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Gallagher M, Sheehy S, Connaughton M, Hickey P, Ivers JH. People experiencing homelessness requiring psychiatric review in prison, a study of a male and female remand prison over 1 year period. Ir J Med Sci 2025:10.1007/s11845-025-03938-z. [PMID: 40227563 DOI: 10.1007/s11845-025-03938-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 03/18/2025] [Indexed: 04/15/2025]
Abstract
BACKGROUND There are high numbers of people experiencing homelessness (PEH) in Ireland. PEH experience barriers to accessing mental health care and are overrepresented in prison populations, particularly in remand prisons. To date, there has been limited research conducted on this population, and their specific needs. AIMS In this study, we explored homelessness in those referred to prison psychiatry teams in Dublin's remand prisons, and profiled the clinical characteristics of the population. METHODS Participants included all persons referred to prison inreach psychiatry teams in one male and one female remand prison over one year between 01/07/22 and 30/06/2023. We examined key aspects of psychiatric service provision including population characteristics, psychiatric and medical history, referral outcomes, alternative pathways and complex health needs. RESULTS A total of 89 PEH were referred to prison mental health services during the study period. High rates of active psychotic illness were found in the cohort, with 68% psychotic at the time of the assessment, and 56% having a diagnosis of serious mental illness. More than half the cohort reported current use of substances and 42% current use of alcohol. Over one-third of referrals were made for those with a history of mental illness, with no current symptoms. Only one-fifth of the cohort were discharged to the prison GP following their initial assessment, the remainder requiring ongoing input from prison inreach or community psychiatric services. Significant vulnerabilities were found within 25% including intellectual disability, and membership of ethnic minorities. CONCLUSIONS There are high rates of mental illness and co-morbid vulnerabilities found in the population. Appropriately addressing the needs of this population will require an integrated, multisystem approach.
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Affiliation(s)
- Margaret Gallagher
- Department of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
- University College, Dublin, Ireland.
| | - Siobhan Sheehy
- University College, Dublin, Ireland
- St John of God's Hospital, Stillorgan, Blackrock, Co., Dublin, Ireland
| | | | - Philip Hickey
- National Forensic Mental Health Service, Portrane Demesne, Co., Dublin, Ireland
| | - Jo-Hanna Ivers
- Department of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Bellass S, Canvin K, Farragher T, McLintock K, Wright N, Hearty P, Seanor N, Cunningham M, Foy R, Sheard L. Understanding and improving the quality of primary care for people in prison: a mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-329. [PMID: 39514203 DOI: 10.3310/grfv4068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Background People in prison are generally in poorer health than their peers in the community, often living with chronic illness and multimorbidity. Healthcare research in prisons has largely focused on specific problems, such as substance use; less attention has been paid to conditions routinely managed in primary care, such as diabetes or hypertension. It is important to understand how primary care in prisons is currently delivered in the United Kingdom and how it can be improved, in order to reduce health inequalities. Objective To understand the quality of primary care in prison, including gaps and variations in care, in order to recommend how quality of prison health care can be improved. Design A mixed-methods study with six interlinked work packages. Setting Predominantly the North of England. Methods Between August 2019 and June 2022, we undertook the following work packages: (1) International scoping review of prison healthcare quality indicators. (2) Stakeholder consensus process to identify United Kingdom focused prison healthcare quality indicators. (3) Qualitative interview study with 21 people who had been in prison and 22 prison healthcare staff. (4) Quantitative analysis of anonymised, routinely collected data derived from prison healthcare records (~ 25,000 records across 13 prisons). (5) Stakeholder deliberation process to identify interventions to improve prison health care. (6a) Secondary analysis of the qualitative data set, focusing on mental health and (6b) analysis of the quantitative data set, focusing on health care of three mental health subgroups. Findings Our scoping review found predominantly only papers from the United States of America and of variable rigour with the main finding being that performance measurement is very challenging in the prison healthcare setting. In collaboration with stakeholders, we prioritised, refined and applied a suite of 30 quality indicators across several healthcare domains. We found considerable scope for improvement in several indicators and wide variations in indicator achievement that could not be attributed to differences in prison population characteristics. Examples of indicators with scope for improvement included: diabetes care, medicines reconciliation and epilepsy review and control. Longer length of stay in prison was generally associated with higher achievement than shorter stays. Indicator achievement was generally low compared to that of community general practice. We found some encouraging trends and relatively good performance for a minority of indicators. Our qualitative interviews found that quality of health care is related to factors that exist at several levels but is heavily influenced by organisational factors, such as understaffing, leading to a reactive and sometimes crisis-led service. Our stakeholder deliberations suggested opportunities for improvement, ideally drawing on data to assess and drive improvement. Our mental health work package found that coded mental illness had mixed associations with indicator achievement, while the interviews revealed that mental distress is viewed by many as an inevitable facet of imprisonment. Limitations Our analyses of indicator achievement were limited by the quality and coverage of available data. Most study findings are localised to England so international applicability may differ. Conclusions Marked variations in the quality of primary care in prisons are likely to be attributable to the local organisation and conditions of care delivery. Routinely collected data may offer a credible driver for change. Study registration This study is registered at researchregistry.com (Ref: 5098). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/05/26) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 46. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sue Bellass
- University of Leeds, Leeds, UK
- Manchester Metropolitan University, Manchester, UK
| | - Krysia Canvin
- University of Leeds, Leeds, UK
- Keele University, Staffordshire, UK
| | | | | | - Nat Wright
- Spectrum Community Health Community Interest Company, Wakefield, UK
| | - Pip Hearty
- Spectrum Community Health Community Interest Company, Wakefield, UK
| | - Nicola Seanor
- North of England Commissioning Support Unit, Durham, UK
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Shah H, Hawks L, Walker RJ, Egede LE. Substance Use Disorders, Mental Illness, and Health Care Utilization Among Adults With Recent Criminal Legal Involvement. Psychiatr Serv 2024; 75:221-227. [PMID: 37674397 PMCID: PMC11451170 DOI: 10.1176/appi.ps.20220491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. METHODS This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015-2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. RESULTS Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18-1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47-3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38-1.91) and inpatient stays (IRR=4.16, 95% CI=2.98-5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01-1.50). CONCLUSIONS Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement.
