Rouse P, Pillai K, McKenna B, Simpson A, Cavney J, Skipworth J, Tapsell R, Madell D
The University of Auckland, Auckland, New Zealand.
Auckland Regional Forensic Psychiatry Service, Waitemata District Health Board, Auckland, New Zealand.
Crim Behav Ment Health. 2025 Aug;35(4):228-239. doi: 10.1002/cbm.70005. Epub 2025 Aug 13.
There is little research into appropriate measures of value for money in prison mental health services.
To develop and evaluate an accountability framework for an enhanced Prison Model of Care for people with serious mental illness in five New Zealand prisons. A key objective was to identify people with such illnesses who were missing from existing caseloads.
A generic public sector accountability framework was modified to provide measures of value for money around efficiency in its three component criteria of effectiveness and economy using a pre/post design, allowing measurement of flows between successive stages of this prison healthcare model. Measures were arranged into common dimensions around outcomes, outputs, inputs and costs, varied across the stages. The framework was populated with data collected from five prisons for the pre- and post-implementation periods.
Improvements in the three criteria were generally obtained across all five areas of service delivery but especially in the screening, assessment, intervention and reintegration stages. Since these three criteria are major components of value for money, they provide evidence for improvement in value for money of the mental health services in these prisons. Other desired operational changes achieved were a threefold increase in the nurse to doctor ratio at the triage stage and slight increase in doctor to nurse ratio at the treatment stage. Overall, the implementation of this model of care achieved an increase in the size of caseload from 6.1% to 7.3% of the prison muster, equivalent to an increase in caseload of 21%.
This accountability framework confirmed the value for money of the Prison Model of Care for severe mental illness, highlighting areas of good performance as well as areas requiring further development. The framework also provides measures that can be used as key performance indicators in ongoing monitoring.
对于监狱心理健康服务中物有所值的适当衡量标准，研究甚少。
为新西兰五所监狱中针对严重精神疾病患者的强化监狱照护模式制定并评估一个问责框架。一个关键目标是识别现有病例清单中遗漏的此类疾病患者。
对一个通用的公共部门问责框架进行修改，以在其有效性、经济性这三个组成标准的效率方面提供物有所值的衡量标准，采用前后设计，从而能够衡量该监狱医疗模式连续阶段之间的流程。衡量标准围绕结果、产出、投入和成本分为共同维度，在不同阶段有所不同。该框架用从五所监狱在实施前和实施后收集的数据进行填充。
在所有五个服务提供领域，这三个标准总体上都有改善，尤其是在筛查、评估、干预和重新融入阶段。由于这三个标准是物有所值的主要组成部分，它们为这些监狱心理健康服务物有所值的改善提供了证据。实现的其他期望的运营变化包括在分诊阶段护士与医生的比例增加了两倍，在治疗阶段医生与护士的比例略有增加。总体而言，这种照护模式的实施使病例清单规模从监狱点名人数的6.1%增加到7.3%，相当于病例清单增加了21%。
这个问责框架证实了针对严重精神疾病的监狱照护模式的物有所值，突出了表现良好的领域以及需要进一步发展的领域。该框架还提供了可作为持续监测中的关键绩效指标的衡量标准。
