Brian McKenna1, Jeremy Skipworth2, Rees Tapsell3, Dominic Madell4, Krishna Pillai2, Alexander Simpson5, James Cavney2, Paul Rouse4. 1. Australian Catholic University and North Western Mental Health, Parkville, Australia. 2. Auckland Regional Forensic Psychiatry Service, Waitemata District Health Board, Auckland, New Zealand. 3. Midland Regional Forensic Psychiatric Service, Waikato District Health Board, Hamilton, New Zealand. 4. The University of Auckland, Auckland, New Zealand. 5. Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: It is well recognised that prisoners with serious mental illness (SMI) are at high risk of poor outcomes on return to the community. Early engagement with mental health services and other community agencies could provide the substrate for reducing risk. AIM: To evaluate the impact of implementing an assertive community treatment informed prison in-reach model of care (PMOC) on post-release engagement with community mental health services and on reoffending rates. METHODS: One hundred and eighty prisoners with SMI released from four prisons in the year before implementation of the PMOC were compared with 170 such prisoners released the year after its implementation. RESULTS: The assertive prison model of care was associated with more pre-release contacts with community mental health services and contacts with some social care agencies in some prisons. There were significantly more post-release community mental health service engagements after implementation of this model (Z = -2.388, p = 0.02). There was a trend towards reduction in reoffending rates after release from some of the prisons (Z =1.82, p = 0.07). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Assertive community treatment applied to prisoners with mental health problems was superior to 'treatment as usual', but more work is needed to ensure that agencies will engage prisoners in pre-release care. The fact that the model showed some benefits in the absence of any increase in resources suggests that it may be the model per se that is effective.
BACKGROUND: It is well recognised that prisoners with serious mental illness (SMI) are at high risk of poor outcomes on return to the community. Early engagement with mental health services and other community agencies could provide the substrate for reducing risk. AIM: To evaluate the impact of implementing an assertive community treatment informed prison in-reach model of care (PMOC) on post-release engagement with community mental health services and on reoffending rates. METHODS: One hundred and eighty prisoners with SMI released from four prisons in the year before implementation of the PMOC were compared with 170 such prisoners released the year after its implementation. RESULTS: The assertive prison model of care was associated with more pre-release contacts with community mental health services and contacts with some social care agencies in some prisons. There were significantly more post-release community mental health service engagements after implementation of this model (Z = -2.388, p = 0.02). There was a trend towards reduction in reoffending rates after release from some of the prisons (Z =1.82, p = 0.07). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Assertive community treatment applied to prisoners with mental health problems was superior to 'treatment as usual', but more work is needed to ensure that agencies will engage prisoners in pre-release care. The fact that the model showed some benefits in the absence of any increase in resources suggests that it may be the model per se that is effective.
Authors: Damian Smith; Susan Harnett; Aisling Flanagan; Sarah Hennessy; Pauline Gill; Niamh Quigley; Cornelia Carey; Michael McGhee; Aoife McManus; Mary Kennedy; Enda Kelly; Jean Carey; Ann Concannon; Harry G Kennedy; Damian Mohan Journal: Front Psychiatry Date: 2018-11-02 Impact factor: 4.157