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Affiliation(s)
- Harini Shah
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Laura Hawks
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Rebekah J Walker
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
| | - Leonard E Egede
- School of Medicine (Shah), Department of Medicine, Division of General Internal Medicine (Hawks, Walker, Egede), and Center for Advancing Population Science (Hawks, Walker, Egede), Medical College of Wisconsin, Milwaukee
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Eseadi C, Amedu AN, Aloh HE. Significance of fostering the mental health of patients with diabetes through critical time intervention. World J Clin Cases 2023; 11:8486-8497. [PMID: 38188207 PMCID: PMC10768517 DOI: 10.12998/wjcc.v11.i36.8486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Critical time intervention (CTI) is an evidence-based model of practice that is time-limited and aims to provide support for most susceptible individuals during a transition period. AIM To examine the significance of fostering the mental health of diabetes patients through CTI using the scoping review methodology. METHODS As part of the scoping review process, we followed the guidelines established by the Joanna Briggs Institute. The search databases were Google Scholar, PubMed, Scopus, PsycINFO, Reference Citation Analysis (https://www.referencecitationanalysis.com/), and Cochrane Library. From these databases, 77 articles were retrieved with the aid of carefully selected search terms. However, 19 studies were selected after two reviewers appraised the full texts to ensure that they are all eligible for inclusion, while 54 papers were excluded. RESULTS This study revealed that diabetic patients who had experienced homelessness were at higher risk of being diagnosed with mental illness and that social support services are impactful in the management of the comorbidity of diabetes and mental health problems. In addition, this review reveals that CTI is impactful in enhancing the mental health of homeless patients during the transitional period from the hospital through social support services. CONCLUSION CTI is a promising intervention for alleviating mental health symptoms in homeless patients. Empirical studies are needed across the globe, involving both hospitalized and community-based patients, to determine how clinically effectively CTI is in managing the mental health of diabetics.
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Affiliation(s)
- Chiedu Eseadi
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
| | - Amos Nnaemeka Amedu
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
| | - Henry Egi Aloh
- Department of Health Services, Alex Ekwueme Federal University, Ndufu-Alike Ikwo 482131, Ebonyi State, Nigeria
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Brooker C, Sirdifield C, van Deinse T. Serious mental illness in probation: A review. EUROPEAN JOURNAL OF PROBATION 2023; 15:60-70. [PMID: 38152573 PMCID: PMC10752355 DOI: 10.1177/20662203231162739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Research into serious mental illness and probation is reviewed. In addition, there is a specific review of the role of specialist mental health probation staff in the United States (US). In the discussion, we compare progress with the care of the seriously mentally ill within probation in Europe and the US. We conclude that the specialist role for probation staff developed in the US has significant advantages which have been well evaluated which should be implemented, in a large multi-centre trial, across Europe.
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Affiliation(s)
| | | | - Tonya van Deinse
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hyde J, Byrne T, Petrakis BA, Yakovchenko V, Kim B, Fincke G, Bolton R, Visher C, Blue-Howells J, Drainoni ML, McInnes DK. Enhancing community integration after incarceration: findings from a prospective study of an intensive peer support intervention for veterans with an historical comparison group. HEALTH & JUSTICE 2022; 10:33. [PMID: 36348203 PMCID: PMC9644600 DOI: 10.1186/s40352-022-00195-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The transition to the community after incarceration presents challenges for returning citizens, including the immediate need to secure housing, employment, and income. Additionally, health care is essential for this population due to high rates of chronic physical health and mental health problems and substance use disorders. There is growing recognition of the need for interventions that support returning citizens as they navigate community reintegration while simultaneously tending to physical and behavioral health needs. We developed and pilot tested a peer support intervention designed to provide social, emotional, and logistic support and promote linkage and engagement in healthcare for returning citizens. We tested the intervention with US military veterans in Massachusetts who were being released from prison and jail. Outcomes related to linkage to and engagement in healthcare were evaluated using an historical comparison group. Engagement in peer support, housing status, and reincarceration rates were monitored for the intervention group. RESULTS There were 43 veterans in the intervention group, and 36 in the historical comparison group. For linkage to primary care within 90 days of release, there were no statistically significant differences between the intervention and comparison groups (58% versus 67%). Intervention participants were significantly more likely to receive substance use treatment than the comparison group (86% versus 19%, p < .0001) and the mean monthly substance use visits was greater in the intervention group (0.96 versus 0.34, p < .007). Engagement in mental health services was greater for the intervention group than the comparison group (93% versus 64%, p < .003). There were no significant differences between groups for emergency department use and hospitalization. At the end of the study period, the majority of intervention participants who had been released for over a year were living in permanent housing (84%). Recidivism among the was low, with 7% re-arrested during the study period. CONCLUSIONS Augmenting reentry support through intensive peer support appears to have substantial benefits for veterans in terms of engaging them in health care and contributing to their longer-term stability, including housing and recidivism. Flexible reentry support such as this intervention may be well suited to meet the widely varying needs of returning citizens.
