Design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study

Abstract

ObjectiveInsomnia is highly prevalent in prisoners and is a risk factor for poor mental well-being, depression, suicidality and aggression, all common concerns in this vulnerable population. Improving sleep management options in prison offers the potential to impact positively on a number of these common risk factors. The study aim was to design a treatment pathway for insomnia in prisons informed by stakeholders with professional or lived experience of insomnia and prison-based interventions.DesignA modified Delphi technique, adapted to the stakeholder (either receiving controlled feedback online or face to face on a series of statements), was used over three rounds to gain consensus on a final treatment pathway design.ParticipantsAcademic sleep researchers, prison staff and prisoners were invited to develop the treatment pathway.ResultsFifteen stakeholders took part in round 1 and thirteen in round 2. There were six statements of contention that comprised concerns over the inclusion of sleep observations, sleep restriction therapy and promethazine. Consensus was high (>80%). Thirteen stakeholders agreed the final pathway in round 3. The final treatment pathway comprised a standardised stepped-care approach for insomnia in prison populations. The pathway resulted in five main stages: (1) transition from community; (2) detection and assessment; (3) treatment for short-term insomnia; (4) treatment for long-term insomnia and (5) transition from prison to community or another establishment.ConclusionsThe treatment pathway is designed to promote early detection of insomnia, potentially reducing unnecessary prescriptions and medication trading, misuse and diversion in the prison setting. It should make a substantial difference in reducing the large number of sleep complaints and positively impact on prisoners, staff and the prison environment. Specifically, improving sleep should have a positive impact on prisoners’ mental and physical well-being and aid smooth running of the prison.

Litigation Over Sleep Deprivation in U.S. Jails and Prisons

“…(15) Given the suffering, health risks, and other consequences associated with sleep deprivation, clinicians have a responsibility to evaluate and treat incarcerated patients with sleeprelated concerns, including underlying conditions that may be contributory. Institutional treatment pathways can support decision making in these scenarios (20). Some evidence suggests that nonpharmacologic strategies, such as relaxation techniques or brief cognitive-behavioral therapy, may help mitigate the effects of incarceration on sleep, and turning to these strategies before pharmacotherapy may be useful for treating insomnia in correctional settings (1,3,20).…”

“…Institutional treatment pathways can support decision making in these scenarios (20). Some evidence suggests that nonpharmacologic strategies, such as relaxation techniques or brief cognitive-behavioral therapy, may help mitigate the effects of incarceration on sleep, and turning to these strategies before pharmacotherapy may be useful for treating insomnia in correctional settings (1,3,20). Careful review of insomnia-related medication prescribing patterns, analysis of patient outcomes, and use of evidence-based formulary restrictions are also key for supporting patient wellbeing (16).…”

Prevalence and Associated Factors of Poor Quality of Sleep among Prisoners in Mettu Town Prison, Oromia, South West Ethiopia, 2019

“…Poor sleep quality, often referred to as "sleep disturbance", is found in up to 55% of the elderly population and consistently increases with age population experiences insomnia at some point in their lives; however, recent figures show prisoners are at least twice as likely to have insomnia and the majorities have poor sleep quality [7]. This is problematic because insomnia has been shown to significantly contribute to poor cognitive functioning, depression, suicide, emotional deregulation, aggression and lack of treatment engagement, all of which may affect the safe running of the prison, an individual's rehabilitation and, ultimately, the likelihood of reoffending [8].…”

“…Moreover, poor sleep hygiene, including daytime naps, boredom or paucity of daytime activity, is evident in prisoners [11]. Availing sleep management options in prison offers the potential to impact positively on a number of these common risk factors [8].…”

Sleep Quality and Psychological Status in a Group of Italian Prisoners

“…Moreover, several studies showed that, during imprisonment, inmates are much more likely to develop sleep disturbances in general, or more specifically, insomnia [42,43]. In this context, the high prevalence of depressive symptoms in prisoners [25,44], in addition to both a high level of anxiety and the prison's environment, could explain the poor sleep quality and the insomnia symptoms.…”