Walsh Jamie, Smith Damian, Byrne Fintan, Hickey Philip, Taylor Enda, Caddow Martin, Reynolds Orla, O'Neill Conor
National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland.
Department of Psychiatry, Trinity College, Dublin, Ireland.
Front Psychiatry. 2024 Jul 19;15:1392072. doi: 10.3389/fpsyt.2024.1392072. eCollection 2024.
The post-release period is associated with an increased risk of morbidity and mortality. Previous studies have identified deficits in pre-release planning for mentally ill people in prison, particularly in remand settings.
We aimed to determine the proportion of mentally ill people in Ireland's main remand prison who were referred for mental health follow up in community and prison settings, who achieved face to face contact with the receiving service.
This retrospective observational cohort study was based in Ireland's main male remand prison, Cloverhill. Participants included all those individuals on the caseload of the prison inreach mental health team who were referred for mental health follow up in community and prison settings at the time of discharge, prison transfer or release from custody over a three-year period, 2015 - 2017. Successful transfer of care (TOC) was defined as face-to-face contact with the receiving service, confirmed by written correspondence or by follow up telephone call. Clinical, demographic and offence related variables were recorded for all participants.
There were 911 discharges from the prison inreach mental health team within the three-year study period. Of these, 121 were admitted to hospital, 166 were transferred to other prison inreach mental health services and 237 were discharged to community based mental health follow up in psychiatric outpatient or primary care settings. One third (304/911) had an ICD-10 diagnosis of schizophreniform or bipolar disorder (F20-31) and 37.5% (161/911) were homeless. Over 90% (152/166) of those referred to mental health teams in other prisons achieved successful TOC, with a median of six days to first face-to face assessment. Overall, 59% (140/237) of those referred to community psychiatric outpatient or primary care services achieved TOC following referral on release from custody, with a median of nine days from release to assessment. Clinical and demographic variables did not differ between those achieving and not achieving successful TOC, other than having had input from the PICLS Housing Support Service.
Successful transfer of care can be achieved in remand settings using a systematic approach with an emphasis on early and sustained interagency liaison and clear mapping of patient pathways. For incarcerated individuals experiencing homelessness and mental health disorders, provision of a housing support service was associated with increased likelihood of successful transfer of care to community mental health supports.
出狱后的一段时间内，发病和死亡风险会增加。此前的研究发现，监狱中患有精神疾病的人在出狱前的规划存在缺陷，尤其是在还押候审的环境中。
我们旨在确定爱尔兰主要还押监狱中被转介到社区和监狱环境中接受心理健康随访的精神疾病患者的比例，以及与接收服务机构进行面对面接触的患者比例。
这项回顾性观察队列研究以爱尔兰主要的男性还押监狱克洛弗希尔为基础。参与者包括监狱内心理健康团队登记在册的所有人员，这些人员在2015年至2017年的三年期间，在出院、转狱或解除羁押时被转介到社区和监狱环境中接受心理健康随访。成功的护理转接（TOC）定义为与接收服务机构进行面对面接触，这通过书面通信或后续电话确认。记录了所有参与者的临床、人口统计学和犯罪相关变量。
在为期三年的研究期间，监狱内心理健康团队有911次出院记录。其中，121人被送往医院，166人被转至其他监狱内心理健康服务机构，237人被转至社区心理健康随访机构，接受精神科门诊或初级保健服务。三分之一（304/911）的人根据国际疾病分类第10版（ICD-10）被诊断为精神分裂症样或双相情感障碍（F20-31），37.5%（161/911）的人无家可归。转介到其他监狱心理健康团队的人中，超过90%（152/166）实现了成功的TOC，首次面对面评估的中位数为6天。总体而言，转介到社区精神科门诊或初级保健服务机构的人中，59%（140/237）在解除羁押后转介后实现了TOC，从解除羁押到评估的中位数为9天。除了接受过PICLS住房支持服务的帮助外，实现和未实现成功TOC的人在临床和人口统计学变量上没有差异。
在还押候审环境中，采用系统方法，强调早期和持续的跨部门联络以及明确患者路径图，可以实现成功的护理转接。对于无家可归且患有精神疾病的被监禁者，提供住房支持服务与成功转接到社区心理健康支持服务的可能性增加有关。
