Transfers from prison to hospital under Sections 47 and 48 of the Mental Health Act between 2011 and 2014

In England and Wales, prisoners with mental disorder of such severity as to warrant inpatient treatment may be transferred to hospital under the Mental Health Act. UK Government guidance recommends that this process should be completed within 14 days; however, evidence suggests that in many cases it can take much longer. This retrospective service evaluation of 64 male prisoners, who were transferred under Section 47 or Section 48, aimed to evaluate transfer durations. The mean time from referral to admission was 76 days. Prisoners with a psychotic disorder were admitted more quickly. Remand prisoners were admitted more quickly than sentenced prisoners. Findings suggest that, in the UK the transfer time of prisoners under Sections 47 and 48 of the Mental Health Act continues to far exceed the 14-day target which raises concern about equivalence of care for prisoners. Our findings support arguments for fundamental amendments to the admissions process

Reflexivity in correctional research: Researcher perspectives on parenthood in a study with incarcerated parents

© The Author(s) 2018. As incarceration rates rise worldwide, increasing numbers of parents are separated from their children. Researchers have studied the psychosocial impact on inmates and their families extensively. However, few researchers have examined how their own perspectives affect the collection and interpretation of data, specifically about parenting in correctional settings. This paper consider methodological implications of conducting research with incarcerated mothers and fathers, employing critical reflexivity to explore researchers’ individual and collective experiences in a study in Australian correctional facilities. Using ourselves as informants, we examine how the context and life experiences of ‘researcher’ and ‘researched’ interact during interviews in a unique and emotionally charged environment. Correctional research requires careful adaptations to collect meaningful data from inmates and recognise their vulnerability as parents. The emotional content of interviews also has implications for analysing and interpreting research data. Our focus on interviewees as mothers and fathers, rather than as offenders, generated greater understanding of the needs of parents in custody. Recognising researchers’ feelings, experiences and perspectives on parenthood can enrich research with families affected by the criminal justice and child protection systems. These insights can also inform the understanding and practice of social workers, health practitioners, educators and students who work with marginalised parents and children

Prevention of suicidal behaviour in prisons: an overview of initiatives based on a systematic review of research on near-lethal suicide attempts

Background: Worldwide, prisoners are at high risk of suicide. Research on near-lethal suicide attempts can provide important insights into risk and protective factors, and inform suicide prevention initiatives in prison. Aims: To synthesize findings of research on near-lethal attempts in prisons, and consider their implications for suicide prevention policies and practice, in the context of other research in custody and other settings. Method: We searched two bibliographic indexes for studies in any language on near-lethal and severe self-harm in prisoners, supplemented by targeted searches over the period 2000–2014. We extracted information on risk factors descriptively. Data were not meta-analyzed owing to heterogeneity of samples and methods. Results: We identified eight studies reporting associations between prisoner near-lethal attempts and specific factors. The latter included historical, prison-related, and clinical factors, including psychiatric morbidity and comorbidity, trauma, social isolation, and bullying. These factors were also identified as important in prisoners' own accounts of what may have contributed to their attempts (presented in four studies). Conclusion: Factors associated with prisoners' severe suicide attempts include a range of potentially modifiable clinical, psychosocial, and environmental factors. We make recommendations to address these factors in order to improve detection, management, and prevention of suicide risk in prisoners

Critical time Intervention for Severely mentally ill Prisoners (CrISP): a randomised controlled trial

Background The transition from prison to community is difficult for prisoners with mental illness. Critical time intervention (CTI) is designed to provide intensive support to meet health, social care and resettlement needs through close working between client and key worker pre, and up to 6 weeks post, release. Objectives To establish whether or not CTI is effective in (1) improving engagement of discharged male prisoners who have mental illness with community mental health teams (CMHTs) and (2) providing practical support with housing, finance and re-establishing social networks. Trial design A multicentre, parallel-group randomised controlled trial, with follow-up at 6 weeks and at 6 and 12 months. A subset of prisoners and case managers participated in a complementary qualitative study. Setting Eight English prisons. Participants One hundred and fifty adult male prisoners, convicted or remanded, cared for by mental health in-reach teams and diagnosed with severe mental illness, with a discharge date within 6 months of the point of recruitment. Intervention Participants were randomised to either the intervention or the control (treatment as usual). The intervention group was assigned a case manager who assessed mental and physical health before and following release, made appropriate links to health, housing and financial services and supported the re-establishment of family/peer contact. Outcome The primary outcome measure was engagement with a CMHT 6 weeks post discharge. Secondary outcomes included contact with mental health services at 6 and 12 months. A health economic evaluation was undertaken using service contact at the follow-up time points. We were unable to assess the intervention’s effect on reoffending and longer-term health-care use because of study delays. Results One hundred and fifty prisoners were recruited: 72 were randomised to the intervention and 78 were randomised to the control. Engagement with teams at 6 weeks was 53% for the intervention group compared with 27% for the control group [95% confidence interval (CI) 0.13% to 0.78%; p = 0.012]. At 6 months’ follow-up, intervention participants showed continued increase in engagement with teams compared with control participants (95% CI 0.12% to 0.89%; p = 0.029); there were no significant differences at 12 months. Increased engagement resulted in higher levels of service use and costs for the intervention than for the control. Qualitative data showed the intervention group reporting better continuity of care and improved access to services. Conclusion The intervention significantly improved contact with services at 6 weeks, although at a higher cost than the control. This is important as, in the days and weeks following release, recently released individuals are at a particularly high risk of suicide and drug overdose. Further research is required to establish how teams can better maintain contact with clients when the intervention ends. Future work Further studies are indicated for groups with different needs, for example women, young prisoners and those in police custody, and at other transition points, for example following arrest and short-term custody, and at points of transition between different mental health services. Trial registration Current Controlled Trials ISRCTN98067793. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information

The CORE-10 in screening for current mental health problems and severe mental illness in prisoners

Background Few mental health screening tools are validated for prisoners. Existing tools do not guide referral between primary and secondary care pathways. Aims This study aimed to assess performance of the CORE‐10 in screening any current mental health problem and current severe mental illness (SMI) in prisoners. Method CORE‐10 ratings were compared with mini international neuropsychiatric interview (MINI) version 6.0 ratings and current practice outcomes for 150 male prisoners. Receiver operating curve (ROC) analyses were used to estimate the likelihood with which CORE‐10 ratings matched MINI ratings, yielding “area under the curve” statistics. Results ROC analyses suggested a strong relationship between CORE‐10 screen scores and the more detailed assessment both in identifying any problem (AUC 0.85) and severe mental illness (AUC 0.76). Sensitivity was 0.88 and 0.83, and specificity was 0.64 and 0.61, respectively. Retest reliability was moderate (ICC = 0.83). The CORE‐10 identified many cases of “any problem” and of severe illness also identified by the MINI who had not been referred to clinical services in routine practice. Conclusions This study provides evidence for the potential of the CORE‐10 for improving appropriate referrals for prisoners to mental health services