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.

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 ExperiencePrisoner / Patient Experience

Prisoner / Patient ExperiencePrisoner / Patient Experience

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.

Mental Health ServicesMental Health Services

The Policy BackgroundThe Policy Background

1996 1999 2001 2007 2009

TimelineTimeline

HMP Belmarsh and

HMP & YOI Isis

Camberwell Green

Magistrates’ Court

Brixton and Kennington

Police stations

HMP Thameside

HMP Brixton

2008 2009 2010 20122011

Lambeth & Southwark

Research and Grant Funded ServicesResearch and Grant Funded Services

Alternatives to custodial remand for

women

Alternatives to custodial remand for

women

Critical time intervention

(reference 2)

Critical time intervention

(reference 2)

Police custody projects

Police custody projects

Preventing transition to psychosis(reference 1)

Preventing transition to psychosis(reference 1)

LD/ASD prevalence,

unmet needs and pathways

LD/ASD prevalence,

unmet needs and pathways

1. 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.

2. 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.

ContextContext

CommissioningCommissioning

Health and Social Care ActHealth and Social Care Act

DisinvestmentDisinvestment

Partnership and consortium arrangementsPartnership and consortium arrangements

Independent and voluntary sector partnershipsIndependent and voluntary sector partnerships

Patient Prisoner ExperiencePatient Prisoner Experience

LEVEL 1

Service design / research design

LEVEL 1

Service design / research design

LEVEL 2

Service implementation

LEVEL 2

Service implementation

LEVEL 3Ongoing service evaluation

LEVEL 3Ongoing service evaluation

HMP BrixtonHMP Brixton

HMP Brixton

LEVEL 1 – Service design / research design

LEVEL 2 – Service implementation

LEVEL 3 – Ongoing service evaluation

Category B Local Remand Prison

Category C & DResettlement Prison

Camberwell Green Magistrates CourtCamberwell 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 ServiceLondon 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 StationsResearch Projects in Police Stations

Outcomes, using a control group - health and re-offending outcomes

Prevalence and unmet needswork

Basic cohort

descriptors

Android app

technology

Alternatives to Custodial Remand for WomenAlternatives to Custodial Remand for Women

But there is still a long way to go …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, Samele, C, Urquia, N, Forrester, A (2012) Asserting prisoners’ right to health: progressing beyond equivalence. Psychiatric Services, volume 63, no. 3.

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.

Preventing Transition to Psychosis in PrisonersPreventing Transition to Psychosis in Prisoners

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.

Prodromal Questionnair

e

Prodromal Questionnair

eCAARMSCAARMS At risk

mental statesAt risk

mental statesFirst episodes of psychosis

First episodes of psychosis

750 301 38 23

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

Level AssessmentLevel Assessment

LEVEL 1

Service design / research design

LEVEL 1

Service design / research design

LEVEL 2

Service implementation

LEVEL 2

Service implementation

LEVEL 3Ongoing service evaluation

LEVEL 3Ongoing service evaluation

Personality DisorderPersonality Disorder

LEVEL 1 – Service design / research design

LEVEL 2 – Service implementation

LEVEL 3 – Ongoing service evaluation

Designed by PrisonersDesigned by Prisoners

LEVEL 1 – Service design / research design

LEVEL 2 – Service implementation

LEVEL 3 – Ongoing service evaluation

Neurodevelopmental disorders in HMP BrixtonNeurodevelopmental disorders in HMP Brixton

* 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.

Jane McCarthy,Lisa Underwood,Eddie Caplin,Andrew Forrester

“…taking two steps forward,

One back “

A Progressive JourneyA Progressive Journey

Thank you

Prisoner / Patient ExperiencePrisoner / 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 DateProgress to Date

PrisonPrison CourtCourt PolicePolice ProbationProbation

Hospital transfer project

- Quantitavtive data collected

Hospital transfer project

- Quantitavtive data collected

Healthcare wing - Quantitavtive data

collected

Healthcare wing - Quantitavtive data

collected

Outreach team- Quantitavtive data

collected

Outreach team- Quantitavtive data

collected

Across the service- Quantitavtive data

collected

Across the service- Quantitavtive data

collected

First round of data collection complete, being prepared for

publication

First round of data collection complete, being prepared for

publication

Basic descriptors completed for the ‘first 500’, being

analysed

Basic descriptors completed for the ‘first 500’, being

analysed

Ethical approval being sought for prevalence and

unmet needs work

Ethical approval being sought for prevalence and

unmet needs work

Ethical approval being sought for

prevalence, unmet needs, outcomes

Ethical approval being sought for

prevalence, unmet needs, outcomes

Data collection using control group to commence early

2013

Data collection using control group to commence early

2013

PrisonPrison CourtCourt PolicePolice

Timeline to OutputsTimeline to Outputs

2012

2013

2014

2015

MayEvaluation approval for prison

evaluation

MayEvaluation approval for prison

evaluation

OctoberPrison quantative data collection

finished

OctoberPrison quantative data collection

finished

JanuaryPrison quantative data analysed

JanuaryPrison quantative data analysed

AugustPublication (3 quantative papers,

1 qualitative paper, 1 editorial

AugustPublication (3 quantative papers,

1 qualitative paper, 1 editorial

MayData collection completed

MayData collection completed

AugustReport sent to stakeholders

AugustReport sent to stakeholders

SummerPublications

(1 quantative, 1 qualitative, 1 editorial re: collaborative

working)

SummerPublications

(1 quantative, 1 qualitative, 1 editorial re: collaborative

working)

NovemberAnalysis of the ‘first 500’ with

report to steering group

NovemberAnalysis of the ‘first 500’ with

report to steering group

JanuaryEthical approval

JanuaryEthical approval

FebruaryCommence prevalence and unmet needs work, identify

control group

FebruaryCommence prevalence and unmet needs work, identify

control group

AugustData collection finishes

AugustData collection finishes

NovemberPublish the ‘first 500’

NovemberPublish the ‘first 500’

2014Analyse data and publish

prevalence and unmet needs and outcomes

2014Analyse data and publish

prevalence and unmet needs and outcomes

To confirm why timescales are achievableTo 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.