ObjectiveTo examine the extent, nature and quality of literature on the impact of the COVID-19 pandemic on the mental health of imprisoned people and prison staff.DesignScoping review.Data ...sourcesPubMed, Embase, CINAHL, Global Health, Cochrane, PsycINFO, PsychExtra, Web of Science and Scopus were searched for any paper from 2019 onwards that focused on the mental health impact of COVID-19 on imprisoned people and prison staff. A grey literature search focused on international and government sources and professional bodies representing healthcare, public health and prison staff was also performed. We also performed hand searching of the reference lists of included studies.Eligibility criteria for selection of studiesAll papers, regardless of study design, were included if they examined the mental health of imprisoned people or prison staff specifically during the COVID-19 pandemic. Imprisoned people could be of any age and from any countries. All languages were included. Two independent reviewers quality assessed appropriate papers.ResultsOf 647 articles found, 83 were eligible for inclusion, the majority (58%) of which were opinion pieces. The articles focused on the challenges to prisoner mental health. Fear of COVID-19, the impact of isolation, discontinuation of prison visits and reduced mental health services were all likely to have an adverse effect on the mental well-being of imprisoned people. The limited research and poor quality of articles included mean that the findings are not conclusive. However, they suggest a significant adverse impact on the mental health and well-being of those who live and work in prisons.ConclusionsIt is key to address the mental health impacts of the pandemic on people who live and work in prisons. These findings are discussed in terms of implications for getting the balance between infection control imperatives and the fundamental human rights of prison populations.
There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ...ventilated conditions facilitate the rapid spread of infectious diseases.
The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors.
Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: as soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons.
The UK Government's Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants.
This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons.
DERR1-10.2196/30749.
The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in ...Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems.
This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area.
Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform.
Of the 115 children approached, 34 (29.6%) consented and took part; of these 34 children, all 34 (100%) completed the baseline Lexplore assessment, and 30 (88%) completed the follow-up. In addition, most children were classified by Lincus as regular (≥1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers.
This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting.
Psychiatric patients may try (or express a desire) to injure themselves in hospital in order to cope with overwhelming emotional pain. Some health care practitioners and patients propose allowing a ...controlled amount of self-injury to occur in inpatient facilities, so as to prevent escalation of distress. Is this approach an example of professional assistance with harm? Or, is the approach more likely to minimise harm, by ensuring safer self-injury? In this article, I argue that health care practitioners who use harm-minimisation can be considered to be helping physical injury to occur, although they do not encourage the act. I consider why there are compelling reasons to believe that a patient who self-injures is not maximally autonomous in relation to that choice. However, I then move onto argue that allowing a degree of self-injury may enable engagement with psychotherapy (enhancing autonomy) and behavioural change. In these circumstances, allowing injury (with precautions) may not be harm, all things considered.
Aims As of 2018, there were over 11 million people imprisoned globally. Suicide and self-harm rates have been found to be markedly elevated among imprisoned individuals, however there is much less ...literature reporting on risk factors for suicide and self-harm following prison release. The immediate post-release period has been found to be a particularly high-risk period for suicide and self-harm. Since many more people are released into the community every year than people kept imprisoned, released prisoners' health is a matter of public health concern. With the societal impact of this topic in mind, this systematic review aims to collate the risk factors for suicide and self-harm upon release from prison. Methods PubMed, PsycINFO, MEDLINE, and Cochrane were systematically searched using keywords relating to prison release, self-harm and suicide for articles published since 1/1/12. Studies were included if they reported data on risk factors for self-harm or suicide and followed prespecified inclusion criteria. Articles were screened by the author and uncertainty was settled by two independent reviewers. Included studies were evaluated using standardised quality assessment tools. Quantitative data were narratively synthesised due to a high level of heterogeneity in between studies. Results 248 articles were identified in total. 10 articles were included, reporting data on self-harm and suicide risk factors from 5 countries. Studies ranged from moderate (n = 2) to high quality (n = 8). Risk factors were categorised into the following: demographic characteristics, psychiatric history, conviction type, and imprisonment history. Risk factors which did not fit into any of these categories were categorised into an ”other” group. It was found that there were many non-modifiable factors such as violent convictions, female sex, Indigenous (Torres Strait Islander or Aboriginal) ethnicity, and single relationship status which increase self-harm or suicide risk upon release. Conclusion To our knowledge, this is the first systematic review to collate the risk factors for suicide and self-harm following prison release. The results show a complex variety of risk factors. The high mortality rate in this group necessitates the need for strategies to intervene before community re-entry. Study into risk factors post-release may guide identification of at-risk groups to target with proactive, coordinated care pre- and post-release. It is likely this will require a multifactorial approach including health, social and community programmes.
