People experiencing homelessness requiring psychiatric review in prison, a study of a male and female remand prison over 1 year period

TL;DR

This study examines the mental health and vulnerabilities of homeless individuals in Irish remand prisons, highlighting the need for integrated care.

Contribution

The study provides a detailed profile of homeless individuals referred to prison psychiatry, emphasizing their complex mental health and social needs.

Findings

68% of participants had active psychotic illness at the time of assessment.

56% had a diagnosis of serious mental illness, and 42% reported current alcohol use.

Only 20% were discharged to prison GPs, with most needing ongoing psychiatric support.

Abstract

There are high numbers of people experiencing homelessness (PEH) in Ireland. PEH experience barriers to accessing mental health care and are overrepresented in prison populations, particularly in remand prisons. To date, there has been limited research conducted on this population, and their specific needs.

In this study, we explored homelessness in those referred to prison psychiatry teams in Dublin’s remand prisons, and profiled the clinical characteristics of the population.

Participants included all persons referred to prison inreach psychiatry teams in one male and one female remand prison over one year between 01/07/22 and 30/06/2023. We examined key aspects of psychiatric service provision including population characteristics, psychiatric and medical history, referral outcomes, alternative pathways and complex health needs.

A total of 89 PEH were referred to prison mental health services during the study period. High rates of active psychotic illness were found in the cohort, with 68% psychotic at the time of the assessment, and 56% having a diagnosis of serious mental illness. More than half the cohort reported current use of substances and 42% current use of alcohol. Over one-third of referrals were made for those with a history of mental illness, with no current symptoms. Only one-fifth of the cohort were discharged to the prison GP following their initial assessment, the remainder requiring ongoing input from prison inreach or community psychiatric services. Significant vulnerabilities were found within 25% including intellectual disability, and membership of ethnic minorities.

There are high rates of mental illness and co-morbid vulnerabilities found in the population. Appropriately addressing the needs of this population will require an integrated, multisystem approach.

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