Continuity of care for recently released prisoners with mental illness: a pilot randomised controlled trial testing the feasibility of a Critical Time Intervention

Jarrett, Manuela; Thornicroft, Graham; Forrester, Andrew; Harty, Mari Anne; Senior, Jane; King, Carlene; Huckle, Sarah; Parrott, Janet; Dunn, Graham; Shaw, Jenny

doi:10.1017/s2045796011000783

Cited by 57 publications

(72 citation statements)

References 13 publications

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“…Four studies were randomised controlled trials (Burke and Keaton 2004; Jarrett et al 2012; Shaw et al 2017; Solomon and Draine 1995). Two were case series with no comparison group (Hartwell and Orr 1999; Roskes and Feldman 1999) and one used a pre-post comparison with outcomes compared to a comparable time period for the same individuals before contact with the program (Brown et al 2013; Buck et al 2011).…”

Section: Resultsmentioning

confidence: 99%

Interventions at the Transition from Prison to the Community for Prisoners with Mental Illness: A Systematic Review

Hopkin

Evans‐Lacko

Forrester

et al. 2018

Adm Policy Ment Health

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Prisoners have high rates of mental illness and the transition from prison to the community is a problematic time for the provision of mental health services and a range of negative outcomes have been identified in this period. A systematic review was conducted to identify interventions for prisoners with diagnosed mental health conditions that targeted this transition period. Fourteen papers from 13 research studies were included. The interventions identified in this review were targeted at different stages of release from prison and their content differed, ranging from Medicaid enrolment schemes to assertive community treatment. It was found that insurance coverage, and contact with mental health and other services can be improved by interventions in this period but the impact on reoffending and reincarceration is complex and interventions may lead to increased return to prison. There is a developing evidence base that suggests targeting this period can improve contact with community mental health and other health services but further high quality evidence with comparable outcomes is needed to provide more definitive conclusions. The impact of programmes on return to prison should be evaluated further to establish the effect of interventions on clinical outcomes and to clarify the role of interventions on reincarceration.Electronic supplementary materialThe online version of this article (10.1007/s10488-018-0848-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Interventions at the Transition from Prison to the Community for Prisoners with Mental Illness: A Systematic Review

Hopkin

Evans‐Lacko

Forrester

et al. 2018

Adm Policy Ment Health

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“…There is a need for further research on ways to best support offenders with ADHD who are released from prison; meanwhile we recommend implementing a critical time intervention approach [60], in which a designated person meets with the offender just before and immediately after release from prison to help implement their care plan and ensure subsequent engagement in healthcare. Appropriate support would include: connecting the offender with their care plan coordinator, ensuring registration with a primary care physician, and helping them understand the implications of discontinuing treatment.…”

Section: Care Management and Multiagency Liaisonmentioning

confidence: 99%

Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus

et al. 2018

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BackgroundAround 25% of prisoners meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Because ADHD is associated with increased recidivism and other functional and behavioural problems, appropriate diagnosis and treatment can be a critical intervention to improve outcomes. While ADHD is a treatable condition, best managed by a combination of medication and psychological treatments, among individuals in the criminal justice system ADHD remains both mis- and under-diagnosed and consequently inadequately treated. We aimed to identify barriers within the prison system that prevent appropriate intervention, and provide a practical approach to identify and treat incarcerated offenders with ADHD.MethodsThe United Kingdom ADHD Partnership hosted a consensus meeting to discuss practical interventions for youth (< 18 years) and adult (≥18 years) offenders with ADHD. Experts at the meeting addressed prisoners’ needs for effective identification, treatment, and multiagency liaison, and considered the requirement of different approaches based on age or gender.ResultsThe authors developed a consensus statement that offers practical advice to anyone working with prison populations. We identified specific barriers within the prison and criminal justice system such as the lack of adequate: staff and offender awareness of ADHD symptoms and treatments; trained mental health staff; use of appropriate screening and diagnostic tools; appropriate multimodal interventions; care management; supportive services; multiagency liaison; and preparation for prison release. Through discussion, a consensus was reached regarding prisoners’ needs, effective identification, treatment and multiagency liaison and considered how this may differ for age and gender.ConclusionsThis practical approach based upon expert consensus will inform effective identification and treatment of offenders with ADHD. Appropriate intervention is expected to have a positive impact on the offender and society and lead to increased productivity, decreased resource utilization, and most importantly reduced rates of re-offending. Research is still needed, however, to identify optimal clinical operating models and to monitor their implementation and measure their success. Furthermore, government support will likely be required to effect change in criminal justice and mental health service policies.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1858-9) contains supplementary material, which is available to authorized users.

