STRESS-testing clinical activity and outcomes for a combined prison in-reach and court liaison service: a 3-year observational study of 6177 consecutive male remands

Conor O'Neill, Damian Smith, Martin Caddow, Fergal Duffy, Philip Hickey, Mary Fitzpatrick, Fintan Caddow, Tom Cronin, Mark Joynt, Zetti Azvee, Bronagh Gallagher, Claire Kehoe, Catherine Maddock, Benjamin O'Keeffe, Louise Brennan, Mary Davoren, Elizabeth Owens, Ronan Mullaney, Laurence Keevans, Ronan Maher, Harry G Kennedy, Conor O'Neill, Damian Smith, Martin Caddow, Fergal Duffy, Philip Hickey, Mary Fitzpatrick, Fintan Caddow, Tom Cronin, Mark Joynt, Zetti Azvee, Bronagh Gallagher, Claire Kehoe, Catherine Maddock, Benjamin O'Keeffe, Louise Brennan, Mary Davoren, Elizabeth Owens, Ronan Mullaney, Laurence Keevans, Ronan Maher, Harry G Kennedy

Abstract

Background: People with major mental illness are over-represented in prison populations however there are few longitudinal studies of prison in-reach services leading to appropriate healthcare over extended periods.

Aims: We aimed to examine measures of the clinical efficiency and effectiveness of a prison in-reach, court diversion and liaison service over a 3 year period. Secondly, we aimed to compare rates of identification of psychosis and diversion with rates previously reported for the same setting in the 6 years previously. We adopted a stress testing model for service evaluation.

Method: All new male remand committals to Ireland's main remand prison from 2012 to 2014 were screened in two stages. Demographic and clinical variables were recorded along with times to assessment and diversion. The DUNDRUM Toolkit was used to assess level of clinical urgency and level of security required. Binary logistic regression was used to assess factors relevant to diversion.

Results: All 6177 consecutive remands were screened of whom 1109 remand episodes (917 individuals) received a psychiatric assessment. 4.1 % (95 % CI 3.6-4.6) had active psychotic symptoms. Levels of self-harm were low. Median time to full assessment was 2 days and median time to admission was 15.0 days for local hospitals and 19.5 days for forensic admissions. Diversion to healthcare settings outside prison was achieved for 5.6 % (349/6177, 95 % CI 5.1-6.3) of all remand episodes and admissions for 2.3 % (95 % CI 1.9-2.7). Both were increased on the previous period reported. Mean DUNDRUM-1 and DUNDRUM-2 Triage Security Scores were appropriate to risk and need.

Conclusions: We found that a two-stage screening and referral process followed by comprehensive assessment optimised identification of acute psychosis. The mapping approach described shows that it is possible for a relatively small team to sustainably achieve effective identification of major mental illness and diversion to healthcare in a risk-appropriate manner. The stress-testing structure adopted aids service evaluation and may help advise development of outcome standards for similar services.

Keywords: Clinical pathways; Court diversion; Court liaison; Prison psychiatry; Risk assessment; Screening.

Figures

Fig. 1
Fig. 1
Service mapping: flow diagram from remand to final mental health disposal for 6177 consecutive male remands 2012–2014 with median times from reception in remand prison to mental health transfer

