Transcript Slide 1

How the Prison Healthcare
Service Currently Manages
Mental Health, BBV and
Drug Treatment
Nat Wright Clinical Director Leeds
Cluster of Prisons
Hepatitis C, substance misuse and
health inequalities conference
London 19th October 2010
Scale of the Problem
• Cross-sectional survey of England and Wales - 38% of male remand
prisoners, 48% of male sentenced prisoners, 25% of female remand,
and 34% of female sentenced prisoners had used drugs during their
current prison term. The most commonly used drugs - cannabis and
heroin. (Singleton et al, 1998).
• Systematic review of the international prevalence studies of prison
populations for drug dependence (13 studies total of 7563
prisoners). Prevalence rates 10-48% in male prisoners and 30-60%
in female prisoners (Fazel et al, 2006).
• Prevalence of injecting reduces in prison BUT injecting practices
more risky and prison is a site of initiation into drugs (Bellis et al,
1997; Boys et al, 2002)
• 7% prison population HCV positive. Number of times in prison an
association with antibodies to HCV and HBV (Weild et al, 2000)
Criminal Justice and Health: a sometimes
uneasy alliance…….
In the days before contraception……
Victorian unmarried mothers, especially
working class ones faced an impossible
dilemma during the nineteenth century.
Most employers would turn them out as
soon as their condition [pregnancy]
became obvious and then it was the
workhouse or often unsympathetic
relatives. After they gave birth few would
employ a mother and child and lodging
your child with a nurse cost money.
The saddest aspect of Emma's desperate
act [charged for murdering her child at
birth] was that it wasn't unusual – that
same year Ann Noakes of Reigate was
charged with murdering her baby son. In
1894 Minnie Wells was tried for killing
her twin daughters.
Jen Newby. Unmarried, Pregnant and Victorian. Writing
Women’s History, 2010.
Barriers to Health
• Social isolation - many prisoners held a long way from their homes
- despite a rise of more than 20% in the prison population, the
number of prison visits has fallen by more than a third over a five
year period (women and young offenders worst affected) (Home Office,
2002)
• Parenting Issues - Over 33% of women prisoners have child under
age five when imprisoned though, though only 5% of these children
remain in their homes
• Large throughput - on short sentences presents problems for
screening programmes and management of chronic diseases
• Punitive culture - sense of distrust, lack of empathy and fear of
being diagnosed with a mental illness (Howerton et al, 2007)
• Budgetary Constraints limiting rehabilitation opportunities high level of purposeful activity protects against suicide risk (Leese et
al, 2006).
Treatment Responses to
Hepatitis C
• Raise awareness of hep C – role for interactive media
• Encourage testing wherever possible
• Develop systems to communicate results (?telephone
answering, ?written confirmation) to community service
• “Shared care” arrangement with hepatology services for
antiviral treatment
• Deliver alongside opiate maintenance treatment in
prisons (in Leeds >3000 per year discharged on opiate
maintenance)
• Remember Hep B vaccination
Management of Substance
Misuse
• Marked increase in provision of prison based
opiate maintenance, but under threat for political
reasons
• Many voices want to see “recovery” (Trojan
horse for abstinence) and therefore time limited
opiate maintenance
• However, less than 20% of prisoners
successfully undergo detoxification (Wright
unpublished data)
• Psychosocial support “patchy” – despite good
evidence base for individual, group based and
therapeutic community interventions (Wright, 2010)
Management of Dual Diagnosis
• A challenge - much of prison healthcare is still in
professional silos (Sainsbury Centre for Mental Health, 2007)
• Need to take greater account of co-morbidity
• Co-training – substance misuse and personality disorder
is everyone’s business
• •Need to consider prison diversion schemes for those
whose offences are not serious yet related to mental illhealth (Draine and Solomon, 1999)
• Prison based offender behaviour programmes can
reduce the risk of re-offending (Sainsbury Centre for Mental
Health, 2008)
In Conclusion
Much is being done to address the
quality of care offered in prisons
but significant cultural, logistical
and political barriers remain
[email protected]
References
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Bellis MA, Weild AR, Beeching NJ, Mutton KJ and , Syed Q. Prevalence of HIV and injecting drug use in
men entering Liverpool prison. British Medical Journal 1997; 315: 30-31
Boys A, Farrell M, Bebbington BT, Coid J, Jenkins R, Lewis G, Marsden J, Meltzer H, Singleton N and
Taylor, C. Drug use and initiation in prison: results from a national prison study in England and Wales.
Addiction 2002; 97: 1551-1560
Draine J and Solomon P. Describing and evaluating jail diversion services for persons with serious
mental illness. Psychiatric Services 1999; 50: 56–61
Fazel S, Bains P and Doll H. Substance abuse and dependence in prisoners: a systematic review.
Addiction 2006; 101(2): 181-191
Fazel S, Benning R and Danesh J. Suicides in male prisoners in England and Wales, 1978-2003. Lancet
2005; 366(9493): 1301-2
Home Office. Prison Statistics England and Wales 2001. London: The Stationery Office, 2002
Howerton A, Byng R, Campbell J, Hess D, Owens C and Aitken P. Understanding help seeking behaviour
among male offenders: a qualitative study. British Medical Journal 2007; 334: 303-306
Leese M, Thomas S and Snow L. An ecological study of factors associated with rates of self-inflicted
death in prisons in England and Wales. International Journal of Law and Psychiatry 2006; 29(5): 355-360
Sainsbury Centre for Mental Health. A review of the use of offending behaviour programmes for people
with mental health problems. Sainsbury Centre for Mental Health: London, 2008
Sainsbury Centre for Mental Health. Getting the basics right: Developing a primary care mental health
service in prisons. London: Sainsbury Centre for Mental Health, 2007
Singleton N, Farrell M and Meltzer H. Substance misuse among prisoners in England and Wales: Further
analysis of data from the ONS survey of psychiatric morbidity among prisoners in England and Wales
carried out in 1997 on behalf of the Department of Health. London: Office for National Statistics, 1998
Weild AR, Gill ON, Bennett D, Livingstone SJM, Parry JV and Curran L. Prevalence of HIV, hepatitis B and
hepatitis C antibodies in prisoners in England and Wales: a national survey. Communicable Disease and
Public Health 2000; 3(2): 121-126
Wright N with Marteau D and Palmer J. The Offender and Drug Treatment: making it work across prisons
and wider secure environments. Leeds: Wrighthealth publishing, 2010