scholarly journals Service transitions, interventions and care pathways following remittal to prison from medium secure psychiatric services in England and Wales: national cohort study

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Sarah-Jayne Leonard ◽  
Roger T. Webb ◽  
Jennifer J. Shaw
Keyword(s):  
Mental Health ◽  
Policy Development ◽  
Psychiatric Services ◽  
Legal Rights ◽  
Care Programme ◽  
England And Wales ◽  
Aftercare Services ◽  
National Cohort ◽  
Legal Entitlement

Background Little is known internationally about return to prison from in-patient psychiatric services, including: circumstances leading to return, aftercare services and subsequent patient outcomes. Aims To examine and describe: (a) circumstances leading to return to prison from medium secure services; (b) available aftercare and early outcomes of returned persons; and (c) implications for policy development. Method Prospective cohort design with all patients (n = 96) returned to prisons from 33 National Health Service (NHS) medium secure services over a 6-month period in England and Wales. Follow-up was conducted for 1 year post-remittal, across 60 prisons. Results Less than 20% of patients with legal entitlement to section 117 aftercare under the Mental Health Act 1983 were receiving care managed/delivered via the care programme approach. Subsequent pathways included: inter-prison transfer (30%), use of the Assessment, Care in Custody and Teamwork process (49%), referral to secure services (21%) and community release (30%). Less than half of community releases were referred to a community mental health team. Conclusions Findings suggest that persons returned to prison are a vulnerable group of patients, many of whom require intervention (e.g. enhanced monitoring, admission to a healthcare wing, readmission to secure mental health services) on return to prison in the absence of targeted aftercare services. More robust guidance for discharge and aftercare planning procedures for persons remitted to prison should be developed to ensure that the benefits of in-patient admission are maintained and that individuals’ legal rights to ongoing aftercare are upheld.

scholarly journals Facilities for carers of in-patients in forensic psychiatric services in England and Wales

2010 ◽  
Vol 34 (9) ◽  
pp. 381-384 ◽  
Author(s):  
Irene Cormac ◽  
Drew Lindon ◽  
Hannah Jones ◽  
Trevor Gedeon ◽  
Michael Ferriter
Keyword(s):  
Mental Health ◽  
Postal Survey ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
England And Wales ◽  
Mental Health Settings ◽  
Forensic Psychiatric ◽  
Minority Ethnic ◽  
Psychiatric Facilities

Aims and methodA postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.ResultsForensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.Clinical implicationsForensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

scholarly journals A randomized study of a smartphone application compared with booklet to improve service user’s knowledge of their legal rights

2017 ◽  
Vol 34 (4) ◽  
pp. 287-293
Author(s):  
B. O’Donoghue ◽  
E. Roche ◽  
A. Naji ◽  
R. Daly ◽  
K. Madigan ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Affective Disorder ◽  
Randomized Study ◽  
Smartphone Application ◽  
Legal Rights ◽  
Service Users ◽  
Information Booklet ◽  
Paper Form ◽  
The Mean

BackgroundThe Mental Health Act 2001 has introduced significant changes to the process of admission to hospital for individuals affected by mental health disorders. This study aimed to determine whether a newly designed smartphone application could result in an improvement in service users’ knowledge of their rights compared with the paper booklet.MethodsThis was a randomized study conducted in an outpatient and day-hospital in North Dublin. Participants were randomized to receive the information booklet as either a smartphone application or in the paper form. A questionnaire which was scored from 0 to 10 was devised and was completed at baseline and at 1-week follow-up.ResultsA total of 42 individuals completed the baseline and follow-up questionnaire and of these, 53.7% were female and the mean age was 38.2 years (s.d.±13.5). A total of 34.1% had a diagnosis of a psychotic disorder, 29.3% had a depressive disorder and 22% had bipolar-affective disorder. The mean score before the intervention in the total group was 3.5 (s.d.±2.2) and this increased to 5.8 (s.d.±2.2) at follow-up. Participants randomized to the smartphone application improving by a mean of 2.5 (s.d.±2.5), while those randomized to the booklet improving by a mean of 2.3 (s.d.±2.6), which was not statistically significant.ConclusionsBoth forms of the information booklet showed improvement in service users’ knowledge of their legal rights. It is possible that each individual will have preference for either a paper form or a smartphone form and this study suggests that both forms should be offered to each individual service user.