Background: In England and Wales, women in prison make up a minority
(<5%) of the total custodial population, yet acts of self-harm are around five times
more common among incarcerated women. While ...there has been a multiagency effort to improve
how acts of self-harm are documented across prisons, the patterns and functions of
self-harm for women in prison have not yet been fully addressed. Aims: We
aimed to determine the patterns, prevalence, and functions of self-harm among women in
prison through a mixed-methods study. Method: A total of 108 women with a
history of self-harm were interviewed across three female prisons. Participants completed
a structured questionnaire detailing their experiences of self-harm across prison and
community settings. Results: We found that women in prison who frequently
self-harmed disclosed high levels of trauma: past experiences of domestic violence
(81.5%), childhood sexual abuse (66.7%), and adult sexual abuse (60.2%). Prevalent methods
of recent in-prison acts of self-harm involved cutting, followed by ligaturing.
Limitations: The study used a cross-sectional design, self-reported
data, and featured a subset of women identified as being at high-risk of self-harm.
Conclusion: Motivations behind acts of self-harm by women in prison are
complex. Triggers appear to be past trauma, deteriorating mental health, and separation
from children or family.
In Case Scenario 1, we are introduced to Ms. J, a young woman with BPD who is emotionally unstable, depressed and self-injuring. We are asked to contemplate what her current therapist ought to do in ...the context of an abruptly-discontinued therapeutic relationship. The case description focuses on the issue of boundary transgressions and their impact on psychotherapeutic treatment, inviting the reader to consider what constitutes an appropriate relationship between a therapist and patient. In this commentary, I will examine the therapeutic alliance discussing the practitioner’s moral obligations in their relationship with Ms. J. I will also consider the rightness or wrongness of the therapist’s actions, possible motivations and intentions, concentrating on the aims of psychotherapy and the nature and value of boundaries in the clinical relationship.
There are now effective drugs to prevent cardiovascular disease and guidelines recommend their use. Patients do not always choose to accept preventive medication at levels of risk reduction ...recommended in guidelines. The purpose of the study was to identify and explore the attitudes of patients and general practitioners towards preventative medication for cardiovascular disease (CVD) after they have received information about it; to identify implications for practice and prescribing.
Qualitative interviews with GPs and patients following presentation of in depth information about CVD risks and the absolute effects of medication.
GP practices in Birmingham, United Kingdom.
In both populations: wide variation on attitudes to preventative medication; concerns about unnecessary drug taking & side effects; preferring to consider lifestyle changes first. In patient population: whatever their attitudes to medication were, the vast majority explained that they would ultimately do what their GP recommended; there was some misunderstanding of the distinction between curative and preventative medication. A common theme was the degree of trust in their doctors' judgement and recommendations, which contrasted with scepticism of the role of pharmaceutical companies and academics. Scepticism in guidelines was also common among doctors although many nevertheless recommended treatment for their patients
A guideline approach to prescribing preventative medication could be against the interests and preferences of the patient. GPs must take extra care to explain what preventative medication is and why it is recommended, attempt to discern preferences and make recommendations balancing these potentially conflicting concerns.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Self-harm, including suicide, is common among prisoners. Staff attitudes and perceptions regarding self-harm may affect quality of care and patient safety.
To systematically review the experiences, ...perceptions and attitudes of staff in adult prisons regarding self-harm.
Systematic searches of EMBASE, Medline, PsycINFO and CINAHL databases were conducted, and supplemented by hand-searching and grey literature review, to identify relevant English-language articles published since the year 2000. Articles were screened by two authors and evaluated with standardised quality appraisal tools. Qualitative data were analysed thematically, whereas quantitative data were narratively synthesised because of high study heterogeneity.
Two thousand articles were identified, of which 32 were included, involving 6389 participants from five countries. Most studies were moderate (
= 15) or poor (
= 10) quality, and seven were rated as good quality. Staff frequently witnessed self-harm and described multiple perceived risk factors and causes of this. Perceptions that self-harm is 'manipulative' or 'attention-seeking' were associated with hostility toward prisoners and lower quality of care. Perceived barriers to preventing and managing self-harm included low staffing levels, prison environments and culture, poor staff confidence and insufficient training. The importance of multidisciplinary teamwork and building staff-prisoner relationships were highlighted. Staff occasionally experienced intense psychological reactions to self-harm, which resulted in adaptive or maladaptive coping that influenced their capacity to care.
There are mixed attitudes and perceptions toward self-harm among prison staff. Further training, support and resources are required to protect staff's well-being and improve self-harm prevention and management in prisons.
Women's Enhanced Medium Secure Services (WEMSS) was a concept borne out of findings that an inappropriate number of women were being held in high secure services, despite not fulfilling high secure ...criterion. A qualitative study of women service users' views of living in WEMSS and comparator medium secure services (MSS) in the UK is presented. Sixteen service users participated in semi-structured interviews. Thematic analysis identified four main themes: experiences of current placement versus previous placements, relationships with staff, challenges of living with other women and having a voice - being involved in care and treatment. The accounts reported suggest that women in WEMSS and standard MSS have very similar experiences of their service, relationships with staff, living with other women and involvement in care. This qualitative study suggests that women in WEMSS and comparable women in MSS have very similar perspectives on what works well in their current services and what is important to them. The main differences between WEMSS and MSS women's accounts were in relation to the amount of pre-transfer information they received and levels of staff support. Implications for practice are discussed, including service-user empowerment addressing barriers to relational security.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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