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Gallagher M, Smith D, Hickey P, Nolan M, Mhuircheartaigh EN, Murray M, Taylor E, Connaughton M, O'Neill C. Men placed on waiting lists for psychiatric admission from Irish Prisons over five years: Clinical outcomes during a forensic "bed crisis". INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101923. [PMID: 37708654 DOI: 10.1016/j.ijlp.2023.101923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/13/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Ireland has low provision rates of general and forensic beds compared with other western countries. In recent years there have been difficulties and delays in accessing forensic beds for prisoners with severe mental illness. AIMS We aimed to determine clinical outcomes for male prisoners assessed as requiring psychiatric admission over an extended period, with time frames for admission and other outcomes. We aimed to determine whether admissions to forensic and non-forensic locations were risk-appropriate. METHODS Participants included all male prisoners placed on psychiatric admission waiting lists in Ireland over five years 2015-2019. We described demographic, clinical and offending variables. We measured clinical outcomes including forensic admission, other admission and recovery with voluntary treatment in prison. We also measured times to clinical outcomes. Security requirements and clinical urgency were assessed using the DUNDRUM Toolkit scales 1 and 2. RESULTS 541 male prisoners were placed on admission waiting lists and spent an aggregate of over 114 years on admission waiting lists during 2015-2019. Almost one quarter improved with voluntary treatment allowing removal from waiting lists, while over 75% did not. Admission was achieved for a majority of cases, albeit after lengthy delays for some. The most frequent outcome was diversion from remand to non-forensic inpatient settings. Non-forensic admissions arranged by the Prison Inreach and Court Liaison Service (PICLS) at Ireland's main remand prison at Cloverhill contributed 54% (179/332) of all admissions achieved and 76% (179/235) of all non-forensic admissions from prison waiting list. Median delay to admission was 59 days for forensic admissions and 69 days for admissions to non-forensic hospitals from sentenced settings, compared with 16.5 days for admissions to non-forensic hospitals from remand. CONCLUSIONS Long delays for forensic admission during a five-year period of limited access to such beds were partly mitigated by transfers to non-forensic hospitals, mainly diversion of minor offenders from remand settings.
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Affiliation(s)
- Margaret Gallagher
- Department of Psychiatry, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; Department of Psychiatry, University College Dublin, Ireland
| | - Damian Smith
- National Forensic Mental Health Service, Portrane Demesne, Co. Dublin, Ireland; Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Philip Hickey
- National Forensic Mental Health Service, Portrane Demesne, Co. Dublin, Ireland
| | - Mark Nolan
- Department of Psychiatry, St James's Hospital, James Street, Dublin 8, Ireland
| | | | - Michael Murray
- Sligo General Hospital, The Mall, Rathquarter, Sligo, Ireland
| | - Enda Taylor
- National Forensic Mental Health Service, Portrane Demesne, Co. Dublin, Ireland
| | | | - Conor O'Neill
- National Forensic Mental Health Service, Portrane Demesne, Co. Dublin, Ireland; Department of Psychiatry, Trinity College, Dublin, Ireland.
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Gilling McIntosh L, Rees C, Kelly C, Howitt S, Thomson LDG. Understanding the mental health needs of Scotland's prison population: a health needs assessment. Front Psychiatry 2023; 14:1119228. [PMID: 37265556 PMCID: PMC10229789 DOI: 10.3389/fpsyt.2023.1119228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction This study reports on an assessment of mental health needs among Scotland's prison population which aimed to describe the scale and nature of need as well as identify opportunities to improve upon the services available. The project was commissioned by the Scottish Government to ensure that future changes to the services available to support the mental health and wellbeing of people in prison would be evidence-based and person-centered. Methods A standardized approach to health needs assessments was employed. The study was comprised of four phases. In phase I a rapid literature review was undertaken to gather evidence on the prevalence of mental health needs experienced by people in prison in the UK. In Phase II a multi-method and multi-informant national mapping exercise involving providers to all Scottish prisons was undertaken to describe the mental health services available, and any gaps in these services, for people in and leaving prison. In Phase III prevalence estimates of several mental health needs were derived for Scotland's current prison population, modeled from a national survey dataset of Scotland's community population using logistic regression. Finally in Phase IV, professional stakeholders and individuals with lived experience were interviewed to understand their experiences and insights on challenges to supporting the mental health and wellbeing of people in prison, and ideas on how these challenges could be overcome. Results Evidence across the four phases of this needs assessment converged indicating that existing provision to support the mental health of people in prison in Scotland was considered inadequate to meet these needs. Barriers to effective partnership working for justice, health, social work and third sector providers appear to have led to inadequate and fragmented care, leaving prisoners without the support they need during and immediately following imprisonment. Conclusions Joint and coordinated action from justice, health and social care, and third sector providers is needed to overcome enduring and structural challenges to supporting the mental health of people in prison. Eighteen evidence-based recommendations were proposed to the Scottish Government relating to the high-level and operational-level changes required to adequately meet the prison population's mental health needs.
