Male Remand Prisoners Research Articles

Implementation costs of the appraise alcohol brief intervention (ABI) for male remand prisoners: A micro-costing protocol and preliminary findings.

This paper documents the methods used to assess the implementation costs of the APPRAISE alcohol brief intervention (ABI) delivered to male remand prisoners across two study sites in Scotland and North East England. We first developed a comprehensive taxonomy of the activities constituting the APPRIASE ABI. Next, data were collected for each activity about the study staff and the subject time spent, in addition to the other resources used and unit costs. From the pilot data collection it was possible to construct a narrative, for both study sites, for how the intervention was delivered and the time required for each activity. The ABI was delivered by Change Grow Live and Humankind intervention staff and staff salaries were obtained from both organizations to calculate the staff delivery costs for each site. Other costs, such as the printing of materials, were estimated based on APPRAISE study records. Due to the ongoing Covid-19 restrictions and limited access to prison resources and staff, there were significant deviations from the initial study protocols. As a result, we document the costs of implementing the ABI as delivered rather than as planned. This paper provides the first estimates of the implementation costs of an ABI delivered in criminal justice setting in the UK. Although these costs are from a pilot implementation that was heavily impacted by the Covid-19 pandemic, this paper nonetheless provides useful, policy-relevant information on the potential costs of providing ABI to remand prisoners. It also serves as a methodological template, guidance, and proof of concept for future micro-costing studies of ABIs in criminal justice settings.

Transfer to community and prison mental health care from Ireland's main remand prison over three years: 2015-2017.

The post-release period is associated with an increased risk of morbidity and mortality. Previous studies have identified deficits in pre-release planning for mentally ill people in prison, particularly in remand settings. We aimed to determine the proportion of mentally ill people in Ireland's main remand prison who were referred for mental health follow up in community and prison settings, who achieved face to face contact with the receiving service. This retrospective observational cohort study was based in Ireland's main male remand prison, Cloverhill. Participants included all those individuals on the caseload of the prison inreach mental health team who were referred for mental health follow up in community and prison settings at the time of discharge, prison transfer or release from custody over a three-year period, 2015 - 2017. Successful transfer of care (TOC) was defined as face-to-face contact with the receiving service, confirmed by written correspondence or by follow up telephone call. Clinical, demographic and offence related variables were recorded for all participants. There were 911 discharges from the prison inreach mental health team within the three-year study period. Of these, 121 were admitted to hospital, 166 were transferred to other prison inreach mental health services and 237 were discharged to community based mental health follow up in psychiatric outpatient or primary care settings. One third (304/911) had an ICD-10 diagnosis of schizophreniform or bipolar disorder (F20-31) and 37.5% (161/911) were homeless. Over 90% (152/166) of those referred to mental health teams in other prisons achieved successful TOC, with a median of six days to first face-to face assessment. Overall, 59% (140/237) of those referred to community psychiatric outpatient or primary care services achieved TOC following referral on release from custody, with a median of nine days from release to assessment. Clinical and demographic variables did not differ between those achieving and not achieving successful TOC, other than having had input from the PICLS Housing Support Service. Successful transfer of care can be achieved in remand settings using a systematic approach with an emphasis on early and sustained interagency liaison and clear mapping of patient pathways. For incarcerated individuals experiencing homelessness and mental health disorders, provision of a housing support service was associated with increased likelihood of successful transfer of care to community mental health supports.

Racial representation of psychological services in a London male remand prison

AimsTo investigate whether racial groups are proportionally represented in referrals for trauma, hearing voices, emotional regulation and psychological therapy.To understand the psychological needs across racial groups in HMP Wormwood Scrubs, the UK's 4th-most diverse prison.To see if the long-established under-representation of Asian males and over-representation of Mixed males in psychological services in the community is also occuring in the prison system.MethodPsychological referrals were recieved via the medical notes system (SystmOne), whereby a prisoner's name, age, location, racial group and reason for referral are trasnferred into the psychology referrals database.773 referrals were made between October 2018 and May 2020. As the prison's population throughout this time period was fluid, the month of December 2019 was used as a reference for the general prison poipulation.Racial groups were specified using the Office of National Statistics' 5-category classification system (White, Black, Asian, Mixed and Other).ResultThere is a consistent under-representation of Asian males in psychological referrals in relation to their general prison population. Whilst this group makes up 17% of the population of the prison, only 10% of prisoners referred to psychological services identified as Asian.Those identifying as Mixed are over-represented in trauma referrals and psychological therapy referrals. The prison's mixed population is 7%, whereas 16% of those being referred for these two reasons were from the same racial category.The proportion of patients who identified as Black, White or Other and were referred for psychology input were found to be representitive of the wider prison population, suggesting no clear over or under-representation.ConclusionTrends seen in the community in regards to Asian males being under-represented in psychological services are also evident in one of the UK's most diverse prison populations.Public health campaigning to reduce stigma and promote help seeking in BAME communities is of vital importance to provide the needed support for those silently dealing with psychological problems.The two largest racial groups in the prison, White and Black individuals, where found to be proportionally represented in their respective referrals to psychological services.One key finding was in regards to Mixed race individuals, who comprise 7% of the total prison population but 16% of psychology referrals. As this racial group is one of the fastest-growing in addition to be over-represented in referrals, it is vital to understand how provisions can be put in place to appropriately address the needs of this group.

