Adrian Hayes

The health and social needs of older male prisoners

This study aimed to quantify the health and social needs of older male prisoners in the North West of England, to determine whether their needs were being met, and to explore an age cut‐off for this group.

Identifying, monitoring and managing prisoners at risk of self-harm/suicide in England and Wales

Rates of self-harm/suicide in prisons are high and procedures for the management of risk are important in reducing such rates. The aim of this study was to evaluate a pilot initiative developed to improve the management of those at risk of self-harm/suicide (Assessment, Care in Custody and Teamwork [ACCT]). The method involved reception screening, clinical presentations of prisoners, care planning and mental health provision for prisoners at risk being compared before and after the pilot. The results were as follows: At reception, there was no change in the proportion of prisoners with suicidal ideation who were placed on an at risk document. While in prison, ACCTs being more likely to be opened following factors indicative of risk rather than actual self-harm and were more likely to contain ‘quality’ entries suggesting improved care of and engagement with vulnerable prisoners. While under the care of an at risk system, a higher proportion of prisoners were likely to be receiving primary mental health care input prior to ACCT implementation and prisoners on ACCT were more likely to be depressed but to be receiving no mental health care. Post-closure reviews were significantly less likely after the introduction of ACCT. The ACCT was piloted followed by phased implementation across the prison estate and findings are discussed in relation to further policy developments.

Social and custodial needs of older adults in prison

BACKGROUND older prisoners are a fast-growing group but there is limited evidence for how well their needs are being met. OBJECTIVES to quantify the social and custodial needs of older prisoners and suggest improvements for service provision. DESIGN cross-sectional study. SETTING twelve prisons holding adult males in North West England. SUBJECTS two hundred and sixty-two prisoners; 97 aged between 50 and 59, 165 aged 60 and over. METHODS interview and case-note review for issues of social and custodial need and quality of life in prison, including Forensic Camberwell Assessment of Need and Lubben Scale for social networks. RESULTS many had problems mixing with younger prisoners, accommodation and activities, and limited contact with friends and family. A small group had personal care needs which were not well managed in prison. CONCLUSION older prisoners have distinct social and custodial needs which need to be addressed by a national strategy for their care and management.

Improvements to Suicide Prevention Training for Prison Staff in England and Wales.

Suicide prevention training for the prison service in England and Wales has been criticized. STORM is a package emphasizing the practice and review of interactions with suicidal persons and was evaluated in a pilot study for use in prisons. Trainees completed questionnaires immediately before and after training and at 6 to 8 months follow-up. Training significantly improved attitudes, knowledge, and confidence, and improvements were maintained at follow-up. Satisfaction with training was very high. STORM was successfully adapted for prison settings, and showed good effects among staff trained. It should be provided to the wider prison estate, with regular refresher training.

The identification and management of suicide risk in local prisons.

Abstract This study aimed to examine rates of mental illness and suicidal ideation in a random sample of prisoners in four UK prisons, and to examine the characteristics and quality of care received by prisoners identified as at current risk of suicide/self harm. Methods used were: cross-sectional study of mental illness and suicidal ideation in a random sample of prisoners, and in all prisoners specifically managed as a suicide risk; examination of suicide risk care plans; and comparative study of information sharing across suicide risk and healthcare documentation. Results showed that prisoners identified as at risk of suicide/self harm had significantly higher rates of clinically significant symptoms of mental illness, as measured by a standardized instrument, than the general prison population. There was a high level of suicide risk that had not been identified. Problems with the delivery of planned care interventions were revealed and little congruence was found between systems of documentation. The suicide care planning system was correctly targeting a proportion of those at risk but high levels of unmet need remained. The care planning and information sharing processes within prisons and between prisons and other agencies should be improved.

Actions taken in response to mental health screening at reception into prison

Screening for mental health problems on reception into custody has been criticised. However, there have been few studies on care pathways through custody as a result of screening identification. We aimed to identify what actions were taken as a result of screening positive for suicidal ideation and mental health problems. Case records for 2166 prisoners newly received into five prisons in England and documented contact with health care professionals in the following month were examined by hand over a four-month period. Altogether, 3% of prisoners were screened as having current suicidal ideas, of whom 30% had no contact with mental health services or risk assessment documentation. Another 21% of new receptions received psychotropic medication, for whom over 60% received no primary mental health assessment, and only 36% received psychotropic medication in prison. Care pathways need to be defined, and screening needs to be delivered as originally intended by initial screen for life-threatening matters, followed by a later, comprehensive assessment of health needs.

