Variations in prison mental health services in England and Wales

TY - JOUR

T1 - Variations in prison mental health services in England and Wales

AU - Forrester, Andrew

AU - Exworthy, Tim

AU - Olumoroti, Olumuyiwa

AU - Sessay, Mohammed

AU - Parrott, Janet

AU - Spencer, Sarah-Jane

AU - Whyte, Sean

PY - 2013/5

Y1 - 2013/5

N2 - 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.

AB - 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.

KW - Prison mental health

KW - Equivalence

KW - In-reach

KW - Criminal justice mental health

KW - Prison service

KW - PSYCHIATRIC MORBIDITY

KW - NATIONAL-SURVEY

KW - EQUIVALENCE

KW - CARE

KW - DISORDERS

KW - COMMUNITY

KW - PRINCIPLE

U2 - 10.1016/j.ijlp.2013.04.007

DO - 10.1016/j.ijlp.2013.04.007

M3 - Article

SN - 0160-2527

VL - 36

SP - 326

EP - 332

JO - International Journal of Law and Psychiatry

JF - International Journal of Law and Psychiatry

IS - 3-4

M1 - N/A

ER -