title: From positive screen to engagement in treatment: a preliminary study of the impact of a new model of care for prisoners with serious mental illness.
abstract: BACKGROUND
  The high prevalence of serious mental illness (SMI) in prisons remains a challenge for mental health services. Many prisoners with SMI do not receive care. Screening tools have been developed but better detection has not translated to higher rates of treatment. In New Zealand a Prison Model of Care (PMOC) was developed by forensic mental health and correctional services to address this challenge. The PMOC broadened triggers for referrals to mental health teams. Referrals were triaged by mental health nurses leading to multidisciplinary team assessment within specified timeframes. This pathway for screening, referral and assessment was introduced within existing resources.
  
  
  METHODS
  The PMOC was implemented across four prisons. An AB research design was used to explore the extent to which mentally ill prisoners were referred to and accepted by prison in-reach mental health teams and to determine the proportion of prison population receiving specialist mental health care.
  
  
  RESULTS
  The number of prisoners in the study in the year before the PMOC (n =  9,349) was similar to the year after (n = 19,421). 24.6 % of prisoners were screened as per the PMOC in the post period. Referrals increased from 491 to 734 in the post period (Z = -7.23, p < 0.0001). A greater number of triage assessments occurred after the introduction of the PMOC (pre = 458; post = 613, Z = 4.74, p < 0.0001) leading to a significant increase in the numbers accepted onto in-reach caseloads (pre = 338; post = 426, Z = 3.16, p < 0.01). Numbers of triage assessments completed within specified time frames showed no statistically significant difference before or after implementation. The proportion of prison population on in-reach caseloads increased from 5.6 % in the pre period to 7.0 % in the year post implementation while diagnostic patterns did not change, indicating more prisoners with SMI were identified and engaged in treatment.
  
  
  CONCLUSIONS
  The PMOC led to increased prisoner numbers across screening, referral, treatment and engagement. Gains were achieved without extra resources by consistent processes and improved clarity of professional roles and tasks. The PMOC described a more effective pathway to specialist care for people with SMI entering prison.
authors.affiliation: Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. Krishna.Pillai@waitematadhb.govt.nz.
authors.forename: Krishna
authors.initials: K
authors.lastname: Pillai
authors.affiliation: The University of Auckland, Auckland, New Zealand. p.rouse@auckland.ac.nz.
authors.forename: Paul
authors.initials: P
authors.lastname: Rouse
authors.affiliation: Australian Catholic University and NorthWestern Mental Health, Level 1 North, City Campus, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia, 3050. Brian.McKenna@mh.org.au.
authors.forename: Brian
authors.initials: B
authors.lastname: McKenna
authors.affiliation: Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. Jeremy.Skipworthi@waitematadhb.govt.nz.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Skipworth
authors.affiliation: Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. James.Cavney@waitematadhb.govt.nz.
authors.forename: James
authors.initials: J
authors.lastname: Cavney
authors.affiliation: Midlands Regional Forensic Psychiatric Service, Waikato District Health Board, Hamilton, New Zealand. Rees.Tapsell@waikatodhb.health.nz.
authors.forename: Rees
authors.initials: R
authors.lastname: Tapsell
authors.affiliation: Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada. Sandy.Simpson@camh.ca.
authors.forename: Alexander
authors.initials: A
authors.lastname: Simpson
authors.affiliation: The University of Auckland, Auckland, New Zealand. Dominic.Madell@middlemore.co.nz.
authors.forename: Dominic
authors.initials: D
authors.lastname: Madell
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D009520:New Zealand; D010348:Patient Care Team / Q000458:organization & administration*; D011329:Prisoners / Q000523:psychology*; D012017:Referral and Consultation; D014218:Triage