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Affiliation(s)
- Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Thomas Byrne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
| | - Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Bo Kim
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, USA
| | - Graeme Fincke
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Rendelle Bolton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Christy Visher
- Center for Drug & Health Studies, Department of Sociology and Criminal Justice, University of Delaware, Wilmington, DE, USA
| | - Jessica Blue-Howells
- VA Healthcare for Re-Entry Veterans, U.S. Department of Veteran Affairs, Washington, USA
| | - Mari-Lynn Drainoni
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - D Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 200 Springs Road, MS 152, Bldg. 70, Rm 285, Bedford, Bedford, MA, 01730, USA
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Reid N, Buchman D, Brown R, Pedersen C, Kozloff N, Stergiopoulos V. The acceptability of financial incentives to support service engagement of adults experiencing homelessness and mental illness: a qualitative study of key stakeholder perspectives Authorship. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1060-1071. [PMID: 36071341 DOI: 10.1007/s10488-022-01217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Evidence suggests financial incentives may effectively support service engagement among people experiencing homelessness, but literature related to their acceptability in this population is limited. This study used qualitative methods to explore stakeholder perspectives on the acceptability of using financial incentives to promote service engagement among homeless adults with mental illness. METHODS As part of a larger mixed-methods pragmatic trial of a community-based brief case management program in Toronto, Canada, twenty-two trial participants were purposefully recruited to participate in semi-structured qualitative interviews, and five service providers and seven key informants were purposefully recruited to participate in a focus group and interviews, respectively. Topics included perspectives of acceptability and lived experiences of using financial incentives to support engagement, health and well-being. Data collection occurred between April 2019 and December 2020. Data was audio-recorded and transcribed. Coding and interpretation of data was informed by grounded theory and inductive thematic analysis. RESULTS Stakeholders held diverse views on the acceptability of financial incentives to promote service engagement in this population. Main themes across groups included moralizing recipient motivation; tensions in how best to define and respect autonomy; and consideration of potential unintended consequences for both individuals and the service system. Significant group differences within some themes emerged. CONCLUSION Results highlight ongoing debates over using financial incentives to facilitate service engagement among adults experiencing homelessness and mental illness. Differences in stakeholder perspectives suggest the need for person-centredness in health and research settings, and balancing theoretical risks and long-term goals with likely potential for immediate benefits.
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Affiliation(s)
- Nadine Reid
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
| | - Daniel Buchman
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, M5T 3M7, Toronto, ON, Canada
- Joint Centre for Bioethics, University of Toronto, 155 College St, M5T 1P8, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, 60 Leonard Ave, M5T 0S8, Toronto, ON, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1000 Queen St. W, M6H 1H4, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, M5T 3M6, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond St, M5B 1W8, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada.
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Lennox C, Leonard S, Senior J, Hendricks C, Rybczynska-Bunt S, Quinn C, Byng R, Shaw J. Conducting Randomized Controlled Trials of Complex Interventions in Prisons: A Sisyphean Task? Front Psychiatry 2022; 13:839958. [PMID: 35592376 PMCID: PMC9110768 DOI: 10.3389/fpsyt.2022.839958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Randomized Controlled Trials (RCT) are the "gold standard" for measuring the effectiveness of an intervention. However, they have their limitations and are especially complex in prison settings. Several systematic reviews have highlighted some of the issues, including, institutional constraints e.g., "lock-downs," follow-ups, contamination of allocation conditions and a reliance on self-report measures. In this article, we reflect on our experiences and will describe two RCTs. People in prison are a significantly disadvantaged and vulnerable group, ensuring equitable and effective interventions is key to reducing inequality and promoting positive outcomes. We ask are RCTs of complex interventions in prisons a sisyphean task? We certainly don't think so, but we propose that current accepted practice and research designs may be limiting our understanding and ability to test complex interventions in the real-world context of prisons. RCTs will always have their place, but designs need to be flexible and adaptive, with the development of other rigorous methods for evaluating impact of interventions e.g., non-randomized studies, including pre-post implementation studies. With robust research we can deliver quality evidence-based healthcare in prisons - after all the degree of civilization in a society is revealed by entering its prisons.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Leonard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jane Senior
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline Hendricks
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Hunter RM, Anderson R, Kirkpatrick T, Lennox C, Warren F, Taylor RS, Shaw J, Haddad M, Stirzaker A, Maguire M, Byng R. Economic evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: a cost-utility and cost-consequences analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:193-210. [PMID: 34351533 PMCID: PMC8882099 DOI: 10.1007/s10198-021-01360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND People in prison experience a range of physical and mental health problems. Evaluating the effectiveness and efficiency of prison-based interventions presents a number of methodological challenges. We present a case study of an economic evaluation of a prison-based intervention ("Engager") to address common mental health problems. METHODS Two hundred and eighty people were recruited from prisons in England and randomised to Engager plus usual care or usual care. Participants were followed up for 12 months following release from prison. The primary analysis is the cost per quality-adjusted life year (QALY) gained of Engager compared to usual care from a National Health Service (NHS) perspective with QALYs calculated using the CORE 6 Dimension. A cost-consequences analysis evaluated cross-sectoral costs and a range of outcomes. RESULTS From an NHS perspective, Engager cost an additional £2737 per participant (95% of iterations between £1029 and £4718) with a mean QALY difference of - 0.014 (95% of iterations between - 0.045 and 0.017). For the cost-consequences, there was evidence of improved access to substance misuse services 12 months post-release (odds ratio 2.244, 95% confidence Interval 1.304-3.861). CONCLUSION Engager provides a rare example of a cost-utility analysis conducted in prisons and the community using patient-completed measures. Although the results from this trial show no evidence that Engager is cost-effective, the results of the cost-consequences analysis suggest that follow-up beyond 12 months post-release using routine data may provide additional insights into the effectiveness of the intervention and the importance of including a wide range of costs and outcomes in prison-based economic evaluations. TRIAL REGISTRATION (ISRCTN11707331).
