Forensic psychiatric care for psychotic patients in prison

Background

Often prison personnel has great worries about releasing severely disturbed clients, with no more than a plastic bag and a bus ticket to town. Many of these clients are certain to return in the foreseeable future, because they have no place to go, no means of living, and no help for their mental health problems. In 2004 a pilot service started in two prisons, in which the local forensic psychiatric service provides care to psychotic prisoners, in the last stage of their imprisonment. The pilot was backed up by a study into the extent and nature of the problems of the clients, and the success in (re)linking them to the mental health services upon their release.

Methods

During one year all new prisoners (n = 1,343) were screened with the Psychosis Screening Questionnaire. Screen positives were clinically diagnosed by the prison medical team. For those with a psychotic disorder (n = 134; 10%), background information was gathered from files and the regular mental health care in prison was registered. Clients referred to the pilot service (n = 46) were assessed for their needs for care (with the CANFOR), and the success of (re)linking them to the mental health services upon their release.

Results

Clients referred to the pilot service had considerably more unmet needs for care (on 6.5 life domains on average) than a regular outpatient forensic psychiatric group (2.5 unmet needs). Relinking them to the mental health services upon their release proved very difficult. Half of the clients did not want any care, or never showed up at their arranged care contact. Only 6 of the 46 clients could be successfully relinked to a new care contact, and another 6 could be successfully guided back to an existing contact.

Conclusion

Psychotic patients in prison are a severely troubled group. They seem to have lost contact with, and appear to be forgotten by, the regular mental health services. This probably contributes to their 'revolving door' imprisonments.