Mental healthcare interfaces in a regional Irish prison

• Date: 11 March 2019
• Published date: 11 March 2019
• Pages: 14-23
• DOI: https://doi.org/10.1108/IJPH-06-2017-0029
• Author: Gautam Gulati,Kizito Otuokpaikhian,Maeve Crowley,Vishnu Pradeep,David Meagher,Colum P. Dunne
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Mental healthcare interfaces in a regional

Irish prison

Gautam Gulati, Kizito Otuokpaikhian, Maeve Crowley, Vishnu Pradeep, David Meagher and

Colum P. Dunne

Abstract

Purpose –The purpose of this paper is to study the demographic, clinical characteristics and outcomes for

those prisoners referred to secondary mental healthcare in a regional Irish prison and the proportion of

individuals diverted subsequently from prison to psychiatric settings.

Design/methodology/approach –The authors conducted a retrospective review of 130 successive

psychiatric assessment case records at a regional mixed gender prison serving six southern Irish counties.

The authors analysed demographics, clinical characteristics and outcomes. Where diversion out of prison

was undertaken, Dangerousness, Understanding, Recovery and Urgency Manual (DUNDRUM) scores were

retrospectively completed to assess security need.

Findings –In total, 8.6 per cent of all committals from liberty were referred by a general practitioner and

8.1 per cent subsequently assessed by the visiting psychiatrist. Predominantly, these were young males

charged with a violent offence. In all, 42.2 per cent of those assessed by secondary care were diagnosed with

a substance misuse disorder and 21.1 per cent with a personality disorder. In total, 20.3 per cent suffered

from a psychotic disorder and 10.6 per cent with an affective disorder. Of those seen by psychiatric services,

51.2 per cent required psychotropic medication, 29.2 per cent required psychological input and

59.3 per cent required addiction counselling. In all, 10.6 per cent of those assessed were diverted from

prison, the majority to approved centres. Mean DUNDRUM-1 scores suggested that those referred to high

and medium secure hospitals were appropriately placed, whereas those diverted to open wards would have

benefited from a low secure/intensive care setting.

Originality/value –The multifaceted need set of those referred strengthens the argument for the provision of

multidisciplinary mental healthcare into prisons. The analysis of security needs for those diverted from prisons

supports the need for Intensive Care Regional Units in Ireland.

Keywords Mental illness, Prisons, Diversion, Psychiatric, Psychosocial

Paper type Research paper

Introduction

Mental illness is over-represented in Irish prisons compared to the general population (Kennedy

et al., 2004; O’Neill et al., 2016) in keeping with data from the UK (Senior et al., 2013) and prisons

worldwide (Fazel and Seewald, 2012; Fazel and Danesh, 2002).

In a country-wide Irish cross-sectional study, Kennedyet al. (2004) estimated that 7.5 per cent of

men on remand, 2.7 per cent of sentenced men and 5.4 per cent of female prisoners should be

diverted to psychiatric services. Rates of psychosis were 7.6 per cent amongst men on remand,

2.7 per cent amongst sentenced men and 5.4 per cent amongst women prisoners. Depressive

disorderwas present in 10 per cent of male remand prisonersand 16 per cent of female prisoners.

In comparison, Senior et al. (2013) screened 3,492 prisoners from six English prisons and found

that 23 per cent suffered from a serious mental illness. They reported that prison mental health

in-reach teams assessed only 25 per cent of these unwell prisoners, subsequently accepting

13 per cent ontotheir caseloads. Fazel and Danesh(2002) reviewed 62 surveys from10 countries

including 23,000 prisoners and found that 3.7 per cent of men and 4 per cent of women had a

psychotic illness,whilst 10 per cent of men and 12 per cent of women sufferedmajor depression.

Received 19 June 2017

Revised 17 January 2018

Accepted 15 May 2018

The authors are grateful to

Professor H.G. Kennedy for

comments on the first draft of this

manuscript.

Gautam Gulati is based at the

Department of Psychiatry,

University Hospital Limerick,

Limerick, Ireland and Graduate

Entry Medical School,

University of Limerick,

Limerick, Ireland.

Kizito Otuokpaikhian is based

at the Department of

Psychiatry, Ennis General

Hospital, Ennis, Ireland.

Maeve Crowley and

Vishnu Pradeep are both based

at the Department of

Psychiatry, University Hospital

Limerick, Limerick, Ireland.

David Meagher is based at the

Department of Psychiatry,

Graduate Entry Medical

School, University of Limerick,

Limerick, Ireland.

Colum P. Dunne is based at the

Graduate Entry Medical

School, University of Limerick,

Limerick, Ireland.

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VOL. 15 NO. 1 2019, pp. 14-23, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-06-2017-0029