Forensic Psychiatry
Simple screening tool enables prison officers to identify prisoners with severe mental illness
Sep 2, 2005 - 2:30:38 AM

A new screening tool has been developed that shows promise for the identification of prisoners with severe mental illness by prison officers.

Many prisoners have severe mental health problems, but traditional mthods of health screening at reception into prison are quite ineffective.

Once prisoners with mental illness find their way on to ordinary prison wings, there is a significant risk that their mental problems will remain unrecognised, and their needs unmet.

The Department of Health wants to develop prison mental health services. According to the National Health Service Plan, 5000 prisoners at any one time should be receiving comprehensive mental health services in prison; all those with severe mental illness should receive treatment; and no prisoner with severe mental illness will leave prison without a care plan and a care co-ordinator.

Reception health screening will play a key part in achieving this, but other screening methods, such as using the observational skills of prison officers, could make an important contribution.

This study, published in the September issue of the Psychiatric Bulletin, took place at Her Majesty's Prison Winchester, a local prison housing adult male prisoners. At the time of the study the prison held about 550 men (30% sentenced and 70% on remand).

The screening tool was developed from open-ended interviews with prison officers, and diagnostic interviews with prisoners. The researchers selected the behaviours identified by prison officers that were most consistently associated with a finding of severe mental illness (based on the diagnostic interview), and grouped these into themes to develop the criteria in the tool.

The screening tool
1. Is the inmate excessively isolating himself from staff and other inmates?
2. Is the inmate's behaviour persistently erratic and/or bizarre?
3. Are the sleeping and eating patterns of the inmate causing concern?
4. Has there been a sudden unexplained change in the inmate's presentation, such as stopping work for no obvious reason?
5. Has the inmate's personal hygiene appeared strange, changed suddenly or deteriorated?
6. Any other symptoms that are likely to suggest the inmate has a mental illness? (If yes, then specify).

A case-comparison study was used to evaluate the tool. 50 prisoners identified by officers as meeting one or more of the screening tool criteria, and 50 randomly selected prisoners, were given diagnostic interviews to determine the proportion in each group with severe mental illness.

19 out of 50 (38%) of the cases identified by prison officers were found to have severe mental illness, compared with none in the comparison group. Prisoners from the case group were more likely to have been living in temporary accommodation or to have been homeless before imprisonment.

The authors of the study conclude that they have developed a short and simple screening tool that has proved to be quick and easy to use with prison officers. Like a new prison reception health screen that has been developed, this screening tool does not rely on staff having to make judgements they are not necessarily trained to make, but uses simple yes/no criteria linked to a protocol.

The tool needs to be evaluated further in other male prisons to determine its effectiveness in these settings. It also needs to be tested in clinical practice when it is applied by prison mental health in-reach staff, rather than a researcher. Similar tools should be developed for use in young offender and women's prisons.

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