Prison Care Network and Alcohol-Related Challenges
Explore the National Prison Care Network's efforts to deliver holistic care within the justice system, addressing alcohol-related issues in prisons, including the role of alcohol in offending behavior and related deaths. Discover insights on patient pathways and assessments for individuals with alcohol issues in the justice system.
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Presentation Transcript
Alcohol (in)justice Symposium Prisons A Missed Opportunity? Dr Craig Sayers Clinical Lead National Prison Care Network 1
National Prison Care Network National Prison Care Network Strategic Network (small team) Collaboration between Health and Justice Aims to help provide and deliver a holistic, person-centred, evidence- based, consistent pathway across the health and justice system Workplan from SG directives and also from prison healthcare team members Recent successes include development of National Prison GP Forum, DiPC work (CoD), Healthcare Assessment of Prisoners 2
Scotlands Prisons Scotland s Prisons 15prisons (2 private)1 Prison population >8,2001 5%female1 >20%held on remand1 1. Scotland s prison population. Available at: https://www.sccjr.ac.uk/wp-content/uploads/2019/10/7-Scotlands-prison-population.pdf. Accessed 16 Nov 2020. 3
Alcohol and Prisoners Alcohol and Prisoners Role of Alcohol in Offending Behaviour: 41-48% prisoners reported being inebriated at time of offence (60% of Young offenders) Over 40% of individuals accused of homicide were under the influence of alcohol at the time of their offence 42% violent crime in Scotland is alcohol related 22% victims of violent crime under the influence of alcohol at the time of offence 4
Alcohol Related Deaths Rates Alcohol Related Deaths Rates For individuals serving a prison sentence: Men 3 x more likely than those outside prison Women 9 x more likely than those outside prison 5
Our Patient Pathway Our Patient Pathway First Night: Admission Process (identify immediate needs) Usually, no accompanying information Assessment of acute withdrawals and/or Delirium Tremens CIWA-Ar assessment / Alternative Assessment Tool 6
CIWA CIWA- -Ar Ar 7
CIWA CIWA- -Ar Ar Limitations Limitations Devised for patients entering alcohol detox units with no other healthcare issues Research not transferrable to other clinical settings High level of subjective scoring elements impacted by other aspects of admission to prison Timeous to complete 8
Alternative Assessment Tool Alternative Assessment Tool ALCOHOL AND BENZODIAZEPINE WITHDRAWAL SCALE Observe the patient and score accordingly. A total score of 5 or more is strongly suggestive of alcohol and/or benzodiazepine withdrawal in a dependent patient. Patients scoring 5 or more should be commenced on the Prison PGD for Diazepam prescribing regime. 3 2 1 0 Pulse >120/min 100-119/min 80-100/min <80/min Tremor Whole Body Tremor Constant tremor of arms Tremor of outstretched hands No tremor Sweats Profuse sweating Beads of sweat Moist palms on palpation No sweats Orientation Disorientated for place/time Disorientated by date for 2days+ Uncertain of date Orientated Anxiety Constant panic and anxiety Anxiety and panics Understandable anxiety Normal presentation Agitation Constantly restless Cannot remain seated Restlessness None Perceptual disturbance Vivid hallucinations Formed hallucinations Fleeting hallucinations No evidence of hallucinations Total Score Date & Time Signature Comments 9
Our Patient Pathway Our Patient Pathway FAST AUDIT 10
Fast Alcohol Screening Test Fast Alcohol Screening Test 11
Alcohol Use Disorders Identification Test (AUDIT) Alcohol Use Disorders Identification Test (AUDIT) 12
Alcohol Use Disorder Alcohol Use Disorder 73% Male Prisoners 36% Potentially Dependent 13
Our Patient Pathway Our Patient Pathway All Patients General Awareness/Harm Minimisation Advice AUDIT (0-7) As above AUDIT (8-19) Psychosocial Interventions (Motivational Interviewing, Accredited Prisoner Programs, Extended Brief Interventions) AUDIT (20+) - Consider Community Assessment (short sentence and remand) and consider clinical input (Prescribing) 14
Our Patient Pathway Our Patient Pathway Plans for Liberation: Throughcare to Community Services (Signposting if patient doesn t wish to engage whilst in prison) Consideration of commencement of Medication (Acamprosate, Disulfiram, Naltrexone) 15
Challenges Challenges Prison doesn t reflect environment where alcohol is readily available Remand and Short Sentences Limited Evidence base for Effective Prison Interventions Lack of Validated Tools for Continued Assessment Throughcare (both on entering and leaving prison) esp Nationally How do we know if we are making a difference? 16
How to Move Forward? How to Move Forward? Ensure withdrawals addressed appropriately and timeously FAST/AUDIT assessments carried out on all patients Alcohol Brief Interventions to be available for all throughout their stay in prison Specialist trained staff to provide input in custody (increased input from addictions psychiatrists and psychologists) Medication options to be available for liberation Improve throughcare at both ends of the patient journey Role of Network to agree consistent approach across the prison estate 17
Contact us: nss.prisoncare@nhs.scot 18
