A Pilot Study of Satisfaction and Adherence with Antipsychotic Medication Amongst Prisoners Dr Alice Mills Mr Dan Bressington Dr Richard Gray Professor Judith Lathlean

Background – Prevalence of Mental Health Problems  Over 90% of prisoners have one or more mental disorders (including substance misuse) (Singleton et al. 1998) 54% male remand prisoners 44% male sentenced prisoners 61% female remand prisoners 42% female sentenced prisoners have three or more disorders  Between 7% and 14% of prisoners have functional psychosis in comparison to 0.4% of the general population

Adherence with Antipsychotic Medication  Estimated prevalence of non-adherence in community settings ranges from 24% to 80%  Non-adherence is a major cause of increased symptoms and relapse  Relapse rates:  One year relapse rate for patients with psychosis who are adherent with treatment is about 20% – 30%  One year relapse rate without medication is around 70%

Adherence with Antipsychotic Medication  Poor adherence associated with re- hospitalisation, poor outcomes and high economic costs  In forensic settings refusal of medication is associated with disturbed and violent behaviour.  Symptoms may go undetected on prison wings  Risk to self, staff and other prisoners  Potential contribution to recidivism

Adherence with Antipsychotic Medication  Treatment adherence is a complex health behaviour affected by several factors such as efficacy of treatment, side effects and beliefs/attitudes about treatment.  No previous studies examining non- adherence with antipsychotics in prisoners

Study Aims  Estimate the point prevalence of non- adherence to antipsychotics in prisoners  Determine prisoners’ satisfaction with and beliefs and attitudes towards antipsychotics  Identify predictors of adherence  Explore subjective experiences of medication  Act as a pilot for a larger study

Research Design  Observational cross sectional survey of treatment non-adherence with antipsychotic medication  Chosen prisons should provide a sample broadly representative of the general prison population  HMP Bronzefield – female local  HMP Brixton – male local  HMP Winchester – male local and cat C  Running parallel to the in-reach research study

Relationship to the In-Reach Study  Three year project undertaken in several prisons including Bronzefield and Winchester  Aims to provide evidence about the success and effectiveness of the in-reach initiative to improve the mental health care of prisoners  Clinical interviews identify those prisoners with severe mental illness who are prescribed antipsychotic medication

Inclusion Criteria  Aged over 18  In prison for at least a month  Capacity to give written informed consent  Absence of organic brain disease or severe learning disability  Prescribed (but not necessarily adherent with) any antipsychotic medication for at least 8 weeks

 To minimise disruption, information gleaned from the in-reach study interview is used to complement data from the current study  Participants at HMP Brixton are recruited with the help of a consultant psychiatrist

Data Collection - Interviews  Self-report and interviewer rated measures to assess: Adherence Satisfaction with treatment (SWAM) Insight into illness (ISP) Psychopathology (BPRS) Attitudes and beliefs towards treatment (DAI) Side effects of treatment (LUNSERS)  Facilitates comparison between responses  Determines associations with adherence/non- adherence

Data Collection - Interviews  Short qualitative interview  Addresses themes of: Past experiences of medication Current views of medication Satisfaction with treatment Relationships with mental health professionals Methods of medication avoidance  Flexible and responsive topic guide  Aims to provide rich, contextual data about participants’ views and experiences

Data Collection – Case Note Analysis  Analysis of IMRs, mental health and general prison records to determine possible predictors of adherence including: –Demographics –Prison characteristics –Health service factors –Illness characteristics –Medication –Violence/behavioural disturbance

Progress So Far…  Recruitment started in July for HMP Bronzefield and in August for HMP Winchester  Recruitment started in September for HMP Brixton  Participants prescribed a variety of different antipsychotics  Recruited only 16 participants so far  We aim to recruit a total of 90 participants (somewhat optimistic!)  Alternative recruitment strategies

Working with Prisons in Mental Health Research  Barriers: Gaining access to prisons Navigating the research governance process with a private healthcare provider Limitations (due to service issues) on research time

Practical Challenges  Obtaining rooms to carry out interviews and ensuring that officers escort prisoners from their cells  Prison officer staffing levels  Non-attendance  Recording equipment

A Pilot Study of Satisfaction and Adherence with Antipsychotic Medication Amongst Prisoners Dr Alice Mills – Mr Dan Bressington Dr Richard Gray Prof Judith Lathlean