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Affiliation(s)
- Rachael Maree Hunter
- Research Department of Primary Care and Population Health, University College London (UCL), Rowland Hill Street, London, NW3 2PF, UK.
| | - Rob Anderson
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tim Kirkpatrick
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Charlotte Lennox
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Fiona Warren
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rod S Taylor
- Primary Care Department, College of Medicine and Health, University of Exeter, Exeter, UK
- University of Glasgow, Glasgow, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | | | - Alex Stirzaker
- NHS England, South West Mental Health Clinical Network, Taunton, UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, Pontypridd, UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
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Reid N, Brown R, Pedersen C, Kozloff N, Sosnowski A, Stergiopoulos V. Using financial incentives to support service engagement of adults experiencing homelessness and mental illness: A qualitative analysis of key stakeholder perspectives. Health Expect 2022; 25:984-993. [PMID: 35104030 PMCID: PMC9122468 DOI: 10.1111/hex.13442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Homelessness and mental illness are associated with poor service engagement, health and health service use outcomes. Existing literature suggests that financial incentives may effectively support service engagement of this population, but studies investigating key stakeholder perspectives are lacking. This study aimed to elicit, using qualitative methods, nuanced service user and provider experiences by using financial incentives to support service engagement among adults experiencing homelessness and mental illness. Methods This qualitative study is part of a larger mixed‐methods pragmatic trial of financial incentives (Coordinated Access to Care for the Homeless—Financial Incentives [CATCH‐FI]) within a community‐based brief case management programme (CATCH) in Toronto, Ontario. Twenty‐two CATCH‐FI participants were purposefully recruited to participate in in‐depth, semi‐structured interviews; five CATCH service providers participated in a focus group and seven key informants in individual interviews. Data collection occurred between April 2019 and December 2020. All interviews and the focus group were audio‐recorded and transcribed. Topic guides prompted participant perspectives on and experiences of using financial incentives to support engagement, health and well‐being. Grounded theory and inductive thematic analysis guided coding and interpretation of transcripts. Triangulation and member‐checking enhanced the analytical rigour and validity of findings. Results CATCH service providers, key informants and subgroup of CATCH‐FI participants perceived financial incentives to directly facilitate service engagement. The majority of CATCH‐FI participants however highlighted that intrinsic motivation and service quality may be relatively more important facilitators of engagement. Most study participants across stakeholder groups perceived that financial incentives have direct positive influences on health and well‐being in enabling access to basic needs and simple pleasures. Conclusions Our data suggest that for some adults experiencing homelessness and mental illness, financial incentives can directly support service engagement. In addition, financial incentives may positively impact health and well‐being by easing financial stress and enabling deeper attention to individual health needs. Further research on the effectiveness and acceptability of financial incentives is needed to improve understanding and uptake of a promising intervention to support health and health service use outcomes in an underserved population. Patient or Public Contribution Study participants provided input into the study research questions, study design, interview guides and interpretation of findings.
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Affiliation(s)
- Nadine Reid
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Child, Youth and Emerging Adult Program, Centre of Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexandra Sosnowski
- Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Health Services Research Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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11
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Simpson AIF, Gerritsen C, Maheandiran M, Adamo V, Vogel T, Fulham L, Kitt T, Forrester A, Jones RM. A Systematic Review of Reviews of Correctional Mental Health Services Using the STAIR Framework. Front Psychiatry 2022; 12:747202. [PMID: 35115956 PMCID: PMC8806032 DOI: 10.3389/fpsyt.2021.747202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Rising demand for correctional mental health services (CMHS) in recent decades has been a global phenomenon. Despite increasing research, there are major gaps in understanding the best models for CMHS and how to measure their effectiveness, particularly studies that consider the overall care pathways and effectiveness of service responses. The STAIR (Screening, Triage, Assessment, Intervention, and Re-integration) model is an evidence-based framework that defines and measures CMHS as a clinical pathway with a series of measurable, and linked functions. METHOD We conducted a systematic review of the reviews of CMHS elements employing PRISMA guidelines, organized according to STAIR pillars. We assessed the quality of included studies using the AMSTAR-2 criteria. Narrative reviews were read and results synthesized. RESULTS We included 26 review articles of which 12 were systematic, metaanalyses, and 14 narrative reviews. Two systematic reviews and seven narrative reviews addressed screening and triage with strong evidence to support specific screening and triage systems. There was no evidence for standardised assessment approaches. Eight systematic reviews and seven narrative reviews addressed interventions providing some evidence to support specific psychosocial interventions. Three systematic reviews and six narrative reviews addressed reintegration themes finding relatively weak evidence to support reintegration methods, with interventions often being jurisdictionally specific and lacking generalizability. CONCLUSIONS The STAIR framework is a useful way to organize the extant literature. More research is needed on interventions, assessment systems, care pathway evaluations, and reintegration models.