Alcohol brief interventions for male remand prisoners: a mixed-methods feasibility and acceptability study

BackgroundThe global prison population exceeds 10 million. Drinking at levels that put a person at risk of health or social harms is a recognised public health concern in remand prisoners. We aimed to explore the feasibility and acceptability of an alcohol brief intervention for adult men on remand in prison and to develop an appropriate alcohol brief intervention and protocol for a multicentre pilot randomised controlled trial. MethodsWe used mixed-methods design in two prisons in the UK (one in Scotland and one in England). Individuals were given information leaflets before the study and consent was obtained from all participants. We used a survey that included questions relating to alcohol use (using the 10-item Alcohol Use Disorders Identification Test) and semi-structured interviews to explore feasibility, and acceptability of an intervention trial, to collect data between June 16, 2016, and Nov 25, 2016. Findings502 incarcerated males (237 [47%] sentenced; 265 [53%] remand) pariticpated in the survey (257 participants in Scotland, 245 particiapnts in England). Most participants were white British (480 men [96%]) and mean age was 33 years (SD 10). 402 (81%) of 496 men scored positive for an alcohol use disorder (188 [80%] of 235 sentenced men; 214 [82%] of 261 remand prisoners). 208 (42%) of 496 men scored as probably dependent on alcohol (81 [34%] of 235 sentenced men; 127 [49%] of 261 remand prisoners). 417 (92%) of 453 men reported that they would not feel coerced to take part in research. 166 (64%; 95% CI 57–69) of 261 men on remand and 113 (48%; 42–55) of 234 sentenced prisoners thought that an alcohol brief intervention of at least 20 min would be useful in the prison setting. We did semi-structured interviews with 24 participants (12 participants in Scotland, 12 participants in England; mean age 30·71 years, range 18–64) to ascertain views of participants. The results show that participants thought that prison is a feasibile and acceptable setting for an alcohol brief intervention; however, participants would like follow-up interventions after release and considered it important that the intervention was not delivered by prison staff. InterpretationThis study resulted in a successful bid to progress this work through a pilot randomised controlled trial. FundingMedical Research Council Public Health Intervention Development scheme (MRC-PHIND).

Alcohol Brief Interventions (ABIs) for male remand prisoners: protocol for development of a complex intervention and feasibility study (PRISM-A)

IntroductionIn the UK, a significant proportion of male remand prisoners have alcohol problems. Alcohol Brief Interventions (ABIs) are an effective component of a population-level approach to harmful and hazardous drinking....

Non-Suicidal Self-Injury in UK Prisoners

ABSTRACTMorbidity related to non-suicidal self-injury is highly prevalent in prisoners. Women carry the largest burden yet gender-specific characteristics are not fully understood. A national prisoner survey in England and Wales was examined for risk factors and correlates associated with non-suicidal self-injury during current prison term and gender among prisoners generally, and females more specifically. The large, representative survey produced a stratified sample of 3142 prisoners (1121 male sentenced prisoners, 1250 male remand prisoners and 771 female prisoners). Prevalence of non-suicidal self-injury was 6.6% (5.7% among males and 9.6% among females). Female gender conferred a significantly higher risk (OR 1.77, 95% CI 1.32 – 2.38, p < 0.001). The most prominent variables that appeared important in the relationship between female gender and non-suicidal self-injury were: past sexual abuse, previous suicide attempt, mental health problems in prison, current medication use, unwanted sexual attention in prison and presence of anxiety disorder.

Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study.

PurposeThis study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services.MethodA purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified.ResultsTwenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners.ConclusionsThe prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.

Maths in Prison

I teach maths to all levels in an adult male remand prison in Ireland and am also studying for a PhD in maths in prison education in Dublin Institute of Technology (DIT). This paper describes recent initiatives piloted by maths teachers and school management to increase attendance, engagement and certification in maths. It assesses the effects of the initiatives and looks at future potential in this setting and in others. To set the paper in context, I begin by describing a typical day as a prison maths teacher.

