A pilot study of dual diagnosis training in prisons
| Date | 11 December 2006 |
| Published date | 11 December 2006 |
| DOI | https://doi.org/10.1108/17556228200600025 |
| Pages | 5-14 |
| Author | Elizabeth Hughes |
| Subject Matter | Health & social care |
5
Apilot study of dual diagnosis training
in prisons
Elizabeth Hughes
Principal Research Fellow, Centre for Clinical and Academic Workforce Innovation, University of Lincoln
The Journal of Mental Health Workforce Development Volume 1 Issue 4 December 2006 © Pavilion Journals (Brighton) Ltd
Abstract
People with dual diagnosis have complex needs
and vulnerabilities that may lead to incarceration in
prisons. Mental health and substance use services
in prisons should have the capabilities to address
their needs while incarcerated and facilitate the
transfer of care to community services on release.
In order to develop these capabilities, a training
programme is required.
Apilot training programme for dual diagnosis
was developed and piloted in five London prisons.
The training was based on a training needs
assessment of prison staffand consultation with
service users. It was delivered in two forms: a five-
day classroom based course, and a ‘blended
learning’ method that comprised a manual and
three sessions of supervision. The course was
evaluated by a brief questionnairethat included
items on attitudes, self-efficacy and knowledge
about working with dual diagnosis.
The evaluation of the training revealed that all
workers, no matter what method of training they
received increased their perception of their skills
(self-efficacy) and increased their attitudes.
Knowledge remained the same (although the
scores pre-training were high). There was no
difference between the two types of training when
mean scores were compared at post-training. There
was also no difference between the mental health
and substance workers regarding their mean scores
at follow-up, apartfrom knowledge.
The conclusion is that the training pilot was
evaluated positively and did indicate that it has some
effect on attitudes and self-efficacy.Morerigorous
evaluation of the impact of the training is required,
using a robust methodology and assessing the
impact on clinical skills and service user outcomes.
Keywords
prison; mental health; dual diagnosis; training
Background
Addressing the needs of people with dual diagnosis (mental
health and substance use problems) has been identified as a
major challenge for mental health services in England
(DoH, 2005). The outcomes for people with dual diagnosis
are likely to be poor and they are likely to have a substantial
amount of unmet needs. Areas of vulnerability include
increased risk of suicide, violence, victimisation, health
problems (such as blood borne infections), poor adherence
to treatment, and homelessness. People with dual diagnosis
often fail to receive appropriate care due to a combination
of difficulties with engagement, lack of clarity around
service responsibilities and lack of capabilities of the mental
health and substance use workforce. The lack of
engagement and the complexity of their problems can
result in criminal behaviours and ultimately imprisonment.
While there are no actual figures of the prevalence of
co-morbid substance use and mental health in the prison
system, it is estimated that the level of dual diagnosis is
likely to be significant (Brooker et al,2003). Surveys (ONS,
1997; 1998) estimate that 70% of prisoners have at least
one diagnosable mental illness or substance use problem.
Often prisoners have multiple diagnoses. These prisoners
are at high risk for suicide. Shaw, Appleby and Baker
(2003) reported that 32% of people who committed
suicide while in prison had two co-morbid diagnoses. Re-
offending rates are also high as co-morbid mental health
and substance use compound the difficulties (lack of
housing, support, access to care etc.) associated with
release from prison that most prisoners experience (Social
Exclusion Unit, 2002; Home Office, 2004). For example,
around half of people with mental illness who are released
from prison lack stable housing (Revolving Door, 2002).
Despite the modernisation of both mental health
(DoH/HM Prison Service, 2001) and substance use services
(HM Prison Service, 1998; 2000) within prisons, there is a
lack of clarity as to who should be providing care for
prisoners with both mental health and substance use
problems, and a lack of skills and knowledge among
workers to provide that care.
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