References

    1. Fazel S, Baillargeon J. The health of prisoners. Lancet. 2011;377:956–965. doi: 10.1016/S0140-6736(10)61053-7.
    1. Pierzchniak P, Purchase N, Kennedy H. Liaison between prison, court and psychiatric services. Health Trends. 1997;29:26–29.
    1. Fazel S, Hayes AJ, Clerici M, Trestman R. Mental health of prisoners: prevalence, adverse outcomes, and interventions. Lancet Psychiatry Online. 2016;9:871–881. doi: 10.1016/S2215-0366(16)30142-0.
    1. Brugha T, Singleton N, Meltzer H, Bebbington P, Farrell M, Jenkins R, Coid J, Fryers T, Melzer D, Lewis G. Psychosis in the community and in prisons: a report from the British National Survey of psychiatric morbidity. Am J Psychiatry. 2005;162:774–780. doi: 10.1176/appi.ajp.162.4.774.
    1. Coid J, Ullrich S. Prisoners with psychosis in England and Wales: diversion to psychiatric inpatient services? Int J Law Psychiatry. 2011;34:99–108. doi: 10.1016/j.ijlp.2011.02.003.
    1. Fazel S, Seewald K. Severe mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis. Br J Psychiatry. 2012;200:364–373. doi: 10.1192/bjp.bp.111.096370.
    1. Linehan SA, Duffy DM, Wright B, Curtin K, Monks S, Kennedy HG. Psychiatric morbidity in a cross-sectional sample of male remanded prisoners? Ir J Psychol Med. 2014;22:128–132. doi: 10.1017/S079096670000923X.
    1. Maden T. Psychiatric Morbidity Among Prisoners in England and Wales: By N. Singleton, H. Meltzer & R. Gatward. Br J Psychiatry. 2000;176:503. doi: 10.1192/bjp.176.5.503.
    1. Curtin K, Monks S, Wright B, Duffy D, Linehan S, Kennedy HG. Psychiatric morbidity in male remanded and sentenced committals to Irish prisons. Ir J Psychol Med. 2014;26:169–173. doi: 10.1017/S079096670000063X.
    1. Pakes F, Winstone J. A site visit survey of 101 mental health liaison and diversion schemes in England. J Forensic Psychiatry Psychol. 2010;21:873–886. doi: 10.1080/14789949.2010.511241.
    1. Pillai K, Rouse P, McKenna B, Skipworth J, Cavney J, Tapsell R, et al. From positive screen to engagement in treatment: a preliminary study of the impact of a new model of care for prisoners with serious mental illness. BMC Psychiatry. 2016;16:1. doi: 10.1186/s12888-016-0711-2.
    1. Department of Health. The Bradley report [Internet]. London; 2009. .
    1. Department of Health, Reed J. Review of mental health and social services for mentally disordered offenders and others requiring similar services. London; 1993. Report no.: Cm. 2088.
    1. Georgiou M, Souza R, Holder S, Stone H, Davies S. Standards for Prison Mental Health Services, quality network for Prison Mental Health Services [Internet]. London: 2015. Royal College Psychiatrists publication number CCQI202. .
    1. Quagliariello M (ed.) (2009). Stress-testing the Banking System. Cambridge: Cambridge University Press. Cambridge books online <. Accessed 29 Aug 2016.
    1. Nelson WB. Accelerated testing—statistical models, test plans, and data analysis. New York: Wiley; 2004.
    1. McInerney C, Davoren M, Flynn G, Mullins D, Fitzpatrick M, Caddow M, Caddow F, Quigley S, Black F, Kennedy HG, O’Neill C. Implementing a court diversion and liaison scheme in a remand prison by systematic screening of new receptions: a 6 year participatory action research study of 20,084 consecutive male remands. Int J Mental Health Syst. 2013;7:18. doi: 10.1186/1752-4458-7-18.
    1. Armonk NY. IBM SPSS Statistics for Windows, 20th edn. IBM Corporation; 2011.
    1. DasGupta A, Cai TT, Brown LD. Interval estimation for a binomial proportion. Stat Sci. 2001;16:101–133. doi: 10.1214/ss/1009213286.
    1. Grubin D, Carson D, Parsons S. Report on new prison reception health screening arrangements: the results of a pilot study in 10 prisons. Newcastle. . Accessed Oct 2002.
    1. Kennedy HG, O’Neill C, Flynn G, Gill P. Dangerousness, understanding, recovery and urgency manual (the Dundrum quartet), 1st edn. . Accessed Mar 2010.
    1. International statistical classification of diseases and related health problems, 10th revision (ICD-10). Geneva; 1992.
    1. Flynn G, O’Neill C, McInerney C, Kennedy HG. The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study. BMC Psychiatry. 2011;11:43. doi: 10.1186/1471-244X-11-43.
    1. Freestone M, Bull D, Brown R, Boast N, Blazey F, Gilluley P. Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit. BMC Psychiatry. 2015;15:239. doi: 10.1186/s12888-015-0620-9.
    1. Flynn G, O’Neill C, Kennedy HG. DUNDRUM-2: prospective validation of a structured professional judgment instrument assessing priority for admission from the waiting list for a forensic mental health hospital. BMC Res Notes. 2011;4:230. doi: 10.1186/1756-0500-4-230.
    1. Birmingham L, Mason D, Grubin D. Identifying mental illness at reception into prison. Crim Behav Mental Health. 2000;10:77–87. doi: 10.1002/cbm.347.
    1. Reed J, Lyne M. The quality of health care in prison: results of a programme of semi-structured inspections. Br Med J. 1997;315:1420–1424. doi: 10.1136/bmj.315.7120.1420.
    1. Birmingham L. Diversion from custody. Adv Psychiatr Treat. 2001;7:198–207. doi: 10.1192/apt.7.3.198.
    1. Chow WS, Priebe S. How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990. BMJ Open. 2016;6(4):e010188. doi: 10.1136/bmjopen-2015-010188.
    1. Irish prison service. Irish prison service annual report 2012 [Internet]. 2012. .
    1. Irish prison service. Irish prison service annual report 2013 [Internet]. 2013. .
    1. Irish prison service. Irish prison service annual report 2014 [Internet]. 2014. .
    1. Hawton K, Linsell L, Adeniji T, Sariaslan A, Fazel S. Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide. Lancet. 2014;383:1147–1154. doi: 10.1016/S0140-6736(13)62118-2.
    1. WHO. Surgical safety checklist (First edn). World Health Organisation. .
    1. WHO. WHO guidelines for safe surgery 2009. Safe surgery saves lives. . Accessed 8 Sep 2016.
    1. Hopkins G. Thornicroft G Engagement with mental health services on release from prison. J Forensic Res. 2014;5:219.
    1. Lennox C, Senior J, King C, Hassan L, Clayton R, Thornicroft G, Shaw J. The management of released prisoners with severe and enduring mental illness. J Foren Psychiatry Psychol. 2012;23(12):67. doi: 10.1080/14789949.2011.634921.
    1. James D. Court diversion at 10 years: can it work, does it work and has it a future? J Foren Psychiatry Psychol. 1999;10:507–524.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe