Mentally disordered offenders : an evaluation of the "open doors" programme at HM Prison, Barlinnie

Abstract

This study was designed to evaluate the effectiveness of a programme which aims to support and manage mentally disordered offenders in HM Prison, Barlinnie. The following hypotheses were tested: 1. Significant levels of psychiatric morbidity would be found in a prison setting. 2. The 'Open Doors' participants had more mental health problems than controls. 3. Participation in the programme improved their mental health. METHODOLOGY: To assess psychiatric morbidity in the prison all the admissions over a one week period were interviewed. The questionnaires recorded demographic and health information and psychological morbidity was assessed using the Clinical Interview Schedule-Revised (CIS-R) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). This cohort was followed up after 5 months to identify which services had been used. Programme participants were interviewed at the beginning and at the end of their involvement with the "Open Doors" programme. The first questionnaire included demographic and health information, the structured clinical interview for DSM-lli-R non patient (SCID), the General Health Questionnaire (GHQ 30), the Holmes and Rahe Social Readjustment Scale examining life events (LE) and the Health of the Nation Outcome scales (HoNOS). The follow up questionnaires included some demographic information and repeated the SCID, the GHQ 30, LE and HoNOS. A participant satisfaction scale was also used on follow up. A control group matched for age, time into imprisonment, length of sentence and charge/conviction were interviewed. Interviews were carried out with programme staff and managers. Interviews were held with other staff groups within the prison and in the community. Group sessions were directly observed. Programme literature and paperwork was examined. RESULTS: The survey of psychological morbidity in the prison population found a 5% incidence of psychosis, 20% depression and 9.2% anxiety disorders. Sixty six percent abused drugs, 16% abused or were dependent on alcohol and 2% used both. Two were referred to 'Open Doors' and less than 10% to other prison mental health services including drug and alcohol workers.Twenty percent of "Open Doors" subjects had a psychotic illness, 30% had a non psychotic depression and 22% an anxiety disorder. They had significantly more mental health problems than the controls. Forty five percent fulfilled criteria for drug abuse or dependence, 35% for alcohol and 5% for both. Over 65% had used drugs intravenously. At follow up interview "Open Doors" participants showed significant improvements in their mental health. CONCLUSIONS: There is a very high incidence of mental ill health in the prison population. Existing services are not able to identify or treat this high volume of mental disorder. The programme was identifying and working with prisoners with significant mental health problems. Those individuals who do become involved in the programme improve following participation and there are high levels of participant satisfaction. However the number of prisoners who do become involved in the programme is small and the impact on the prison population is therefore low.