National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.
Irish Prison Service, Mountjoy Prison Complex, North Circular Road, Dublin 7, Ireland.
Int J Ment Health Syst. 2012 Apr 9;6(1):2. doi: 10.1186/1752-4458-6-2.
Vulnerable prisoners and mentally disordered offenders who present with risk of harm to self or others were accommodated in Special Observation Cells (SOCs) isolated from others for considerable periods of time. This practice has been criticised by the Council of Europe Committee for the Prevention of Torture. The objective of this initiative was to reduce the use of seclusion within the prison and to improve the care of vulnerable and mentally ill prisoners within the prison.
The prison studied is a committal centre for sentenced prisoners with an official bed capacity of 630. The forensic mental health in-reach team, in co-operation with the prison health service followed the 'spiral' of planning, action and fact finding about the results of the action. In December 2010 a 10 bed High Support Unit (HSU) was established within the prison. During the first year, 96 prisoners were admitted. A third (35%) reported psychotic symptoms, 28% were referred due to the immediate risk of self-harm, 17% were accommodated for medical treatments and increased observation, 13% received specialised treatment by the Addiction Psychiatry team, 6% presented with emotional distress. One prisoner was accommodated on the HSU due to the acute risk he posed to others. A major mental illness was diagnosed in 29%, 20% required short-term increased support for crisis intervention and were found not to have a mental illness. A further 10% were deemed to be feigning symptoms of mental illness to seek refuge in the HSU. 7% had personality disorder as their primary diagnosis and 4% had a learning disability. Stratifying risk within the prison population through the provision of the HSU decreased the total episodes of seclusion in the prison by 59% (p < 0.001) in addition to providing a more effective psychiatric in-reach service to the prison. Pathways between the prison and the forensic psychiatric hospital saw no change in activity but improved continuity of care.
The next step is to further stratify risk by establishing a low support unit to serve as a step-down from the high support unit.
有自我伤害或伤害他人风险的弱势囚犯和精神障碍罪犯被安置在特殊观察牢房（SOC）中，与其他人隔离相当长的时间。这种做法受到欧洲防止酷刑委员会的批评。该倡议的目的是减少监狱内的禁闭使用，并改善监狱内弱势和精神病囚犯的护理。
该监狱是一个有 630 个官方床位的已决犯移送中心。法医心理健康外展小组与监狱卫生服务部门合作，按照规划、行动和事实调查的“螺旋式”方式，了解行动结果。2010 年 12 月，在监狱内设立了一个 10 张床位的高支持单位（HSU）。在第一年，有 96 名囚犯入住。三分之一（35%）报告有精神病症状，28%是因为立即有自我伤害的风险而被转介，17%是因为需要医疗和加强观察而入住，13%接受了成瘾精神病学团队的专门治疗，6%表现出情绪困扰。一名囚犯因对他人构成急性风险而被安置在 HSU。29%被诊断出患有严重精神疾病，20%需要短期增加危机干预支持，而没有被诊断出患有精神疾病。另有 10%被认为是在装病以寻求在 HSU 避难。7%的人主要诊断为人格障碍，4%的人有学习障碍。通过提供 HSU 在监狱人口中对风险进行分层，使监狱内的禁闭总次数减少了 59%（p<0.001），同时为监狱提供了更有效的精神病外展服务。监狱和法医精神病院之间的途径没有改变活动，但改善了护理的连续性。
下一步是通过建立一个低支持单位，作为从高支持单位降级的步骤，进一步对风险进行分层。