Older men and older women remand prisoners: mental illness, physical illness, offending patterns and needs.

Older prisoners are the fastest growing group of prisoners in most countries. They have high rates of physical and psychiatric co-morbidity, compared to community dwelling older persons and also compared with other prisoner groups. Very high rates of mental illness have been found in remand (pre-trial) prisoners when compared with other prisoner groups; however to date there have been no studies examining older male and female remand prisoners. A retrospective chart review was conducted of all remands, to a male and a female prison, over a six and half-year period. Demographic data were collected pertaining to psychiatric and medical diagnoses and seriousness of offending. We found rising numbers of older prisoners amongst male remand prisoners. Older remand prisoners had very high rates of affective disorder and alcohol misuse. They had rates of psychotic illnesses and deliberate self-harm comparable to younger remand prisoners. High rates of vulnerability were found among older prisoners and older prisoners had a greater need for general medical and psychiatric services than younger prisoners. We also found comparable offending patterns with younger prisoners and high rates of sexual offending among the older male prisoner group. Given the ageing population of many countries it is likely the numbers of older prisoners will continue to grow and given their high levels of both physical and psychiatric illness this will have implications for future service delivery.

Mental health in-reach in an urban UK remand prison.

Prison mental health in-reach teams (MHITs) have developed in England and Wales over the last decade. Services have been nationally reviewed, but detailed descriptions of their work have been scarce. The purpose of this paper is to describe the functions of one MHIT in a busy, ethnically diverse, male remand prison in London, UK. Clinical and demographic data were collected for prisoners referred to the MHIT using a retrospective design over an 18-week period in 2008/2009 (n=111). Foreign national prisoners and sentenced prisoners were significantly under-referred. Most referrals were already known to community mental health services, although around a quarter accessed services for the first time in prison. Around a third presented with self-harm/suicide risks. Substance misuse problems were common. Although the MHIT had evolved systems to promote service access, prisoner self-referrals were limited. Foreign national prisoners require enhanced investment to improve service access. MHITs identify people with mental disorders for the first time in prisons, but better screening arrangements are needed across systems. An evaluation of multiple MHIT models could inform a wider delivery template. Originality/value - One of the first ground-level evaluations of MHITs in England and Wales.

Do valerian teabags improve subjective sleep quality for male remand prisoners with a dual diagnosis?

Insomnia is a problem commonly identified by remand prisoners who also have a concurrent dual diagnosis of substance misuse and mental health problems. Historically, sleep problems in prison have been treated with either hypnotics or benzodiazepines but these cause adverse side effects and are often misused. Valerian teabags were introduced in 2004 but their efficacy was untested within the prison setting. The aim of this study was to establish whether Valerian teabags improve subjective sleep quality for men with sleep disturbance and dual diagnosis in a remand prison setting within a 14‐day period. The findings show that herbal alternatives appear to improve sleep quality for prisoners with complex needs.

An Empirical Study on the Relationship Between Intellectual Ability and an Understanding of the Legal Process in Male Remand Prisoners

Research conducted in Australia and around the world in the last decade has shown that people with significant intellectual impairments are over-represented in all areas of the criminal justice system. They are particularly over-represented in remand populations appearing before court. Previous research has suggested that as many as one-quarter of offenders facing sentencing in court have difficulty in understanding court procedures and it is suspected that a majority of these individuals suffer a significant intellectual impairment. The purpose of this study was to establish whether remandees with significant intellectual impairments (IQ < 70) have an accurate understanding of the court system. Seventy-four remand prisoners took part in the study. Remandees with an IQ of less than 70 demonstrated a significantly poorer understanding of the court system than those remandees with an IQ of 70 and above. The implications of these results are discussed in relation to the need for law reform and diversionary practices for this population of remandees.

An Empirical Study on the Relationship Between Intellectual Ability and an Understanding of the Legal Process in Male Remand Prisoners

Research conducted in Australia and around the world in the last decade has shown that people with significant intellectual impairments are over-represented in all areas of the criminal justice system. They are particularly over-represented in remand populations appearing before court. Previous research has suggested that as many as one-quarter of offenders facing sentencing in court have difficulty in understanding court procedures and it is suspected that a majority of these individuals suffer a significant intellectual impairment. The purpose of this study was to establish whether remandees with significant intellectual impairments (IQ < 70) have an accurate understanding of the court system. Seventy-four remand prisoners took part in the study. Remandees with an IQ of less than 70 demonstrated a significantly poorer understanding of the court system than those remandees with an IQ of 70 and above. The implications of these results are discussed in relation to the need for law reform and diversionary p...

