From Positive Screen to Engagement in Treatment: A Preliminary Study of ihe Impact of a New Model of Care for Prisoners with Serious Mental Illness
BACKGROUND:
The
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.
METHOD:
The 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.
RESULTS:
The
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.
CONCLUSIONS:
The
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.
Below: The Prison Model of Care Referral and Treatment Pathway
Below: Diagnostic cumulative composition of in-reach case load under treatment over 12 month study period
- 1Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. Krishna.Pillai@waitematadhb.govt.nz.
- 2The University of Auckland, Auckland, New Zealand. p.rouse@auckland.ac.nz.
- 3Australian Catholic University and NorthWestern Mental Health, Level 1 North, City Campus, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia, 3050. Brian.McKenna@mh.org.au.
- 4Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. Jeremy.Skipworthi@waitematadhb.govt.nz.
- 5Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. James.Cavney@waitematadhb.govt.nz.
- 6Midlands Regional Forensic Psychiatric Service, Waikato District Health Board, Hamilton, New Zealand. Rees.Tapsell@waikatodhb.health.nz.
- 7Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada. Sandy.Simpson@camh.ca.
- 8The University of Auckland, Auckland, New Zealand. Dominic.Madell@middlemore.co.nz.
- BMC Psychiatry. 2016 Jan 15;16(1):9. doi: 10.1186/s12888-016-0711-2.
No comments:
Post a Comment