Setting

This audit is relevant to all psychiatric specialties with multidisciplinary mental health teams who interact with prisoners on the care programme approach (CPA).

Background

The CPA is an integral part of providing a safe and effective service for those with mental health problems in prison. Continuity of care from prison to the community is a particular conundrum. Prisoner mental health is an important aspect of healthcare. Singleton et al (1998) found that 90% of prisoners had psychiatric morbidity (psychosis, neurosis, personality disorder, or substance misuse problems).

Standards

The aim was to analyse the quality of CPA by multidisciplinary teams in prisons as per the standards set out in The CPA Handbook (Care Programme Approach Association, 2009):

ᐅ comprehensive initial assessment

ᐅ appointment of a care coordinator

ᐅ date set for the next CPA review (every 6 months and before release, transfer or discharge)

ᐅ appropriate focus on risk assessment and management

ᐅ documented care plan, updated appropriately

ᐅ a crisis and contingency plan that is ‘formulated, updated and circulated’

ᐅ identification of unmet needs

ᐅ outcomes reviewed using the HoNOS-secure instrument (the Health of the Nation Outcome Scales for users of secure and forensic services), completed initially, then every 6 months and before discharge)

ᐅ if CPA is withdrawn, that an appropriate handover (e.g. letter to general practitioner) is undertaken (which could include exchange of information, plans for reviews, support and follow-up, and whom to contact if necessary, for example in the case of relapse).

Method

Data collection

Case files (inmate medical records and prison mental health team files) were selected randomly for analysis to determine whether the national standards were being adhered to. These covered all accepted referrals from the prison mental health team, but only those relating to patients who had been discharged were reviewed.

Data were collected using an appropriately devised audit tool, which listed the national standards. In addition, the following data were obtained:

ᐅ dates of referral, acceptance and discharge

ᐅ age, gender and ethnicity

ᐅ index offence

ᐅ sentence type

ᐅ diagnostic category.

Data analysis

The number of individuals (on CPA) who met the national standards was determined and the percentage calculated. The results were presented in tabular form and in charts.