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      Understanding the mental health needs of Scotland's prison population: a health needs assessment

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          Abstract

          Introduction

          This study reports on an assessment of mental health needs among Scotland's prison population which aimed to describe the scale and nature of need as well as identify opportunities to improve upon the services available. The project was commissioned by the Scottish Government to ensure that future changes to the services available to support the mental health and wellbeing of people in prison would be evidence-based and person-centered.

          Methods

          A standardized approach to health needs assessments was employed. The study was comprised of four phases. In phase I a rapid literature review was undertaken to gather evidence on the prevalence of mental health needs experienced by people in prison in the UK. In Phase II a multi-method and multi-informant national mapping exercise involving providers to all Scottish prisons was undertaken to describe the mental health services available, and any gaps in these services, for people in and leaving prison. In Phase III prevalence estimates of several mental health needs were derived for Scotland's current prison population, modeled from a national survey dataset of Scotland's community population using logistic regression. Finally in Phase IV, professional stakeholders and individuals with lived experience were interviewed to understand their experiences and insights on challenges to supporting the mental health and wellbeing of people in prison, and ideas on how these challenges could be overcome.

          Results

          Evidence across the four phases of this needs assessment converged indicating that existing provision to support the mental health of people in prison in Scotland was considered inadequate to meet these needs. Barriers to effective partnership working for justice, health, social work and third sector providers appear to have led to inadequate and fragmented care, leaving prisoners without the support they need during and immediately following imprisonment.

          Conclusions

          Joint and coordinated action from justice, health and social care, and third sector providers is needed to overcome enduring and structural challenges to supporting the mental health of people in prison. Eighteen evidence-based recommendations were proposed to the Scottish Government relating to the high-level and operational-level changes required to adequately meet the prison population's mental health needs.

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          Most cited references53

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          Using thematic analysis in psychology

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            Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II.

            The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.
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              Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers.

              Many of the standardized interviews currently used in psychiatry require the interviewer to use expert psychiatric judgements in deciding upon the presence or absence of psychopathology. However, when case definitions are standardized it is customary for clinical judgements to be replaced with rules. The Clinical Interview Schedule was therefore revised, in order to increase standardization, and to make it suitable for use by 'lay' interviewers in assessing minor psychiatric disorder in community, general hospital, occupational and primary care research. Two reliability studies of the revised Clinical Interview Schedule (CIS-R) were conducted in primary health care clinics in London and Santiago, Chile. Both studies compared psychiatrically trained interviewer(s) with lay interviewer(s). Estimates of the reliability of the CIS-R compared favourably with the results of studies of other standardized interviews. In addition, the lay interviewers were as reliable as the psychiatrists and did not show any bias in their use of the CIS-R. Confirmatory factor analysis models were also used to estimate the reliabilities of the CIS-R and self-administered questionnaires and indicated that traditional measures of reliability are probably overestimates.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                17 May 2023
                2023
                : 14
                : 1119228
                Affiliations
                [1] 1Centre for Clinical Brain Sciences, Division of Psychiatry, University of Edinburgh , Edinburgh, United Kingdom
                [2] 2Forensic Mental Health Services Managed Care Network , Carstairs, United Kingdom
                [3] 3Department of Forensic Psychiatry, The State Hospitals Board for Scotland , Carstairs, United Kingdom
                Author notes

                Edited by: Nigel McKenzie, University College London, United Kingdom

                Reviewed by: Alexander Ian Frederic Simpson, University of Toronto, Canada; Claire Maclean, NHS Greater Glasgow and Clyde, United Kingdom

                *Correspondence: Lindsey Gilling McIntosh l.gilling.mcintosh@ 123456ed.ac.uk
                Article
                10.3389/fpsyt.2023.1119228
                10229789
                37265556
                1885161b-8d06-41ad-92ff-4c01c09e979f
                Copyright © 2023 Gilling McIntosh, Rees, Kelly, Howitt and Thomson.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 08 December 2022
                : 27 April 2023
                Page count
                Figures: 0, Tables: 2, Equations: 1, References: 53, Pages: 17, Words: 15444
                Funding
                Funded by: Scottish Government, doi 10.13039/100012095;
                This study was funded by the Scottish Government Population Health Directorate. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising from this submission.
                Categories
                Psychiatry
                Original Research
                Custom metadata
                Forensic Psychiatry

                Clinical Psychology & Psychiatry
                mental health,vulnerable population,scotland,health needs assessment,prison healthcare

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