The Substance Misuse Treatment Needs of Minority Prisoner Groups: Women, Young Offenders and Ethnic Minorities

AbstractObjectives: To describe the prevalence of psychiatric morbidity and the treatment needs of new committals to Irish prisons.Methods: A population survey of 615 prisoners representing 7.9% of male committals to Irish prisons in the year of survey, 313 remands (9.6% of total remand committals) and 302 sentenced committals (6.4% of total sentenced committals). The main outcome measures were ICD-10 diagnoses of mental disorder based on interviews using SADS-L and prison medical records.Results: Current prevalence rates of any psychotic illness were 3.8% (remand) and 0.3% (sentenced), six month prevalence rate 5.1% (remand) and 2.6% (sentenced) and lifetime rate 9.3% (remand) and 6.6% (sentenced). Schizophrenia and drug/organic psychoses were the most common psychoses. Major depressive disorder had a current prevalence of 4.5% (remand) and 4.6% (sentenced), a six month prevalence of 4.8% (remand) and 6.0% (sentenced), and a lifetime prevalence of 8.6% (remand) and 15.9% (sentenced). Sixty-point-six per cent of the sample had a current substance misuse problem.Conclusions: There is significant psychiatric morbidity in committal prisoners.

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What can be done to improve outcomes for prisoners with a dual diagnosis?

Advances in Dual Diagnosis ◽

10.1108/add-07-2015-0016 ◽

2016 ◽

Vol 9 (1) ◽

pp. 14-25 ◽

Cited By ~ 4

Author(s):

Hattie Catherine Ann Moyes ◽

Joshua James Heath ◽

Lucy Victoria Dean

Keyword(s):

Mental Health ◽

Dual Diagnosis ◽

Substance Misuse ◽

Service Providers ◽

Female Gender ◽

Integrated Treatment ◽

International Studies ◽

Treatment Needs ◽

Content Type ◽

Practical Implications

Purpose – The purpose of this paper is to review the literature on offenders with a dual diagnosis and discuss how prison-based services can improve to better meet the needs of prisoners with co-occurring substance misuse and mental health disorders. Design/methodology/approach – A comprehensive literature search of PsycINFO, JSTOR, PubMed and Google Scholar, reviewing international studies on dual diagnosis amongst offender and community samples spanning the last three decades, supplemented by international policy, guidance papers and reports was conducted to explore how services can be improved. Findings – It was found that research into dual diagnosis amongst prisoners internationally was scarce. However, from the evidence available, several consistent factors emerged that led to the following recommendations: integrated treatment needs to be coordinated and holistic, staged and gender-responsive; increased availability of “low level”, flexible interventions; transitional support and continuity of care upon release with the utilisation of peer mentors; comprehensive assessments in conducive settings; mandatory dual diagnosis training for staff; and increased funding for female/gender-responsive services. Practical implications – The recommendations can inform commissioners, funders and service providers of areas where support must be improved to address the needs of prisoners with a dual diagnosis. Social implications – Improved outcomes for prisoners with a dual diagnosis would likely have a positive effect on society, with improvements in mental health and substance misuse treatment impacting on rates of reoffending. Originality/value – This paper brings originality and value to the sector because it reviews relevant research on dual diagnosis and translates it into practical implications for policy makers.

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Implementation of a medical education programme for addictions MDT members to improve knowledge and confidence in managing substance users with complex comorbidities

BMJ Open Quality ◽

10.1136/bmjoq-2020-001112 ◽

2020 ◽

Vol 9 (4) ◽

pp. e001112

Author(s):

Marie Alexandra Edison ◽

Bridget Browne ◽

Jeffrey Fehler

Keyword(s):

Mental Health ◽

Early Detection ◽

Workforce Development ◽

Substance Misuse ◽

Cost Effective ◽

Education Programme ◽

Holistic Care ◽

Physical And Mental Health ◽

Treatment Needs ◽

Complex Needs

BackgroundPublic Health England (PHE) has highlighted a rising number of deaths due to addiction, and notable changes in patient profiles. Management is now frequently intertwined with medical comorbidities and polypharmacy, as the patient group presents with more complex needs. Early detection is vital to minimise harm. Mental health frequently needs treating in tandem, but ‘cross-referral’ services can fail to recognise or meet these needs. A cohesive, confident multidisciplinary team (MDT) is vital for holistic care and accelerating recovery in cost-effective ways. Furthermore, MDTs are uniquely placed to effectively broker communications between multiple care inputs.MethodsMDT members of an addictions centre participated in a three-and-a-half-months education programme, encompassing eight PHE-recommended topics. These related to physical and mental health substance misuse sequelae, and specific population treatment needs.ResultsThere was a statistically significant improvement in all areas including: recognising early physical and/or mental health deterioration signs, providing basic health advice and appropriate escalation. Regarding PHE topics, biggest mean improvements were in managing substance misuse with physical comorbidities and pregnancy (38.2% and 35.9% respectively, p<0.0001). Additionally, biological mechanisms increased 26.0%, physical health consequences 24.2%, hepatic disorders 31.7%, older people 31.3%, homeless populations 31.8% and coexisting mental health 24.6% (all p≦0.002). Confidence communicating concerns to internal and external clinicians also increased (14% and 21%, respectively, p≦0.001).ConclusionA teaching programme improved MDT knowledge and confidence in early detection, escalation and communication of physical and mental comorbidities associated with substance misuse. This intervention should support harm reduction strategies on individual and wider-community levels. Introducing an education programme ensures a sustainable approach to workforce development and helps facilitate holistic care cost-effectively. Clear communication between multiple ‘cross-referral’ services involved with complex needs is essential for comprehensive integrated care.

