Using the stress-vulnerability model to better understand suicide in prison populations.

Suicide is the culmination of the interaction of a number of factors with the critical component being distress. The contribution of mental illness as a vulnerability factor in an individual case of suicide by a prisoner may be significant, marginal or non-existent. Because of the high prevalence in prison populations of all risk factors for suicide, relying solely on those factors is of little use in elaborating the risk of suicide for a given prisoner. Whilst a current mental illness or past history of a suicide attempt are two factors that appear to be strongly associated with completed suicide, no screening or risk assessment tool has any proven efficacy in predicting suicide in prison populations. The stress-vulnerability model offers a more sophisticated and comprehensive assessment and also informs a more individualised needs-based management of the risk of suicide with an emphasis on detecting and responding to a prisoner's distress.

A prison mental health network in the RANZCP.

OBJECTIVE: Consider the unique features and challenges of prison psychiatry. CONCLUSIONS: A Prison Mental Health Network within the Royal Australian and New Zealand College of Psychiatrists would serve many useful functions including improving the quality of mental health services by promoting high clinical standards and ethical practice by psychiatrists working in prisons.

Long-acting injectable buprenorphine - 'best practice' opioid agonist therapy for Australian prisoners.

OBJECTIVE: To consider opioid agonist therapy in prisons. CONCLUSIONS: Given the substantial risks of substance misuse by prisoners, long-acting injectable buprenorphine should be adopted as 'best practice' treatment in Australian prison populations.

Engagement of mental health service users and carers in care planning - Is it meaningful and adding value?

OBJECTIVE: Consider whether mental health service users and carers meaningfully engage in care planning and whether care planning adds value to patient care. CONCLUSION: A review of the meta-analyses and systematic reviews of service users and carers identified many barriers to their meaningful engagement in care planning. No research has demonstrated any measurable benefits or positive outcomes linked to mental health care planning.

Aggressive behaviour, victimization and crime among severely mentally ill patients requiring hospitalisation.

BACKGROUND: Severe mental illness is associated with increased risk of aggressive behaviour, crime and victimization. Mental health policy does not acknowledge this evidence. The number of forensic beds has risen dramatically. AIMS: To examine the prevalence of aggressive behaviour, victimization and criminality among people receiving in-patient treatment for severe mental illness in an inner-city area. METHOD: Self-reports of aggressive behaviour and victimization and criminal records were collected for 205 in-patients with severe mental illness. RESULTS: In the preceding 6 months 49% of the men and 39% of the women had engaged in aggressive behaviour and 57% of the men and 48% of the women had been victims of assault; 47% of the men and 17% of the women had been convicted of at least one violent crime. CONCLUSIONS: Aggressive behaviour and victimization are common among severely mentally ill people requiring hospitalisation in the inner city. Rates of violent crime are higher than in the general population.