Controlling COVID-19 outbreaks in the correctional setting: A mathematical modelling study.

Correctional centres (termed here 'prisons') are at high risk of COVID-19 and have featured major outbreaks worldwide. Inevitable close contacts, frequent inmate movements, and a disproportionate burden of co-morbidities mean these environments need to be prioritised in any public health response to respiratory pathogens such as COVID-19. We developed an individual-based SARS-CoV-2 transmission model for the prison system in New South Wales, Australia - incorporating all 33 correctional centres, 13,458 inmates, 578 healthcare and 6,909 custodial staff. Potential COVID-19 disease outbreaks were assessed under various mitigation strategies, including quarantine on entry, isolation of cases, rapid antigen testing of staff, as well as immunisation.Without control measures, the model projected a peak of 472 new infections daily by day 35 across the prison system, with all inmates infected by day 120. The most effective individual mitigation strategies were high immunisation coverage and prompt lockdown of centres with infected inmates which reduced outbreak size by 62-73%. Other than immunisation, the combination of quarantine of inmates at entry, isolation of proven or suspected cases, and widespread use of personal protective equipment by staff and inmates was the most effective strategy. High immunisation coverage mitigates the spread of COVID-19 within and between correctional settings but is insufficient alone. Maintaining quarantine and isolation, along with high immunisation levels, will allow correctional systems to function with a low risk of outbreaks. These results have informed public health policy for respiratory pathogens in Australian correctional systems.

Preparing correctional settings for the next pandemic: a modeling study of COVID-19 outbreaks in two high-income countries.

Introduction: Correctional facilities are high-priority settings for coordinated public health responses to the COVID-19 pandemic. These facilities are at high risk of disease transmission due to close contacts between people in prison and with the wider community. People in prison are also vulnerable to severe disease given their high burden of co-morbidities. Methods: We developed a mathematical model to evaluate the effect of various public health interventions, including vaccination, on the mitigation of COVID-19 outbreaks, applying it to prisons in Australia and Canada. Results: We found that, in the absence of any intervention, an outbreak would occur and infect almost 100% of people in prison within 20 days of the index case. However, the rapid rollout of vaccines with other non-pharmaceutical interventions would almost eliminate the risk of an outbreak. Discussion: Our study highlights that high vaccination coverage is required for variants with high transmission probability to completely mitigate the outbreak risk in prisons.

Lessons learned from keeping NSW's prisons COVID-free.

PURPOSE: New South Wales (NSW) correctional system houses 30% of prisoners in Australia and at this time has only had a single documented case of COVID-19 amongst its prisoner population. The coordinated response by Justice Health and Forensic Mental Health Network (The Network) undertaken with the support of NSW Ministry of Health, in partnership with Corrective Services NSW (CSNSW), Youth Justice and private jails has ensured that the NSW correctional system has remained otherwise COVID-free. DESIGN/METHODOLOGY/APPROACH: A research study of how a range of partners which support the operations of NSW Correctional System developed an effective approach for the prevention a COVID-19 epidemic amongst its inmates. FINDINGS: Establishment of effective partnerships, early coordination of representatives from all aspects of the NSW correctional system, limited access to the correctional environment, reduced prison population and strict isolation of all new receptions have all contributed to maintaining this COVID-free status despite other NSW settings with similar risk profiles, such as aged care facilities and cruise ship arrivals, experiencing serious outbreaks. RESEARCH LIMITATIONS/IMPLICATIONS: Although Australia/New Zealand context of suppressed community infection rates for COVID-19 (which are approaching elimination in some jurisdictions) is in contrast to the situation in other parts of the world, the principles described in this paper will be useful to most other correctional systems. PRACTICAL IMPLICATIONS: Modelling was used to underline our approach and reinforced the veracity of following this approach. ORIGINALITY/VALUE: The Network and CSNSW has been able to mount an effective, integrated response to the COVID-19 pandemic, which has been sustainable through the first peak of COVID-19 cases. This case study catalogues the process of developing this response and details each intervention implemented with inventive use of tables to demonstrate the impact of the range of interventions used.

Reduced ambivalence to the role of the cardiometabolic health nurse following a 6-month trial.

PURPOSE: To determine the changes in attitudes toward the inclusion of a cardiometabolic health nurse for the physical healthcare management of people with serious mental illness following a 6-month trial. DESIGN AND METHODS: Repeated survey of nurses working in a regional mental health facility. FINDINGS: Nurses working in mental health were initially supportive of the role. A 6-month trial of a cardiometabolic health nurse in the workplace reduced ambivalence and increased positivity toward the role. PRACTICE IMPLICATIONS: Reduced ambivalence and improved positivity toward the role may facilitate less organization resistance to the implementation of a cardiometabolic health nurse in the mental healthcare setting. Specialized training and role recognition may be needed to further support this role.

Development, validation and initial outcomes of a questionnaire to investigate the views of nurses working in a mental health setting regarding a cardiometabolic health nursing role.

People with serious mental illness experience disparities in primary health care. One solution is a specialist nursing position responsible for the coordination of the primary care of people with serious mental illness. However the views of nurses regarding this proposed role are only beginning to emerge. This study reports the readability, factorability, internal consistency and responses from a questionnaire regarding the views of nurses working in a mental health setting regarding the proposed role. The questionnaire was determined to have adequate readability, and internal consistency. Nurses are positive towards the development of the role however the cost-effectiveness should be considered.

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: baseline physical health outcomes from a randomised controlled trial.

