019. The present cross-sectional observational study aimed to evaluate the need of psychiatric care in pre-trial detention and the PDC's potential to improve it. METHODS File record data were collected from the Office of Corrections and Rehabilitation of the Canton of Zurich. Differences in primary psychiatric care consultations and psychiatric hospital admissions between pre-trial detainees and sentenced prisoners were examined. In addition, a total cohort of pre-trial detainees of the first 18 months of PDC operations was examined to identify differences between three treatment groups: (1) pre-trial detainees exclusively treated in the PDC (n = 41), (2) pre-trial detainees exclusively treated in a psychiatric hospital (n = 58), and (3) pre-trial detainees treated in both the PDC as well as a psychiatric hospital (n = 16). RESULTS In the 5 years before the PDC opened, pre-trial detainees had significantly more primary psychiatric care consultations and were admitted to psychiatric hospitals on significantly more occasions than were sentenced prisoners. In the first 18 months of the PDC, psychiatric hospital admission rates for pre-trial detainees decreased by 18.5% and pretrial detainees exclusively treated in the PDC differed significantly from other treatment groups concerning mental disorder, gender, and alleged index offense. They were more likely to be diagnosed with adjustment disorders and were less likely to be diagnosed with schizophrenia spectrum disorder. CONCLUSION The use of mental health care among pre-trial detainees is significantly more frequent than among sentenced prisoners concerning both primary care and inpatient treatment. Since establishment of the novel on-site PDC admissions to psychiatric hospitals were found to decrease. Data indicates that especially male pre-trial detainees with adjustment disorders benefitted from this innovative path forward in correctional healthcare. Further research is needed to improve the PDC's service for female pre-trial detainees.
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Affiliation(s)
- Juliane Gerth
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland
| | - Jérôme Endrass
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland.,Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
| | - Michael Weber
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland
| | - Marc Graf
- Department of Forensic Psychiatry, University of Basel, Basel, Switzerland.,Department of Forensic Psychiatry, University Psychiatric Hospitals, Basel, Switzerland
| | - Jay P Singh
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Publication Academy Inc., Reston, VA, United States
| | - Astrid Rossegger
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Research and Development, Office of Corrections and Rehabilitation, Zurich, Switzerland.,Department of Forensic Psychiatry, University of Basel, Basel, Switzerland
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Neumann B, Ross T, Opitz-Welke A. Foreign National Patients in German Prison Psychiatry. Front Psychiatry 2019; 10:988. [PMID: 32116816 PMCID: PMC7033612 DOI: 10.3389/fpsyt.2019.00988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/12/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Over the past few years, the share of foreign national prisoners in the European and American justice systems has increased at a disproportionately high rate, yet studies on mental health issues among this diverse group are rare. Recent research suggests a range of factors leading to mental health vulnerability in foreign national prisoners, including language barriers, isolation, cultural misunderstanding, and legal standing. Relevant findings of topic-related studies indicate that under-referral to mental health services due to missed or misinterpreted symptoms is a major risk for foreign national prisoners. AIMS We aimed to investigate the disparities regarding the percentage of foreign national patients who were treated in high-security hospitals compared to the psychiatric ward of prison hospitals-after adjusting for diagnosis, age, marital status, and substance abuse. We hypothesized that foreign national patients were underrepresented in compulsory, high-security mental health care. We also aimed to explore citizenship-related institutional disparities concerning diagnoses and self-harmful behavior. METHOD From 2010 to 2015, data collected from high-security hospitals in the federal state of Baden-Wurttemberg and the psychiatric ward of a Berlin prison hospital was evaluated by comparing nationality, diagnosis, and self-harm using Fisher's exact test and χ²-test. The odds ratios for citizenship-related differences in diagnosis and institution of treatment were evaluated by using logistic regression. RESULTS Mentally ill foreign national patients were significantly less likely to be treated in high-security hospitals rather than prison hospital psychiatry (adjusted for diagnosis, age at admission, marital status, and substance abuse; adjusted OR = 0.5). Foreign nationals and Germans in prison hospital psychiatry showed no significant disparities in diagnosis; however, in high-security hospitals, foreign nationals were more likely to have been diagnosed with schizophrenia/psychotic or neurotic/stress-related disorders and were less likely to have been diagnosed with personality disorders than German patients. Additionally, foreign nationals were more likely to commit self-harm than Germans in prison hospital psychiatry, but significant citizenship-related differences could not be verified in high-security hospital patients. CONCLUSION Treatment conditions of foreign national patients in prison psychiatry must be improved. To achieve this, the psychiatric assessment and (mental) health-related aspects of these patients should be further investigated.
