Supporting prisoners with mental health needs in the transition to RESETtle in the community: the RESET study.

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.

Mental health in immigration detention: A comparison of foreign national ex-prisoners and other detainees.

BACKGROUND: People held in immigration removal centres have a range of vulnerabilities relating both to disappointment at imminent removal from the country of hoped-for residence and various antecedent difficulties. An important subgroup in the UK is of foreign national ex-prisoners who have served a period of incarceration there. Prisoners generally have higher rates of mental disorders than the general population. It is, however, not clear whether foreign national ex-prisoners in UK immigration removal centres have higher rates of mental disorders than other detainees. AIMS: To compare the screened prevalence of mental disorders, levels of unmet needs and time in detention between foreign national ex-prisoners and others in Immigration Removal Centres in England. METHODS: We conducted a secondary analysis of cross-sectional survey data from a previously published study in one Immigration Removal Centre. RESULTS: The 28 foreign national ex-prisoners had been in immigration detention for longer and reported greater levels of unmet needs than the other 66 detainees. The highest levels of unmet needs among the foreign national ex-prisoners were in the areas of psychological distress and intimate relationships. After adjusting for time spent in detention, there was evidence to suggest that foreign national ex-prisoners had a higher screened prevalence of substance use disorders, autism spectrum disorders and attention-deficit hyperactivity disorder than the other detainees. CONCLUSIONS/IMPLICATIONS FOR CLINICAL PRACTICE: This study supports the view that foreign national ex-prisoners are a vulnerable group within immigration detention who have needs for enhanced and specialist service provision, including appropriate arrangements for health screening and active consideration to alternatives to their detention.

Liaison and diversion services in South East London: Referral patterns over a 25-year period.

Criminal justice liaison and diversion services identify people with mental health needs and ensure they receive appropriate support. We describe a 25-year period of one such service that deals with a population of 864,540 in South East London that was set up in 1991. We used data from three time periods. A diagnosis of a mental illness was recorded in 70.0-80.3% of court liaison and diversion referrals. The proportion receiving a hospital order declined from 15.4% in 1991/1992 to 1.1% in 2015/2016; 54/199 (27.1%) of referrals to the police liaison and diversion service were detained in hospital. Although the service is designed to support any individual with a mental health issue, these results suggest that it has dealt mainly with people who have severe mental illness. Further research is required to understand how best to benefit a wider range of people with mental health issues who attend the lower (Magistrates') courts, and whether screening for mental disorders can be applied in liaison and diversion settings to aid the implementation of national policy. We also need to understand how disposal decisions are made, and which are most effective.

Mental health services in the prisons of Bangladesh.

In this narrative review we consider what is known about mental health conditions in the prison system in Bangladesh and describe the current provision of mental health services for prisoners with mental health needs. We contextualise this within the literature on mental health conditions in correctional settings in the wider sub-continental region and low- and middle-income countries (LMICs) more broadly. We augment findings from the literature with information from unstructured interviews with local experts, and offer recommendations for research, policy and practice.

Continuing clozapine with granulocyte colony-stimulating factor in patients with neutropenia.

BACKGROUND: The current guidelines dictate that clozapine should be stopped following the emergence of neutropenia. Various alternative approaches have been tried in the past, among them one rarely used alternative being to continue treatment with clozapine with coprescription of granulocyte colony-stimulating factor (G-CSF). AIM AND METHOD: In this case series we aim to describe the treatment and progress of a number of patients in a secure psychiatric hospital in the UK. These patients were restarted on clozapine in combination with G-CSF, in spite of previous neutropenia associated with clozapine treatment. DISCUSSION AND CONCLUSION: We hope that this case series will raise the profile of a potentially effective alternative to discontinuing clozapine after neutropenia.

Aripiprazole use combined with depot antipsychotic medication: two cases demonstrating its ability to reduce prolactin levels in an adolescent forensic hospital.

Many patients maintained on depot medication have raised prolactin levels, which can lead to a range of long-term medical problems. The addition of aripiprazole can reduce prolactin levels and restore sexual function in these patients. The cases described demonstrate the potential role of aripiprazole in a forensic setting.