People with serious mental illness (SMI) are more likely to have poorer health and poorer health behaviours, and therefore are at greater risk for cardiometabolic health comorbidities compared to those without SMI. Referral to a specialist cardiometabolic health care nurse may result in increased detection of poor cardiometabolic health in at-risk individuals. In this article, we present the results of the physical health measures of people with serious mental illness who have accessed a community mental health service in a regional centre and argue for the need for a multidisciplinary approach. Our data show the high prevalence of obesity, hypertension, low activity, smoking and nicotine dependence, alcohol misuse disorders, and poor diet among people with serious mental illness. The high prevalence of at-risk factors for poor cardiometabolic health in people with serious mental illness adds support for the role of a specialist cardiometabolic health care nurse in the detection and referral for multidisciplinary treatment to improve the physical health outcomes for people with serious mental illness.

Self-reported health, health behaviors, attitudes, and beliefs of regional mental health consumers.

PURPOSE: This article reports baseline data from a randomized controlled trial investigating the impact of a specialist cardiometabolic healthcare nurse on physical health care. DESIGN AND METHODS: Survey of community-based mental health consumers randomized to a cardiometabolic health nurse intervention. FINDINGS: Findings show a high prevalence of respiratory conditions, hypercholesterolemia, hypertension, and low quality of life. Participants reported regular blood pressure but infrequent cholesterol and blood glucose testing. Few received advice about smoking cessation, diet, or physical activity. Participants were mostly satisfied with physical healthcare provision; however, positive health behaviors are lacking. PRACTICE IMPLICATIONS: An individualized intervention based on knowledge and attitudes may be necessary.

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: protocol for a randomised controlled trial.

BACKGROUND: People with a serious mental illness are at significantly greater risk of poor cardiometabolic health with recent studies showing a greater than two-fold increase in the risk of obesity, infectious diseases, diabetes and cardiovascular disease. Contributing factors to this disparity include poorer health behaviours such as suboptimal physical activity, poor diet, smoking, alcohol and illicit drug misuse. In particular, the limited access to primary health care experienced by people with a serious mental illness has been highlighted. Persons with a serious mental illness are around 30% less likely than those without serious mental illness to receive health assessments, hospital admissions or procedures for cardiovascular disease and diabetes, and are less likely to undergo cancer screening or receive vaccinations. Studies show that mental health consumers may be more likely to use mental health services rather than primary care for contact with the health care system. However mental health nurses report several barriers to their capacity to provide cardiometabolic health care crucial for the treatment of people with a serious mental illness. OBJECTIVES: To assess the impact of a specialist Cardiometabolic Health Nurse on the physical health care of community based mental health consumers. SETTING: Community mental health facility in a large regional centre in Central Queensland, Australia. DESIGN/METHODS: Community based mental health consumers will be randomised to receive either usual care, or consultations with a Cardiometabolic Health Nurse. The Cardiometabolic Health Nurse will be responsible for assessing the client and coordinating cardiometabolic health care as required. Post intervention review of health records will be performed with the primary outcome measure being self-reported physical health. Secondary outcomes include the utilisation of primary care services and changes in health behaviours. We hypothesise that the Cardiometabolic Health Nurse will increase the utilisation of health care services for mental health consumers. RESULTS: Data collection commenced in March 2013 and will conclude September 2013. Preliminary finding are expected in December 2013.

The activities that nurses working in community mental health perform: a geographical comparison.

OBJECTIVE: The primary aim of the present study was to identify the activities that nurses in community mental health services undertake. METHOD: A dataset containing records of the community and ambulatory interventions involving the nursing staff of 252 mental health facilities was analysed. RESULTS: Nurses spend most of their time performing clinical care (78%), followed by clinical organisation (12%), mental health administration (6%) and integration activities (4%). There were minimal differences between treating units located in metropolitan, rural and remote areas in terms of the numbers of consumers receiving care, the time nurses spent with consumers, the types of nursing activities undertaken and the amounts of time spent on each of the four types of nursing activities. CONCLUSIONS: These findings suggest that nurses in mental health community settings spend more time in clinical care than nurses in other healthcare settings.

The characteristics of consumers receiving case management in the community: a review of literature.

Mental health nurses increasingly provide care for consumers in the community who once would have received treatment in psychiatric inpatient units. The purpose of this review is to determine the characteristics of these consumers. We searched electronic databases and obtained information on some of the characteristics of community mental health consumers. For some nurses, over half of their caseloads are consumers with schizophrenia. Up to about one-third of consumers may be involuntary, but this proportion varies considerably. Impairments of health and social functioning appear common among consumers of community mental health services. This study identifies the need for greater interrogation of national databases to enhance understanding of community caseloads.

Community mental health nurses, caseloads, and practices: a literature review.

Deinstitutionalization, and more recently, earlier discharges from psychiatric inpatient units, have created and intensified the need for case management in community mental health. Nurses have been at the forefront of providing this case management. This literature review provides a synthesis of research and policy on the contribution of mental health nurses to community case management. The focus of this review is on the proportion of case management that mental health nurses undertake, the caseloads of case managers, and the interventions that mental health nurses most frequently perform in the community. The professional compositions of mental health case management workforces have been associated with economic imperatives, professional priorities, and the choice of case management models. The influence of mental health nurses in the case management workforce is particularly strong in the U.K. and Australia, but less so in the U.S.A. where social workers and people without mental health qualifications perform similar roles. Although heavy caseloads seem to be common among case managers, the research in this area is quite weak. The interventions that mental health nurses perform most often include case management (e.g., coordinating care), counselling, and medication management. Caring for the physical health of consumers might often be overlooked.