Smith Damian, Harnett Susan, Flanagan Aisling, Hennessy Sarah, Gill Pauline, Quigley Niamh, Carey Cornelia, McGhee Michael, McManus Aoife, Kennedy Mary, Kelly Enda, Carey Jean, Concannon Ann, Kennedy Harry G, Mohan Damian
National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland.
Department of Psychiatry, Trinity College, Dublin, Ireland.
Front Psychiatry. 2018 Nov 2;9:549. doi: 10.3389/fpsyt.2018.00549. eCollection 2018.
Prison mental health services have tended to focus on improving the quality of care provided to mentally disordered offenders at the initial point of contact with the prison system and within the prison environment itself. When these individuals reach the end of their sentence and return to the community, there is an increased risk of morbidity, mortality, homelessness and re-imprisonment. New models of care have been developed to minimize these risks. The objective of this project was to establish a Pre-Release Planning (PReP) Programme with social work expertise, to enhance interagency collaboration and improve continuity of care for mentally disordered offenders upon their release. We aimed to evaluate the first 2 years of the programme by measuring its success at improving the level of mental health support and the security and quality of accommodation achieved by participants upon release in comparison to that reported at time of imprisonment. Additionally, we aimed to explore the impact of these outcomes on rates of re-imprisonment. A process of participatory action research was used to develop and evaluate the first 2 years of the programme. This was a naturalistic prospective observational whole cohort study. The PReP Programme supported 43 mentally disordered offenders, representing 13.7%, (43/313) of all new assessments by the prison's inreach mental health service during the 2 years study period. When compared with that reported at time of reception at the prison, gains were achieved in level of mental health support (FET < 0.001) and security and quality of accommodation (FET < 0.001) upon release. Of those participants seen by the PReP Programme, 20 (46.5%, 20/43) were returned to prison during the 2-years study period. There was no significant relationship between re-imprisonment and gains made in mental health support (FET = 0.23) or accommodation (FET = 0.23). We have shown that compared to that reported at time of reception at prison, the level of mental health support and the security of tenure and quality of accommodation both improved upon release following the intervention of the programme. Improved mental health support and accommodation were not associated with lower rates of re-imprisonment.
监狱心理健康服务往往侧重于在与监狱系统初次接触时以及在监狱环境本身内，提高为患有精神障碍的罪犯提供的护理质量。当这些人刑期结束并返回社区时，发病、死亡、无家可归和再次入狱的风险会增加。已经开发了新的护理模式以尽量减少这些风险。本项目的目标是建立一个具有社会工作专业知识的提前释放计划（PReP）项目，以加强机构间合作，并改善患有精神障碍的罪犯获释后的护理连续性。我们旨在通过衡量该项目在改善心理健康支持水平以及参与者获释后所获得的住宿安全性和质量方面的成功程度（与入狱时报告的情况相比），来评估该项目的前两年。此外，我们旨在探讨这些结果对再次入狱率的影响。采用参与式行动研究过程来开发和评估该项目的前两年。这是一项自然主义前瞻性观察性全队列研究。PReP项目为43名患有精神障碍的罪犯提供了支持，占两年研究期间监狱内部心理健康服务所有新评估对象的13.7%（43/313）。与入狱时报告的情况相比，获释时在心理健康支持水平（FET<0.001）以及住宿安全性和质量（FET<0.001）方面都有改善。在PReP项目所服务的参与者中，20人（46.5%，20/43）在两年研究期间再次入狱。再次入狱与心理健康支持方面（FET = 0.23）或住宿方面（FET = 0.23）的改善之间没有显著关系。我们已经表明，与入狱时报告的情况相比，在该项目干预后，获释时的心理健康支持水平以及居住权安全性和住宿质量都有所改善。心理健康支持和住宿条件的改善与更低的再次入狱率无关。
