Psychiatric symptoms and histories among people detained in police cells.

OBJECTIVES: This study examined the psychiatric symptoms, mental health histories and psychiatric medication use in a sample of people detained in police cells. Offences that led to the detention episode were compared between those with and without psychiatric symptoms. METHOD: Detainees were interviewed by nurses who completed a clinical interview and the Brief Psychiatric Rating Scale. Full histories of contact data for participants were then drawn from the public mental health services database and the police database, and from their general practitioners. RESULTS: One-third of the 614 detainees exhibited psychiatric symptoms in police custody; and 42% received medical treatment after arrest. Over half (55%) of the detainees had previous contact with the public mental health system. Having a history of contact with mental health services was found to contribute significantly to psychiatric symptoms in police cells. Offences committed by detainees did not differ between those presenting with and without psychiatric symptoms. CONCLUSIONS: Many detainees in police cells experience psychiatric symptoms. This creates a significant clinical need necessitating timely access to health care and a continuity of care with health service providers beyond the initial police cell contact. Such a service model will require the development of functional interagency partnerships between the police and health services.

Mental disorders in female prisoners.

OBJECTIVE: The objective of the study was to investigate the rates of mental disorder among women in prison in Victoria, and to compare with community rates. DESIGN: A midnight census of all women in prison in Victoria was undertaken. Respondents were interviewed with a version of the Composite International Diagnostic Interview (CIDI), an adapted version of the Personality Diagnostic Questionnaire (PDQ-4+) and a demographics questionnaire. MAIN OUTCOME MEASURES: Twelve-month prevalence rates of ICD-10 mental disorders including depressive disorders, anxiety disorders and drug-related disorders were examined. Prevalence of personality disorders was also investigated. RESULTS: Eighty-four per cent of the female prisoners interviewed met the criteria for a mental disorder (including substance harmful use/dependence) in the year prior to interview. This rate was reduced to 66% when drug-related disorders were excluded. Forty-three per cent of subjects were identified as cases on a personality disorder screener. For all disorders, (except obsessive-compulsive disorder and alcohol harmful use) women in prison had a significantly greater likelihood of having met the 12-month diagnostic criteria when compared to women in the community. The most prevalent disorders among the female prisoners were: drug use disorder (57%), major depression (44%), Posttraumatic stress disorder (36%), and personality disorders. Almost a quarter (24%) of respondents were identified as a 'case' on the psychosis screen. CONCLUSIONS: In the present study female prisoners had significantly higher rates of the mental disorders investigated (with the exceptions of OCD and alcohol harmful use) when compared with women in the community. The pattern of disorder found among female prisoners is consistent with the abuse literature, suggesting that histories of abuse among the prison population may account for part of the discrepancy. These results highlight the need for improved assessment and treatment resources to meet the demands of this population.

Low hospital inpatient readmission rate in patients with borderline personality disorder: a naturalistic study at Southern Health, Victoria, Australia.

OBJECTIVE: To study how the standard management protocol and the special management contract relate to the clinical profile of patients with borderline personality disorder and their hospital admission pattern. METHOD: A retrospective review was undertaken using naturalistic data from the Client Management Interface over a 2-year period. The standard management protocol patient group and the special treatment contract patient group were compared with respect to variables which included basic demographic data, number of admissions, length of stay and comorbidity. RESULTS: Eighty patients received a diagnosis of borderline personality disorder. The majority (81.2%) were managed with the standard management protocol and only 41.5% had more than one admission. For those who received a special treatment contract (18.8%), 93.3% of them had more than one admission. The special treatment contract group had a significantly higher total number of admissions (p < 0.001), a higher number of admissions when they received (p < 0.001) and did not receive (p = 0.001) a diagnosis of borderline personality disorder, a higher number of comorbidities (p = 0.004) but not more presentations to the emergency department. CONCLUSIONS: Most patients with borderline personality disorder treated with the standard management protocol had a low readmission rate. The small group of patients with comorbidities managed with a special treatment contract had multiple readmissions but not more crisis presentations to the emergency department. Further studies are required to elucidate the therapeutic mechanism of the standard management protocol and special treatment contract and how that impacts on presentations and admissions to a hospital.