Psychiatric out-patient services: origins and future

2006 ◽  
Vol 12 (5) ◽  
pp. 309-319 ◽  
Author(s):  
Helen Killaspy
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Alternative Model ◽  
Community Mental Health Services ◽  
Psychiatric Services ◽  
Early 20Th Century ◽  
Clinical Implications ◽  
Missed Appointments ◽  
Cost Implications

Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.

scholarly journals Understanding community care law in England and Wales

2009 ◽  
Vol 15 (6) ◽  
pp. 428-433 ◽  
Author(s):  
Danny Allen
Keyword(s):  
Mental Health ◽  
Community Care ◽  
Mental Health Problems ◽  
Case Law ◽  
Mental Capacity ◽  
Care Provision ◽  
Care Programme ◽  
England And Wales ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act

SummaryAlthough psychiatrists in England and Wales are generally familiar with the Mental Health Act 1983 and the Mental Capacity Act 2005, there is a body of law that is available to assist patients in the community with which they are generally less familiar. There are two main reasons for this. The first is that it is a rather confused amalgam of different statutes and case law affecting each other in ways that are less than clear. The other is that the care programme approach (CPA) was meant to cut through all this and make care provision straightforward. In fact, the latter has never been the case and community care law has always sat uneasily alongside the CPA, but in October 2008 the CPA was withdrawn from some patients with mental health problems. This article explains what is meant by community care law and how psychiatrists can use it to help their patients.

Impact of socioeconomic position and distance on mental health care utilization by incident users of antidepressants. A Danish nationwide follow-up study

2017 ◽  
Vol 41 (S1) ◽  
pp. S341-S341
Author(s):  
A. Packness ◽  
F. Waldorff ◽  
L. Hastrup ◽  
E. Simonsen ◽  
M. Vestergaard ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Utilization ◽  
Mental Health Care ◽  
Psychiatric Services ◽  
Equal Access ◽  
Care Utilization ◽  
Follow Up Study ◽  
Mental Health Care Utilization

IntroductionEqual access to health care treatment is a highly prioritized goal in most OECD countries. Timely access has become a priority too; in Denmark now with a 4-week deadline from referral to diagnosis. When mental health services become more centralized and allocation of patients to treatment further away from home become more common, it could have a negative impact on the goal of equal access.ObjectiveTo determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants.MethodA nationwide, Danish, register based, follow-up study on frequencies of contacts to out-patient psychiatric services, psychologist consultations supported by public funding and therapeutic talks by general practice.Preliminary resultsOutpatient-psychiatric services were reached more often by patients in low SEP measured by income, but their frequencies of visits were less. Contacts to psychologists were less than half for patients in low SEP and less frequent too. Mental health service by GP showed low SEP associated with low contact. No difference in use of emergency or inpatient psychiatric services was found. Distance to provider showed interaction with SEP and contact to psychologist and frequencies of contact to outpatient psychiatrists. When distance increased by 5 km, contact to psychologist fell by 11% among lowest income group and frequencies of visits to outpatient psychiatrist fell by 5%.Preliminary conclusionLower SEP is associated with lower mental health care utilization. Increased distance to provider increases inequity in mental health service utilization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Community forensic psychiatry and the forensic mental health liaison model

2012 ◽  
Vol 18 (6) ◽  
pp. 408-415 ◽  
Author(s):  
Muthusamy Natarajan ◽  
Jayanth Srinivas ◽  
Gill Briscoe ◽  
Steven Forsyth
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Forensic Psychiatry ◽  
Perceived Risk ◽  
Community Support ◽  
Forensic Mental Health ◽  
Political Issue ◽  
England And Wales

SummaryCare and follow-up of patients discharged from medium secure units in England and Wales is uncoordinated and inconsistent, although the perceived risk of violence by people with mental disorders is a primary political issue. This article outlines models of community support for these individuals, and describes a forensic mental health liaison service in operation in England.

Characteristics of and trends in subgroups of prisoner suicides in England and Wales

2011 ◽  
Vol 41 (11) ◽  
pp. 2275-2285 ◽  
Author(s):  
N. Humber ◽  
M. Piper ◽  
L. Appleby ◽  
J. Shaw
Keyword(s):  
Mental Health ◽  
Suicide Prevention ◽  
Drug Dependence ◽  
Policy Development ◽  
Case Series ◽  
Mental Healthcare ◽  
Service Level ◽  
Treatment Needs ◽  
England And Wales ◽  
History Of

