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Train all prison staff to spot mental health problems, says NICE

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All staff working within the criminal justice system, including nurses, should receive training to better recognise and respond to mental health problems, according to new draft guidance.

The National Institute for Health and Care Excellence has published draft guidance intended to improve the assessment, treatment and prevention of mental health problems in adults within with the criminal justice system.

“People in prison must receive the same level of care as offered to those outside”

Mark Baker

NICE noted that an estimated 39% of offenders supervised by probation services and 90% of people residing in prison have some form of mental health problem.

When finalised, its guideline will apply to anyone who comes into contact with the English criminal justice system – including time spent serving a community or prison sentence, and any probationary periods.

Currently, the NHS is not responsible for healthcare provision, including mental healthcare, for people in police and court custody.

However, NICE recommended that criminal justice and healthcare services consider coordinating their work to improve management of urgent mental health problems presenting in the community.

On entry to prison, all people deemed to be at risk of a mental health problem should be referred to the prison’s mental health in-reach team immediately, before they are allocated to a cell, said NICE.

In addition, it backed the establishment of therapeutic community programmes within the prison to provide treatment for between 12 to 18 months on a twice weekly or daily basis.

“Nursing staff are perfectly placed to form this bridge and drive forward these improvements”

Ian Hulatt

All criminal justice staff should also receive regular training on the prevalence of mental health problems within their working environment – to help them to recognise changes in behaviour and take into account that this may indicate a problem.

Professor Nick Kosky, associate medical director of Dorset Healthcare University NHS Foundation Trust and chair of the committee that drafted the NICE guideline, said: “Recognising when someone needs support with a mental health problem is always crucial.

“The time someone may spend completing a community or prison sentence is no exception,” he said. “It is a stressful period of time, which makes it imperative that we spot and address problems quickly.”

During 2012-14, 199 inmates committed suicide in prison, of which 70% of cases involved a person who was identified as having a mental health problem.

Additionally, close to 26,000 incidents of self-harm were reported by prisons in England and Wales during 2014, an increase of 11% compared with 2013.

Mark Baker

Mark Baker

Mark Baker

Professor Mark Baker, director of the centre for guidelines at NICE, said: “Schizophrenia, psychosis, anxiety and depression are more common in people who are in prison than they are in the general population.

“We need to ensure these people are properly supported, particularly if they are to be released back into the community,” he said.

“Delivering care in such a restrictive environment is difficult, but it cannot become a barrier or excuse,” he said. “People in prison must receive the same level of care as offered to those outside.”

A consultation on the draft guidance is currently open and will run until 18 November.

Responding to the proposals, the Royal College of Nursing said the rising number of mental health problems in the criminal justice system proved they were “not being managed effectively”.

Ian Hulatt, the RCN’s professional lead for mental health nursing, said: “Mental health is a unique area of health care and it’s critical that all staff can access specific training to ensure those with mental health problems receive the care they need.

Ian Hulatt

Ian Hulatt

Ian Hulatt

“These problems aren’t left behind in prison; criminal justice services need to work in collaboration with the NHS to make sure no one falls through the cracks,” he said. “Patients need one line of care that transcends their contact with the criminal justice system.

“Nursing staff are perfectly placed to form this bridge and drive forward these improvements,” said Mr Hulatt. “However, more nurses are needed to affect this change – and this will require investment.

“It’s vital that all staff involved have the skills and the resources they need to work together to put these guidelines into action,” he added.

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Readers' comments (3)

  • Quite so and Histopathologists and Coroner's Police should be carrying out their work in a proper manner too where someone in state custody dies.

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  • as a prison nurse I would say we are acutely aware of mental health issues as we deal with them every day

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  • Criminalms need to be in prison not hospital what is this world coming to when a man can kill someone and just be sent to hospital and not prison because of uk so call humen rights act i think mental health and offenders with learning difficulties should be sent to prison murder and rape is not a excuse and mental health should not be a get out of free prison card i saw the so call care not custody for offenders with learning difficulties offenders with LD know right from wrong and there for should be sent to prison the so call government need to stop trying to save money and lock these people up prison not hospital

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