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Affiliation(s)
- Lindsey Gilling McIntosh
- Centre for Clinical Brain Sciences, Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Cheryl Rees
- Centre for Clinical Brain Sciences, Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline Kelly
- Forensic Mental Health Services Managed Care Network, Carstairs, United Kingdom
| | - Sheila Howitt
- Department of Forensic Psychiatry, The State Hospitals Board for Scotland, Carstairs, United Kingdom
| | - Lindsay D. G. Thomson
- Centre for Clinical Brain Sciences, Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
- Forensic Mental Health Services Managed Care Network, Carstairs, United Kingdom
- Department of Forensic Psychiatry, The State Hospitals Board for Scotland, Carstairs, United Kingdom
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Carabellese F, Parente L, Kennedy HG. Reform of Forensic Mental Health Services in Italy: Stigma and Blaming the Messenger: Hermenoia. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022:306624X221113531. [PMID: 35861358 DOI: 10.1177/0306624x221113531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n. 81/2014), Italian psychiatrists are now obliged to answer calls to give evidence on strictly legal issues such as the social dangerousness of the mentally ill offender drawing on evidence or paradigms that many believe do not belong to medical knowledge. Psychiatrists must now learn to communicate about the relationship between psychiatry and society as required by law. This public expression engages with the cultural climate of society. Otherwise, the risk is of increasing the level of complexity leading to real misunderstandings that paradoxically may feed the stigma. The Italian reform provides an opportunity for reflection on some issues concerning psychiatric action, on how the public perceives the mentally ill and their psychiatrists, on the relationship between psychiatry and the world of law, on clinical methodologies for structured professional judgment, on public communication regarding severe mental illness, and the risk that psychiatrists may inadvertently be blamed for conveying an unwelcome message about mental illness and social dangerousness-we have called this social sensitivity against psychiatrists "hermanoia," blaming the messenger. The authors do not provide certain solutions but propose good practices.
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Tong K, Smith D, Mohan C, Hickey P, Taylor E, McLoughlin L, Kennedy HG, O'Neill C. Psychiatric court reports and diversion outcomes in a remand prison over three years. Ir J Psychol Med 2021:1-11. [PMID: 34629124 DOI: 10.1017/ipm.2021.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES There has been a notable increase in requests for psychiatric reports from District Courts for persons remanded to Ireland's main remand prison, Cloverhill. We aimed to identify if reports were prepared for persons with severe mental illness and if they led to therapeutic benefits such as diversion to healthcare. Measures of equitability between Cloverhill and other District Courts were explored. METHODS For District Court-requested reports completed by the Prison Inreach and Court Liaison Service (PICLS) at Cloverhill Prison from 2015 to 2017, we recorded clinical variables and therapeutic outcomes such as diversion to inpatient psychiatric settings. RESULTS Of 236 cases, over half were diverted to inpatient or outpatient psychiatric care. One-third of remand episodes were admitted to a psychiatric hospital, mainly in non-forensic settings. Nearly two-thirds had major mental illness, mainly schizophrenia and related conditions. Almost half had active psychosis. Cases in Cloverhill District Court and other District Courts were similarly likely to have active psychosis (47% overall) and hospital admission (33% overall). Voluntary reports were more likely to identify active psychosis, with over 90% diverted to inpatient or outpatient community treatment settings. CONCLUSIONS This is the first large scale study of diversion outcomes following requests for psychiatric advice from District Courts in Ireland. Requests were mainly appropriate. Over half led to diversion from the criminal justice system to healthcare settings. There is a need for a complementary network of diversion initiatives at every stage of the criminal justice system to effectively divert mentally ill individuals to appropriate settings at the earliest possible stage.
