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Background: In England, court‐based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. Aims: This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. Methods: A realist evaluation was undertaken involving multiple agencies based within an inner‐city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi‐structured interviews with the court staff, judiciary and clinicians from the L&D service. Results: The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. Conclusion: A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs. [ABSTRACT FROM AUTHOR]

Background: Transfer to a psychiatric hospital of prisoners who need inpatient treatment for a mental disorder is an important part of prison healthcare in the UK. It is an essential factor in ensuring the principle of equivalence in the treatment of prisoners. In England and Wales, delays in transferring unwell prisoners to hospital were identified by the 2009 Bradley Report. There has been no subsequent systematic review of progress in so doing nor a corresponding appraisal of transfer arrangements in other parts of the world. Aim: To conduct a systematic review of international literature about transfers of mentally unwell individuals from prison to hospital for the treatment of mental disorder since 2009. Method: Eight databases were searched for data‐based publications using terms for prison and transfer to hospital from 1 January 2009 to 4 August 2022. Inclusion criteria limited transfer to arrangements for pre‐trial and sentenced prisoners going to a health service hospital, excluding hospital orders made on the conclusion of criminal hearing. Results: In England, four articles were identified, all showing that transfer times remain considerably longer than the national targets of 14 days (range, 14 days to >9 months); one study from Scotland found shorter mean transfer times, but more patients had been transferred to psychiatric intensive care units than to secure forensic hospitals. There were only two studies that investigated prison to hospital transfers for mental disorder from outside the UK and only one reported time‐to‐transfer data. Conclusions: Findings from this literature review highlight failures to resolve transfer delays in England and provide little evidence about the problem elsewhere. Given the lack of data, it is unclear whether other countries do not have this problem or simply that there has been no research interest in it. A possible confounding factor here is that, in some countries, all treatment for prisoners' mental disorders occurs in prison. However, the principle that prisons are not hospitals seems important when people need inpatient care. Prospective, longitudinal cohort studies are urgently needed to map transfer times and outcomes. [ABSTRACT FROM AUTHOR]

Background: FACTS is a Wales‐wide mental health service for 10–17‐year‐olds with needs beyond the remit of mainstream child and adolescent mental health services (CAMHS). As a purely consultation‐liaison service, it differs from other UK services in the field. Aims: To describe a complete cohort of referrals to FACTS 2013–2017 with service exit by June 2018. Methods: Clinical, social and offending data were extracted from FACTS records. Results: 80 young people completed a FACTS episode, averaging nearly a year (309 days; range 13–859 days). Mostly boys (65, 81%) of mean age 15.4 years (range 9–18), two‐thirds (n = 53) had three or more referral reasons, one invariably being threatened/actual harm to others; only half were criminal‐justice involved. Half (41, 51%) were committing sexually harmful acts. Half were self‐harming (41, 51%). All but seven had had at least one adverse childhood experience (ACE), nearly half (35, 44%) four or more. Nevertheless, post‐traumatic stress disorder (PTSD) was rarely diagnosed (7, 9%); just over one‐quarter (23, 29%) had no diagnosis at all. Correspondence analyses endorsed two distinct Attention deficit hyperactivity disorder groups, distinguished by presence/absence of evidenced brain damage or dysfunction. Suicide‐related behaviours clustered with the other diagnoses, flashbacks and psychotic symptoms with no diagnosis. Change in home circumstances during a FACTS episode was slight. Conclusions: The complexity of presenting problems and service involvement evidences need for FACTS. The extent of persistently harmful sexual behaviours is a novel finding, suggesting need for more expert input for this at other service levels. Rarity of PTSD diagnoses was surprising given the extent of ACEs. This raises concerns that services focus on disorder signs rather than the child's inner life. Given the extent of problems, minimal change may be a positive outcome – especially when remaining in the community. Further development of this service should include explicit case‐by‐case goals and indicative outcome markers. [ABSTRACT FROM AUTHOR]

We hope that the Northern Ireland Mental Health Strategy 2021-2031 will help fill this gap in community provision (Department of Health, 2021). Given the shortfall in funding for health services in prisons, mental health teams lack the capacity to meet the needs of prisoners, with waiting times for urgent and routine mental health assessments falling significantly below regional and national standards. Northern Ireland (NI) is a distinct jurisdiction within the United Kingdom (UK), with a population of about 1.9 million. [Extracted from the article]

Background: People held in immigration removal centres have a range of vulnerabilities relating both to disappointment at imminent removal from the country of hoped-for residence and various antecedent difficulties. An important subgroup in the UK is of foreign national ex-prisoners who have served a period of incarceration there. Prisoners generally have higher rates of mental disorders than the general population. It is, however, not clear whether foreign national ex-prisoners in UK immigration removal centres have higher rates of mental disorders than other detainees.Aims: To compare the screened prevalence of mental disorders, levels of unmet needs and time in detention between foreign national ex-prisoners and others in Immigration Removal Centres in England.Methods: We conducted a secondary analysis of cross-sectional survey data from a previously published study in one Immigration Removal Centre.Results: The 28 foreign national ex-prisoners had been in immigration detention for longer and reported greater levels of unmet needs than the other 66 detainees. The highest levels of unmet needs among the foreign national ex-prisoners were in the areas of psychological distress and intimate relationships. After adjusting for time spent in detention, there was evidence to suggest that foreign national ex-prisoners had a higher screened prevalence of substance use disorders, autism spectrum disorders and attention-deficit hyperactivity disorder than the other detainees.Conclusions/implications For Clinical Practice: This study supports the view that foreign national ex-prisoners are a vulnerable group within immigration detention who have needs for enhanced and specialist service provision, including appropriate arrangements for health screening and active consideration to alternatives to their detention. [ABSTRACT FROM AUTHOR]

Background: Internationally, there is evidence of high rates of mental disorders amongst police custody detainees but this literature is limited, and there has been little research into the unmet needs of police detainees in the UK, or elsewhere. Such research could support better focussed interventions for improving health and recidivism outcomes.Aim: To examine psychiatric and developmental morbidity amongst police detainees, and ascertain differences in need between morbidity categories.Method: We used a cross-sectional study design and interviewed a 40% sample of people entering police custody in one South London police station over a 2-week period. A series of standardised measures was administered to screen for the presence of mental illness, general health and social care needs.Results: A cohort of 134 people was generated, of whom nearly one-third (39, 29%) had current mental illness (major depression and/or psychosis); more had a lifetime diagnosis (54, 40%). Just under a fifth met the threshold for post-traumatic stress disorder (11, 8%). Clinically relevant alcohol or daily cannabis use affected about one quarter of the sample. Twenty-one percent (or 28) screened positive for personality disorder, 11% (or 15) for attention deficit hyperactivity disorder and 4% (6) for intellectual disability. Nearly one-fifth (24, 18%) were at risk for suicide. Those with psychosis, and those deemed at risk for suicide, had the highest levels of unmet need and, indeed, overall need. The most frequent unmet need was for accommodation.Conclusion: Our findings not only confirm high rates of mental health problems amongst police detainees but also demonstrate their high risk of suicide and high levels of unmet need, especially as regards accommodation. This underscores the need to provide mental health services in police stations, to help identify and resolve these issues at this early stage in the criminal justice system. Extending accommodation capacity to help some arrestees may help to save lives and interrupt cycling through the criminal justice system. [ABSTRACT FROM AUTHOR]

Throughout the world, women involved in criminal justice systems often present with substantial needs and vulnerabilities. Diverting vulnerable people away from prison is government policy in England and Wales, but full psychiatric and social assessments are expensive and hard to access. A screening and quick response initiative - alternatives to custodial remand for women (ACRW) - was implemented across three areas of London (West, South and East) to supplement existing court liaison and diversion services, to assess the feasibility of a supplementary custodial remand service as part of a women's specialist service pathway in the criminal justice system in England. Three mental health trusts and two voluntary sector providers offered this service enhancement - a screening and service link provision in three London boroughs between 2012 and 2014. We conducted a service evaluation using routinely collected service use record data. The service made 809 contacts, of whom 104 had contact on multiple occasions. Many were identified as at risk of self-harm (46%) or had histories of hospital admission for mental disorder (36%), but few were referred either to the liaison and diversion service or specialist mental health services. The largest group of referrals was to women's community services outside the health service (e.g. counselling, domestic violence or sexual abuse services). 180 women had dependent children and 22 were pregnant, increasing the urgency to find non-custodial alternatives. As well as confirming high levels of need amongst women entering the criminal justice system, this evaluation confirms the feasibility of working across sectors in this field, providing an extra layer of service that can complement existing liaison and diversion service provision. The service was responsive and most women using it were kept out of custody. Research is now required to understand the appropriateness of the referrals, the extent to which women follow them through and the impact on their mental health and desistance from offending. [ABSTRACT FROM AUTHOR]

