The current reform of prison health care is founded on a health care partnership established between the Prison Service and the National Health Service (NHS) in 2000. This partnership is designed to ensure that prisoners have access to the same range and quality of health care services as the general public receives from the NHS. Psychiatric morbidity is prevalent among prisoners. Most of those in prison with mental health problems, including the majority with complex treatment needs, are managed in prison primary care.
Mental Health Primary Care in Prison is the first, and as far as I am aware, the only mental health guide for primary health care staff working in prisons. It began life as the diagnostic and management guidelines for mental disorders in primary care, published in 1996 by the World Health Organization. These guidelines were adapted for UK primary care in 2000 and this version, for UK prisons, was published in 2002.
The book is supported by a stand-alone website (http:www.prisonmentalhealth.org). It also comes with additional electronic resources in the form of two floppy disks, the contents of which are described below.
The guide has five main sections plus a comprehensive resource directory and a list for further reading, including details of useful websites. The first section deals with the diagnosis and management of specific mental disorders in adults, young people and mothers; Section two tackles more general management issues such as assessment, the interface with the NHS, using the Mental Health Act 1983 and common law, comorbidity, and patients at risk of suicide and self-injury; Section three focuses on groups with particular needs including ethnic minorities, prisoners with learning disabilities and victims of sexual assault; Section four concentrates on managing difficult behaviours such as aggression, food refusal and dirty protests; Section five tackles ethical issues and working with voluntary organisations.
The two floppy disks that accompany the book contain files in Word format that can be printed out as leaflets or adapted for use in another format. The first disk contains information and self-help for use with patients. The second disk contains information for prison officers and a range of instruments including the Severity of Alcohol Dependence Questionnaire and the Edinburgh Post Natal Depression scale designed to assist health care workers carrying out assessments.
So, what do I think of this book? Well, I have to say that it does not make scintillating bedtime reading, but then it was not written for that purpose. As far as being a reference guide goes, I think it is easy to use, reasonably comprehensive and evidence-based. Its real strength, however, lies in the fact that it was developed with the assistance of staff who actually work on the front line of prison health care. Their involvement has undoubtedly helped to produce a set of best practice guidelines that are workable in a prison environment.
Although this book is not aimed at specialists, I would still recommend it to psychiatrists, especially trainees, who want to learn more about the assessment and management of people with mental health problems in prison.
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