Abstract
BackgroundVulnerable prisoners and mentally disordered offenders who present with risk of harm to self or others were accommodated in Special Observation Cells (SOCs) isolated from others for considerable periods of time. This practice has been criticised by the Council of Europe Committee for the Prevention of Torture. The objective of this initiative was to reduce the use of seclusion within the prison and to improve the care of vulnerable and mentally ill prisoners within the prison.ResultsThe prison studied is a committal centre for sentenced prisoners with an official bed capacity of 630. The forensic mental health in-reach team, in co-operation with the prison health service followed the 'spiral' of planning, action and fact finding about the results of the action. In December 2010 a 10 bed High Support Unit (HSU) was established within the prison. During the first year, 96 prisoners were admitted. A third (35%) reported psychotic symptoms, 28% were referred due to the immediate risk of self-harm, 17% were accommodated for medical treatments and increased observation, 13% received specialised treatment by the Addiction Psychiatry team, 6% presented with emotional distress. One prisoner was accommodated on the HSU due to the acute risk he posed to others. A major mental illness was diagnosed in 29%, 20% required short-term increased support for crisis intervention and were found not to have a mental illness. A further 10% were deemed to be feigning symptoms of mental illness to seek refuge in the HSU. 7% had personality disorder as their primary diagnosis and 4% had a learning disability. Stratifying risk within the prison population through the provision of the HSU decreased the total episodes of seclusion in the prison by 59% (p < 0.001) in addition to providing a more effective psychiatric in-reach service to the prison. Pathways between the prison and the forensic psychiatric hospital saw no change in activity but improved continuity of care.ConclusionsThe next step is to further stratify risk by establishing a low support unit to serve as a step-down from the high support unit.
Highlights
Vulnerable prisoners and mentally disordered offenders who present with risk of harm to self or others were accommodated in Special Observation Cells (SOCs) isolated from others for considerable periods of time
The agreed principles of risk-need responsivity, stratification of risk and need and the necessity of reducing the use of isolation cells (SOCs) emerged from the process as a common agenda and the High Support Unit, with co-operative working emerged as the common solution
The introduction of the high support unit has achieved the goal of reducing the use of special observation cells and has improved compliance with human rights standards [5,6], as recommended [7,12,13]
Summary
Vulnerable prisoners and mentally disordered offenders who present with risk of harm to self or others were accommodated in Special Observation Cells (SOCs) isolated from others for considerable periods of time This practice has been criticised by the Council of Europe Committee for the Prevention of Torture. Human Rights [3] and European Convention on Human Rights [4] have set out that prisoners retain all their human rights including the rights to life, freedom from torture, privacy and family life These rights have been elaborated for prisoners in the UN Standard Minimum Rules for the Treatment of Prisoners [5] and the Council of Europe Committee for the Prevention of Torture (CPT) Standards [6]. The Irish Prison Service has been visited regularly by the CPT and this project arose in response to these inspection reports [7]
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