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Affiliation(s)
- Alexander I. F. Simpson
- Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Cory Gerritsen
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | | | - Vito Adamo
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tobias Vogel
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fulham
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tamsen Kitt
- Department of Psychology, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Andrew Forrester
- Forensic Psychiatry, Department of Psychological Medicine and Clinical Neursciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Roland M. Jones
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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12
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Reid N, Mason J, Kurdyak P, Nisenbaum R, de Oliveira C, Hwang S, Stergiopoulos V. Evaluating the Impact of a Critical Time Intervention Adaptation on Health Care Utilization among Homeless Adults with Mental Health Needs in a Large Urban Center. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:57-66. [PMID: 33611924 PMCID: PMC8811242 DOI: 10.1177/0706743721996114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. METHODS Provincial population-based administrative data from Ontario, Canada, were used in a pre-post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. RESULTS Pre-post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. CONCLUSIONS An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.
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Affiliation(s)
- Nadine Reid
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joyce Mason
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Health Economics, Hull York Medical School, University of York, York, UK
| | - Stephen Hwang
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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13
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MacInnes D, Khan AA, Tallent J, Hove F, Dyson H, Grandi T, Parrott J. Supporting prisoners with mental health needs in the transition to RESETtle in the community: the RESET study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2095-2105. [PMID: 33638649 DOI: 10.1007/s00127-021-02045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Homelessness is linked to poor mental health and an increased likelihood of offending. People often lose accommodation when they enter prison and struggle to find accommodation upon release leading to an increased likelihood of relapse and reoffending. The RESET intervention was developed to support prisoners with mental health needs for 12 weeks after release to coordinate their transition into the community and obtaining secure housing. METHODS The primary objective of the study was to assess the participants housing situation. A prospective cohort design followed up 62 prisoners with mental health needs for 9 months post-release. Data were collected at three time points regarding accommodation, reoffending and contact and engagement with services. Inferential statistics using Chi-squared tests and t tests were used to examine differences in scores between the two groups at each time point. RESULTS The RESET group was significantly more likely to have secure housing at all three time points being housed for approximately twice as many days than the comparison group (244 vs 129 days at 9 months: p ≤ 0.01). The RESET group also had a significantly greater level of contact with GPs and significantly more received benefits at all three time points. CONCLUSION This is the first study to focus on reducing homeless for recently released prisoners with mental health needs. The RESET intervention was successful in achieving its main objective; accommodating participants in permanent housing and reducing homelessness. There was also an association between receiving the intervention and greater engagement with other services. This supports the view that secure housing is important in ensuring a positive transition from prison to the community for prisoners with mental health needs.
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14
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Pho M, Erzouki F, Boodram B, Jimenez AD, Pineros J, Shuman V, Claypool EJ, Bouris AM, Gastala N, Reichert J, Kelly M, Salisbury-Afshar E, Epperson MW, Gibbons RD, Schneider JA, Pollack HA. Reducing Opioid Mortality in Illinois (ROMI): A case management/peer recovery coaching critical time intervention clinical trial protocol. J Subst Abuse Treat 2021; 128:108348. [PMID: 33745757 DOI: 10.1016/j.jsat.2021.108348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
Individuals with a history of opioid use are disproportionately represented in Illinois jails and prisons and face high risks of overdose and relapse at community reentry. Case management and peer recovery coaching are established interventions that may be leveraged to improve linkage to substance use treatment and supportive services during these critical periods of transition. We present the protocol for the Reducing Opioid Mortality in Illinois (ROMI), a type I hybrid effectiveness-implementation randomized trial of a case management, peer recovery coaching and overdose education and naloxone distribution (CM/PRC + OEND) critical time intervention (CTI) compared to OEND alone. The CM/PRC + OEND is a novel, 12-month intervention that involves linkage to substance use treatment and support for continuity of care, skills building, and navigation and engagement of social services that will be implemented using a hub-and-spoke model of training and supervision across the study sites. At least 1000 individuals released from jails and prisons spanning urban and rural settings will be enrolled. The primary outcome is engagement in medication for opioid use disorder. Secondary outcomes include health insurance enrollment, mental health service engagement, and re-arrest/recidivism, parole violation, and/or reincarceration. Mixed methods will be used to evaluate process and implementation outcomes including fidelity to, barriers to, facilitators of, and cost of the intervention. Videoconferencing and other remote processes will be leveraged to modify the protocol for safety during the COVID-19 pandemic. Results of the study may improve outcomes for vulnerable persons at the margin of behavioral health and the criminal legal system.
