Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

The 43 police forces in England and Wales have made over 13 million arrests in the last decade. Yet despite this high volume criminal justice system activity, and evidence of substantial health morbidity across the criminal justice pathway, mental health services in police custody have so far only been developed in patches, and the literature in this area is limited. Referrals (n=1092) to a pilot mental health service operating across two police stations in a London borough were examined over an 18-month period in 2012/13. The referred group had high levels of mental health and substance misuse problems (including acute mental illness, intoxication and withdrawal), self-harm, suicide risk and vulnerability, with some important gender differences. Although this work has limitations, the findings are broadly consistent with the small existing literature and they confirm the need for services that are sufficiently resourced to meet the presenting needs

Suicide ideation amongst people referred for mental health assessment in police custody

Purpose The purpose of this paper is to examine the prevalence of suicide ideation amongst a group of people who had been arrested and taken into police custody, and were then referred to a mental health service operating in the police stations. Design/methodology/approach A referred sample of 888 cases were collected over an 18-month period during 2012/2013. Clinical assessments were conducted using a template in which background information was collected (including information about their previous clinical history, substance misuse, alleged offence, any pre-identified diagnoses, and the response of the service) as part of the standard operating procedure of the service. Data were analysed using a statistical software package. Findings In total, 16.2 per cent (n=144) reported suicide ideation, with women being more likely to report than men. In total, 82.6 per cent of the suicide ideation sample reported a history of self-harm or a suicide attempt. Suicide ideation was also associated with certain diagnostic categories (depression, post-traumatic stress disorder and personality disorder), a history of contact with mental health services, and recent (within 24 hours) consumption of alcohol or drugs. Originality/value This evaluation adds to the limited literature in this area by describing a large sample from a real clinical service. It provides information that can assist with future service designs and it offers support for calls for a standardised health screening process, better safety arrangements for those who have recently used alcohol or drugs (within 24 hours) and integrated service delivery across healthcare domains (i.e. physical healthcare, substance use, and mental health)

Information pathways into prison mental health care

Police and court liaison and diversion services provide important specialist mental health input along critical stages of the criminal justice pathway. Effective sharing of information between the services and relevant justice agencies is essential. However, various problems exist with the flow of information between agencies and services across the criminal justice pathway. This service evaluation explored how clinically relevant information is transferred, by drawing on the perspectives of prison healthcare staff in a large urban UK male prison. A qualitative service evaluation was conducted using semi-structured interviews with a purposive sample of 11 prison staff. The main themes included: gaps in the transfer of essential information, (particularly concerning risk and offending information); information gathering to fill these gaps; the importance of professional relationships, information sharing between agencies; and information solutions. Improving information transfer across the criminal justice pathway could prevent treatment delays and ensure more timely mental healthcare in prison

Personality disorder services in England: findings from a national survey

Aims and method: We aimed to evaluate the availability and nature of services for people affected by personality disorder in England by conducting a survey of English National Health Service (NHS) mental health trusts and independent organisations. Results: In England, 84% of organisations reported having at least one dedicated personality disorder service. This represents a fivefold increase compared with a 2002 survey. However, only 55% of organisations reported that patients had equal access across localities to these dedicated services. Dedicated services commonly had good levels of service use and carer involvement, and engagement in education, research and training. However, a wider multidisciplinary team and a greater number of biopsychosocial interventions were available through generic services. Clinical implications: There has been a substantial increase in service provision for people affected by personality disorder, but continued variability in the availability of services is apparent and it remains unclear whether quality of care has improved

Differences between homeless and non-homeless people in a matched sample referred for mental health reasons in police custody

Introduction: Homelessness has risen across high-income countries in the last decade, and in the United Kingdom, there has been a drastic increase in people living on the streets. Due to these increases, policy responses from public services are required to address the needs of this group. The risk factors for homelessness and conditions that this group live in mean they are at elevated risk of both mental health problems and contact with the criminal justice system. Despite this, there is little previous research on the homeless in police custody. Methods: Our study used a matched sample of homeless (n = 77) and non-homeless (n = 77) individuals to examine whether there were different needs across this group and whether the responses of a criminal justice mental health service differ for this group. This study is a secondary data analysis of a more extensive study. Results: Homeless and non-homeless detainees referred to the mental health service were broadly similar. However, differences in some variables show that homeless detainees had higher rates and frequency of substance misuse as well as some suggestion of more acute immediate need. Onward referrals were lower for homeless people, and it is not clear why this is the case. In addition, for those referred contact with services over time was reduced compared to the non-homeless group. Discussion: Our findings indicate that mental health services in police custody may need adaptations to ensure homeless individuals’ higher level of need is addressed and that they receive appropriate care both during and after detention. Further quantitative and qualitative research is needed to confirm why responses differ and to assess what can be done to address this issue

Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care

BACKGROUND: Schizophrenia patients frequently develop somatic co-morbidity. Core tasks for GPs are the prevention and diagnosis of somatic diseases and the provision of care for patients with chronic diseases. Schizophrenia patients experience difficulties in recognizing and coping with their physical problems; however GPs have neither specific management policies nor guidelines for the diagnosis and treatment of somatic co-morbidity in schizophrenia patients. This paper systematically reviews the prevalence and treatment of somatic co-morbidity in schizophrenia patients in general practice. METHODS: The MEDLINE, EMBASE, PsycINFO data-bases and the Cochrane Library were searched and original research articles on somatic diseases of schizophrenia patients and their treatment in the primary care setting were selected. RESULTS: The results of this search show that the incidence of a wide range of diseases, such as diabetes mellitus, the metabolic syndrome, coronary heart diseases, and COPD is significantly higher in schizophrenia patients than in the normal population. The health of schizophrenic patients is less than optimal in several areas, partly due to their inadequate help-seeking behaviour. Current GP management of such patients appears not to take this fact into account. However, when schizophrenic patients seek the GP's help, they value the care provided. CONCLUSION: Schizophrenia patients are at risk of undetected somatic co-morbidity. They present physical complaints at a late, more serious stage. GPs should take this into account by adopting proactive behaviour. The development of a set of guidelines with a clear description of the GP's responsibilities would facilitate the desired changes in the management of somatic diseases in these patients

Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services

Scoping studies have been used across a range of disciplines for a wide variety of purposes. However, their value is increasingly limited by a lack of definition and clarity of purpose. The UK's Service Delivery and Organisation Research Programme (SDO) has extensive experience of commissioning and using such studies; twenty four have now been completed

Dietary intake of fish, omega-3, omega-6 polyunsaturated fatty acids and vitamin D and the prevalence of psychotic-like symptoms in a cohort of 33 000 women from the general population

<p>Abstract</p> <p>Background</p> <p>Low intake of fish, polyunsaturated fatty acids (PUFA) and vitamin D deficiency has been suggested to play a role in the development of schizophrenia. Our aim was to evaluate the association between the intake of different fish species, PUFA and vitamin D and the prevalence of psychotic-like symptoms in a population-based study among Swedish women.</p> <p>Methods</p> <p>Dietary intake was estimated using a food frequency questionnaire among 33 623 women aged 30-49 years at enrolment (1991/92). Information on psychotic-like symptoms was derived from a follow-up questionnaire in the years 2002/03. Participants were classified into three predefined levels: low, middle and high frequency of symptoms. The association between diet and psychotic-like symptoms was summarized in terms of relative risks (RR) and corresponding 95% confidence intervals and was evaluated by energy-adjusted multinomial logistic regression.</p> <p>Results</p> <p>18 411 women were classified as having a low level of psychotic-like symptoms, 14 395 as middle and 817 as having a high level. The risk of high level symptoms was 53% (95% CI, 30-69%) lower among women who ate fish 3-4 times per week compared to women who never ate fish. The risk was also lower for women with a high intake of omega-3 and omega-6 PUFA compared to women with a lower intake of these fatty acids. The effect was most pronounced for omega-6 PUFAs. The RR comparing the highest to the lowest quartile of omega-6 PUFAs intake was 0.78 (95% CI, 0.64-0.97). The associations were J-shaped with the strongest reduced risk for an intermediate intake of fish or PUFA. For fatty fish (herring/mackerel, salmon-type fish), the strongest inverse association was found for an intermediate intake (RR: 0.81, 95% CI, 0.66-0.98), whereas a high intake of fatty fish was associated with an increased risk of psychotic-like symptoms (RR: 1.90, 95% CI, 1.34-2.70). Women in the highest compared with the lowest quartile of vitamin D consumption experienced a 37% (95% CI, 22-50%) lower risk of psychotic-like symptoms.</p> <p>Conclusion</p> <p>Our findings raise a possibility that adult women with a high intake of fish, omega-3 or omega-6 PUFA and vitamin D have a lower rate of psychotic-like symptoms.</p