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Continuity of supply of psychiatric medicines for newly received prisoners

  • Lamiece Hassan (a1) (a2), Jane Senior (a1), Dawn Edge (a3) and Jenny Shaw (a1) (a2)
Abstract
Aims and method

A retrospective case-note review was undertaken at five English prisons between June 2008 and March 2009 to estimate the proportion of psychiatric medicines (antidepressants, antipsychotics and hypnotics/anxiolytics) reported at prison reception that are discontinued on entry to prison.

Results

Of the 1006 records sampled, the review showed that 18% of prisoners had been prescribed psychiatric medication before being placed in custody. Altogether, 240 separate psychiatric medicines were recorded among prisoners at reception. Of these, 47% were not prescribed during the first week of custody. In only 11% of cases where medication was discontinued had psychiatric assessment been completed.

Clinical implications

Prison mental health policy states that psychiatric medication should not be withdrawn in custody without proper clinical assessment. Denial of medication in the absence of clinical assessment during early custody has the potential to create additional stress in individuals during a period of increased vulnerability and risk.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Lamiece Hassan (lamiece.hassan@nhs.net)
Footnotes
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Declaration of interest

None.

Footnotes
References
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Continuity of supply of psychiatric medicines for newly received prisoners

  • Lamiece Hassan (a1) (a2), Jane Senior (a1), Dawn Edge (a3) and Jenny Shaw (a1) (a2)
Submit a response

eLetters

Prison GP services are reluctant to prescribe psychotropics

Trevor D Broughton, Consultant Forensic Psychiatrist
11 July 2011

The significant frustration felt by those routinely working in the difficult and challenging environment of prison has rightly had the spotlight shone upon it (1). In my experience General Practitioners (GPs) working in these settings are reluctant to prescribe psychotropic medications often to the point of obstinacy. The reasons put forward are mostly that:- (a) the GPs themselves have no experience or confidence in prescribing these medications and (b) there isa perception that this is solely the remit of in-reach mental health services. The latter explanation has taken on absurd dimensions where prison GPs have refused to continue a prescription of a commonly used antidepressant, started by a GP in the community, without it being authorized by a psychiatrist! I would like to see a similar study done comparing the continuity of prescribing of other chronic medications (i.e. anti-hypertensives or anti-hyperglycaemic agents) for newly received prisoners. I suspect that there wouldbe significantly less discontinuity with these agents, as a GP would be rightly criticized for claiming that he or she wouldn't continue with a patient'sACE-Inhibitor unless it was prescribed by a cardiologist! Indeed arecent audit from the Offender Health Research Network (2010) (2) hinted that psychotropic medications were more likely to be omitted following reception when compared to other medications. In my view this issue highlights the ongoing fault-lines of professional disdain and mistrust towards psychiatry among our other medical colleagues (3),(4),(5). Solving this problem will have to go beyond the platitude of the "additional training required" and necessitate a significant drive to improve the image of psychiatry as a credible medicaldiscipline.

References:

1) Hassan L et al (2011) Continuity of supply of psychiatric medicines for newly received prisonersThe Psychiatrist 2011; 35: 244-248

2) Offender Health Research Network (April 2010) "An audit of medication prescribing practices following imprisonment" OHRN. Available at: www.ohrn.nhs.uk/resource/Research/MedicationAuditOHRN2010.pdf (Last accessed: 10.07.2011)

3) Craddock N et al (2008) “Wake-up call for British psychiatry” BJPsych 193(1):6-9

4) Brockington & Mumford (2002)“Recruitment into psychiatry” BJPsych 180:307-312

5) Storer D (2002) “Recruiting and retaining psychiatrists” BJPsych 180:296-297
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