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Secondary mental healthcare in prisons in England and Wales: results of a postal questionnaire

  • Nick Kosky (a1) and Clifford Hoyle (a2)
Abstract
Aims and method

Prison mental health inreach teams (PMHITs) were introduced in response to policy from 2003. This provision comes under the responsibility of the National Health Service. Service development and structure was not defined in policy. A total of 97 prisons of an estimated 100 known to have a PMHIT were targeted by postal questionnaire and responses covered 62 prisons. Team structures were captured in the data with specific regard to the number of available professional sessions.

Results

Findings determine there is generally no correlation between input and prison capacity, although there was some evidence of correlation in the high secure (category A) estate and that the female estate was generally better served.

Clinical implications

It is evident from this study that PMHITs have evolved piecemeal, with no clear standards or equity across the estate. This is of concern.

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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
Nick Kosky (nick.kosky@dorset-pct.nhs.uk)
Footnotes
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Declarations of interest None.

Footnotes
References
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1 HM Prison Service & NHS Executive Working Group. The Future Organisation of Prison Health Care. Department of Health, 1999.
2 Department of Health & HM Prison Service. Changing the Outlook: A Strategy for Developing Mental Health Services in Prisons. Department of Health, 2001.
3 Royal College of Psychiatrists. Prison Psychiatry: Adult Prisons in England and Wales (College Report CR141). Royal College of Psychiatrists, 2007.
4 Office for National Statistics. Psychiatric Morbidity among Prisoners in England and Wales. ONS, 1997 (http://www.statistics.gov.uk/STATBASE/Product.asp?vlnk=2676).
5 Department of Health. Improving Health, Supporting Justice: The National Delivery Plan of the Health and Criminal Justice Programme Board. Department of Health, 2009.
6 Daily Hansard. Written Answers 9 January 2007. Hansard, 2007 (http://www.publications.parliament.uk/pa/cm200607/cmhansrd/cm070109/text/70109w0018.htm).
7 HM Prison Service. Categorisation and allocation. Prison Service Order, no. 0900. HM Prison Service.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Secondary mental healthcare in prisons in England and Wales: results of a postal questionnaire

  • Nick Kosky (a1) and Clifford Hoyle (a2)
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eLetters

The Needs of Remand versus Sentenced Prisoners

Oriana Chao, Consultant Forensic Psychiatrist
11 January 2012

In their paper Kosky and Hoyle (1) use a postal questionnaire to consider the provision of secondary mental health care in prisons and their results state "there is generally no correlation between input and prison capacity, although there was some evidence of correlation in the high secure... estate."

Their introduction states "(t)he ONS data quantifies the ranges of morbidity across remand, convicted and female populations but do not consider security categorisation or age range." The high prevalence of mental disorder in prisons has been well documented with higher levels of mental ill-health established amongst particular groups e.g. women, older prisoners and juveniles (2). Perhaps more important is the absence of discussion in this paper of the higher morbidity amongst remand as compared to sentenced prisoners, a difference highlighted by Singleton et al (3). Indeed the Royal College of Psychiatrists in their 2007 Report provided specific guidelines on psychiatric input to prisons. In this theyacknowledged the method by which they came to the suggested norms was a guide, but crucially they differentiated between, not only security categorisation, but also local remand versus dispersal prisons(4). It is also worth noting that most prisons hold prisoners of a lower category, and the majority of prisoners in category A establishments are not actually category A.

Given known differences in levels of morbidity between remand and sentenced prisoners, it is surprising Kosky and Hoyle have chosen not to use this information in their results, particularly as this data was readily available (in terms of remand versus dispersal prisons). In our view this information is essential when considering any future secondary mental healthcare planning. However it would be even more useful if this included the proportion of remand versus convicted prisoners in establishments as well as the prison turnover. The paper perhaps only highlights what we already know anecdotally, that secondary healthcare in prisons varies and this variation may be arbitrary.

1 Kosky N, Hoyle C. Secondary mental healthcare in prisons in Englandand Wales: results of a postal questionnaire. The Psychiatrist 2011; 35: 445-448. 2 Fazel S, Baillargeon J. The Health of Prisoners. Lancet 2011; 377: 956- 65 3 Singleton N, Meltzer H, Gatwood R, Coid J & Deasy D. 1998; Psychiatric morbidity among prisoners in England and Wales. London: HMSO. 4 Royal College of Psychiatrists. Prison Psychiatry: Adult Prisons in England and Wales (College Report CR141). Royal College of Psychiatrists, 2007.

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Conflict of interest: Both authors work in prisons

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