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“…A further question is whether or not in-reach staff from outside the prison should follow people up and hand over care when they are in the community or if CMHT staff should take responsibility for CTI delivery while the person is still in prison, thus removing the need for a client to have two key workers within a relatively short period. This was a model we explored in our pilot study, 54 choosing to adopt the former model for this trial, but a fuller examination of models is warranted in attempts to maximise resources and service delivery.…”

Section: Discussionmentioning

confidence: 99%

“…53 In our earlier study, the CTI model was adapted and piloted for use with a male prisoner population. 54 Case managers were identified to proactively engage with prisoners with SMI before their release from prison in order to agree a discharge plan and provide practical help to ensure, as far as possible, that the prisoner's most pressing needs on release could be met. In addition, their role was to proactively support the person and liaise in person with service providers following release to ensure that engagement and transfer of care to community services went smoothly.…”

Section: Critical Time Interventionmentioning

confidence: 99%

Critical time Intervention for Severely mentally ill Prisoners (CrISP): a randomised controlled trial

Shaw

Conover

Herman

et al. 2017

Health Serv Deliv Res

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BackgroundThe transition from prison to community is difficult for prisoners with mental illness. Critical time intervention (CTI) is designed to provide intensive support to meet health, social care and resettlement needs through close working between client and key worker pre, and up to 6 weeks post, release.ObjectivesTo establish whether or not CTI is effective in (1) improving engagement of discharged male prisoners who have mental illness with community mental health teams (CMHTs) and (2) providing practical support with housing, finance and re-establishing social networks.Trial designA multicentre, parallel-group randomised controlled trial, with follow-up at 6 weeks and at 6 and 12 months. A subset of prisoners and case managers participated in a complementary qualitative study.SettingEight English prisons.ParticipantsOne hundred and fifty adult male prisoners, convicted or remanded, cared for by mental health in-reach teams and diagnosed with severe mental illness, with a discharge date within 6 months of the point of recruitment.InterventionParticipants were randomised to either the intervention or the control (treatment as usual). The intervention group was assigned a case manager who assessed mental and physical health before and following release, made appropriate links to health, housing and financial services and supported the re-establishment of family/peer contact.OutcomeThe primary outcome measure was engagement with a CMHT 6 weeks post discharge. Secondary outcomes included contact with mental health services at 6 and 12 months. A health economic evaluation was undertaken using service contact at the follow-up time points. We were unable to assess the intervention’s effect on reoffending and longer-term health-care use because of study delays.ResultsOne hundred and fifty prisoners were recruited: 72 were randomised to the intervention and 78 were randomised to the control. Engagement with teams at 6 weeks was 53% for the intervention group compared with 27% for the control group [95% confidence interval (CI) 0.13% to 0.78%;p = 0.012]. At 6 months’ follow-up, intervention participants showed continued increase in engagement with teams compared with control participants (95% CI 0.12% to 0.89%;p = 0.029); there were no significant differences at 12 months. Increased engagement resulted in higher levels of service use and costs for the intervention than for the control. Qualitative data showed the intervention group reporting better continuity of care and improved access to services.ConclusionThe intervention significantly improved contact with services at 6 weeks, although at a higher cost than the control. This is important as, in the days and weeks following release, recently released individuals are at a particularly high risk of suicide and drug overdose. Further research is required to establish how teams can better maintain contact with clients when the intervention ends.Future workFurther studies are indicated for groups with different needs, for example women, young prisoners and those in police custody, and at other transition points, for example following arrest and short-term custody, and at points of transition between different mental health services.Trial registrationCurrent Controlled Trials ISRCTN98067793.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.

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Continuity of care for recently released prisoners with mental illness: a pilot randomised controlled trial testing the feasibility of a Critical Time Intervention

Abstract: Continuity of care for prisoners with severe mental illness can be improved by working with them to identify their needs prior to release, and by assisting them to engage effectively to the necessary agencies in the community.

Cited by 57 publications

References 13 publications

Interventions at the Transition from Prison to the Community for Prisoners with Mental Illness: A Systematic Review

Interventions at the Transition from Prison to the Community for Prisoners with Mental Illness: A Systematic Review

Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus

Critical time Intervention for Severely mentally ill Prisoners (CrISP): a randomised controlled trial

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