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Affiliation(s)
- Kezanne Tong
- Senior Registrar, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Prison Inreach and Court Liaison Service, Cloverhill Prison, Dublin, Ireland
| | - Damian Smith
- Consultant Forensic Psychiatrist, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Prison Inreach and Court Liaison Service, Cloverhill Prison, Dublin, Ireland
| | - Christopher Mohan
- Registrar, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Philip Hickey
- Forensic Community Mental Health Nurse, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Prison Inreach and Court Liaison Service, Cloverhill Prison, Dublin, Ireland
| | - Enda Taylor
- Forensic Community Mental Health Nurse, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Prison Inreach and Court Liaison Service, Cloverhill Prison, Dublin, Ireland
| | - Lisa McLoughlin
- Consultant Forensic Psychiatrist, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Harry G Kennedy
- Consultant Forensic Psychiatrist and Executive Clinical Director, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Clinical Professor in Forensic Psychiatry, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Conor O'Neill
- Consultant Forensic Psychiatrist, National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Clinical Senior Lecturer, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- Prison Inreach and Court Liaison Service, Cloverhill Prison, Dublin, Ireland
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Kennedy HG, Mohan D, Davoren M. Forensic psychiatry and Covid-19: accelerating transformation in forensic psychiatry. Ir J Psychol Med 2021; 38:145-153. [PMID: 32434610 PMCID: PMC7556898 DOI: 10.1017/ipm.2020.58] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 02/07/2023]
Abstract
Swift medically led scientifically informed responses to the Covid-19 epidemic nationally have been demonstrably superior to other, non-scientific approaches. In forensic psychiatry and across all psychiatric services, urgent and clinically led responses have underlined redundancies and confusions in the governance of mental health services and a vacuum in policy makers. For the future, a greater emphasis on services for patients with schizophrenia and other severe, enduring mental disorders must aim at reducing standardised mortality ratios, managing risk of violence and improving hard outcomes such as symptomatic remission, functional recovery and forensic recovery of autonomy. This will require more use of information technology at service level and at national level where Scandinavian-style population-based data linkage research must now become legally sanctioned and necessary. A national research and development centre for medical excellence in forensic psychiatry is urgently required and is complimentary to and different from quality management.
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Affiliation(s)
- H. G. Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - D. Mohan
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - M. Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
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Abstract
SUMMARYForensic psychiatry services have grown and become more complex in structures, processes and pathways. Legacy customs, practices and changing policy are now organised into formal models of care. These are written accounts of how a health service is delivered, outlining best practice and services for patients progressing through the stages of their condition and the care and treatment available. This article explores the four key elements of a model of care: goals; pathways and processes; treatment programmes; and systematic evaluation. It describes the most common model of care in forensic services, which builds on structures of stratified therapeutic security. It also considers variations on this basic or standard model matched to needs arising from the complex interrelationship with other parts of the mental health service for the population served and with criminal justice, primary care and physical health, housing and welfare agencies.
