Abstract
BackgroundInternational studies show a consistent finding of women in prisons as having a high prevalence of mental disorder. Most will be treated within the prison however the most severely ill require transfer to a hospital facility. The primary aim of our study was to survey the total provincial female prison population in Ontario, Canada, to determine the proportion that require treatment in a psychiatric hospital, and the security level required. The secondary aim was to investigate the validity and psychometric properties of DUNDRUM-1 and DUNDRUM-2 in making these assessments.MethodsWe carried out a cross-sectional study of all remand and sentenced female inmates detained in all 16 provincial jails that hold women in Ontario. The severity of mental health need was categorised by mental health staff on a five-point scale. Two forensic psychiatrists then examined all medical files of prisoners that had been categorised in the highest two categories and a random sample of nearly a quarter of those in the third category. An overall opinion was then made as to whether admission was required, and whether a high intensity bed was needed, and files were rated using DUNDRUM-1 and DUNDRUM-2.ResultsThere were 643 female inmates in provincial prisons in Ontario. We estimated that approximately 43 (6.7%) required admission to a hospital facility, of which 21.6 [prorated] (3.4%) required a high intensity bed such as a psychiatric intensive care bed within a secure hospital. The DUNDRUM-1 and -2 tools showed good internal validity. Total scores on both DUNDRUM-1 and DUNDRUM-2 were significantly different between those assessed as needing admission and those who did not, and distinguished the level of security required.ConclusionThis is the first study to determine level of need for prison to hospital transfers in Canada and can be used to inform service capacity planning. We also found that the DUNDRUM toolkit is useful in determining the threshold and priorities for hospital transfer of female prisoners.
Highlights
International studies show a consistent finding of women in prisons as having a high prevalence of mental disorder
Aside from psychiatric hospitals operated by the Ontario Ministry of Health and Long-Term Care that are designated Schedule 1 facilities, there is a Schedule 1 psychiatric facility known as a “treatment centre” that is operated by the Ministry of Community Safety and Correctional Services (MCSCS), which is for male prisoners who require psychiatric treatment
We found that total DUNDRUM-1 scores distinguished between those needing hospital admission versus those that did not, area under the curve (AUC) = 0.75
Summary
International studies show a consistent finding of women in prisons as having a high prevalence of mental disorder. 4% of women in prisons worldwide have a psychotic illness, and around 14% have a major depressive disorder [4] This group frequently have complex and multiple needs due to having simultaneous mental disorders, high rates of previous trauma [5] and high levels of psychological distress [6]. In order to develop inpatient services to meet the needs of female prisoners, there must be an attempt to quantify the level of need, and to estimate the number and proportion of female inmates who are most severely ill, and who need transfer to hospital for treatment. We set out to estimate the number of female prisoners currently in provincial jails in Ontario that require mental health treatment in a hospital facility. The secondary aim was to investigate the utility of DUNDRUM-1 and DUNDRUM-2 in making these assessments
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
