Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
Int J Law Psychiatry. 2013 May-Aug;36(3-4):326-32. doi: 10.1016/j.ijlp.2013.04.007. Epub 2013 May 10.
In responding to high levels of psychiatric morbidity amongst prisoners and recognising earlier poor quality prison mental health care, prison mental health in-reach teams have been established in England and Wales over the last decade. They are mostly provided by the National Health Service (NHS), which provides the majority of UK healthcare services. Over the same period, the prison population has grown to record levels, such that prisons in England and Wales now contain almost 90,000 of the world's overall prison population of over 10 million people (roughly the size of Paris or Istanbul). This study provides an overview of mental health in-reach services in prisons in England and Wales, including variations between them, through a telephone survey of senior staff in all prisons and young offender institutions in England and Wales. 73% of prisons took part; of them 13% had no in-reach team at all (usually low security establishments) and the majority of services were run by NHS teams, usually according to a generic community mental health team (CMHT) model rather than other specialist models. Team size was unrelated to prison size. Each nurse covered around 500 prisoners, each doctor over 3700. Many provided few or no healthcare cells and 24-h psychiatric cover (including on-call cover) was uncommon. Despite developments in recent years, mental health in-reach services still fall short of community equivalence and there is wide variation in service arrangements that cannot be explained by prison size or function. The aim of community equivalence has not yet been reached in prison healthcare and a more sophisticated measure of service improvement and standardisation would now be useful to drive and monitor future development.
在应对囚犯中较高水平的精神疾病发病率，并认识到早期监狱心理健康护理质量较差的情况后，过去十年中，英格兰和威尔士已建立了监狱心理健康上门服务团队。这些团队主要由国家卫生服务局（NHS）提供，NHS 提供了英国大部分医疗保健服务。同期，囚犯人数增长至创纪录水平，以至于英格兰和威尔士的监狱现在关押了全球超过 1 亿囚犯中的近 90,000 人（大致相当于巴黎或伊斯坦布尔的规模）。本研究通过对英格兰和威尔士所有监狱和青少年罪犯机构的高级工作人员进行电话调查，概述了监狱内心理健康上门服务，包括其之间的差异。73%的监狱参与了调查；其中 13%的监狱根本没有上门服务团队（通常是低安全级别的监狱），而大多数服务是由 NHS 团队提供的，通常按照通用的社区心理健康团队（CMHT）模式运行，而不是其他专业模式。团队规模与监狱规模无关。每位护士照顾大约 500 名囚犯，每位医生照顾超过 3700 名囚犯。许多监狱提供的医疗服务很少或根本没有，24 小时精神病学覆盖（包括随叫随到的覆盖）也很少见。尽管近年来有所发展，但心理健康上门服务仍未达到社区等效水平，而且服务安排存在广泛差异，无法用监狱规模或功能来解释。监狱医疗保健中尚未达到社区等效的目标，因此，现在需要更复杂的服务改进和标准化衡量标准，以推动和监测未来的发展。