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Simpson AIF, Gerritsen C, Maheandiran M, Adamo V, Vogel T, Fulham L, Kitt T, Forrester A, Jones RM. A Systematic Review of Reviews of Correctional Mental Health Services Using the STAIR Framework. Front Psychiatry 2021; 12:747202. [PMID: 35115956 PMCID: PMC8806032 DOI: 10.3389/fpsyt.2021.747202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Rising demand for correctional mental health services (CMHS) in recent decades has been a global phenomenon. Despite increasing research, there are major gaps in understanding the best models for CMHS and how to measure their effectiveness, particularly studies that consider the overall care pathways and effectiveness of service responses. The STAIR (Screening, Triage, Assessment, Intervention, and Re-integration) model is an evidence-based framework that defines and measures CMHS as a clinical pathway with a series of measurable, and linked functions. METHOD We conducted a systematic review of the reviews of CMHS elements employing PRISMA guidelines, organized according to STAIR pillars. We assessed the quality of included studies using the AMSTAR-2 criteria. Narrative reviews were read and results synthesized. RESULTS We included 26 review articles of which 12 were systematic, metaanalyses, and 14 narrative reviews. Two systematic reviews and seven narrative reviews addressed screening and triage with strong evidence to support specific screening and triage systems. There was no evidence for standardised assessment approaches. Eight systematic reviews and seven narrative reviews addressed interventions providing some evidence to support specific psychosocial interventions. Three systematic reviews and six narrative reviews addressed reintegration themes finding relatively weak evidence to support reintegration methods, with interventions often being jurisdictionally specific and lacking generalizability. CONCLUSIONS The STAIR framework is a useful way to organize the extant literature. More research is needed on interventions, assessment systems, care pathway evaluations, and reintegration models.
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Affiliation(s)
- Alexander I F Simpson
- Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Cory Gerritsen
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | | | - Vito Adamo
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tobias Vogel
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fulham
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tamsen Kitt
- Department of Psychology, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Andrew Forrester
- Forensic Psychiatry, Department of Psychological Medicine and Clinical Neursciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Roland M Jones
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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Feeney A, Umama-Agada E, Curley A, Asghar M, Kelly BD. Police Involvement in Involuntary Psychiatry Admission: A Report From the Dublin Involuntary Admission Study. Psychiatr Serv 2020; 71:1292-1295. [PMID: 33050793 DOI: 10.1176/appi.ps.201900614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to compare diagnostic and demographic factors among patients who were involuntarily admitted to psychiatry care with or without police involvement. METHODS All admissions to psychiatry units in two university hospitals in Ireland were studied over a 3.5-year period. RESULTS Of 2,715 admissions, 443 (16%) were involuntary; complete data were available for 390 of these involuntary admissions, of which 78 (20%) involved police. Patients with police involvement did not differ significantly from those without police involvement in gender, marital and employment status, or diagnosis. The former patients had a longer mean admission duration and were more likely to be admitted under the "risk criterion" of the Mental Health Act 2001. Multivariable testing indicated that these variables do not independently predict police involvement. CONCLUSIONS The diagnostic or demographic factors examined did not contribute to police involvement in involuntary admission. Features such as homelessness, social exclusion, or criminogenic factors might underlie police involvement.
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Affiliation(s)
- Anna Feeney
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Emmanuel Umama-Agada
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Aoife Curley
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Muhammad Asghar
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, and Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin (Feeney, Kelly); Longford/Westmeath Mental Health Services, Westmeath, Ireland (Umama-Agada); Monaghan Mental Health Services, St. Davnet's Complex, Monaghan, Ireland (Curley); South Kerry Mental Health Services, University Hospital Kerry, Tralee, Ireland (Ashgar)
