Prison psychiatry: is the training experience safe?

Date09 July 2018
Pages219-227
Published date09 July 2018
DOIhttps://doi.org/10.1108/JMHTEP-02-2017-0014
AuthorRuairi Page,Matthew Tovey,Fiona Hynes
Subject MatterHealth & social care,Mental health,Mental health education
Prison psychiatry: is the training
experience safe?
Ruairi Page, Matthew Tovey and Fiona Hynes
Abstract
Purpose Training in the prison settings is a mandatory part of higher training in forensic psychiatry. Violence
in prisons is a recognised issue, which can impact on trainee safety and overall training experience. The Royal
College of Psychiatrists have produced guidelines regarding the safety of the environment in inpatientmental
health settings, but there is currently no such guidance regarding the prison setting. The purpose of this
paper is to report on a survey of UK-based ST4-6 trainees in forensic psychiatry regarding their training
experience in prisons, focusing on supervision and safety.
Design/methodology/approach The authors constructed an electronic survey which comprised of
18 items. This was sent to each UK training programme director in forensic psychiatry, who were asked to
distribute the survey to trainees in their region.
Findings There were 36 unique responses, out of an approximate total of 100 trainees. The questions fell
into two broad categories: trainee safety and trainee supervision. The main themes that arose were that the
majority of trainees (59 per cent) reported that they had not received a formal induction at their prison and had
not received training in using the Assessment, Care in Custody and Teamwork framework (58 per cent) and
serious incident review protocol (83 per cent). The vast majority (76 per cent) reported not being allocated a
personal safety alarm, and 27 per cent reported having received a direct threat from a patient in prison.
Responses with regards to consultant supervision were varied. The majority indicated that they received
weekly supervision (62 per cent).
Originality/value The findingsindicate that there are a number of areaswhere both safety and supervision
within the prisonenvironment may be improved. Thisis concerning given the standards outlinedby Promoting
Excellence (General Medical Council), which highlights the importance of a safe and supported learning
environment, andsuggests the need for further analysislocally of training opportunitieswithin prisons.
Keywords Training, Prison, Forensic psychiatry, Prison safety, Prison training, Specialist registrar
Paper type Research paper
Introduction
Training in the prison settings is a mandatory part of UK higher training in forensic psychiatry. It is
widely known that working and training within the prison pose unique challenges. Not only do
some prisoners present with a range of mental health difficulties including personality disorder,
substance misuse and severe mental illness, but their management is further complicated by the
restrictions of the custodial environment. Prison services have developed their own processes to
manage their unique challenges. For example the Safer Custodyguidance (Ministry of Justice)
which includes the Assessment, Care in Custody and Teamwork (ACCT) process, used in order
to support the management of prisoners at risk of self-harm, suicide or violence from or towards
others, which is likely to be unfamiliar to the clinicians working in non-prison settings. Therefore,
trainees need adequate preparation and supervision to work in prison settings.
One concern for trainees may be the threat to their personal safety in the prison environment,
which can be understood given the nature of custodial settings, and factors such as gang
rivalries, overcrowding, minor disputes, and prison design, which contribute to the violent
attacks that occur in prisons (Morgan, 2009). According to the HM Inspectorate of Prisons
Annual Report 2014/2015 (HM Chief Inspector of Prisons for England and Wales, 2015),
Received 28 February 2017
Revised 9 May 2017
11 October 2017
Accepted 24 November 2017
The authors of this study would
like to thank all of the UK ST4-ST6
Forensic Psychiatry trainees who
participated in the survey. The
authors would also like to thank all
of the UK Forensic Psychiatry
Training Programme Directors who
distributed the survey to their
trainees, to KwikSurveys (www.
kwiksurveys.com) for use of their
online survey software, and to the
Royal College of Psychiatrists
Forensic faculty for their support
with the survey. The authors report
no declarations of interest.
Ruairi Page is a CT3 Psychiatry
at Birmingham and Solihull
Mental Health NHS Foundation
Trust, Birmingham, UK.
Matthew Tovey is a Consultant
Forensic Psychiatrist at
Forensic Psychiatry, South
Staffordshire and Shropshire
Healthcare NHS Foundation
Trust, Stafford, UK.
Fiona Hynes is a Consultant
Forensic Psychiatrist at
Birmingham and Solihull Mental
Health NHS Foundation Trust,
Birmingham, UK.
DOI 10.1108/JMHTEP-02-2017-0014 VOL. 13 NO. 4 2018, pp. 219-227, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
PAGE219

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