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Affiliation(s)
- Britta Neumann
- Institute of Forensic Psychiatry, Charité University of Medicine Berlin, Berlin, Germany
| | - Thomas Ross
- Forensic Psychiatry and Psychotherapy, Reichenau Psychiatric Center and University of Ulm, Ulm, Germany
| | - Annette Opitz-Welke
- Institute of Forensic Psychiatry, Charité University of Medicine Berlin, Berlin, Germany
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Abstract
AIMS The UK has one of the largest systems of immigration detention in Europe.. Those detained include asylum-seekers and foreign national prisoners, groups with a higher prevalence of mental health vulnerabilities compared with the general population. In light of little published research on the mental health status of detainees in immigration removal centres (IRCs), the primary aim of this study was to explore whether it was feasible to conduct psychiatric research in such a setting. A secondary aim was to compare the mental health of those seeking asylum with the rest of the detainees. METHODS Cross-sectional study with simple random sampling followed by opportunistic sampling. Exclusion criteria included inadequate knowledge of English and European Union nationality. Six validated tools were used to screen for mental health disorders including developmental disorders like Personality Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Disorder (ASD) and Intellectual Disability, as well as for needs assessment. These were the MINI v6, SAPAS, AQ-10, ASRS, LDSQ and CANFOR. Demographic data were obtained using a participant demographic sheet. Researchers were trained in the use of the screening battery and inter-rater reliability assessed by joint ratings. RESULTS A total of 101 subjects were interviewed. Overall response rate was 39%. The most prevalent screened mental disorder was depression (52.5%), followed by personality disorder (34.7%) and post-traumatic stress disorder (20.8%). 21.8% were at moderate to high suicidal risk. 14.9 and 13.9% screened positive for ASD and ADHD, respectively. The greatest unmet needs were in the areas of intimate relationships (76.2%), psychological distress (72.3%) and sexual expression (71.3%). Overall presence of mental disorder was comparable with levels found in prisons. The numbers in each group were too small to carry out any further analysis. CONCLUSION It is feasible to undertake a psychiatric morbidity survey in an IRC. Limitations of the study include potential selection bias, use of screening tools, use of single-site study, high refusal rates, the lack of interpreters and lack of women and children in study sample. Future studies should involve the in-reach team to recruit participants and should be run by a steering group consisting of clinicians from the IRC as well as academics.
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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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Affiliation(s)
- A Forrester
- Offender Health Research Network, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
| | - A Till
- School of Psychiatry, Health Education North West (Mersey), Regatta Place, Summers Road, Brunswick Business Park, Liverpool, UK
| | - A Simpson
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Canada
| | - J Shaw
- Offender Health Research Network, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
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Pridmore S, Money TT, Pridmore W. Suicide: What the General Public and the Individual Should Know. Malays J Med Sci 2018; 25:15-19. [PMID: 30918451 PMCID: PMC6422589 DOI: 10.21315/mjms2018.25.2.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/08/2017] [Indexed: 11/30/2022] Open
Abstract
Background The predominant, current western view is that all suicide is the result of mental disorder. This view is much too narrow and does not admit extensive information regarding the social, economic, and forensic factors (among many others) which may contribute to completed suicide. A consequence of this narrow view is that prevention strategies mainly focus on the detection and treatment of mental disorder. A preferred approach is to place greater emphasis on public health approaches to suicide prevention. Objective To develop and suggest a body of information which may be useful in a public health approach to suicide. Conclusion It is suggested that the following be available to the general public: i) suicide is a fact of life which should be minimised, ii) suicide has many different triggers, iii) most people who take their lives are able to make decisions, and iv) increased public discussion and understanding of suicide is desirable. Five pieces of information that may be useful to those contemplating suicide include: i) don’t murder the part of you that wants to live, ii) suicide actions may leave you alive but disabled, iii) suicide hurts other people, iv) suicidal impulses do pass if you hold on, and v) suicide is a waste.
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Affiliation(s)
- Saxby Pridmore
- Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - Tammie T Money
- Post-Graduate Student, Australian National University Medical School, Garran, ACT, Australia
| | - William Pridmore
- Post-Graduate Student, Australian National University Medical School, Garran, ACT, Australia
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Bouras N, Ikkos G, Craig T. From Community to Meta-Community Mental Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E806. [PMID: 29677100 PMCID: PMC5923848 DOI: 10.3390/ijerph15040806] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/24/2022]
Abstract
Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.
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Affiliation(s)
- Nick Bouras
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, P.O. Box 27, London SE5 8AF, UK.
| | - George Ikkos
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA4 7LP, UK.
| | - Thomas Craig
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, P.O. Box 27, London SE5 8AF, UK.
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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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Affiliation(s)
- Karen Slade
- Division of Psychology, Nottingham Trent University, UK.
| | - Chiara Samele
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lucia Valmaggia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Andrew Forrester
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, UK.
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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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Affiliation(s)
- Gareth Hopkin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Chiara Samele
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Karan Singh
- Department of Forensic Psychiatry, Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK
| | - Tom Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lucia Valmaggia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Andrew Forrester
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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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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Affiliation(s)
- Chiara Samele
- Informed Thinking, 10 Grove Road, London, SW19 1BL, UK.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Andrew Forrester
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, 108 Landor Road, London, SW9 9NT, UK
| | - Norman Urquía
- Informed Thinking, 10 Grove Road, London, SW19 1BL, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Gareth Hopkin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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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]
Affiliation(s)
- Gareth Hopkin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Chiara Samele
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Karan Singh
- Kent and Medway NHS and Social Care Partnership Trust, London, UK
| | - Andrew Forrester
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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