Coral Sirdifield

A systematic review of research on the epidemiology of mental health disorders in prison populations: a summary of findings

Brooker et al. (2002) conducted a systematic review of research into the mental health of prisoners. Their final report included a review of the epidemiology of the prison population, an overview of the interventions used to treat the major mental health disorders in both the general and prison populations, and a review of service delivery and organisation for prisoners with mental health disorders. The review found a high prevalence of mental health disorders in prison populations, with up to 15% of prisoners having four or five co-existing mental disorders. This review has been updated, using the same methodology, to include literature dated from 2002 to August 2006. This paper presents findings from the epidemiology section of the updated review, which includes 18 new studies. The recent studies largely reflect the findings of earlier research. However, some studies in the updated review focus on countries where little of this type of research has previously been conducted. The prevalence of mental health disorders, suicide, and substance misuse remains high in prison populations around the world – demonstrating the need for suitable evidence-based interventions to address these issues. Future research should concentrate on mapping interventions available to prisoners and evaluating their effectiveness.

General practitioners’ experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis

BackgroundBenzodiazepines are often prescribed long-term inappropriately. We aimed to systematically review and meta-synthesise qualitative studies exploring clinicians’ experiences and perceptions of benzodiazepine prescribing to build an explanatory model of processes underlying current prescribing practices.MethodsWe searched seven electronic databases for qualitative studies in Western primary care settings published in a European language between January 1990 and August 2011 analysing GP or practice nurse experiences of benzodiazepine prescribing. We assessed study quality using the Critical Appraisal Skills Programme Checklist. We analysed findings using thematic synthesis.ResultsWe included eight studies from seven countries published between 1993 and 2010. Benzodiazepine prescribing decisions are complex, uncomfortable, and demanding, taken within the constraints of daily general practice. Different GPs varied in the extent to which they were willing to prescribe benzodiazepines, and individual GPs’ approaches also varied. GPs were ambivalent in their attitude towards prescribing benzodiazepines and inconsistently applied management strategies for their use. This was due to the changing context of prescribing, differing perceptions of the role and responsibility of the GP, variation in GPs’ attitudes to benzodiazepines, perceived lack of alternative treatment options, GPs’ perception of patient expectations and the doctor-patient relationship. GPs faced different challenges in managing initiation, continuation and withdrawal of benzodiazepines.ConclusionWe have developed a model which could be used to inform future interventions to improve adherence to benzodiazepine prescribing guidance and improve prescribing through education and training of professionals on benzodiazepine use and withdrawal, greater provision of alternatives to drugs, reflective practice, and better communication with patients.

The prevalence of mental health disorders amongst offenders on probation: a literature review.

Background There is increasing focus on addressing the mental health needs of offenders throughout the criminal justice system. However, there is currently a gap in the literature for a review of research into the prevalence of mental health disorders amongst offenders on probation. Aims To review existing literature on the prevalence of mental health disorders in probation populations in order to inform the provision of health services to this group. Method A comprehensive review of the literature on the topic to date across ASSIA, Web of Science, IBSS, CINAHL and MEDLINE databases. Results A total of 18 papers were identified. Four of these studies were based on probation approved premises, six on probation psychiatric services and eight on broader probation populations. The prevalence of mental illness reported varies widely across these papers. Conclusion One can tentatively conclude that there is a high prevalence of mental illness and high rates of co-morbidity in offenders on probation. However, variation in study settings and methodology make it difficult to reach firm conclusions on the likely prevalence of mental illness in probation populations from the existing literature. There is a need for further high-quality research in this area.

Probation and mental illness

Levels of mental illness amongst prisoners are high, but little is known about the situation of those serving community sentences. More information is needed at a time when the UK Department of Health is seeking to improve mental health service access for all offenders. To estimate the prevalence of both current and lifetime mental illness, an epidemiological survey was conducted on individuals under probation supervision in Lincolnshire, England. Assessment included the Mini International Neuropsychiatric Inventory and other measures of mental health. We estimate that around 39% of individuals in this probation population are suffering from current mental illnesses, anxiety disorders being the most common. Furthermore, around 60% have substance abuse problems and around 48% have personality disorders. Lifetime mental illness, co-morbidity and dual diagnosis were also found to be high. In common with other groups of offenders, the prevalence of mental health problems in those serving community sentences is high.

