The prisoner/patient experience
in offender mental health
Dr. Andrew Forrester
Consultant and Honorary Senior Lecturer in Forensic Psychiatry,
South London and Maudsley NHS Foundation Trust and Institute of
Psychiatry, King’s College London.
Prisoner / Patient Experience
Why are prisoner/patient experiences useful?
•
The nature of partnership and consent
•
Autonomy vs paternalism
•
Incorporation vs objectification
•
Listening to patients is at the core of good healthcare
•
They might know something we don’t …
Prisoner / Patient Experience
Mental Health Services
Why develop offender mental health services?
Prisons – over 10 million internationally –
over-representation of SMI, substance misuse, personality
disorder (Singleton et al, 1998)
Police stations – 1.3 million arrested for notifiable offences
in England and Wales – substantial morbidity
(McKinnon et al, 2010)
McKinnon, I & Grubin, D (2010) Health screening in police custody. J. Forensic Leg Med, 17(4), 209-212
Singleton et al (1998) Psychiatric morbidity among prisoners in England and Wales. London: Office for National Statistics.
The Policy Background
1996
1999
2001
2007
2009
Timeline
Lambeth & Southwark
2008
2009
HMP Brixton
Camberwell
Green
Magistrates’
Court
2010
HMP
Belmarsh and
HMP & YOI
Isis
2011
Brixton and
Kennington
Police
stations
2012
HMP
Thameside
Research and Grant Funded Services
LD/ASD
prevalence,
unmet
needs and
pathways
Preventing
transition to
psychosis
(reference 1)
Police
custody
projects
1.
2.
Critical time
intervention
(reference 2)
Alternatives
to custodial
remand for
women
Jarrett, M, Craig, T, Parrott, J, Forrester, A, Winton-Brown, T, Maguire, H, McGuire, P, Valmaggia, L (2012) Identifying men at
ultra high risk of psychosis in a prison population. Schizophrenia Research, volume 136, April, pages 1-6.
Jarrett, M, Thornicroft, G, Forrester, A, Harty, M, Senior, J, King, C, Huckle, S, Parrott, J, Dunn, G, Shaw, J (2012) Continuity of
care for recently released prisoners with mental illness: a pilot randomised controlled trial testing the feasibility of a Critical Time
Intervention. Epidemiology and Psychiatric Sciences.
Context
Commissioning
Health and Social Care Act
Disinvestment
Partnership and consortium arrangements
Independent and voluntary sector partnerships
Patient Prisoner Experience
LEVEL 1
Service design / research design
LEVEL 2
Service implementation
LEVEL 3
Ongoing service evaluation
HMP Brixton
HMP Brixton
Category B
Local Remand Prison
Category C & D
Resettlement Prison
LEVEL 1 – Service design / research design
LEVEL 2 – Service implementation
LEVEL 3 – Ongoing service evaluation
Camberwell Green Magistrates Court
Camberwell Green Magistrates Court
LEVEL 1 – Service design / research design
LEVEL 2 – Service implementation
LEVEL 3 – Ongoing service evaluation
London Metropolitan Police Service
London Metropolitan Police Service
LEVEL 1 – Service design / research design
LEVEL 2 – Service implementation
LEVEL 3 – Ongoing service evaluation
Research Projects in Police Stations
Android app
Basic cohort
technology
descriptors
Prevalence and
unmet needs
work
Outcomes, using
a control group
- health and
re-offending
outcomes
Alternatives to Custodial Remand for Women
But there is still a long way to go …
Forrester, A, Olumotori, O, Spencer, S, Sessay, M, Parrott, J, Exworthy, T, Whyte, S (in submission)
Variations in prison mental health services in England and Wales. The International Journal of Law and
Psychiatry (in submission).
Exworthy, T, Wilson, S, Forrester, A (2011) Beyond equivalence: prisoners’ right to
health. The Psychiatrist, volume 35, pages 201-202.
Exworthy, T, Samele, C, Urquia, N, Forrester, A (2012) Asserting prisoners’ right to health: progressing
beyond equivalence. Psychiatric Services, volume 63, no. 3.
Wilson, S, James, D, Forrester, A (2011) The medium-secure project and criminal
justice mental health. The Lancet, volume 378, issue 9786, pages 110-111.
Preventing Transition to Psychosis in Prisoners
A collaboration with SLaM’s Oasis group
preventing transition to psychosis
•Improving outcomes
•Early symptoms lead to 58% transition over 8 years
•The Impact of treating psychosis in prisoners early
Prodromal
Questionnaire
750
At risk mental
states
CAARMS
301
38
First episodes
of psychosis
23
Craig, T, Parrott, J, Forrester, A, Winton-Brown, T, Maguire, H, McGuire, P, Valmaggia, L (2012) Identifying men at
ultra high risk of psychosis in a prison population. Schizophrenia Research, volume 136, April, pages 1-6.
