The introduction and development of a mental health integrated support unit within an English Prison: clinical, care staff and Operational Officer perspectives

McClelland, Norman, Brandon, Toby, Dyer, Wendy, Cassidy, Kathryn, Ridley, Louis and Biddle, Paul (2023) The introduction and development of a mental health integrated support unit within an English Prison: clinical, care staff and Operational Officer perspectives. Journal of Forensic Practice, 25 (1). pp. 1-11. ISSN 2050-8794

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Abstract

Purpose
There is clear evidence that prison can be detrimental to mental health and that wider society has tended to assume “out of sight, out of mind” for prisoners in mental distress. The lack of access to effective mental health care in prisons along with increasingly lower numbers of prison officers, or Operational Officers (OOs), has created a negative culture that requires the development of specialist services. With this comes a need to conduct evaluations, and investigations, into the roles of OOs and mental health-care staff. This study aims to report on a commissioned evaluation around the introduction and development of an HMP Mental Health Unit, named the integrated support unit (ISU), in the North of England. This study’s section of the wider evaluation focuses on the early team building, working practice and development of mental health registered nurses, other care staff and OOs within the ISU.

Design/methodology/approach
Three focus groups incorporating two professional groups took place on the ISU. The first of six Mental Health Workers (MHW) including Registered Mental Health Nurses and support workers; the second of two sets of two ISU dedicated OOs. The areas addressed within each of the groups concerned why staff wanted to work in the ISU, as well as how they would measure its potential success, and the necessary skills competencies and training they thought were required to prepare them to work in the area.

Findings
Overall, the participants expressed an interest or enthusiasm for their work having actively chosen to work in the ISU. There was a strong sense of a wish for the unit to succeed; in fact, success was a motivating drive for all. Both OOs and MHW emphasised the importance of teamworking, autonomy and freedom as well as information sharing. Analysis also revealed many areas of practice that were challenging. The findings are optimistic for the development of such special units as evaluated here. The drivers for different professions along with their measures of success in the field are discussed in detail. The relationship, expectations, hopes and needs of both MHW and prison officers working in a multidisciplinary unit provide useful information to support both policy and practice in the field. The authors make recommendations around training regimes and how they can effectively coordinate the different symbiotic professional roles. The ISU is a new initiative in offender management within prisons and is reviewed as a model of mental health practice in prison settings.

Practical implications
The value in recruiting to the ISU dedicated OOs, with committed interests in mental health. A continued emphasis on the ongoing development of team working, focussing on issues of risk, trust and treatment. The development (by nurses) of a formal/mandatory period of training for new OO’s prior to taking up a role on the ISU. For mental health nurses to embrace team leadership/educator roles in the areas of mental health awareness, team building and conflict resolution. To capture and formulate and develop the specific range of mental health interventions offered within the ISU.

Originality/value
The presented research explores and evaluates the introduction of a new mental health wing (ISU) for 11 patients in a Northern UK prison. It does this through the consideration of group discussions with both MHW and OOs on this wing. This work is part of a larger study.

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