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Forrester A. Mental health care provision for segregated prisoners in England. MEDICINE, SCIENCE, AND THE LAW 2024; 64:179-181. [PMID: 38414414 DOI: 10.1177/00258024241236022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
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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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Sales CP, Forrester A, Tully J. Delays in transferring patients from prisons to secure psychiatric hospitals: An international systematic review. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023; 33:371-385. [PMID: 37667423 DOI: 10.1002/cbm.2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/12/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Transfer to a psychiatric hospital of prisoners who need inpatient treatment for a mental disorder is an important part of prison healthcare in the UK. It is an essential factor in ensuring the principle of equivalence in the treatment of prisoners. In England and Wales, delays in transferring unwell prisoners to hospital were identified by the 2009 Bradley Report. There has been no subsequent systematic review of progress in so doing nor a corresponding appraisal of transfer arrangements in other parts of the world. AIM To conduct a systematic review of international literature about transfers of mentally unwell individuals from prison to hospital for the treatment of mental disorder since 2009. METHOD Eight databases were searched for data-based publications using terms for prison and transfer to hospital from 1 January 2009 to 4 August 2022. Inclusion criteria limited transfer to arrangements for pre-trial and sentenced prisoners going to a health service hospital, excluding hospital orders made on the conclusion of criminal hearing. RESULTS In England, four articles were identified, all showing that transfer times remain considerably longer than the national targets of 14 days (range, 14 days to >9 months); one study from Scotland found shorter mean transfer times, but more patients had been transferred to psychiatric intensive care units than to secure forensic hospitals. There were only two studies that investigated prison to hospital transfers for mental disorder from outside the UK and only one reported time-to-transfer data. CONCLUSIONS Findings from this literature review highlight failures to resolve transfer delays in England and provide little evidence about the problem elsewhere. Given the lack of data, it is unclear whether other countries do not have this problem or simply that there has been no research interest in it. A possible confounding factor here is that, in some countries, all treatment for prisoners' mental disorders occurs in prison. However, the principle that prisons are not hospitals seems important when people need inpatient care. Prospective, longitudinal cohort studies are urgently needed to map transfer times and outcomes.
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Affiliation(s)
| | - Andrew Forrester
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - John Tully
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Academic Unit of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
SummaryLiaison and diversion services are concerned with ensuring that individuals with mental health problems and related vulnerabilities who come into contact with the criminal justice system receive appropriate support and treatment. In the past 15 years there have been significant changes in policy, legislation and the broader landscape in community, custodial and hospital settings which have shaped these services. The Bradley Report, published in 2009, represents an important landmark in this field. Bradley made 82 recommendations, from interventions to improve identification of mental illness and vulnerable individuals at risk of offending to effecting speedier transfers of mentally disordered prisoners to hospital. Some progress has been made in achieving these recommendations, and further investment is promised, but at present only half of England is covered by liaison and diversion services.LEARNING OBJECTIVES•Appreciate how services have developed over the past 15 years to provide support and treatment and divert mentally disordered people from custody at all stages in the criminal justice process•Recognise how government policy has shaped the development of liaison and diversion services over the past 15 years•Understand the impact of the 2007 amendments to the Mental Health Act on the diversion of mentally disordered people from custody
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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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Hales H, Dixon A, Newton Z, Bartlett A. Assaults by Mentally Disordered Offenders in Prison: Equity and Equivalence. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:317-326. [PMID: 26780106 DOI: 10.1007/s11673-016-9698-0] [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: 12/03/2013] [Accepted: 06/11/2015] [Indexed: 06/05/2023]
Abstract
Managing the violent behaviour of mentally disordered offenders (MDO) is challenging in all jurisdictions. We describe the ethical framework and practical management of MDOs in England and Wales in the context of the move to equivalence of healthcare between hospital and prison. We consider the similarities and differences between prison and hospital management of the violent and challenging behaviours of MDOs. We argue that both types of institution can learn from each other and that equivalence of care should extend to equivalence of criminal proceedings in court and prisons for MDOs. We argue that any adjudication process in prison for MDOs is enhanced by the relevant involvement of mental health professionals and the articulation of the ethical principles underpinning health and criminal justice practices.
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Affiliation(s)
- Heidi Hales
- HMYOI Cookham Wood, CNWL NHS Foundation Trust, Sir Evelyn Road, Rochester, UK.
| | - Amy Dixon
- HMP Holloway, 1 Parkhurst Road, London, UK, N7 0NU
| | - Zoe Newton
- HMP Holloway, CNWL NHS Foundation Trust, I Parkhurst Road, London, N7 0NU, UK
| | - Annie Bartlett
- PHSE, St Georges, University of London, Cranmer Terrace, London, SW17 0RE, 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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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]
Affiliation(s)
- Andrew Forrester
- Forensic Psychiatry, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry/King's College London, London, UK
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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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Affiliation(s)
- Andrew Forrester
- South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, UK.
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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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Affiliation(s)
- Andrew Forrester
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
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Affiliation(s)
- Simon Wilson
- Oxleas NHS Foundation Trust and Institute of Psychiatry, Institute of Psychiatry, London SE5 8AF, UK.
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Wilson S. Prison psychiatry. Med Leg J 2011; 79:35-48. [PMID: 21673057 DOI: 10.1258/mlj.2011.011014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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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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Affiliation(s)
- Andrew Forrester
- South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, UK.
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