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Affiliation(s)
- Mai Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medical Center, 5841 S. Maryland, MC 5065, Chicago, IL 60637, United States; Illinois Department of Public Health, 69 W Washington St, Suite 35, Chicago, IL 60307, United States.
| | - Farah Erzouki
- University of Chicago Urban Labs, 33 N. LaSalle Street, Suite 1600, Chicago, IL 60602, United States
| | - Basmattee Boodram
- School of Public Health, Division of Community Health Sciences, University of Illinois at Chicago, 1603 W. Taylor Street, 689 SPHPI, MC923, Chicago, IL 60612, United States.
| | - Antonio D Jimenez
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, 851 SPHPI, MC 923, Chicago, IL 60612, United States.
| | - Juliet Pineros
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor Street, 856 SPHPI MC 923, Chicago, IL 60612, United States.
| | - Valery Shuman
- University of Illinois at Chicago, 1603 W. Taylor Street, SPHPI MC 923, Chicago, IL 60612, United States.
| | - Emily Jane Claypool
- Crown Family School of Social Work, Policy and Practice, The University of Chicago, 969 E. 60th St, Chicago, IL 60637, United States.
| | - Alida M Bouris
- Crown Family School of Social Work, Policy and Practice, Chicago Center for HIV Elimination, Behavioral, Social, and Implementation Sciences, Third Coast Center for AIDS Research, Transmedia Story Lab, Ci3, The University of Chicago, 969 E 60th St, Chicago, IL 60637, United States; Center for the Study of Gender and Sexuality, Center for Human Potential and Public Policy, Ci3: Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, The University of Chicago, United States.
| | - Nicole Gastala
- University of Illinois at Chicago, Mile Square Health Center, 1220 S. Wood St., Chicago, IL 60608, United States.
| | - Jessica Reichert
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, 300 W. Adams St. Suite 200, Chicago, IL 60606, United States.
| | - Marianne Kelly
- Community Resource Center (CRC), Cook County Sheriff's Office, 50 W. Washington St, Rm 701, Chicago, IL 60602, United States.
| | - Elizabeth Salisbury-Afshar
- Department of Family Medicine and Community Health, University of Wisconsin Madison, School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI 53715, United States.
| | - Matthew W Epperson
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, 969 E. 60th Street, Chicago, IL 60637, United States.
| | - Robert D Gibbons
- Department of Medicine and Public Health Sciences (Biostatistics), Center for Health Statistics, Department of Comparative Human Development, Committee on Quantitative Methods in Social Behavioral and Health Sciences, The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Office W260, Chicago, IL 60637, United States.
| | - John A Schneider
- Department of Medicine and Public Health Sciences, The University of Chicago, 5841 S. Maryland Ave MC2000, Chicago, IL 60637, United States; The Chicago Center for HIV Elimination, 5837 S. Maryland Ave, Chicago, IL 60637, United States.
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, Department of Public Health Sciences, University of Chicago Urban Labs, Biological Sciences Collegiate Division, 969 East 60th St, Chicago, IL 60637, United States.
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15
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Lennox C, Stevenson R, Owens C, Byng R, Brand SL, Maguire M, Durcan G, Stevenson C, Shaw J, Quinn C. Using multiple case studies of health and justice services to inform the development of a new complex intervention for prison-leavers with common mental health problems (Engager). HEALTH & JUSTICE 2021; 9:6. [PMID: 33598771 PMCID: PMC7890896 DOI: 10.1186/s40352-021-00131-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND People in the criminal justice system have complex needs but often do not make use of services outside of prison, in many cases due to poorly joined up working between health and criminal justice services. The 'Engager' programme aimed to develop a complex collaborative care intervention for people leaving prison with common mental health problems that could support their transition into the community and facilitate joined up working between health, justice and social services. To augment our core intervention theory, we wanted to learn from innovative and forward-thinking services providing interagency support and/or treatment for people experiencing common mental health problems within the criminal justice system. We wanted to identify key elements of interagency practice to understand what was and was not effective in engaging people, maintaining their contact and improving mental health and other aspects of their lives. METHOD We used a multiple case study design with a focused ethnographic approach in four study sites. Data came from three sources (documents, field notes and semi-structured interviews) underwent a framework analysis. RESULTS We identified seven main themes, namely: collaboration, client engagement, client motivation, supervision, therapeutic approach, peers and preparations for ending. Engaging and motivating clients was dependent on the relationship built with the professional. This relationship was developed through building trust and rapport, which required time and respectful, open and honest communication. Professionals were often unable to build this relationship effectively if they did not work in effective interagency collaborations, particularly those which included shared practices and were supported by effective supervision. CONCLUSIONS The multiple case study design contributed insights as to how health and justice services work together. The main themes identified are well known factors in health and justice co-working. However, the novel insights were gleaned examining interdependence and interactions in complex, multifactorial phenomena and practice, in particular the importance of shared practice and supervision models. The approach of selecting a small number of cases representing identified knowledge gaps contributed a valuable addition to the program theory and delivery for an innovative complex intervention.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Rachel Stevenson
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Christabel Owens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA UK
| | - Sarah L. Brand
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL Wales
| | - Graham Durcan
- Centre for Mental Health, South Bank Technopark, 90 London Rd, London, SE1 6LD UK
| | - Caroline Stevenson
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, The University of Manchester, 2.315 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA UK
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16
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Reid N, Nisenbaum R, Hwang SW, Durbin A, Kozloff N, Wang R, Stergiopoulos V. The Impact of Financial Incentives on Service Engagement Among Adults Experiencing Homelessness and Mental Illness: A Pragmatic Trial Protocol. Front Psychiatry 2021; 12:722485. [PMID: 34413804 PMCID: PMC8369574 DOI: 10.3389/fpsyt.2021.722485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: People experiencing homelessness and mental illness have poorer service engagement and health-related outcomes compared to the general population. Financial incentives have been associated with increased service engagement, but evidence of effectiveness is limited. This protocol evaluates the acceptability and impact of financial incentives on service engagement among adults experiencing homelessness and mental illness in Toronto, Canada. Methods: This study protocol uses a pragmatic field trial design and mixed methods (ClinicalTrials.gov Identifier: NCT03770221). Study participants were recruited from a brief multidisciplinary case management program for adults experiencing homelessness and mental illness following hospital discharge, and were randomly assigned to usual care or a financial incentives arm offering $20 for each week they attended meetings with a program provider. The primary outcome of effectiveness is service engagement, measured by the count of participant-provider health-care contacts over the 6-month period post-randomization. Secondary health, health service use, quality of life, and housing outcomes were measured at baseline and at 6-month follow-up. Quantitative data will be analyzed using descriptive statistics and inferential modeling including Poisson regression and generalized estimating equations. A subset of study participants and other key informants participated in interviews, and program staff in focus groups, to explore experiences with and perspectives regarding financial incentives. Qualitative data will be rigorously coded and thematically analyzed. Conclusions: Findings from this study will contribute high quality evidence to an underdeveloped literature base on the effectiveness and acceptability of financial incentives to improve service engagement and health-related outcomes among adults experiencing homelessness and mental illness.
