Prison psychiatry

Question 1

Mental health disorders

Answer 1

• 90% prisoners have a mental disorder

- 20-30% have substance missuse

Question 2

Personality disorders

Answer 2

• antisocial PD is most common in men

- second most common is paranoid personality disorder

Question 3

Psychosis in prison

Answer 3

0. 52%

- 1/4th of all psychoses are attributable to psychoactive substances

Question 4

Suicide

Answer 4

• 8x higher in prison population than the general population
• majority occur within 6 months of imprisonment
• more life sentence prisoners
• remand prisoners, young offenders and those with a history of substance misuse and violent offences are at particular risk

Question 5

Serious violence in the severely mentally disordered

Answer 5

-probability is less than 1%

Question 6

Risk assessment

Answer 6

• can be clinical approach (subjective)
• actuarial- uses probabilities and is popular in forensics
• structured professional judgment (HCR-20)

Question 7

HCR 20

Answer 7

• popular tool for violence risk
• historical, clinical and risk
• 10 historic items
• 5 clinical items
• 5 risk management items

Question 8

Historical risk items in HCR20

Answer 8

1. previous violence
2. young age at first incident
3. unstable relationships
4. major mental illness
5. substance use
6. psychopathy
7. employment issues
8. personality disorder
9. early maladjustment
10. previous supervision failure

Question 9

Clinical items HCR-20

Answer 9

1. negative attitudes to health services
2. active symptoms
3. impulsivity
4. treatment unresponsiveness
5. lack of insight

Question 10

Risk items in HCR-20

Answer 10

1. management plan lacks feasibility
2. exposure to destabilisers
3. non-compliance
4. stress
5. lack of personal support

Question 11

SARA

Answer 11

• spousal assault risk assessment

- 20 item set of risk factors for use in the assessment of spousal assault

Question 12

SVR-20

Answer 12

• sexual violence risk 20 scale

- 20 item guide for assessing violence risk in sex offenders

Question 13

VRAG

Answer 13

• Violence risk appraisal guide is entirely reliant on historical factors
• validated in Canadian prisons
• made of 12 items and includes PCL_R as a subscale

Question 14

Items on VRAG

Answer 14

• PCL-R (diagnoses psychopathy)
• elementary school difficulties
• personality disorder
• younger age
• separated from parents before age of 16
• never married
• absence of schizophrenia
• victim injury
• alcohol abuse
• female victim
• failed conditional release
• history of non-violent offence

Question 15

Violence Risk Scale

Answer 15

-23 dynamic and 6 static variables

Question 16

PCL-R

Answer 16

• scale to diagnose psychopathy
• informs risk assessment and treatment decisions
• 0-40 score range
• 0-2 for each item
• 20 items in total
• cut off of 25 used to diagnose psychopathy

Question 17

The static 99

Answer 17

• ten item actuarial assessment instrument created by Hanson and Thornton
• used with adult male sex offenders who are at least 18 years of age at the time of release to the community

Question 18

SORAG

Answer 18

• sexual risk offender appraisal guide

- a 14 item actuarial instrument that incorporates the PCL-R