1. Dr Wallace Brink Consultant in Forensic Psychiatry Devon Cluster Prisons

2. Syllabus for MRCPsych II Psychiatry in Prisons Knowledge of the presence of psychiatric disorder in prison populations Suicide in prisons Psychiatric treatment in prison settings

3. PRISONS Prisons operate at different levels of security and cater for individuals on remand and serving sentences Significant increase in UK prison population

4. STATISTICS Remand Prisoners 70 - 90% psychiatric morbidity amongst remands 5% psychotic or affective disorder Three times more likely to have psychosis or major depression than the general population Co-morbidity with mental illness, substance misuse and personality disorder is the norm Officer’s national, statistics 10% of male remands suffer a functional psychosis Substance misuse rate 38%, higher amongst remand than serving prisoners 6 - 8 times elevated suicide rate amongst prison population

5. STATISTICS SENTENCED PRISONERS 6- 7% of male sentenced prisoners have a psychotic illness 4.5% 0f female sentence prisoners have a psychotic illness High rates of substance misuse (22 vs 30%) High rates of PD (9 vs 16%) (APD most common)

6. Suicide in Prisons Higher rates than in match general populations hanging., self-strangulation ACCT (Assessment, Care in Custody & Teamwork) High Risk –Male –First week in prison –History of substance misuse –Charged with violent or sexual offence –Single cell accommodation –Life sentenced prisoners –Young offenders

7. REASONS FOR ELEVATED PSYCHIATRIC MORBIDITY Remand Acute withdrawal Addiction in custody New asylum population Demographics

8. CASE e.g. Anonymised 36y male Serious offender Assault to severe injury Attempted murder

9. Bradley Report 82 recommendations Tackle over representation of people with mental health problems in prisons National Network of Criminal Justice Mental Health Teams to divert people to service from Police, Courts and following release 14 day maximum wait to transfer for urgent treatment

10. WHAT DOES THE VISITING PSYCHIATRIST DO? Triage Case management Transfer to local hospitals Management of difficult prisoners Consultation

11. TAKE HOME MESSAGES Syllabus Itinerant population Forensic experience

12. Further Reading Prison Psychiatry: Adult Prisons in England and Wales. College Report CR141, February 2007. RCPsych Suicide in prisons. Council Report CR99, February 2002. RCPsych