Improving mental health screening of prisoners

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Strands Project Theme
Project Description

Early identification and intervention for those with a first episode of a psychotic illness such as schizophrenia, or even emerging psychosis, has become the gold standard for clinical practice in the mental health field.  However, offenders, particularly those incarcerated, have been largely ignored in the development of models of care and services.  Little is known about their particular clinical needs and how an early intervention model might best be adapted to those in contact with the criminal justice system.  Those in contact with the criminal justice system are well known to have much higher risk of severe mental illnesses than those in the general population.  The relationship between psychosis and an increased risk of antisocial behaviour including violence and criminality is well documented.  Prevalence studies have consistently shown high rates of psychotic disorders in the adult prison population, typically ranging from 3% to 5% of all prisoners.  Little is known, for example, about early psychosis or, indeed those at-risk for psychosis, and offending. It has been suggested that the early stage of psychosis prior to treatment or the first-episode of psychosis may be the period most associated with serious violence.

This study will extend the Stages of Psychosis in a Prison Population (SOPP) study currently taking place in NSW prisons.  The SOPP study is investigating the prevalence of early psychosis, established psychosis and at-risk mental states among those entering prison, both men and women, juvenile and adult offenders.  The SOPP study also aims to establish the demographic, clinical and forensic characteristics of individuals identified to be within each of the three study groups, providing invaluable information to inform the development of a needs-responsive intervention.  For a defined period, the extension of SOPP will allow all prisoners received into prison to be approached for screening for eligibility into the study.  The recruited sample will then be used in a sensitivity analysis to assess the extent of under-recognition of at-risk states and psychotic illnesses when existing mental health referral pathways are relied upon.