Psychiatric morbidity and treatment needs among prisoners

Background Epidemiological surveys consistently show that levels of psychiatric morbidity in prisons are very high. Prevalence rates of mental disorder are only imperfect predictors of treatment need. Government policy states that mental health service provision ought to be based on an assessment of need. Yet few assessments of mental health needs among prisoners exist in the academic literature. Method 368 male and female prisoners were interviewed using the same diagnostic instruments used in the National Prison Survey of Psychiatric Morbidity (Singelton et al., 1998) for the purpose of comparing the two samples according to sex and sentencing status. The MRC Needs for Care Assessment was used to determine the treatment needs of each prisoner and the extent to which they had been met. Results Prevalence rates of psychiatric disorders were broadly in line with those found in the National Prison Survey of Psychiatric Morbidity. There was only partial overlap between diagnosis and adjudged needs for treatment. Depression, alcohol and drug abuse were the most commonly identified problems in the sample. In total 78.1% of prisoners had at least one treatment need. Women had significantly higher numbers of overall treatment needs but men had significantly higher levels of unmet needs. In total around half of all treatment needs were met. The number of treatment needs and levels of unmet needs did not differ significantly between sentenced and remand prisoners. Conclusions This study identified high levels of psychiatric treatment needs among the sample when compared to the general population, suggesting a filtering system by which the mentally ill come preferentially into the prison system. Failed detection of mental illness and under resourcing of services are the biggest barriers to the adequate provision of mental health care in prison. Results from this study should enable improved service planning for this vulnerable population

Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder

BACKGROUND: High levels of psychiatric morbidity in prisoners have important implications for services. Assessing Needs for Psychiatric Treatment in Prisoners is an evaluation of representative samples of prisoners in a male and a female prison in London. This paper reports on the prevalence of mental disorders. In a companion paper, we describe how this translates into mental health treatment needs and the extent to which they have been met. METHODS: Prisoners were randomly sampled in a sequential procedure based on the Local Inmate Data System. We interviewed roughly equal numbers from the following groups: male remand; male sentenced prisoners (Pentonville prison); and female remand; female sentenced prisoners (Holloway prison). Structured assessments were made of psychosis, common mental disorders, PTSD, personality disorder and substance abuse. RESULTS: We interviewed 197 male and 171 female prisoners. Psychiatric morbidity in male and female, sentenced and remand prisoners far exceeded in prevalence and severity than in equivalent general population surveys. In particular, 12% met criteria for psychosis; 53.8% for depressive disorders; 26.8% for anxiety disorders; 33.1% were dependent on alcohol and 57.1% on illegal drugs; 34.2% had some form of personality disorder; and 69.1% had two disorders or more. Moreover, in the year before imprisonment, 25.3% had used mental health services. CONCLUSIONS: These rates of mental ill-health and their similarity in remand and sentenced prisoners indicate that diversion of people with mental health problems from the prison arm of the criminal justice system remains inadequate, with serious consequences for well-being and recidivism

Assessing needs for psychiatric treatment in prisoners: 2. Met and unmet need

BACKGROUND: In a companion paper, we established high levels of psychiatric morbidity in prisoners (Bebbington et al. Soc Psychiatry Psychiatr Epidemiol, 2016). In the current report, we evaluate how this morbidity translates into specific needs for treatment and the consequent implications for services. Mental health treatment needs and the extent to which they had been met were assessed in a representative sample of prisoners in a male and a female prison in London (Pentonville and Holloway). METHODS: Prisoners were sampled at random in a sequential procedure based on the Local Inmate Data System. We targeted equal numbers of male remand, male sentenced, female remand, and female sentenced prisoners. Following structured assessment of psychosis, common mental disorders, PTSD, personality disorders and disorders of abuse, we used the MRC Needs for Care Assessment (NFCAS) to establish whether potential needs for care in ten areas of mental health functioning were met, unmet, or incapable of being met by services. RESULTS: Data on treatment experience were provided by 360 inmates. Eighty percent of females and 70% of males had at least one need for treatment. Over half (53.7%) of the needs of female prisoners were met, but only one third (36.5%) in males. Needs for medication were unmet in 32% of cases, while those for psychological treatment were unmet in 51%. CONCLUSIONS: Unmet needs for mental health treatment and care were common in the two prisons. This has adverse consequences both for individual prisoners and for the effective functioning of the criminal justice system

Participation in a 10-week course of yoga improves behavioural control and decreases psychological distress in a prison population