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Mcloughlin A, Feeney A, Cooney J. Homelessness, emergency care and mental health. Inner-city emergency department psychiatry referrals: a retrospective descriptive analysis. Ir J Med Sci 2020; 190:1201-1204. [PMID: 33006047 PMCID: PMC7529317 DOI: 10.1007/s11845-020-02392-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | - Anna Feeney
- Psychiatry Registrar, St. Patrick's Hospital, Dublin 8, Ireland
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Irish Medical Organisation Doolin Memorial Lecture 2019: rhetoric and reality in mental health—Ireland and the world. Ir J Med Sci 2020; 189:1127-1134. [DOI: 10.1007/s11845-019-02163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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The prevalence of major mental illness, substance misuse and homelessness in Irish prisoners: systematic review and meta-analyses. Ir J Psychol Med 2019; 36:35-45. [PMID: 30931873 DOI: 10.1017/ipm.2018.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AimsTo systematically review studies from Irish prisons that estimate the prevalence of major mental illness, alcohol and substance misuse, and homelessness at the time of committal. METHODS Healthcare databases were searched for studies quantifying the point prevalence for each outcome of interest. Searches were augmented by scanning of bibliographies and searches of governmental and non-governmental websites. Proportional meta-analyses were completed for each outcome. RESULTS We found eight, six and five studies quantifying the point prevalence of major mental illness, substance misuse, and homelessness respectively. Considerable heterogeneity was found for each subgroup (except psychosis where substantial heterogeneity was observed) and random effects models were used to calculate pooled percentages. The pooled percentage for psychotic disorder was 3.6% [95% confidence interval (CI) 3.0-4.2%], for affective disorder 4.3% (95% CI 2.1-7.1%), for alcohol use disorder 28.3% (95% CI 19.9-37.4%), for substance use disorder 50.9% (95% CI 37.6-64.2%) and for those who were homeless on committal 17.4% (95% CI 8.7-28.4%). CONCLUSIONS Estimates for the prevalence of psychotic illness and substance abuse amongst Irish prisoners are in keeping with international estimates of morbidity in prisons, whilst those for affective disorders are lower. The prevalence of homelessness in committal to Irish prisons is higher than some international estimates. Rates for psychoses, alcohol and substance misuse as well as homelessness in Irish prisons are significantly higher than the general population prevalence of these vulnerabilities. A need for service development is discussed.
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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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Affiliation(s)
- Andrew Forrester
- Edenfield Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Gareth Hopkin
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Gulati G, Otuokpaikhian K, Crowley M, Pradeep V, Meagher D, Dunne CP. Mental healthcare interfaces in a regional Irish prison. Int J Prison Health 2019; 15:14-23. [PMID: 30827156 DOI: 10.1108/ijph-06-2017-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to study the demographic, clinical characteristics and outcomes for those prisoners referred to secondary mental healthcare in a regional Irish prison and the proportion of individuals diverted subsequently from prison to psychiatric settings. DESIGN/METHODOLOGY/APPROACH The authors conducted a retrospective review of 130 successive psychiatric assessment case records at a regional mixed gender prison serving six southern Irish counties. The authors analysed demographics, clinical characteristics and outcomes. Where diversion out of prison was undertaken, Dangerousness, Understanding, Recovery and Urgency Manual (DUNDRUM) scores were retrospectively completed to assess security need. FINDINGS In total, 8.6 per cent of all committals from liberty were referred by a general practitioner and 8.1 per cent subsequently assessed by the visiting psychiatrist. Predominantly, these were young males charged with a violent offence. In all, 42.2 per cent of those assessed by secondary care were diagnosed with a substance misuse disorder and 21.1 per cent with a personality disorder. In total, 20.3 per cent suffered from a psychotic disorder and 10.6 per cent with an affective disorder. Of those seen by psychiatric services, 51.2 per cent required psychotropic medication, 29.2 per cent required psychological input and 59.3 per cent required addiction counselling. In all, 10.6 per cent of those assessed were diverted from prison, the majority to approved centres. Mean DUNDRUM-1 scores suggested that those referred to high and medium secure hospitals were appropriately placed, whereas those diverted to open wards would have benefited from a low secure/intensive care setting. ORIGINALITY/VALUE The multifaceted need set of those referred strengthens the argument for the provision of multidisciplinary mental healthcare into prisons. The analysis of security needs for those diverted from prisons supports the need for Intensive Care Regional Units in Ireland.
