Using initiative to provide clinical intervention groups in prison: a process evaluation

Abstract

We present a process evaluation of a new anger control intervention within an urban remand prison in London, UK. An anger control group was created and run as an extension of the prison in-reach healthcare team, in order to meet the needs of prisoners. We evaluate the aims of the intervention, therapeutic methodology, administrative process, and post-intervention outcomes. We report change in anger scores (State Trait Anger Expression Inventory; STAXI-II), showing how a service of this type might deliver important benefits. Through the use of a focus group with the clinicians who ran the service, we have reflected on this process to inform the evaluation. We conclude that anger management may have a useful role in remand prisons, not just for violent offenders, but as part of a wider public health agenda. Resources for new prison healthcare groups are scarce, particularly in urban remand prisons, and clinicians may have to collaborate with other teams to provide a range of interventions. Following the expressed needs of the prisoner population promotes a strong uptake of clients. Prison health services operate within a complex and environment which restricts healthcare teams' ability to run groups. We provide recommendations on overcoming potential barriers to care.

Cognitive–behavioural suicide prevention for male prisoners: a pilot randomized controlled trial

“…Indeed, treatment refusal and attrition among prisoners is higher than for most other clinical groups with non-completion of treatment endemic to all interventions delivered with prison settings (Wormith & Olver, 2002). Within prisoner groups, typical rates of refusal to enter treatment are up to 70% (Black et al, 2011; Dalton, Majoy & Sharkey, 1998) and treatment drop-outs can be as high as 93% (Gondolf & Foster, 1991). Although our previous trial of CBSP for suicidal people experiencing psychosis (Tarrier et al , 2014) achieved an attrition rate of less than 30%, attrition for the current study (44%) was more in keeping with other trials of CBT for suicide prevention (Morley et al , 2014) and intervention evaluations conducted with prisoner participants (Black et al, 2011; Olver, Stockdale & Wormith, 2011).…”

“…Within prisoner groups, typical rates of refusal to enter treatment are up to 70% (Black et al, 2011; Dalton, Majoy & Sharkey, 1998) and treatment drop-outs can be as high as 93% (Gondolf & Foster, 1991). Although our previous trial of CBSP for suicidal people experiencing psychosis (Tarrier et al , 2014) achieved an attrition rate of less than 30%, attrition for the current study (44%) was more in keeping with other trials of CBT for suicide prevention (Morley et al , 2014) and intervention evaluations conducted with prisoner participants (Black et al, 2011; Olver, Stockdale & Wormith, 2011). As such, when conducting future trials, researchers may need to pay even more attention to assessing and enhancing motivation amongst the target group of participants, and prison staff, to facilitate successful recruitment.…”

“…Within prisoner groups, typical rates of refusal to enter treatment are up to 70% (Dalton et al . 1998; Black et al 2011) and treatment drop-outs can be as high as 93% (Gondolf & Foster, 1991). Although our previous trial of CBSP for suicidal people experiencing psychosis (Tarrier et al 2014) achieved an attrition rate of less than 30%, attrition for the current study (44%) was more in keeping with other trials of CBT for suicide prevention (Morley et al 2014) and intervention evaluations conducted with prisoner participants (Black et al 2011; Olver et al .…”

Prison psychiatry

“…An analysis of 1510 medical files of remand prisoners in Switzerland in 2007 revealed several associations between psychological symptoms, especially anxiety, insomnia, and physical health problems. Special interventions such as anger management groups may improve mental health in remand prisoners [31]. Special interventions such as anger management groups may improve mental health in remand prisoners [31].…”

Improving access to psychological therapies in prisons

“…The ‘low‐intensity’ IAPT clinician supports the patient through self‐help materials, encouraging them to conduct the exercises contained within them and to apply the various techniques to their lives. This approach, though, has limitations in prison environments that not only introduce barriers to service access (Black et al, ) but also has a population with lower intelligence quotients and a higher prevalence of attention deficit hyperactivity disorder, underlying personality disorder or compromised literacy and numeracy (Singleton et al, ). This potentially compromises the ability of such prisoners to take part; these lower intensity interventions rely heavily upon manualised self‐guidance.…”