Presentation on theme: "Mental Health Needs of Female Prisoners"— Presentation transcript:
1Mental Health Needs of Female Prisoners Dr Pradeep PasupuletiNHS GG&CConsultant Forensic PsychiatristVisiting Psychiatrist at HMP Cornton Vale
2Today’s talk 20 slides Case examples Evidence on prevalence of mental disorder is prisonsHMP Cornton Vale statsChallenges
3Case example 142 year old, h/o “hearing voices” for 17 years, diagnosis of paranoid schizophrenia, had few very long admissions into psychiatric hospitals, no improvement in symptoms, diagnosis reviewed to BPD 3 years ago before discharging from psychiatric services. Banned from GP practice, frequent attendee at A&E asking to get admitted into hospital, evicted from 4 previous temporary accommodations.6 prison sentences in the past 3 years. Longest in the community 4 weeks. Repeated public order offences.Presentation in prison characterised by responding to auditory hallucinations, occasional abusive towards staff and fellow inmates but no major management problems. Liberation in 4 weeks.
4Case example 2A 26 year old presenting with frequent history of self harm, excessive drinking and non-compliance with any of the community support packages. Repeat offender, most offences were against support workers including the index offence. Has been on various antidepressants from the age of 18, had few crisis admissions mostly in the context of self harm whilst under the influence of alcohol. h/o CSA, disruptive at school, alcoholism in the family.Disruptive in prison, poor frustration tolerance, unpredictable behavior involving self harm and violence.Due for liberation in 4 weeks.
5Case example 319 year old, 4th time in custody, mostly for BoP (para suicide) and BoB. h/o CSA, abusive family. Previously contacts with CAMHS, seen by LD services, poor compliance, discharged as ‘nothing much to offer’.Evidently low IQ, frequent self harm behaviour in prison and “wants to end her life”.SW very anxious about her liberation as she goes back into same abusive household, ‘no help’ from health and unlikely to comply with any conditions.
6Mental disorders in prisons Fazel and Danesh (2002)Systematic review of 62 surveys (12 countries), prisoners: 4% psychosis, 12% major depressive disorder, 47% (M) & 21% (F) ASPDSingleton et al, 1998The largest study into prisoners in England and WalesPsychosis 7% in convicted male prisoners (n=1121) and 10% in male remanded prisoners (n=1250).40% and 59% respectively had neurotic disorder,63% and 58% alcohol abuse, and 43% and 51% drug abuse.
7Scottish studiesCook et al (1994): 7.3% major psychological disorder, 32% neurotic, 38% alcohol abuse or dep and 21% drug abuse or depDavidson et al (1995): in a study on remand prisoners (n=389) 2.3% psychosis, 24.8% neurotic, 22% alcohol abuse or dependence and 73% drug abuse or dep
8Scottish studiesBartlett et al (2000): study of inceptions into HMP Barlinnie over a one week period, 5% psychotic and 30% depression and anxietyFraser, Thomson and Graham: A six month audit of prison transfers, 16/22 within 3 daysHMIP report 2007: 80% in Cvale had some MH problems; 60% under the influence of drugs at the time of offenceHer Majesty’s Inspectorate of Prisonsreport
9Female prison estate Prison Number Cornton Vale 186 Polmont 104 Edinburgh106Greenock52Aberdeen (Community Integration Centre)3Total451Data accurate on
102012 statistics Average admissions per year to HMP Cornton Vale: 2000 Number of referrals to prison mental health team: 693 ( per month)Total new appointments: 81Total number of follow-up appointments: 133 (41 patients)
11D&A Statistics Addictions referrals Oct 12- Mar 13 (5 months) Type NumberAverage no. of admissions834Total number of referrals428 (51%)Drug detox345 (41%)Alcohol detox83 (10%)
12Prison transfers Year Number of transfers 2007 7 2008 6 2009 8 2010 13 201115201229
18Key challenges Variations in Court diversion framework Problems with centralizationPoor correspondencePrison as a facility for “further psychiatric assessment”Provision of Psychiatric reports to the court- delaysCentralization: female prisoners find themselves far from home. Problems with visits from family. Problems to access services during and aftercare.
19Challenges in custodial setting Complex needsDiagnostic complexity: Mental illness V PDUndiagnosed LDASDCo-morbid substance misuseARBDProblem behaviour
20ChallengesModel of care for the visiting psychiatrist: Clinic list management V Case managementIdeal Prison Mental Health TeamHospital transfers: access to bedsYoung offenders
21Aftercare challenges Follow-up arrangements PD, a “diagnosis of exclusion”HomelessnessD&AVariations in inter-agency working models
22Current practice Developing multidisciplinary approach MDMHT as a forum for case discussionsCase management model in complex cases (CPA, ASP Act)New challenging behaviour serviceTeaching and trainingGood relationships