Reception screening and mental health needs assessment in a male remand prison

Aims and Method This study was designed to clarify the nature and extent of psychiatric provision that would be needed if a new health screening protocol were to be introduced into the prison system. The reception screening questionnaires for every inmate coming into the prison over a 15-week period were reviewed using the new protocol. A further mental health assessment was undertaken on those who had screened positive. Results 201 men (32.6%) were found to be positive for serious mental illness Clinical Implications Based on this analysis, large increases in psychiatric resources would not be needed if the proposed new reception health screening processes were in place, although a reorganisation of the way in which services are delivered may be required.

Reception screening and mental health needs assessment in a male remand prison

Aims and MethodThis study was designed to clarify the nature and extent of psychiatric provision that would be needed if a new health screening protocol were to be introduced into the prison system. The reception screening questionnaires for every inmate coming into the prison over a 15-week period were reviewed using the new protocol. A further mental health assessment was undertaken on those who had screened positive.Results201 men (32.6%) were found to be positive for serious mental illnessClinical ImplicationsBased on this analysis, large increases in psychiatric resources would not be needed if the proposed new reception health screening processes were in place, although a reorganisation of the way in which services are delivered may be required.

Substance use in remand prisoners — a consecutive case study

Abstract Objectives: To determine the prevalence of drug and alcohol use among newly remanded prisoners, assess the effectiveness of prison reception screening, and examine the clinical management of substance misusers among remand prisoners. Design: A consecutive case study of remand prisoners screened at reception for substance misuse and treatment needs and comparison of findings with those of prison reception screening and treatment provision. Setting: A large adult male remand prison (Durham). Subjects: 548 men aged 21 and over awaiting trial. Main outcome measures: Prevalence of substance misuse; treatment needs of substance misusers; effectiveness of prison reception screening for substance misuse; provision of detoxification programmes. Results: Before remand 312 (57%) men were using illicit drugs and 181 (33%) met DSM-IV drug misuse or dependence criteria; 177 (32%) men met misuse or dependence criteria for alcohol. 391 (71%) men were judged to require help directed at their drug or alcohol use and 197 (36%) were judged to require a detoxification programme. The prison reception screen identified recent illicit drug use in 131 (24%) of 536 men and problem drinking in 103 (19%). Drug use was more likely to be identified by prison screening if an inmate was using multiple substances, using opiates, or had a diagnosis of abuse or dependence. 47 (9%) of 536 inmates were prescribed treatment to ease the symptoms of substance withdrawal. Conclusions: The prevalence of substance misuse in newly remanded prisoners is high. Prison reception health screening consistently underestimates drug and alcohol use. In many cases in which substance use is identified the quantities and numbers of different substances being used are underestimated. Initial management of inmates identified by prison screening as having problems with dependence producing substances is poor. Few receive a detoxification programme, so that many are left with the option of continuing to use drugs in prison or facing untreated withdrawal. Key messages In screening for substance use in remand prisoners a positive finding must be considered the norm rather than the exception Present prison reception procedures fail to identify the extent to which substances are used and misused by people newly remanded to prison Provision of detoxification programmes for prisoners identified by reception screening as having serious drug and alcohol related problems is inadequate Prisoners who need help but think that asking for this is more likely to result in punishment than treatment are not likely be truthful about their substance use More consideration needs to be given to reducing substance misuse in prisons by improving assessment at reception and providing better treatment for misusers rather than using random urine screening to detect and punish offenders

Substance use in remand prisoners: a consecutive case study

Objectives: To determine the prevalence of drug and alcohol use among newly remanded prisoners, assess the effectiveness of prison reception screening, and examine the clinical management of substance misusers among...

Prevalence of mental disorder in remand prisoners: consecutive case study.

To define the prevalence of mental disorder and need for psychiatric treatment in new remand prisoners and to determine to what extent these are recognised and addressed in prison. Study of consecutive male remand prisoners at reception using a semistructured psychiatric interview. Large remand prison for men (HMP Durham). 669 men aged 21 years and over on remand, awaiting trial. Prevalence of mental disorder at reception, prisoners need for psychiatric treatment, identification of mental disorder by prison reception screening, and numbers placed appropriately in the prison hospital. 148 (26%) men had one or more current mental disorders (excluding substance misuse) including 24 who were acutely psychotic. The prison reception screening identified 34 of the men with mental disorder and six of those with acute psychosis. 168 men required psychiatric treatment, 50 of whom required urgent intervention; 16 required immediate transfer to psychiatric hospital. Of these 50, 17 were placed on the hospital wing because of mental disorder recognised at prison screening. Not only is the prevalence of mental disorder, in particular severe mental illness, high in this population, but the numbers identified at reception are low and subsequent management in prison is poor.