BackgroundThe suicide rate is higher in prisoners compared with the general population. The aim was to describe the characteristics of and longitudinal trends in prisoner suicides in England and Wales.MethodA case series was ascertained from the Safer Custody and Offender Policy Group at the Ministry of Justice and included a 9-year (1999–2007) national census of prisoner suicides. Questionnaires were completed by prison staff on sociodemographic, custodial, clinical and service-level characteristics of the suicides.ResultsThere was a fall in the number of prison suicides and a decline in the proportion of young prisoner (18–20 years) suicides over time. Females were over-represented. Upward trends were found in prisoners with a history of violence and with previous mental health service contact. A downward trend was found in those with a primary psychiatric diagnosis of drug dependence. Drug dependence was found to be significant in explaining suicides within the first week of custody.ConclusionsThe findings provide an important insight to aid a target set in the National Suicide Prevention Strategy in England to reduce suicides in the prisoner population by 20% and highlight an important area for policy development in mental health services. Examining trends identified subgroups that may require improved mental healthcare and recognized those that appeared to be having their treatment needs more adequately met. Evidence suggests that targeted suicide prevention strategies for subgroups of prisoners are required.

scholarly journals Mental health needs of young offenders in custody and in the community

2006 ◽  
Vol 188 (6) ◽  
pp. 534-540 ◽  
Author(s):  
Prathiba Chitsabesan ◽  
Leo Kroll ◽  
Sue Bailey ◽  
Cassandra Kenning ◽  
Stephanie Sneider ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Needs ◽  
Health Needs ◽  
Young Offenders ◽  
Psychosocial Needs ◽  
Mental Health Needs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Programme ◽  
England And Wales

BackgroundResearch has revealed high levels of mental health needs in young offenders but many studies have been small, focusing on specific populations.AimsTo evaluate the mental health and psychosocial needs of a nationally representative sample of juvenile offenders in England and Wales, including female offenders and those from Black and minority ethnic groups.MethodA cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, was conducted in six geographically representative areas across England and Wales. Each young person was interviewed to obtain demographic information, mental health and social needs, and psychometric data.ResultsYoung offenders were found to have high levels of needs in a number of different areas including mental health (31%), education/work (36%) and social relationships (48%). Young offenders in the community had significantly more needs than those in secure care and needs were often unmet. One in five young offenders was also identified as having a learning disability (IQ < 70).ConclusionsNeeds for young offenders were high but often unmet. This emphasises the importance of structured needs assessment within custody and community settings in conjunction with a care programme approach that improves continuity of care.

Breast Cancer Risk After Supradiaphragmatic Radiotherapy for Hodgkin's Lymphoma in England and Wales: A National Cohort Study

2012 ◽  
Vol 30 (22) ◽  
pp. 2745-2752 ◽  
Author(s):  
Anthony J. Swerdlow ◽  
Rosie Cooke ◽  
Andrew Bates ◽  
David Cunningham ◽  
Stephen J. Falk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Hodgkin’S Lymphoma ◽  
Ductal Carcinoma ◽  
Hodgkin's Lymphoma ◽  
England And Wales ◽  
Treatment Type ◽  
National Cohort

Purpose To investigate breast cancer risk after supradiaphragmatic radiotherapy administered to young women with Hodgkin's lymphoma (HL) in a much larger cohort than previously to provide data for patient follow-up and screening individualized according to treatment type, age, and time point during follow-up. Patients and Methods Breast cancer risk was assessed in 5,002 women in England and Wales treated for HL with supradiaphragmatic radiotherapy at age < 36 years from 1956 to 2003, who underwent follow-up with 97% completeness until December 31, 2008. Results Breast cancer or ductal carcinoma in situ developed in 373 patients, with a standardized incidence ratio (SIR) of 5.0 (95% CI, 4.5 to 5.5). SIRs were greatest for those treated at age 14 years (47.2; 95% CI, 28.0 to 79.8) and continued to remain high for at least 40 years. The maximum absolute excess risk was at attained ages 50 to 59 years. Alkylating chemotherapy or pelvic radiotherapy diminished the risk, but only for women treated at age ≥ 20 years, not for those treated when younger. Cumulative risks were tabulated in detail; for 40-year follow-up, the risk for patients receiving ≥ 40 Gy mantle radiotherapy at young ages was 48%. Conclusion This article provides individualized risk estimates based on large numbers for patients with HL undergoing follow-up after radiotherapy at young ages. Follow-up of such women needs to continue for 40 years or longer and may require more-intensive screening regimens than those in national general population programs. Special consideration is needed of potential measures to reduce breast cancer risk for girls treated with supradiaphragmatic radiotherapy at pubertal ages.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

Sign in / Sign up

Export Citation Format

Share Document