The effectiveness of an enhanced thinking skills programme in offenders with antisocial personality traits

Although evidence is emerging that enhanced thinking skills (ETS) interventions are effective in reducing recidivism in prisoners, there is limited evidence supporting the effectiveness of ETS improving behaviour and functioning in prisoners with antisocial personality disorder (ASPD) traits. This study investigated the effectiveness of a group ETS programme in improving antisocial attitudes, anger regulation and social problem-solving skills in offenders with traits diagnostic of ASPD. A controlled trial was conducted comparing ETS programme with treatment as usual (TAU). Outcome measures were the Antisocial Personality Questionnaire, the Novaco Anger Scale and the Social Problem-Solving Inventory-Short Form. Significant improvements in the ETS group on all of the outcome measures were evident, when compared to TAU group. This study provides evidence that cognitive skills programmes based on ETS improve functioning in offenders with traits diagnostic of ASPD. The ETS programmes may be a therapeutic option when working with this historically difficult to treat group. However, further research is required that includes a randomised design, more objective behavioural outcome measures and a longer follow-up period.

Handedness, measures of hemispheric asymmetry, and lateralised lexical decision

The goals of the present study were to evaluate the differences between measures of lateralisation in the human brain derived from a dichotic listening (DL) task and from a task involving identification of visually presented consonant‐vowel‐consonant (CVC) nonwords, and to correlate these lateralisation indices with performance on a lexical decision task involving visually presented words and nonwords. Visual stimuli were presented either in a central position, or to the left or right of fixation. Left‐handed and right‐handed participants completed each of the three tasks. Lateralisation indices were derived from performance on the DL and CVC tasks, and latency and accuracy measures of lexical decision performance were obtained for targets presented centrally and parafoveally. Lateralisation indices for left‐handed and right‐handed participants differed significantly for both tasks, and the two lateralisation indices had different pattern of correlation with lexical decision performance for left‐ and right‐handers. For left‐handers, lateralisation indices derived from the (visual) CVC task were correlated with lexical decision response latency for targets in central and left visual field. For right‐handers, lateralisation indices derived from the (auditory) DL task were correlated with lexical decision response latency for targets in central and right visual field. A possible explanation for this finding is that the two laterality measures reflect specialisation for different types of linguistic processing in the human brain.

An independent evaluation of the Department of Health's procedure for the transfer of prisoners to hospital under the Mental Health Act 1983

In the UK, the Mental Health Act 1983 allows for the transfer of prisoners to hospital for treatment of acute mental illness. Historically, this process has been problematic with long delays. The Department of Health has produced guidance to encourage significant improvements in transfer delays. The research comprised: a clinical assessment of the psychiatric symptoms of prisoners awaiting transfer, an audit of transfer times, and interviews with key stakeholders. Prisoners awaiting transfer were severely ill with a mean score of 65 (range 25–120) measured by the Brief Psychiatric Rating Scale. Transfers were completed on average in 42 days. Barriers in the process included: communication difficulties, bed availability, a clash in organisational cultures, as well as security, clinical and assessment disputes. Since the guidance there has been a marked improvement transfer times. However, remaining difficulties within the transfer process are discussed.

Homicide convictions in different age-groups: a national clinical survey

The purpose of this study was to examine the social, clinical and forensic characteristics of all convicted homicide perpetrators by different age-groups over an 8-year period (1997–2004) in England and Wales. Perpetrators aged under 25 were more likely to use hitting or kicking compared to other offenders, and their victims were more often young, male and a stranger. In contrast, perpetrators aged 65 and over were most likely to use strangulation/suffocation and the victim was more often a female and a family member or spouse. In younger perpetrators, drug and alcohol misuse and previous violence were more common. Older perpetrators had high rates of affective disorder and were more likely to be mentally ill at the time of the offence. Targeting substance and alcohol misuse and street violence may reduce homicide risk in younger people. Preventing homicide among the elderly might be best achieved through more specialised GP training to improve recognition and treatment of depression.