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Partnership in Working with Young Offenders with Substance Misuse Problems

The Howard Journal of Criminal Justice ◽

10.1111/j.1468-2311.2005.00371.x ◽

2005 ◽

Vol 44 (3) ◽

pp. 254-268 ◽

Cited By ~ 6

Author(s):

John Minkes ◽

Richard Hammersley ◽

Peter Raynor

Keyword(s):

Substance Misuse ◽

Young Offenders

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Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review

BJPsych Open ◽

10.1192/bjo.2021.1022 ◽

2021 ◽

Vol 7 (6) ◽

Author(s):

R. Hall ◽

L. Mitchell ◽

J. Sachdeva

Keyword(s):

Multivariate Analysis ◽

Gender Identity ◽

Access To Care ◽

Neurodevelopmental Disorders ◽

Substance Misuse ◽

Case Note ◽

Service Users ◽

Treatment Needs ◽

Retrospective Case ◽

Case Note Review

Background UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently ‘detransition’. Aims To describe service users’ access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify ‘detransitioning’. Method A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and ‘accessing care’ or ‘other outcome’. Results The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7–19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1–1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1–17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1–4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning. Conclusions Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.

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Prevalence and Nature of Mental Disorders Among Young Offenders in Custody and Community: A Meta-Analysis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1675 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S460-S460 ◽

Cited By ~ 1

Author(s):

M. Livanou ◽

V. Furtado ◽

S. Singh

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Psychiatric Disorders ◽

Meta Analysis ◽

Computer Assisted ◽

Young Offenders ◽

Prevalence Rates ◽

Treatment Needs ◽

Prevalence Studies ◽

Age Variations

IntroductionPrevalence studies show that nearly 80% of young offenders present psychiatric comorbidity. Juvenile offenders are at 3 times higher risk of being diagnosed with a psychiatric disorder. Recent systematic reviews have mainly focused on youth in detention neglecting youth in the community. Females and ethnic minorities have been overlooked in the literature in spite of the increasing rates of psychiatric disorders striking these groups.ObjectiveTo perform a meta-analysis on the prevalence rates of various mental disorders including depression, psychosis, PTSD, conduct disorder, ADHD, learning disabilities and personality disorders among young offenders. Self-harm and suicidal behaviour are examined too.AimsTo compare the prevalence of psychiatric disorders among young offenders across custody and community and to emphasise on gender, age, and ethnic variations.MethodsRelevant studies have been identified with computer-assisted searching and scanning of reference lists. Prevalence of mental disorders based on gender, age and ethnicity along with potential moderating factors are extracted from the included studies. Meta-regression is performed to test covariates that might have contributed to differences in prevalence rates across studies.ResultsAfter searching the relevant literature, 99 studies were determined to be eligible for data extraction.ConclusionsYoung offenders with ongoing mental health problems comprise a vulnerable group within forensic psychiatric services that needs special attention. More prevalence studies should be conducted to improve mental health provision. Ethnic, gender, and age variations across young offenders should be addressed and turn interventions into a tailored process that responds to the young person's particular treatment needs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment Needs and Service Utilization in Older U.S. Adults Evidencing High-Risk Substance Use

Journal of Aging and Health ◽

10.1177/0898264320929537 ◽

2020 ◽

Vol 32 (10) ◽

pp. 1363-1375

Author(s):

Kathleen A. Fairman ◽

Nicole K. Early

Keyword(s):

Substance Use ◽

Psychological Distress ◽

High Risk ◽

Drug Use ◽

Binge Drinking ◽

Service Utilization ◽

Substance Misuse ◽

Community Dwelling ◽

Drug Misuse ◽

Treatment Needs

Objectives: Because substance misuse by older adults poses clinical risks and has not been recently assessed, we examined substance use patterns, treatment needs, and service utilization in those evidencing high-risk use. Methods: We identified National Survey on Drug Use and Health respondents (2015–2018) aged ≥50 years reporting multiple-occasion binge drinking, illicit drug use, prescription drug misuse, or substance dependence. Past-year psychological symptoms were assessed using validated scales. Results: The sample, representing 10.2% of community-dwelling older U.S. adults, evidenced clinically important risks: 65.2% past-month binge drinking, 27.3% mental illness, 14.3% psychological distress, 10.6% combined alcohol/drug use, and 6.5% suicidality. Treatment receipt was uncommon (27.7%), positively associated with distress, and negatively associated with binge drinking. Of those not receiving treatment, 3.8% perceived treatment need. Discussion: Findings highlight the value of substance misuse screening and brief interventions, suggesting potential treatment referral opportunities for those evidencing psychological distress.

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