Background: Research into neurodevelopmental disorders in adult offenders has tended to be disorder specific, so hindering service planning for a group of offenders with similar vulnerabilities.Aim: To examine vulnerabilities for mental illness and self-harming behaviours among male prisoners screening positive for a range of neurodevelopmental difficulties-including but not confined to disorders of intellectual ability, attention deficit hyperactivity, and in the autistic spectrum.Method: In a cross-sectional study, prisoners who screened positive for neurodevelopmental difficulties were compared to prisoners who screened negative for the same on indicators of suicide-related and self-harm behaviours, mental illness, and substance misuse using the Mini International Neuropsychiatric Interview (MINI).Results: Of 87 prisoners who screened positive for neurodevelopmental difficulties, 69 had full MINI mental health data. In comparison with 69 neurotypical men in the same prison, the neurodevelopmental difficulties group was significantly more likely to have thought about self-harm and suicide in the last month and to have significantly higher rates of concurrent mental disorders including psychosis, anxiety, depression, personality disorder, and substance dependency disorders.Conclusions: This is one of the first studies to examine the mental health of adults with neurodevelopmental difficulties in a prison setting. This group, unlike those who meet diagnostic threshold, is not routinely considered by mental health or correctional services. The study found prisoners with neurodevelopmental difficulties showed greater vulnerability to mental disorder and thoughts of suicide and suicide-related behaviours than other prisoners. Accordingly, we recommend routine early screening across the criminal justice system for any neurodevelopmental difficulties to inform decision-making on the most appropriate disposal and support. [ABSTRACT FROM AUTHOR]

Background: Care pathway approaches were introduced into health care in the 1980s and have become standard international practice. They are now being introduced more specifically for health care in the criminal justice system. Care pathway delivery has the theoretical advantage of encouraging a whole-systems approach for health and social care within the criminal justice system, but how well is it supported by empirical evidence?Aims: The aim of this study is to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000.Method: We used an exploratory narrative method to review the nature and extent of evidence streams supporting health care delivery within interagency pathway developments since 2000. The available literature was reviewed using a keyword search approach with three databases: PubMed, Medline, and Google Scholar.Findings: Research in this field has covered police custody, courts, prisons, and the wider community, but there is little that follows the entire career through all these elements of offender placement. Main themes in the research to date, regardless of where the research was conducted, have been counting the disorder or the need, development and evaluation of screening tools, and evaluation of clinical intervention styles. Most evidence to date is simply observational, although the possibility of conducting randomised controlled trials of interventions within parts of the criminal justice system, especially prisons, is now well established.Conclusions: Access to health care while passing through the criminal justice system is essential because of the disproportionately high rates of mental disorder among offenders, and the concept of structured pathways to ensure this theoretically satisfying, but as yet empirically unsupported. Further, substantial cuts in services, generally following government economies, are largely unresearched. Considerable investment in new possibilities, driven by both pressure groups and government, tend to be informed by good will and theory rather than hard evidence and are often not evaluated even after introduction. This must change. [ABSTRACT FROM AUTHOR]

The majority of extradition requests the UK received since 2004, and the entry into force of the European Arrest Warrant, have come from its former EU partners. A newer addition to the law, the forum bar to extradition, may stop an extradition where the connections to the UK of the individual and his alleged crime are such that it is not appropriate to extradite in the circumstances. Keywords: Asperger syndrome; criminal cooperation; extradition; mental health EN Asperger syndrome criminal cooperation extradition mental health 77 79 3 04/29/21 20210401 NES 210401 The mental health of people sought from the United Kingdom by the way of extradition rarely makes front page news. [Extracted from the article]

Telemedicine, or telehealth, has been with us for some time and has progressed particularly well in countries when doctor and patient may be separated by long distances. Feelings between patient and interviewer develop more quickly in a natural environment and the interviewer can test their own feelings, for example, does the patient create a sense of fear and threat. Likely limits on the development of a good working relationship arising from the barriers surrounding telehealth practices may encourage a view that the patient is an object presenting with a collection of signs and symptoms, rather than a human being. [Extracted from the article]