Review of service delivery and organisational research focused on prisoners with mental disorders

This paper reports a structured review of the service development and organisational (SDO) research literature focused on prisoners with mental disorders. A large number of databases were searched, using a combined free-text and thesaurus approach. Papers were included if they had been published since 1983, were written in English, and contained research findings. Commentaries or descriptions of local service innovation were excluded. In all, 103 papers were identified that met all criteria; these were divided into 13 categories (e.g. screening, 18 papers; professional roles, 13 papers). The paper concludes that there is a clear need to consider commissioning SDO research for offenders in England and Wales in a coherent programme.

A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing

BackgroundBenzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people.ObjectiveThe aim of this study was to identify and synthesise qualitative studies exploring patients’ experiences and perceptions of receiving benzodiazepines and Z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing.MethodsA systematic search of six databases for qualitative studies exploring patients’ experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis.ResultsNine papers were included and seven analytical themes were identified relating to patients’ experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and Z-drugs: (1) patients’ negative perceptions of insomnia and its impact, (2) failed self-care strategies, (3) triggers to medical help-seeking, (4) attitudes towards treatment options and service provision, (5) varying patterns of use, (6) withdrawal, (7) reasons for initial or ongoing use.ConclusionsInappropriate use and prescribing of benzodiazepines and Z-drugs is perpetuated by psychological dependence, absence of support and patients’ denial/lack of knowledge of side effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing.

Mental disorder and probation policy and practice: A view from the UK☆

This article is concerned with the manner in which offenders with mental illnesses serving community sentences are identified and treated by the probation service in the UK. It presents the results of recent research examining the prevalence levels of current and lifetime mental illness, substance misuse, and dual diagnosis and suicide rates amongst those serving community sentences in the UK. These high levels of mental disorder are not being addressed by probation policy or practice in a manner that is effective or sensitive. The article concludes by considering the relevance of innovative approaches to the treatment of offenders with mental illnesses in the community currently being adopted in the US to the UK.

Lord Bradley’s review of people with mental health or learning disabilities in the criminal justice system in England: All not equal in the eyes of the law?

In December 2007, Lord Bradley was asked by the Government, in a six‐month period, to review court liaison and diversion schemes for mentally ill people. A year and a half later, and having extended the brief to encompass the entire criminal justice system, Lord Bradley has reported. The Government has now responded to Bradleys’ findings (Ministry of Justice, 2009) so it is timely to comment on the review particularly in relation to prisons in England. The English prison population is almost at its highest ever level and currently stands at around 82,000 people ‐ according to the Prison Service’s standard of certified normal accommodation, the prison population is now 8000 more than it should be. As HM Chief Inspector of Prisons, Anne Owers, has noted ‘activity and support from staff . . . were the two things thought to be most helpful by prisoners with mental health and emotional problems, in over‐crowded and under‐resourced prisons these essential elements of care are at a premium’ (HM Inspectorate of Prisons, 2007).

Detainees in police custody: results of a health needs assessment in Northumbria, England

PURPOSE The purpose of this paper is to assess the health needs of detainees in police custody in Northumbria, England, and to identify any gaps in, or possible improvements to, the current model of healthcare provision. DESIGN/METHODOLOGY/APPROACH The current model of service provision was investigated using a combination of existing literature, and interviews with key members of staff. In addition, researchers examined the custody records of a stratified random sample of 1,917 records from 2010 and 2011. Data were collected from the risk assessments completed by Custody Sergeants, and any associated records of medical assessments by Forensic Medical Examiners (FME). FINDINGS Detainees experience a wide range of health problems. Delivery of healthcare in custody could be improved through increasing the skill-mix in this setting, computerising FME records and improving communication between agencies. Research limitations/implications - The police did not always record the reason why a forensic medical examiner was called out, thus this aspect of data collection was limited. ORIGINALITY/VALUE This health needs assessment will help to determine the way in which resources for health care in custody, currently held by the police, are reallocated once the funding transfers to the NHS in the near future.

The Importance of Mental Health Awareness Training in a European Probation Training Curriculum

In 2009 the CEP held a conference centring around the concept of a pan-European probation training curriculum. This article draws on the results of an evaluation of some training conducted in the UK to argue that mental health awareness training should form part of such a common training programme. The article outlines the potential benefits of making such training mandatory for staff working in probation systems across Europe. In addition, it identifies the role of instructional design in constructing learning resources which are flexible enough to be reconfigured to be relevant in different cultural contexts without diminishing the learning process.