A Pilot Study of Satisfaction and Adherence with Antipsychotic Medication Amongst Prisoners

1. A Pilot Study of Satisfaction and Adherence with Antipsychotic Medication Amongst Prisoners Dr Alice Mills Mr Dan Bressington Dr Richard Gray Professor Judith Lathlean

2. Background – Prevalence of Mental Health Problems • Over 90% of prisoners have one or more mental disorders (including substance misuse) (Singleton et al. 1998) 54% male remand prisoners 44% male sentenced prisoners 61% female remand prisoners 42% female sentenced prisoners have three or more disorders • Between 7% and 14% of prisoners have functional psychosis in comparison to 0.4% of the general population

3. Adherence with Antipsychotic Medication • Estimated prevalence of non-adherence in community settings ranges from 24% to 80% • Non-adherence is a major cause of increased symptoms and relapse • Relapse rates: • One year relapse rate for patients with psychosis who are adherent with treatment is about 20% – 30% • One year relapse rate without medication is around 70%

4. Adherence with Antipsychotic Medication • Poor adherence associated with re-hospitalisation, poor outcomes and high economic costs • In forensic settings refusal of medication is associated with disturbed and violent behaviour. • Symptoms may go undetected on prison wings • Risk to self, staff and other prisoners • Potential contribution to recidivism

5. Adherence with Antipsychotic Medication • Treatment adherence is a complex health behaviour affected by several factors such as efficacy of treatment, side effects and beliefs/attitudes about treatment. • No previous studies examining non-adherence with antipsychotics in prisoners

6. Study Aims • Estimate the point prevalence of non-adherence to antipsychotics in prisoners • Determine prisoners’ satisfaction with and beliefs and attitudes towards antipsychotics • Identify predictors of adherence • Explore subjective experiences of medication • Act as a pilot for a larger study

7. Research Design • Observational cross sectional survey of treatment non-adherence with antipsychotic medication • Chosen prisons should provide a sample broadly representative of the general prison population • HMP Bronzefield – female local • HMP Brixton – male local • HMP Winchester – male local and cat C • Running parallel to the in-reach research study

8. Relationship to the In-Reach Study • Three year project undertaken in several prisons including Bronzefield and Winchester • Aims to provide evidence about the success and effectiveness of the in-reach initiative to improve the mental health care of prisoners • Clinical interviews identify those prisoners with severe mental illness who are prescribed antipsychotic medication

9. Inclusion Criteria • Aged over 18 • In prison for at least a month • Capacity to give written informed consent • Absence of organic brain disease or severe learning disability • Prescribed (but not necessarily adherent with) any antipsychotic medication for at least 8 weeks

10. To minimise disruption, information gleaned from the in-reach study interview is used to complement data from the current study • Participants at HMP Brixton are recruited with the help of a consultant psychiatrist

11. Data Collection - Interviews • Self-report and interviewer rated measures to assess: • Adherence • Satisfaction with treatment (SWAM) • Insight into illness (ISP) • Psychopathology (BPRS) • Attitudes and beliefs towards treatment (DAI) • Side effects of treatment (LUNSERS) • Facilitates comparison between responses • Determines associations with adherence/non-adherence

12. Data Collection - Interviews • Short qualitative interview • Addresses themes of: • Past experiences of medication • Current views of medication • Satisfaction with treatment • Relationships with mental health professionals • Methods of medication avoidance • Flexible and responsive topic guide • Aims to provide rich, contextual data about participants’ views and experiences

13. Data Collection – Case Note Analysis • Analysis of IMRs, mental health and general prison records to determine possible predictors of adherence including: • Demographics • Prison characteristics • Health service factors • Illness characteristics • Medication • Violence/behavioural disturbance

14. Progress So Far… • Recruitment started in July for HMP Bronzefield and in August for HMP Winchester • Recruitment started in September for HMP Brixton • Participants prescribed a variety of different antipsychotics • Recruited only 16 participants so far • We aim to recruit a total of 90 participants (somewhat optimistic!) • Alternative recruitment strategies

15. Working with Prisons in Mental Health Research • Barriers: • Gaining access to prisons • Navigating the research governance process with a private healthcare provider • Limitations (due to service issues) on research time

16. Practical Challenges • Obtaining rooms to carry out interviews and ensuring that officers escort prisoners from their cells • Prison officer staffing levels • Non-attendance • Recording equipment

17. A Pilot Study of Satisfaction and Adherence with Antipsychotic Medication Amongst Prisoners Dr Alice Mills – Alice.Mills@soton.ac.uk Mr Dan Bressington Dr Richard Gray Prof Judith Lathlean