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A study of psychotropic medication prescribing patterns in English prisons

A study of psychotropic medication prescribing patterns in English prisons

Portfolio Eligibility
Automatically eligible
MREC N° 09JH0903J54
Research Summary
The prevalence of mental disorder is higher in prisons than it is in the community (Singleton et al, 1998; Gunn et al, 1991). Over the past fifty years psychotropic medications have revolutionised mental health care, changing the lives of many of those living with mental illness for the better. Whilst UK policy entitles prisoners to the same standard of health care as that available in the community (Health Advisory Committee for the Prison Service, 1997), in the past prisons have been criticised for falling short of prisoners’ health needs. This programme of study aims to consider the extent to which the prescription of psychotropic medication in prisons is equivalent to that in the community, both in terms of the types of medications prescribed and the prescribing process itself. A mixed methods design will be employed, making use of observational data on prescribing trends in addition to collecting rich, qualitative data on personal perspectives and experiences.
Study Type Observational
Design Type Cross-sectional study
Disease(s) Attention deficit hyperactivity disorder conduct disorders
Phase N/A
Current Status Closed - follow-up complete
Closure Date 10/29/2013
Global Sample Size 2358
Global Recruitment to Date
Geographical Scope UK Multi-Centre
Lead Country England
Additional Information

Project Lay Summary What is this study about? A high proportion of people in prison have mental health problems requiring treatment with medication. Department of Health policy states that people in prison should have access to the same standards of healthcare as people in the wider community; however there is emerging evidence that use of psychotropic (mood altering) medication is significantly different in prisons than in general practice. Research suggests that older-type psychotropic medications are more frequently used in prisons even when newer, safer alternatives are available. This study aims to compare the prescribing of psychotropic medication in four or more UK prisons with prescribing in the community. The researchers will compare two groups identified as being prescribed psychotropic medication on one ‘census’ day: a sample of 1500 people in prison and a randomised sample of 2000 people in the community. The researchers will use the General Practice Research Database to collect prescribing data for community patients, and the SystemOne database for prison patients. The study will compare the types of antidepressants, antipsychotic medication, anxiolytics (tranquilisers), hypnotics and medications for ADHD prescribed in these two groups. The study will provide information on the dose, type and cost of medications prescribed and will assess whether NICE guidelines for antidepressant prescribing are being met. The research team also want to find out how the decision-making process in prescribing medication for mental health problems might differ in prisons compared to community healthcare settings. The researchers will conduct up to 50 interviews with people in prison who are receiving psychotropic medication, and staff responsible for prescribing or administering medication in prisons. The interviews will be audio recorded and written transcripts produced to enable the researchers to identify themes about people’s experiences of psychotropic medication prescribing in prison. MHRN Lay Summary

Main Inclusion Criteria
Point prevalence survey On the defined ‘prevalence’ (census) day (exact date TBC), the patient should be: • alive; • aged 18 years or over; • in receipt of prescribed antidepressant, antipsychotic, hypnotic/ anxiolytic and/or stimulant medication; and • either in custody (prison sample); OR GP registered (community sample). Prisoner interview • Prescribed antidepressant, antipsychotic, anxiolytic and/or stimulant medication during their current period of custody OR immediately prior to custody; and • has had prior contact with, OR is currently on the caseload of, prison mental health services. Staff interview: • Member of staff based at the prison; and • involved in the practice of, management of or development of policy related to the prescribing, dispensing or administering of medication in the prison.
Main Exclusion Criteria
Point prevalence survey None Prisoner interview • Not capable of consenting for themselves. • Been in custody less than 1 month. • Not safe to see due to the nature of previous offences or history, some prisoners may be deemed by prison or healthcare staff as not safe for the researcher to interview alone. Staff interview None.
Chief Investigator(s)
Prof Jenny Shaw
Further details, please contact
Dr Lamiece Hassan

Institute of Cardiovascular Sciences (University of Manchester)
Jean MacFarlane Building
Oxford Road
Greater Manchester
M13 9PL

Tel: 0161 306 8012
Funder(s) Department of Health
NIHR Health Services and Delivery Research
Sponsor(s) Institute of Cardiovascular Sciences (University of Manchester)
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