Reducing the use of seclusion for mental disorder in a prison: implementing a high support unit in a prison using participant action research

The prison studied is a committal centre for sentenced prisoners with an official bed capacity of 630. The forensic mental health in-reach team, in co-operation with the prison health service followed the 'spiral' of planning, action and fact finding about the results of the action. In December 2010 a 10 bed High Support Unit (HSU) was established within the prison. During the first year, 96 prisoners were admitted. A third (35%) reported psychotic symptoms, 28% were referred due to the immediate risk of self-harm, 17% were accommodated for medical treatments and increased observation, 13% received specialised treatment by the Addiction Psychiatry team, 6% presented with emotional distress. One prisoner was accommodated on the HSU due to the acute risk he posed to others. A major mental illness was diagnosed in 29%, 20% required short-term increased support for crisis intervention and were found not to have a mental illness. A further 10% were deemed to be feigning symptoms of mental illness to seek refuge in the HSU. 7% had personality disorder as their primary diagnosis and 4% had a learning disability. Stratifying risk within the prison population through the provision of the HSU decreased the total episodes of seclusion in the prison by 59% (p < 0.001) in addition to providing a more effective psychiatric in-reach service to the prison. Pathways between the prison and the forensic psychiatric hospital saw no change in activity but improved continuity of care.The next step is to further stratify risk by establishing a low support unit to serve as a step-down from the high support unit.In many jurisdictions prisons do not have a cap on numbers and are prone to overcrowding. Large numbers of mentally ill persons are committed to prisons internationally [1] and this has been confirmed in the prison population described here [2]. International conventions on human rights such as the Universal Declaration of Human Rights [3] and European Convention on Human Rights [4]