Dr Wallace BrinkConsultant in Forensic Psychiatry

Devon Cluster Prisons

Syllabus for MRCPsych IIPsychiatry in Prisons

• Knowledge of the presence of psychiatric disorder in prison populations

• Suicide in prisons

• Psychiatric treatment in prison settings

PRISONS

Prisons operate at different levels of security and cater for individuals on remand and serving sentences

Significant increase in UK prison population

STATISTICS

Remand Prisoners• 70 - 90% psychiatric

morbidity amongst remands

• 5% psychotic or affective disorder

• Three times more likely to have psychosis or major depression than the general population

• Co-morbidity with mental illness, substance misuse and personality disorder is the norm

• Officer’s national, statistics 10% of male remands suffer a functional psychosis

• Substance misuse rate 38%, higher amongst remand than serving prisoners

• 6 - 8 times elevated suicide rate amongst prison population

STATISTICS

SENTENCED PRISONERS •6- 7% of male sentenced prisoners have a psychotic illness •4.5% 0f female sentence prisoners have a psychotic illness

• High rates of substance misuse (22 vs 30%)

• High rates of PD (9 vs 16%) (APD most common)

Suicide in Prisons• Higher rates than in match general populations• hanging., self-strangulation• ACCT (Assessment, Care in Custody &

Teamwork)• High Risk

– Male– First week in prison– History of substance misuse– Charged with violent or sexual offence– Single cell accommodation– Life sentenced prisoners– Young offenders

REASONS FOR ELEVATED PSYCHIATRIC MORBIDITY

• Remand

• Acute withdrawal

• Addiction in custody

• New asylum population

• Demographics

CASE e.g.

• Anonymised

• 36y male

• Serious offender

• Assault to severe injury

• Attempted murder

Bradley Report• 82 recommendations • Tackle over representation of people with

mental health problems in prisons• National Network of Criminal Justice Mental

Health Teams to divert people to service from Police, Courts and following release

• 14 day maximum wait to transfer for urgent treatment

WHAT DOES THE VISITING PSYCHIATRIST DO?

• Triage

• Case management

• Transfer to local hospitals

• Management of difficult prisoners

• Consultation

TAKE HOME MESSAGES

• Syllabus

• Itinerant population

• Forensic experience

Further Reading• Prison Psychiatry: Adult Prisons in

England and Wales. College Report CR141, February 2007. RCPsych

• Suicide in prisons. Council Report CR99, February 2002. RCPsych