1. Mental Health Needs of Female Prisoners
Dr Pradeep Pasupuleti
NHS GG&C
Consultant Forensic Psychiatrist
Visiting Psychiatrist at HMP Cornton Vale

2. Today’s talk 20 slides Case examples
Evidence on prevalence of mental disorder is prisons
HMP Cornton Vale stats
Challenges

3. Case example 1
42 year old, h/o “hearing voices” for 17 years, diagnosis of paranoid schizophrenia, had few very long admissions into psychiatric hospitals, no improvement in symptoms, diagnosis reviewed to BPD 3 years ago before discharging from psychiatric services. Banned from GP practice, frequent attendee at A&E asking to get admitted into hospital, evicted from 4 previous temporary accommodations.
6 prison sentences in the past 3 years. Longest in the community 4 weeks. Repeated public order offences.
Presentation in prison characterised by responding to auditory hallucinations, occasional abusive towards staff and fellow inmates but no major management problems. Liberation in 4 weeks.

4. Case example 2
A 26 year old presenting with frequent history of self harm, excessive drinking and non-compliance with any of the community support packages. Repeat offender, most offences were against support workers including the index offence. Has been on various antidepressants from the age of 18, had few crisis admissions mostly in the context of self harm whilst under the influence of alcohol. h/o CSA, disruptive at school, alcoholism in the family.
Disruptive in prison, poor frustration tolerance, unpredictable behavior involving self harm and violence.
Due for liberation in 4 weeks.

5. Case example 3
19 year old, 4th time in custody, mostly for BoP (para suicide) and BoB. h/o CSA, abusive family. Previously contacts with CAMHS, seen by LD services, poor compliance, discharged as ‘nothing much to offer’.
Evidently low IQ, frequent self harm behaviour in prison and “wants to end her life”.
SW very anxious about her liberation as she goes back into same abusive household, ‘no help’ from health and unlikely to comply with any conditions.

6. Mental disorders in prisons
Fazel and Danesh (2002)
Systematic review of 62 surveys (12 countries), prisoners: 4% psychosis, 12% major depressive disorder, 47% (M) & 21% (F) ASPD
Singleton et al, 1998
The largest study into prisoners in England and Wales
Psychosis 7% in convicted male prisoners (n=1121) and 10% in male remanded prisoners (n=1250).
40% and 59% respectively had neurotic disorder,
63% and 58% alcohol abuse, and 43% and 51% drug abuse.

7. Scottish studies
Cook et al (1994): 7.3% major psychological disorder, 32% neurotic, 38% alcohol abuse or dep and 21% drug abuse or dep
Davidson et al (1995): in a study on remand prisoners (n=389) 2.3% psychosis, 24.8% neurotic, 22% alcohol abuse or dependence and 73% drug abuse or dep

8. Scottish studies
Bartlett et al (2000): study of inceptions into HMP Barlinnie over a one week period, 5% psychotic and 30% depression and anxiety
Fraser, Thomson and Graham: A six month audit of prison transfers, 16/22 within 3 days
HMIP report 2007: 80% in Cvale had some MH problems; 60% under the influence of drugs at the time of offence
Her Majesty’s Inspectorate of Prisonsreport

9. Female prison estate Prison Number Cornton Vale 186 Polmont 104
Edinburgh
106
Greenock 52
Aberdeen (Community Integration Centre) 3
Total
451
Data accurate on

10. 2012 statistics Average admissions per year to HMP Cornton Vale: 2000
Number of referrals to prison mental health team: 693 ( per month)
Total new appointments: 81
Total number of follow-up appointments: 133 (41 patients)

11. D&A Statistics Addictions referrals Oct 12- Mar 13 (5 months) Type
Number
Average no. of admissions
834
Total number of referrals
428 (51%)
Drug detox
345 (41%)
Alcohol detox
83 (10%)

12. Prison transfers Year Number of transfers 2007 7 2008 6 2009 8 2010 13
2011 15
2012 29

13. 2012 prison transfers
Section
Number
S 136 6
S 52 21
Informal 2

14. Statistics Diagnosis Number (%) Schizophrenia, relapse 17 (65%)
Acute Psychotic episode
6 (23%)
Manic episode
3 (12%)
Depressive episode
1 (4%)
Others- Organic psychosis, Munchausen
2 (8%)

15. Distribution

16. Levels of security

17. Health Board distribution

18. Key challenges Variations in Court diversion framework
Problems with centralization
Poor correspondence
Prison as a facility for “further psychiatric assessment”
Provision of Psychiatric reports to the court- delays
Centralization: female prisoners find themselves far from home. Problems with visits from family. Problems to access services during and aftercare.

19. Challenges in custodial setting
Complex needs
Diagnostic complexity: Mental illness V PD
Undiagnosed LD
ASD
Co-morbid substance misuse
ARBD
Problem behaviour

20. Challenges
Model of care for the visiting psychiatrist: Clinic list management V Case management
Ideal Prison Mental Health Team
Hospital transfers: access to beds
Young offenders

21. Aftercare challenges Follow-up arrangements
PD, a “diagnosis of exclusion”
Homelessness
D&A
Variations in inter-agency working models

22. Current practice Developing multidisciplinary approach
MDMHT as a forum for case discussions
Case management model in complex cases (CPA, ASP Act)
New challenging behaviour service
Teaching and training
Good relationships