Background: Yoga and meditation have been shown to be effective in alleviating symptoms of depression and anxiety in healthy volunteers and psychiatric populations. Recent work has also indicated that yoga can improve cognitive-behavioural performance and control. Although there have been no controlled studies of the effects of yoga in a prison population, we reasoned that yoga could have beneficial effects in a setting where psychosocial functioning is often low, and the frequency of impulsive behaviours is high. Methods: Participants were recruited from 7 British prisons and randomly allocated to either a 10-week yoga programme (yoga group; 1 class per week; N=45) or a control group (N=55). Self-report measures of mood, stress, and psychological distress were collected before and after the intervention period. Participants completed a cognitive-behavioural task (Go/No-Go) at the end of the study, which assessed behavioural response inhibition and sustained attention. Results: Participants in the yoga group showed increased self-reported positive affect, and reduced stress and psychological distress, compared to participants in the control group. Participants who completed the yoga course also showed better performance in the cognitive-behavioural task, making significantly fewer errors of omission in Go trials and fewer errors of commission on No-Go trials, compared to control participants. Conclusions: Yoga may be effective in improving subjective wellbeing, mental health, and executive functioning within prison populations. This is an important consideration given the consistently high rates of psychological morbidity in this group and the need for effective and economical intervention programmes. © 2013 The Authors

Evaluation of noise level of Xylem’s grinderpumps

Xylem är ett ledande globalt företag inom vattenteknik som fokuserar på hela cykeln av vattenhantering. Syftet med examensarbetet är att undersöka och utvärdera ljudnivån för Xylems grinderpumpar. Grinderpumpar har en skäranordning bestående av en kniv och en skärplatta som tillsammans finfördelar fasta föremål. Dessa pumpar installeras ofta i anslutning till bostaden, därför kan ljudnivån som pumpen ger upphov till upplevas som störande. För att göra pumpen mer konkurrenskraftig var ljudnivån på pumparna ett problem som behövde förbättras. Målet med examensarbetet var att föreslå verifierade förbättringar som gav lägre ljudnivå, utan bekostnad på pumpens prestanda samt kvarnfunktion. Det genomfördes en analys av Xylems och konkurrenters befintliga produkter, vilket låg som grund för utvecklingen av koncept. Det utfördes tester av pumparna, för att utvärdera hur ljudnivån förhöll sig till olika parametrar. Dessutom utvärderades vad som gav upphov till ljudet och hur det förhöll sig till fysikaliska teorier såsom Reynoldstal och skjuvning. Utifrån resultaten av dessa tester beslutades det att vidareutveckla skäranordningens kniv. Det togs fram prototyper som testades i syfte att utvärdera hur olika utformningar påverkade ljudet. Testerna visade att bottenbredden på knivens blad hade stor påverkan på ljudnivån, vilket även låg i linje med teorin gällande skjuvning. Vidare tester visade att en strömlinjeformad kniv gav upphov till lägre ljudnivå, som sammanfaller med teori om att turbulens skapar ljud. Dessa två aspekter beaktades vid utformningen av den slutgiltiga kniven. Ljudnivån för grinderpumpen har minskats med 5 dB(A), vilket innebär att ljudtrycket har minskat med 68 %. Detta motsvarar en tydlig hörbar förändring av ljudnivån. Minskningen av ljudnivån har åstadkommits genom att göra kniven mer strömlinjeformad och minska arean på bladens bottenbredd.Xylem is a leading global company working with water technology, with focus on the entire water cycle. The aim of this master thesis is to examine and evaluate the noise level of Xylem’s grinder pumps. The grinder pumps have a grinder function consisting of a cutter wheel and a cutting ring, which shred solid objects. The grinder pumps are often installed adjacent to a household, the sound level that the pump generates can therefore be perceived as disturbing. In order to make the pump more competitive, the sound level needed to be reduced. The objective of the thesis was to propose verified improvements that decreased the sound level, without impairing the performance of the pump or the grinder function. An analysis of Xylem’s and competitors’ existing products was conducted, which served as a foundation for the concept development. The pumps were tested in order to evaluate what impact different parameters had on the sound level. Additionally, evaluations regarding what generated the sound and its relation to physical theories such as Reynolds number and shear stress were conducted. Based on the results of these tests, it was decided to further develop the cutter wheel. Prototypes were developed and tested in order to assess how different design parameters affected the sound. The tests showed that the bottom width of the cutter wheels blade had a great impact on the sound level, which is consistent with the theory regarding shear stress. Further tests showed that a streamlined cutter wheel resulted in a lower sound level, which coincides with the theory regarding how turbulence generates sound. These two aspects were considered when designing the final cutter wheel. The sound level of the grinder pump has been reduced by 5 dB (A), thus the sound pressure has been reduced by 68%. This has resulted in a clear audible change in the sound level. The reduction of the sound level has been achieved by making the cutter wheel more streamlined, and by reducing the area of the blades’ bottom

Care versus custody: Challenges in the provision of prison mental healthcare

Prison mental health in-reach teams (MHIRTs) were introduced to provide the same range and quality of services to prisoners with severe and enduring mental health problems as is available to the general population (‘equivalence of care’). Drawing on a qualitative study of a MHIRT at an English prison, this chapter highlights the difficulties of striving to provide equivalent care in an anti-therapeutic environment which prioritises security and control. It argues that the team were heavily co-opted into penal governance and risk management activities and faced considerable hostility from those who saw prisoners as undeserving of care. It questions the notion of ‘healthy prisons’ and recommends that resources currently invested in the prison system be redirected into efforts to create socially just communities