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Affiliation(s)
- Gautam Gulati
- Department of Psychiatry, University Hospital Limerick , Limerick, Ireland
- Graduate Entry Medical School, University of Limerick , Limerick, Ireland
| | | | - Maeve Crowley
- Department of Psychiatry, University Hospital Limerick , Limerick, Ireland
| | - Vishnu Pradeep
- Department of Psychiatry, University Hospital Limerick , Limerick, Ireland
| | - David Meagher
- Department of Psychiatry, Graduate Entry Medical School, University of Limerick , Limerick, Ireland
| | - Colum P Dunne
- Graduate Entry Medical School, University of Limerick , Limerick, Ireland
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Capuzzi E, Pini E, Malerba MR, Cova F, Lax A, Mauri S, Ornaghi A, Provenzi M, Rubelli P, Sergio MR, Truisi E, Clerici M. Factors associated with referrals to high security forensic services among people with severe mental illness and receiving inpatient care in prison. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:90-94. [PMID: 30616859 DOI: 10.1016/j.ijlp.2018.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/12/2018] [Accepted: 11/11/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prison mental health care is a significant topic which has been already studied and described in literature, particularly because of important implications both in the prison and in the health care system. It's not uncommon that inmates suffering from mental disorders are referred to high security forensic services (HSFS) but, to date, studies assessing factors associated with relevant referrals to these services are missing. So, the aim of our study is to investigate socio-demographic, criminological, psychopathological and toxicological variables among those who were referred to HSFS as compared to their non-referred counterpart. METHODS We conducted a cross-sectional study recruiting 159 subjects receiving prison inpatient care in an Italian jail, between January 2010 and August 2015. No subjects were excluded from the study. The mean age was 39. RESULTS About half of included prisoners suffered from personality disorder while one-third from psychotic disorders. >60% of the subjects had comorbid substance use disorders. The odds of being referred to HSFS were related to previous admission (odds ratio [OR] = 5.34, 95% confidence interval [CI] 1.66-17.16), diagnosis of psychosis (OR = 2.79, 95% CI 1.11-7.04) and cannabis use disorder (OR = 2.68, 95% CI 1.14-6.28). Personality disorder was inversely associated to the referral to forensic facilities (OR = 0.37, 95% CI 0.14-0.97). CONCLUSIONS Mental health services should improve preventive measures for vulnerable prisoners in order to reduce criminal recidivism and forensic readmission.
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Affiliation(s)
- Enrico Capuzzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy; Department of Neuroscience, Doctorate School of the University of Milano-Bicocca, Monza, Italy.
| | - Elena Pini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Francesca Cova
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Annamaria Lax
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Sara Mauri
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Alessandra Ornaghi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Milena Provenzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Paola Rubelli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Maria Ripalta Sergio
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Emanuele Truisi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Massimo Clerici
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
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15
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Kennedy HG, Simpson A, Haque Q. Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services. Front Psychiatry 2019; 10:733. [PMID: 31681042 PMCID: PMC6813277 DOI: 10.3389/fpsyt.2019.00733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
We propose that excellence in forensic and other mental health services can be recognized by the abilities necessary to conduct randomized controlled trials (RCTs) and equivalent forms of rigorous quantitative research to continuously improve the outcomes of treatment as usual (TAU). Forensic mental health services (FMHSs) are growing, are high cost, and increasingly provide the main access route to more intensive, organized, and sustained pathways through care and treatment. A patient newly diagnosed with a cancer can expect to be enrolled in RCTs comparing innovations with the current best TAU. The same should be provided for patients newly diagnosed with severe mental illnesses and particularly those detained and at risk of prolonged periods in a secure hospital. We describe FMHSs in four levels 1 to 4, basic to excellent, according to seven domains: values or qualities, clinical organization, consistency, timescale, specialization, routine outcome measures, and research. Excellence is not elitism. Not all centers need to achieve excellence, though all should be of high quality. Services can provide each population with a network of centers with access to one center of excellence. Excellence is the standard needed to drive the virtuous circle of research and development that is necessary for teaching, training, and the pursuit of new knowledge and better outcomes. Substantial advances in treatment of severe mental disorders require a drive at a national and international level to create services that meet these standards of excellence and are focused, active, and productive to drive better functional outcomes for service users.
