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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. - PowerPoint PPT Presentation
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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 Experience
Prisoner / 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 Services
The Policy Background
1996 1999 2001 2007 2009
Timeline
HMP Belmarsh and
HMP & YOI Isis
Camberwell Green
Magistrates’ Court
Brixton and Kennington
Police stations
HMP ThamesideHMP Brixton
2008 2009 2010 20122011
Lambeth & Southwark
Research and Grant Funded Services
Alternatives to custodial remand for
women
Critical time intervention
(reference 2)
Police custody projects
Preventing transition to psychosis(reference 1)
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.
Context
Commissioning
Health and Social Care Act
Disinvestment
Partnership and consortium arrangements
Independent and voluntary sector partnerships
Patient Prisoner Experience
LEVEL 1Service design / research design
LEVEL 2Service implementation
LEVEL 3Ongoing service evaluation
HMP 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 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
Outcomes, using a control group - health and re-offending outcomes
Prevalence and unmet needswork
Basic cohort descriptors
Android apptechnology
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, 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 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
eCAARMS At risk
mental statesFirst 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 Assessment
LEVEL 1Service design / research design
LEVEL 2Service implementation
LEVEL 3Ongoing 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
* 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 Journey
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 ProbationHospital transfer
project- Quantitavtive data
collected
Healthcare wing - Quantitavtive data
collected
Outreach team- Quantitavtive data
collected
Across the service- 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
Ethical approval being sought for
prevalence, unmet needs, outcomes
Data collection using control group to commence early
2013
Prison Court Police
Timeline to Outputs
2012
2013
2014
2015
MayEvaluation approval for prison
evaluation
OctoberPrison quantative data collection
finished
JanuaryPrison quantative data analysed
AugustPublication (3 quantative papers,
1 qualitative paper, 1 editorial
MayData collection completed
AugustReport sent to stakeholders
SummerPublications
(1 quantative, 1 qualitative, 1 editorial re: collaborative
working)
NovemberAnalysis of the ‘first 500’ with
report to steering group
JanuaryEthical approval
FebruaryCommence prevalence and unmet needs work, identify
control group
AugustData collection finishes
NovemberPublish the ‘first 500’
2014Analyse data and publish
prevalence and unmet needs and outcomes
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.