Background: The prison population in England and Wales is approximately 85,000, and elevated rates of mental health difficulties have been reported among the prisoners. Despite frequent recommendations for family interventions to optimise prisoner outcomes, the evidence for its use and impact in prison remain unclear.Aim: The aim of the study is to conduct a systematic review of published literature on family interventions in prisons.Methods: Embase, PsychINFO and Medline were searched using terms for family interventions and for prisoners or young offenders. No limit was imposed on study design, but, for inclusion, we required that papers were written in English and published in peer-reviewed journals.Results: Nine hundred eighty-three titles were retrieved. Twenty-two met criteria for inclusion. Three were case studies, 12 were descriptive, 6 were quasi-experimental and one was a randomised controlled trial. Interventions and study methods were too heterogeneous for meta-analysis. All studies gave positive conclusions about family interventions, but empirical data on effectiveness were slight.Conclusions: Consistency in findings across the wide-ranging studies suggested that family therapies may indeed be helpful for prisoners and their families, so further research is warranted. The fact that a randomised controlled trial proved feasible should encourage researchers to seek more robust data and to determine which form of intervention is effective and in which circumstances. It would also be useful to develop an improved understanding of mechanisms of change. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article focuses on improving access to psychological therapies in prisons. In Wales and England, the equivalence of care principle has undermined health service developments in prison. The higher prevalence of mental ill health in prisoners is well established. In England and Wales, prison psychology services have been provided by forensic psychologists.

The article discusses the development of criminal liaison and diversion services in many countries since the 1990s. The expansion of the services in the form of mental health courts in the U.S. are examined. Particular focus is given to the development at a time when the number of people in prisons has been increasing worldwide.

ABSTRACT Background Despite improved mental health services in prisons in England and Wales, there are often delays in transferring acutely mentally ill prisoners to hospital, particularly in the London area. Aim To establish whether clinical pathway interventions can reduce such transfer delays. Methods Two clinical pathway interventions - one based in a medium secure forensic hospital and the other in a remand prison (pre-trial/sentence) - were independently introduced to manage referrals of prisoners with acute mental illness in London, UK. Time taken to transfer to hospital was measured for each and compared with the best available estimates for time to transfer prior to the new pathways. Results Both interventions produced significant reductions in prison to hospital transfer times. Conclusions/implications for practise The nature of the projects precluded ideal research design, but despite small sample sizes, provision of modestly funded small but dedicated elements of service to target the specified problem of transfer to hospital delays showed a significant advantage for such provision, whether hospital or prison based, psychiatrist or nurse led. Further research is now required to examine the whole pathway. More secure psychiatric beds may be required, at least in the short term, to support diversion policies and enable compliance with national policy directive, and to establish whether redesigned pathways can enhance treatment and behavioural outcomes for acutely mentally ill prisoners on a larger scale. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background There is worldwide evidence of high rates of mental disorder among prisoners, with significant co-morbidity. In England and Wales, mental health services have been introduced from the National Health Service to meet the need, but prison health-care wings have hardly been evaluated. Aims/hypotheses To conduct a service evaluation of the health-care wing of a busy London remand (pre-trial) prison and examine the prevalence and range of mental health problems, including previously unrecognised psychosis. Methods Service-use data were collected from prison medical records over a 20-week period in 2006–2007, and basic descriptive statistics were generated. Results Eighty-eight prisoners were admitted (4.4 per week). Most suffered from psychosis, a third of whom were not previously known to services. Eleven men were so ill that they required emergency compulsory treatment in the prison under Common Law before hospital tranfer could take place. Over a quarter of the men required hospital transfer. Problem behaviours while on the prison health-care wing were common. Conclusions and implications Prison health-care wings operate front-line mental illness triaging and recognition functions and also provide care for complex individuals who display behavioural disturbance. Services are not equivalent to those in hospitals, nor the community, but instead reflect the needs of the prison in which they are situated. There is a recognised failure to divert at earlier points in the criminal justice pathway, which may be a consequence of national failure to fund services properly. Hosptial treatment is often delayed. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the issue of transferring acute mentally ill prisoners in London, England to hospitals.