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The prisoner/patient experience in offender mental health

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.

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The prisoner/patient experience in offender mental health

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  1. 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.

  2. Prisoner / Patient Experience 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 …

  3. Prisoner / Patient Experience

  4. Mental Health Services 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.

  5. The Policy Background 1996 1999 2001 2007 2009

  6. Timeline Lambeth & Southwark 2010 2012 2008 2009 2011 Camberwell Green Magistrates’ Court Brixton and Kennington Police stations HMP Belmarsh and HMP & YOI Isis HMP Thameside HMP Brixton

  7. Research and Grant Funded Services Preventing transition to psychosis (reference 1) LD/ASD prevalence, unmet needs and pathways Critical time intervention (reference 2) Police custody projects Alternatives to custodial remand for women 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.

  8. Context Commissioning Health and Social Care Act Disinvestment Partnership and consortium arrangements Independent and voluntary sector partnerships

  9. Patient Prisoner Experience LEVEL 1 Service design / research design LEVEL 2 Service implementation LEVEL 3 Ongoing service evaluation

  10. HMP Brixton HMP Brixton Category B Local Remand Prison Category C & D Resettlement Prison LEVEL 1 – Service design / research design LEVEL 2 – Service implementation LEVEL 3 – Ongoing service evaluation

  11. Camberwell Green Magistrates Court Camberwell Green Magistrates Court LEVEL 1 – Service design / research design LEVEL 2 – Service implementation LEVEL 3 – Ongoing service evaluation

  12. London Metropolitan Police Service London Metropolitan Police Service LEVEL 1 – Service design / research design LEVEL 2 – Service implementation LEVEL 3 – Ongoing service evaluation

  13. Research Projects in Police Stations Basic cohort descriptors Android app technology Outcomes, using a control group - health and re-offending outcomes Prevalence and unmet needs work

  14. Alternatives to Custodial Remand for Women

  15. 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, Wilson, S, Forrester, A (2011) Beyond equivalence: prisoners’ right to health. The Psychiatrist, volume 35, pages 201-202. Exworthy, T, Samele, C, Urquia, N, Forrester, A (2012) Asserting prisoners’ right to health: progressing beyond equivalence. Psychiatric Services, volume 63, no. 3. 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.

  16. Preventing Transition to Psychosis in Prisoners • 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 Prodromal Questionnaire CAARMS At risk mental states First episodes of psychosis 750 301 38 23 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.

  17. Level Assessment LEVEL 1 Service design / research design LEVEL 2 Service implementation LEVEL 3 Ongoing service evaluation

  18. Personality Disorder LEVEL 1 – Service design / research design LEVEL 2 – Service implementation LEVEL 3 – Ongoing service evaluation

  19. Designed by Prisoners LEVEL 1 – Service design / research design LEVEL 2 – Service implementation LEVEL 3 – Ongoing service evaluation

  20. Neurodevelopmental disorders in HMP Brixton Approached up to week 23 (1st May 2012 to 5th October 2012) N = 218 Jane McCarthy, Lisa Underwood, Eddie Caplin, Andrew Forrester Not recruited / Screened N = 79 Recruited / Screened N = 139 Positive on assessment screen : N = 35 Screened negative but reported ND : N = 6* No NDD N = 98 Any NDD N = 41 Refused : N = 58 No English : N = 17 Advised not to : N = 3 Lacked capacity : N = 1 ADHD N = 30 MINI N = 1 QT N = 0 ASD N = 15 LD N = 16 + on LDSQ N = 11 Reported * N = 5 + on AQ20 N = 17 Reported* N = 1 + on ASRS N = 25 Reported* N = 5 13 Positive on DIVA (9 referred to outreach, 2 left but sent letter to GP, 1 left but sent report, 1 left & unable to pass on results) 1 Negative on DIVA but given clinical Dx 9 Negative on DIVA 4 Following up 1 Lost to follow-up 2 Negative on QT 9 BIQ (70-84) 3 Negative on DIVA 2 Lost to follow-up 5 Negative 9 Following up 3 Lost to follow-up 1 Negative 1 Negative on QT 3 BIQ (70-84) 1 Lost to follow-up * 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.

  21. A Progressive Journey “…taking two steps forward, One back “

  22. Thank you

  23. Prisoner / Patient Experience The implementation of the Bradley pathway across Lambeth’s criminal justice mental health services has enhanced service : • Availability • Accessibility • Acceptability • Quality

  24. Progress to Date Prison Court Police Probation First round of data collection complete, being prepared for publication Ethical approval being sought for prevalence and unmet needs work Hospital transfer project - Quantitavtive data collected Basic descriptors completed for the ‘first 500’, being analysed Healthcare wing - Quantitavtive data collected Ethical approval being sought for prevalence, unmet needs, outcomes Outreach team - Quantitavtive data collected Data collection using control group to commence early 2013 Across the service - Quantitavtive data collected

  25. Timeline to Outputs Prison Court Police 2012 May Evaluation approval for prison evaluation May Data collection completed November Analysis of the ‘first 500’ with report to steering group October Prison quantative data collection finished August Report sent to stakeholders January Ethical approval 2013 January Prison quantative data analysed February Commence prevalence and unmet needs work, identify control group Summer Publications (1 quantative, 1 qualitative, 1 editorial re: collaborative working) August Publication (3 quantative papers, 1 qualitative paper, 1 editorial August Data collection finishes November Publish the ‘first 500’ 2014 2014 Analyse data and publish prevalence and unmet needs and outcomes 2015

  26. 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.

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