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Affiliation(s)
- Nadine Reid
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Division of Biostatistics, Dalla Lana School of Public Health University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Durbin
- MAP Centre for Urban Health Solutions Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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17
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Parrott JM, Houben FR, Visser RC, MacInnes DL. Mental health and offending in older people: Future directions for research. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:218-226. [PMID: 31418962 DOI: 10.1002/cbm.2121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The number of older people and their proportion of the prison population in high-income countries is increasing substantially. This pattern is mirrored by the age profile in forensic hospital services, and both trends seem counter to the age-crime curve concept. How do we understand this and what are the mental health needs of this growing group? AIM The aim of this review is to identify existing research robust enough to inform policy and practice in relation to mental health in older offenders and the knowledge gaps that should drive future research. METHODS A keyword-based search strategy of the databases Embase, PsychINFO, Medline, and grey literature 2008-2018. Article selection was limited to empirical research with the potential to inform policy or practice and findings synthesised narratively. RESULTS Much of the research in this field focuses on prevalence and the increased psychiatric morbidity of the older offender population. Older prisoners and those older patients in secure hospitals have needs that differ in some respects from their younger counterparts and community-dwelling older people. There are few studies of interventions for mental health in older prisoners or into the challenges of timely release given their complex needs. Discharge of older individuals from secure settings is also an area where further research is required in order to inform policy and service provision. CONCLUSIONS The older population in prisons and secure settings is growing, and there is much concern as to how far facilities and services have been able to identify and meet the mental health needs of those of older age. Cooperation between researchers and services and between disciplines will be essential if we are to secure a more robust evidence base in this respect. Engaging service users in such research and considering the whole criminal justice pathway including diversion remains a priority.
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Affiliation(s)
| | - Fiona R Houben
- Department of Health and Wellbeing, Canterbury Christchurch University, Kent, UK
| | | | - Douglas L MacInnes
- Department of Health and Wellbeing, Canterbury Christchurch University, Kent, UK
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18
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Forrester A, Hopkin G. Mental health in the criminal justice system: A pathways approach to service and research design. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:207-217. [PMID: 31478274 DOI: 10.1002/cbm.2128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Care pathway approaches were introduced into health care in the 1980s and have become standard international practice. They are now being introduced more specifically for health care in the criminal justice system. Care pathway delivery has the theoretical advantage of encouraging a whole-systems approach for health and social care within the criminal justice system, but how well is it supported by empirical evidence? AIMS The aim of this study is to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. METHOD We used an exploratory narrative method to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. The available literature was reviewed using a keyword search approach with three databases: PubMed, Medline, and Google Scholar. FINDINGS Research in this field has covered police custody, courts, prisons, and the wider community, but there is little that follows the entire career through all these elements of offender placement. Main themes in the research to date, regardless of where the research was conducted, have been counting the disorder or the need, development and evaluation of screening tools, and evaluation of clinical intervention styles. Most evidence to date is simply observational, although the possibility of conducting randomised controlled trials of interventions within parts of the criminal justice system, especially prisons, is now well established. CONCLUSIONS Access to health care while passing through the criminal justice system is essential because of the disproportionately high rates of mental disorder among offenders, and the concept of structured pathways to ensure this theoretically satisfying, but as yet empirically unsupported. Further, substantial cuts in services, generally following government economies, are largely unresearched. Considerable investment in new possibilities, driven by both pressure groups and government, tend to be informed by good will and theory rather than hard evidence and are often not evaluated even after introduction. This must change.
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Affiliation(s)
- Andrew Forrester
- Edenfield Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Gareth Hopkin
- Department of Health Policy, London School of Economics and Political Science, London, UK
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19
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Duggan C. Looking from the outside: No substitute for rigorous evaluation. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:189-195. [PMID: 31483552 DOI: 10.1002/cbm.2129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Looking in from the outside, what would the ordinary person expect of forensic mental health services? I suggest that there are three questions he or she would ask: (a) Are there public health measures that can be introduced to prevent those with mental disorder going on to commit crimes? (b) Can we identify in advance the individual who is likely to go on and commit a violent act because of his or her mental health difficulties, and prevent that or limit damage? (c) If a seriously harmful act has already been committed, what interventions might prevent a repetition? All of these questions are about prevention of an untoward event in the future and anticipate knowledge. How secure can we be that current forensic mental health practitioners can make adequately evidenced responses? I fear that examination of current literature would indicate that they and their academic colleagues would fall short of these expectations. Reasons for this are undoubtedly numerous. The issues are complex, with the interplay of many variables from the vagaries of human nature through varying presentations of disorders, still often classified rather than diagnosed, to widely differing environments which, further, may suddenly change in a critical way. The impact of a serious offence can be so catastrophic that officialdom often decides that "something must be done." Yet, without a good evidence base, such decision-making is often ineffective and wasteful of resources. The limited evidence base has not been helped by the virtual extinction of an academic forensic psychiatry infrastructure and funding within British universities and the National Health Service. This does not bode well for the future.
