Abstract
Psychosis is more prevalent among people in prison compared with the community. Early detection is important to optimise health and justice outcomes; for some, this may be the first time they have been clinically assessed. Determine factors associated with a first diagnosis of psychosis in prison and describe time to diagnosis from entry into prison. This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006-2012). Logistic regression was used to identify factors associated with a first diagnosis of psychosis. Cox regression was used to describe time to diagnosis from entry into prison. Of the 38 489 diagnosed with psychosis for the first time, 1.7% (n = 659) occurred in prison. Factors associated with an increased likelihood of being diagnosed in prison (versus community) were: male gender (odds ratio (OR) = 2.27, 95% CI 1.79-2.89), Aboriginality (OR = 1.81, 95% CI 1.49-2.19), older age (OR = 1.70, 95% CI 1.37-2.11 for 25-34 years and OR = 1.63, 95% CI 1.29-2.06 for 35-44 years) and disadvantaged socioeconomic area (OR = 4.41, 95% CI 3.42-5.69). Eight out of ten were diagnosed within 3 months of reception. Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in NSW prisons for detecting those with serious mental illness. It is important these individuals receive appropriate care in prison, have the opportunity to have matters reheard and possibly diverted into treatment, and are subsequently connected to community mental health services on release. None.
Highlights
Psychosis is more prevalent among people in prison compared with the community
Eight out of ten were diagnosed within 3 months of reception. Among those diagnosed with psychosis for the first time, only a small number were identified during incarceration with most identified in the first 3 months following imprisonment. This suggests good screening processes are in place in New South Wales (NSW) prisons for detecting those with serious mental illness
The current study describes those identified as having a first diagnosis of psychosis in NSW prisons, between July 2006 and December 2012, factors associated with a first diagnosis in prison and time to first diagnosis after entry into prison using data from a population-based linkage study
Summary
This retrospective cohort study describes individuals identified for the first time with psychosis in New South Wales (NSW) prisons (2006–2012). Our study population included all individuals who had a first diagnosis of psychosis between 1 July 2006 and 31 December 2012 in NSW, Australia Individuals in NSW with at least one public or private hospital admission episode or emergency department presentation in which a primary or additional diagnosis of psychosis was recorded in either the NSW Admitted Patients Data Collection (APDC) between July 2001 and December 2012, or in the NSW Emergency Patients Data Collection (EDDC) between June 2005 and December 2012 (Fig. 1). We examined the NSW Mental Health Ambulatory data collection (MH-AMB) to determine whether any of the first-diagnosis group had any psychosis-related presentation in this collection between July 2006 and December 2012 and before the diagnosis dates determined from APDC or EDDC and if so, considered this to be the first diagnosis. Prison diagnoses and treatment episodes are recorded in the APDC, EDDC and the MH-AMB database
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