Hales Heidi, Somers Nadia, Reeves Chrissy, Bartlett Annie
Wells Unit, Three Bridges Secure Unit, St Bernard's Hospital, Uxbridge Road, Middlesex, UB1 3EU, UK.
St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
Crim Behav Ment Health. 2016 Apr;26(2):136-52. doi: 10.1002/cbm.1953. Epub 2015 Mar 24.
The high prevalence of mental disorders among women in prison is recognised worldwide. In England and Wales, successive governments and independent reports have argued that the equivalent of community care in prisons is acceptable but that some mental health assessment units (MHAUs), staffed by professional clinicians, should remain. These have not been researched.
This paper aimed to explore patterns of use of a MHAU in a women's prison in England and to test the hypothesis that it was being used only, as intended--to hold women pending transfer to a health service hospital or in a bona fide crisis.
Anonymised data on all women transferred to one MHAU between 1 January 2008 and 31 August 2010 were obtained from the prison files and subjected to descriptive analysis.
Less than a third of these women were transferred to an outside hospital; this group stayed longest in the unit. An overlapping group of 52% of the women was under a special assessment, care in custody and teamwork protocol because of suicide or serious self-harm risk. Thus, 188 (68%) admissions fulfilled national protocol criteria for MHAU admissions. Two in five women admitted were released or returned to ordinary prison locations. Nevertheless, over 80% of the women were known to external mental health services, and 64 (30%) were so unwell on arrival in prison that they were transferred directly to the MHAU. Over a third of admissions were of women admitted more than once during the 32 months of study, and this was significantly more likely after release from prison directly to the community.
Our hypothesis was not sustained, and it seems unlikely that this prison MHAU is unique in being used outside its strict remit. A shift from studying the epidemiology of mental disorder in prisons to the epidemiology of mental health needs could benefit this vulnerable group and the wider community alike.
监狱中女性精神障碍的高患病率在全球范围内都得到了认可。在英格兰和威尔士，历届政府及独立报告均认为，监狱中相当于社区护理的服务是可以接受的，但应由专业临床医生配备的一些心理健康评估单元（MHAUs）应予以保留。然而，这些单元尚未得到研究。
本文旨在探讨英格兰一所女子监狱中一个心理健康评估单元的使用模式，并检验该单元仅按预期使用的假设，即用于在女性转至医疗服务医院之前关押她们或处理真正的危机情况。
从监狱档案中获取了2008年1月1日至2010年8月31日期间转至一个心理健康评估单元的所有女性的匿名数据，并进行了描述性分析。
这些女性中不到三分之一被转至外部医院；这一组在该单元停留的时间最长。由于存在自杀或严重自残风险，52%的女性属于特殊评估、羁押期间护理和团队协作方案的范畴。因此，188例（68%）入院符合心理健康评估单元入院的国家方案标准。五分之二的入院女性被释放或返回普通监狱地点。然而，超过80%的女性为外部心理健康服务机构所知，64例（30%）女性在入狱时病情严重，因此被直接转至心理健康评估单元。超过三分之一的入院女性在32个月的研究期间多次入院，且在从监狱直接释放至社区后这种情况更有可能发生。
我们的假设未得到支持，而且该监狱心理健康评估单元似乎不太可能是唯一在其严格职权范围之外使用的单元。从研究监狱中精神障碍的流行病学转向研究心理健康需求的流行病学，可能会使这一弱势群体和更广泛的社区都受益。
