Dominic Madell

From positive screen to engagement in treatment: a preliminary study of the impact of a new model of care for prisoners with serious mental illness

BackgroundThe high prevalence of serious mental illness (SMI) in prisons remains a challenge for mental health services. Many prisoners with SMI do not receive care. Screening tools have been developed but better detection has not translated to higher rates of treatment. In New Zealand a Prison Model of Care (PMOC) was developed by forensic mental health and correctional services to address this challenge. The PMOC broadened triggers for referrals to mental health teams. Referrals were triaged by mental health nurses leading to multidisciplinary team assessment within specified timeframes. This pathway for screening, referral and assessment was introduced within existing resources.MethodThe PMOC was implemented across four prisons. An AB research design was used to explore the extent to which mentally ill prisoners were referred to and accepted by prison in-reach mental health teams and to determine the proportion of prison population receiving specialist mental health care.ResultsThe number of prisoners in the study in the year before the PMOC (n = 19,349) was similar to the year after (n = 19,421). 24.6 % of prisoners were screened as per the PMOC in the post period. Referrals increased from 491 to 734 in the post period (Z = −7.23, p < 0.0001). A greater number of triage assessments occurred after the introduction of the PMOC (pre = 458; post = 613, Z = 4.74, p < 0.0001) leading to a significant increase in the numbers accepted onto in-reach caseloads (pre = 338; post = 426, Z = 3.16, p < 0.01). Numbers of triage assessments completed within specified time frames showed no statistically significant difference before or after implementation. The proportion of prison population on in-reach caseloads increased from 5.6 % in the pre period to 7.0 % in the year post implementation while diagnostic patterns did not change, indicating more prisoners with SMI were identified and engaged in treatment.ConclusionsThe PMOC led to increased prisoner numbers across screening, referral, treatment and engagement. Gains were achieved without extra resources by consistent processes and improved clarity of professional roles and tasks. The PMOC described a more effective pathway to specialist care for people with SMI entering prison.

Self-reported health-related quality of life of mental health service users with serious mental illness in New Zealand

INTRODUCTION Although people with serious mental illness (SMI) have a high prevalence of physical illness, health-related quality of life (HQoL) has not been sufficiently explored. AIM To explore the self-reported HQoL of mental health service users in New Zealand. METHODS Responses on the Medical Outcomes Study 36 Item Short Form (SF-36) measure of HQoL from 404 adult mental health service users in a metropolitan district health board area in New Zealand were analysed and compared to a representative sample of the general population. RESULTS Mental health service users scored significantly lower on all eight domains of the SF-36 than the general population, the largest difference being in the role limitation-emotional domain. DISCUSSION Being female, younger than 25, obese or overweight, or of New Zealand European/Other ethnicity were associated with poorer functioning on multiple HQoL domains. Future studies should seek to understand the factors contributing to perceptions of HQoL of mental health service users in New Zealand.

Patterns of mental health service contact before and after forensic mental health contact in New Zealand

Objective: To describe patterns of mental health service contact before and after contact with a regional forensic mental health service (FMHS) to assist regional mental health service planning. Method: All new referrals to Auckland Regional FMHS in 2006 were audited for contact with mental health services in the three years before and three years after their contact in 2006. Results: A total of 925 identified individuals were referred to the Auckland Regional FMHS in 2006, predominantly through the court (81%) or prison (17%). In the preceding three years, 30.2% of these service users had no mental health service contact, 41.4% had general adult mental health service (GAMHS) contact alone, 22.6% had both FMHS and GAMHS contact, and 5.8% had FMHS contact alone. In the three years after 2006, 13.4% had no further contact with either FMHS or GAMHS, 20.3% had GAMHS contact alone, 51.2% of the sample had contact with both FMHS and GAMHS, and 15% had only FMHS contact. Conclusions: The service utilization patterns of this population support the establishment of strong links between GAMHS and FMHS in courts and prisons. Further research is needed to determine the specific models most likely to improve clinical outcomes.

Evaluation of general practice house officer attachments in Counties Manukau: insights and benefits

BACKGROUND The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS HOs saw 300-600 patients in one practice and 800-1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care.

Impact of an assertive community treatment model of care on the treatment of prisoners with a serious mental illness

Objectives: This study aims to describe the impact of a mental health assertive community treatment prison model of care (PMOC) on improving the ability to identify prisoner needs, provide interventions and monitor their efficacy. Methods: We carried out a file review across five prisons of referrals in the year before the implementation of the PMOC in 2010 (n = 423) compared with referrals in the year after (n = 477). Results: Some improvements in the identification of needs and providing interventions were detected. There was increased use of medication management and clinically significant improvement in addressing engagement with families. Monthly multi-disciplinary team face-to-face contact improved. Conclusions: Meeting the needs of mentally ill prisoners is challenged by the complexity of the custodial environment. Improvements made resulted from changing the model of care, rather than adding new resources.

A Systematic Review of Literature Relating to Problem-Solving Youth Courts

This article presents the results of a systematic review of empirical studies of problem-solving youth courts. Some of the 24 studies reviewed showed positive effects of court processes and others showed few substantial benefits in comparison with other kinds of programme. In general, the studies were not necessarily guided by a coherent research strategy. The article concludes by suggesting that a therapeutic jurisprudence evaluation model suggested by Wiener et al. could be applied to future youth problem-solving court research to assist in understanding youth problem-solving court processes and outcomes [Wiener, R.L., Winick, B.J., Skovran Georges, L., & Castro, A. (2010). A testable theory of problem solving courts: Avoiding past empirical and legal failures. International Journal of Law and Psychiatry, 33, 417–427].