Background

Ireland has low provision rates of general and forensic beds compared with other western countries. In recent years there have been difficulties and delays in accessing forensic beds for prisoners with severe mental illness.

Aims

We aimed to determine clinical outcomes for male prisoners assessed as requiring psychiatric admission over an extended period, with time frames for admission and other outcomes. We aimed to determine whether admissions to forensic and non-forensic locations were risk-appropriate.

Methods

Participants included all male prisoners placed on psychiatric admission waiting lists in Ireland over five years 2015–2019. We described demographic, clinical and offending variables. We measured clinical outcomes including forensic admission, other admission and recovery with voluntary treatment in prison. We also measured times to clinical outcomes. Security requirements and clinical urgency were assessed using the DUNDRUM Toolkit scales 1 and 2.

Results

541 male prisoners were placed on admission waiting lists and spent an aggregate of over 114 years on admission waiting lists during 2015–2019. Almost one quarter improved with voluntary treatment allowing removal from waiting lists, while over 75% did not. Admission was achieved for a majority of cases, albeit after lengthy delays for some. The most frequent outcome was diversion from remand to non-forensic inpatient settings. Non-forensic admissions arranged by the Prison Inreach and Court Liaison Service (PICLS) at Ireland's main remand prison at Cloverhill contributed 54% (179/332) of all admissions achieved and 76% (179/235) of all non-forensic admissions from prison waiting list. Median delay to admission was 59 days for forensic admissions and 69 days for admissions to non-forensic hospitals from sentenced settings, compared with 16.5 days for admissions to non-forensic hospitals from remand.

Conclusions

Long delays for forensic admission during a five-year period of limited access to such beds were partly mitigated by transfers to non-forensic hospitals, mainly diversion of minor offenders from remand settings.

中文翻译：

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五年内被列入爱尔兰监狱精神病入院等候名单的男性：法医“床位危机”期间的临床结果

背景

与其他西方国家相比，爱尔兰普通床位和法医床位的供应率较低。近年来，患有严重精神疾病的囚犯在获取法医床位方面遇到了困难和延误。

目标

我们的目的是确定被评估为需要长期精神病入院的男性囚犯的临床结果，以及入院时限和其他结果。我们的目的是确定进入法医和非法医地点是否适合风险。

方法

参与者包括 2015 年至 2019 年五年内爱尔兰精神病入院等候名单上的所有男性囚犯。我们描述了人口统计学、临床和犯罪变量。我们测量了临床结果，包括法医入院、其他入院和监狱自愿治疗的康复情况。我们还测量了达到临床结果的时间。使用 DUNDRUM 工具包等级 1 和 2 评估安全要求和临床紧迫性。

结果

2015 年至 2019 年期间，有 541 名男性囚犯被列入入院候补名单，并在入院候补名单上总共度过了超过 114 年的时间。近四分之一的人通过自愿治疗而获得改善，允许从候补名单中删除，而超过 75% 的人则没有。大多数病例都已获准入院，尽管有些病例经过了长时间的延误。最常见的结果是从还押转移到非法医住院环境。爱尔兰克洛弗山主要还押监狱的监狱内达和法院联络服务处 (PICLS) 安排的非法医认罪占所有收监人数的 54% (179/332)，占所有非法医认罪人数的 76% (179/235)。监狱等候名单。法医入院延迟入院的中位时间为 59 天，判刑后转入非法医医院的入院延迟中位为 69 天，而还押后转入非法医医院的入院延迟中位为 16.5 天。

结论

由于转入非法医医院（主要是将未成年罪犯从还押场所转移），在五年期间有限获得此类床位期间，法医入院的长期延误得到了部分缓解。