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Affiliation(s)
- Conor Duggan
- Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
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Interventions at the Transition from Prison to the Community for Prisoners with Mental Illness: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:623-634. [PMID: 29362981 PMCID: PMC5999162 DOI: 10.1007/s10488-018-0848-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prisoners have high rates of mental illness and the transition from prison to the community is a problematic time for the provision of mental health services and a range of negative outcomes have been identified in this period. A systematic review was conducted to identify interventions for prisoners with diagnosed mental health conditions that targeted this transition period. Fourteen papers from 13 research studies were included. The interventions identified in this review were targeted at different stages of release from prison and their content differed, ranging from Medicaid enrolment schemes to assertive community treatment. It was found that insurance coverage, and contact with mental health and other services can be improved by interventions in this period but the impact on reoffending and reincarceration is complex and interventions may lead to increased return to prison. There is a developing evidence base that suggests targeting this period can improve contact with community mental health and other health services but further high quality evidence with comparable outcomes is needed to provide more definitive conclusions. The impact of programmes on return to prison should be evaluated further to establish the effect of interventions on clinical outcomes and to clarify the role of interventions on reincarceration.
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Stranger support: How former prisoners with mental illnesses navigate the public landscape of reentry. Health Place 2019; 56:155-164. [PMID: 30772595 DOI: 10.1016/j.healthplace.2019.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prisoners with mental illnesses (MI) are released from prison into environments where they are under-treated and under-supported by our criminal justice, social service, and health systems. Public space and interactions within those spaces have been shown to have positive effects in similar populations, including individuals with MI. This qualitative study explored the role different interactions play during the course of reentry. The study aimed to understand the more everyday relational dynamics that former prisoners with MI experience in public and private spaces. METHODS Semi-structured interviews on both experiences of public spaces and interactions within were conducted with 36 former prisoners with MI. Go-along interviews were conducted as a follow-up to these interviews with a subsample of 11 participants in order to identify and describe public spaces and interactions within those spaces. Phenomenological analysis was used to analyze data collected. RESULTS Participants described an array of supportive relationships with familiar strangers fostered in public spaces. Participants also described receiving stranger support from relationships typically associated with conventional and institutional supports. This form of "stranger support" was juxtaposed against the burdens and risks of reciprocal intimate relationships. IMPLICATIONS Public space and public space interactions can provide support streams to counterbalance the more complex support of intimate relationships. Providers might consider the utility of familiar strangers in helping clients to navigate these sometimes risky, but potentially fruitful spaces.
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Smith D, Harnett S, Flanagan A, Hennessy S, Gill P, Quigley N, Carey C, McGhee M, McManus A, Kennedy M, Kelly E, Carey J, Concannon A, Kennedy HG, Mohan D. Beyond the Walls: An Evaluation of a Pre-Release Planning (PReP) Programme for Sentenced Mentally Disordered Offenders. Front Psychiatry 2018; 9:549. [PMID: 30450059 PMCID: PMC6224649 DOI: 10.3389/fpsyt.2018.00549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Prison mental health services have tended to focus on improving the quality of care provided to mentally disordered offenders at the initial point of contact with the prison system and within the prison environment itself. When these individuals reach the end of their sentence and return to the community, there is an increased risk of morbidity, mortality, homelessness and re-imprisonment. New models of care have been developed to minimize these risks. Objectives: The objective of this project was to establish a Pre-Release Planning (PReP) Programme with social work expertise, to enhance interagency collaboration and improve continuity of care for mentally disordered offenders upon their release. We aimed to evaluate the first 2 years of the programme by measuring its success at improving the level of mental health support and the security and quality of accommodation achieved by participants upon release in comparison to that reported at time of imprisonment. Additionally, we aimed to explore the impact of these outcomes on rates of re-imprisonment. Methods: A process of participatory action research was used to develop and evaluate the first 2 years of the programme. This was a naturalistic prospective observational whole cohort study. Results: The PReP Programme supported 43 mentally disordered offenders, representing 13.7%, (43/313) of all new assessments by the prison's inreach mental health service during the 2 years study period. When compared with that reported at time of reception at the prison, gains were achieved in level of mental health support (FET p < 0.001) and security and quality of accommodation (FET p < 0.001) upon release. Of those participants seen by the PReP Programme, 20 (46.5%, 20/43) were returned to prison during the 2-years study period. There was no significant relationship between re-imprisonment and gains made in mental health support (FET p = 0.23) or accommodation (FET p = 0.23). Conclusions: We have shown that compared to that reported at time of reception at prison, the level of mental health support and the security of tenure and quality of accommodation both improved upon release following the intervention of the programme. Improved mental health support and accommodation were not associated with lower rates of re-imprisonment.
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Affiliation(s)
- Damian Smith
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Susan Harnett
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Aisling Flanagan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Sarah Hennessy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Pauline Gill
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Niamh Quigley
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Cornelia Carey
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Michael McGhee
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Aoife McManus
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | | | | | | | - Ann Concannon
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Harry G Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Damian Mohan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
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