Level Assessment
LEVEL 1
Service design / research design
LEVEL 2
Service implementation
LEVEL 3
Ongoing service evaluation
Personality Disorder
LEVEL 1 – Service design / research design
LEVEL 2 – Service implementation
LEVEL 3 – Ongoing service evaluation
Designed by Prisoners
LEVEL 1 – Service design / research design
LEVEL 2 – Service implementation
LEVEL 3 – Ongoing service evaluation
Neurodevelopmental disorders in HMP Brixton
Approached up to week 23
(1st May 2012 to 5th October 2012)
N = 218
Not recruited / Screened
N = 79
Recruited / Screened
N = 139
Refused : N = 58
No English : N = 17
Advised not to : N = 3
Lacked capacity : N = 1
No NDD
N = 98
MINI
N=1
+ on ASRS
N = 25
13 Positive on DIVA
(9 referred to outreach, 2 left but sent
letter to GP, 1 left but sent report, 1 left
& unable to pass on results)
1 Negative on DIVA but given clinical Dx
9 Negative on DIVA
4 Following up
1 Lost to follow-up
Jane McCarthy,
Lisa Underwood,
Eddie Caplin,
Andrew Forrester
Reported *
N=5
3 Negative on DIVA
2 Lost to follow-up
Any NDD
N = 41
QT
N=0
+ on AQ20
N = 17
5 Negative
9 Following up
3 Lost to follow-up
Positive on assessment screen : N = 35
Screened negative but reported ND : N = 6*
ADHD
N = 30
ASD
N = 15
LD
N = 16
Reported*
N=1
+ on LDSQ
N = 11
Reported*
N=5
1 Negative
2 Negative on QT
9 BIQ (70-84)
1 Negative on QT
3 BIQ (70-84)
1 Lost to follow-up
* These participants screened negative during the assessment but reported that they had
been given a diagnosis in the past. QT=Quick Test. BIQ=Borderline IQ.
A Progressive Journey
“…taking two steps forward,
One back “
Thank you
Prisoner / Patient Experience
The implementation of the Bradley pathway across Lambeth’s
criminal justice mental health services has enhanced service :
• Availability
• Accessibility
• Acceptability
• Quality
Progress to Date
Prison
Court
Police
Probation
Hospital transfer
project
- Quantitavtive data
collected
First round of data
collection complete,
being prepared for
publication
Basic descriptors
completed for the
‘first 500’, being
analysed
Ethical approval
being sought for
prevalence and
unmet needs work
Healthcare wing
- Quantitavtive data
collected
Ethical approval
being sought for
prevalence, unmet
needs, outcomes
Outreach team
- Quantitavtive data
collected
Data collection using
control group to
commence early
2013
Across the service
- Quantitavtive data
collected
Timeline to Outputs
Prison
Court
May
Evaluation approval for prison
evaluation
May
Data collection completed
October
Prison quantative data collection
finished
August
Report sent to stakeholders
Police
2012
2013
January
Prison quantative data analysed
August
Publication (3 quantative papers,
1 qualitative paper, 1 editorial
2014
Summer
Publications
(1 quantative, 1 qualitative, 1
editorial re: collaborative
working)
November
Analysis of the ‘first 500’ with
report to steering group
January
Ethical approval
February
Commence prevalence and
unmet needs work, identify
control group
August
Data collection finishes
November
Publish the ‘first 500’
2014
Analyse data and publish
prevalence and unmet needs
and outcomes
2015
To confirm why timescales are achievable
Forrester, A, Singh, J, Ardino, V, Slade, K, Samele, C, Exworthy, T & Sen, P (2012) Prison in-reach: evolution and function after more than a decade of
development. Epidemiology and Psychiatric Services (in submission).
Mudathikundan, F, Chao, O & Forester, A (2012) Proposals for fitness to plead legislation in England and Wales and offender mental health implications. The
International Journal of Law and Psychiatry (in submission).
MacLennan, F, Slade, K, Brown, P & Forrester, A (2012) Improving access to psychological therapies in prisons. Criminal Behaviour and Mental Health (in
submission).
Forrester, A, Exworthy, T, Chao, O, Slade, K, Parrott, J (2012) Influencing the care pathway for prisoners with acute mental illness. Criminal Behaviour and
Mental Health (in submission).
Slade, K & Forrester, A (2012) Measuring IPDE-SQ personality disorder prevalence in pre-sentence and early-stage prison populations, with sub-type
estimates. The International Journal of Law and Psychiatry (in press).
Forrester, A, Olumotori, O, Spencer, S, Sessay, M, Parrott, J, Exworthy, T, Whyte, S (2012) Variations in prison mental health services in England and Wales.
The International Journal of Law and Psychiatry.(in submission).
Exworthy, T, Samele, C, Urquia, N, Forrester, A (2012) Asserting prisoners’ right to health: progressing beyond equivalence. Psychiatric Services, volume 63,
no. 3, pages
Jarrett, M, Craig, T, Parrott, J, Forrester, A, Winton-Brown, T, Maguire, H, McGuire, P, Valmaggia, L (2012) Identifying men at ultra high risk of psychosis in a
prison population. Schizophrenia Research, volume 136, April, pages 1-6.
Jarrett, M, Thornicroft, G, Forrester, A, Harty, M, Senior, J, King, C, Huckle, S, Parrott, J, Dunn, G, Shaw, J (2012) Continuity of care for recently released
prisoners with mental illness: a pilot randomised controlled trial testing the feasibility of a Critical Time Intervention. Epidemiology and Psychiatric Sciences.
Exworthy, T, Wilson, S, Forrester, A (2011) Beyond equivalence: prisoners’ right to health. The Psychiatrist, volume 35, pages 201-202.
Wilson, S, James, D, Forrester, A (2011) The medium-secure project and criminal justice mental health. The Lancet, volume 378, issue 9786, pages 110-111.
Black, G, Forrester, A, Wilks, M, Riaz, M, Maguire, H, Carlin, P (2011) Using initiative to provide clinical intervention groups in prison: a process evaluation.
International Review of Psychiatry, volume 23, number 1, pages 70-76.
Mills, A, Lathlean, J, Bressington, D, Forrester, A, Van Veenhuyzen, W, Gray, R (2011) Prisoners’ experiences of antipsychotic medication: influences on
adherence. Journal of Forensic Psychiatry and Psychology, volume 22, issue 1, pages 110-125.