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Affiliation(s)
- Harry G Kennedy
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.,National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Alexander Simpson
- Division for Forensic Psychiatry-University of Toronto Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Quazi Haque
- Elysium Healthcare, London, United Kingdom.,Division for Forensic Psychiatry-University of Toronto Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health-University of Toronto, Toronto, ON, Canada
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16
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A 25-year dynamic ecological analysis of psychiatric hospital admissions and prison committals: Penrose’s hypothesis updated. Ir J Psychol Med 2018; 38:182-185. [DOI: 10.1017/ipm.2018.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AimsThere is renewed interest in the inverse association between psychiatric hospital and prison places, with reciprocal time trends shown in more than one country. We hypothesised that the numbers of admissions to psychiatric hospitals and committals to prisons in Ireland would also correlate inversely over time (i.e. dynamic measures of admission and committal rather than static, cross-sectional numbers of places).MethodPublicly available activity statistics for psychiatric hospitals and prisons in Ireland were collated from 1986 to 2010.ResultsThere was a reciprocal association between psychiatric admissions and prison committals (Pearson r=−0.788, p<0.001), an increase of 91 prison committals for every 100 psychiatric hospital admissions foregone.ConclusionPenrose’s hypothesis applies to admissions to psychiatric hospitals and prisons in Ireland over time (dynamic measures), just as it does to the numbers of places in psychiatric hospitals and prisons in Ireland and elsewhere (static, cross-sectional measures). Although no causal connection can be definitively established yet, mentally disordered prisoners are usually known to community mental health services. Psychiatric services for prisons and the community should be linked to ensure that the needs of those currently accessing care through prisons can also be met in the community.
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17
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Smith D, Harnett S, Flanagan A, Hennessy S, Gill P, Quigley N, Carey C, McGhee M, McManus A, Kennedy M, Kelly E, Carey J, Concannon A, Kennedy HG, Mohan D. Beyond the Walls: An Evaluation of a Pre-Release Planning (PReP) Programme for Sentenced Mentally Disordered Offenders. Front Psychiatry 2018; 9:549. [PMID: 30450059 PMCID: PMC6224649 DOI: 10.3389/fpsyt.2018.00549] [Citation(s) in RCA: 3] [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: 07/11/2018] [Accepted: 10/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Prison mental health services have tended to focus on improving the quality of care provided to mentally disordered offenders at the initial point of contact with the prison system and within the prison environment itself. When these individuals reach the end of their sentence and return to the community, there is an increased risk of morbidity, mortality, homelessness and re-imprisonment. New models of care have been developed to minimize these risks. Objectives: The objective of this project was to establish a Pre-Release Planning (PReP) Programme with social work expertise, to enhance interagency collaboration and improve continuity of care for mentally disordered offenders upon their release. We aimed to evaluate the first 2 years of the programme by measuring its success at improving the level of mental health support and the security and quality of accommodation achieved by participants upon release in comparison to that reported at time of imprisonment. Additionally, we aimed to explore the impact of these outcomes on rates of re-imprisonment. Methods: A process of participatory action research was used to develop and evaluate the first 2 years of the programme. This was a naturalistic prospective observational whole cohort study. Results: The PReP Programme supported 43 mentally disordered offenders, representing 13.7%, (43/313) of all new assessments by the prison's inreach mental health service during the 2 years study period. When compared with that reported at time of reception at the prison, gains were achieved in level of mental health support (FET p < 0.001) and security and quality of accommodation (FET p < 0.001) upon release. Of those participants seen by the PReP Programme, 20 (46.5%, 20/43) were returned to prison during the 2-years study period. There was no significant relationship between re-imprisonment and gains made in mental health support (FET p = 0.23) or accommodation (FET p = 0.23). Conclusions: We have shown that compared to that reported at time of reception at prison, the level of mental health support and the security of tenure and quality of accommodation both improved upon release following the intervention of the programme. Improved mental health support and accommodation were not associated with lower rates of re-imprisonment.
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Affiliation(s)
- Damian Smith
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Susan Harnett
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Aisling Flanagan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Sarah Hennessy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Pauline Gill
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Niamh Quigley
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Cornelia Carey
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Michael McGhee
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Aoife McManus
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | | | | | | | - Ann Concannon
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Harry G Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Damian Mohan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
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