Having worked as a nurse in prison I felt able to fight for my patients 'rights' in that, all prisoners should be offered the same level of healthcare in custody as they are outside. Unfortunately i didn't read the small print which should read "except for drug users". I am really struggling with treatment on offer for substance misuse now i am working in this area, although i realise that treatments have come on leaps and bounds I currently feel that i am having to detox clients off treatment despite the fact that they are stable for the first time in their lives!!! We are not commisioned to offer maintenance (i'm a nurse i don't want to think about commisioning!!) Not sure if i want encouragement or agreement here to be honest.... just feel a bit lost in the system and concerned about the clients! Help?

Hi, I am a nurse working in prison (IDTS) just about to go live in a new,purpose-built wing.
For the last 8 months I have been monitoring the detoxes of the majority of patients coming through with only a very few patients who came in already scripted, who were permitted to have their dose continued.
I,too, have felt the frustration of 'the system', having previously had years of 'community' work getting people into treatment and knowing how very easy this is to do.
I agree it is very hard to see patients go through the misery of detox, especially when the've done it a hundred of times before!
I have also been pleased to see how well some of these people are when the first couple of weeks are over.
I dont think replacement treatment is suitable 'for everyone' but I am very pleased that it will be available for those who want and need it in my locality.
I also have serious concern about capacity within the treatment system as a whole and what will happen to those started on medication who dont manage to keep their script when they leave.

Thanks for your thoughts Ann, can feel a bit isolated in prisons sometimes!! Not always able to voice my frustrations when people above me are very 'for' the system. My main frustration lies with people who are being detoxed then having a reintroduction within a few months prior to discharge purely because they lie outside of our remit... just seems crazy to me. Have to agree that replacement treatment is not the answer for all, just wish we could be a bit more flexible. Have been very lucky with people leaving custody and setting up treatment outside, never had an issue yet, well that is if they turn up to the appointment!!!!! but on the whole smooth transition from custody to community (great CARAT team to thank for that!!)

I'm sorry for the delay in coming to this discussion but I've just come back from escaping prison for a couple of weeks having been on my summer holidays. Clurr you didn't mention whether the prison in which you work has received IDTS funding? If so then there will be funding available for maintenance according to individual clinical need and both DH and the NTA are really pushing this important agenda. If you're not yet IDTS funding then I would argue it still should be possible to offer some maintenance though compromises may have to be made. In my experience it was possible to continue maintenance scripts for those being received on remand into the prison with core health care funding. Obviously IDTS funding makes greater provision for care planning, review etc etc. I hope this helps a little?

yes we do have IDTS however the criteria I am asked to work from states that if the person has mental health issues they can be maintained otherwise........it's a no, unless they are due out within a few months. It's the people who have never been off illicit drugs and are doing really well that i am concerned for, one example is a chap who will be left on nothing for 3 months after a detox then have a re-tox prior to leaving... just seems crazy to me??? We don't have remands so i can't comment on their treatment.

This message has been edited. Last edited by: clurr,

quote:

Originally posted by clurr:
if the person has mental health issues they can be maintained otherwise........it's a no

While I might not agree with the classification it's common for addiction to be classified as a mental health issue
e.g. http://www.cks.nhs.uk/clinical_topics#-325205

I also know nothing of prison bureaucracy - but surely it could be argued that the client has a mental health issue unless shown otherwise?

Jeff

Hi Clurr, it maybe time to revisit the policy if you now have IDTS funding as the criteria from DH/NTA is that provision should according to health need

thanks very much for your help/advise on this it's greatly appreciated

On a philosophical note there is a major diffence between the community and the incarcerated population. In the community an individual has the choice of treatment options or no treatment. People do not choose to go to prison (yes I too have heard anecdotal evidence of a few who need a rest in prison).They therefore do not have the choice of treatment options. That choice is made for them. no amount of pretence to providing the same as a community service will hide that basic fact. It really is about time we dealt with this issue with a degree of honesty

I know I a can be naive, but I thought prison was about the deprivation of liberty, not the deprivation of good healthcare.

If I recall correctly, it cost the last prison who did not use best-evidence treatment a lot of money in compensation.

Jerry i am not sure i fully understand your point, no a full range of treatment options isn't available but i still believe i should be able to offer the best treatment possible (from limited options admittedly)for the individuals in my care??

On a good note seemed to have ironed out a few of my issues and more realistic treatment plans are now being offered to the clients, they are much happier!

"A full range of treatment options isn't available"

Does this mean diabetes is not treated with insulin, or epilepsy with modern anti-convulsants? What restricts treatment in prison that does not restrict treatment outside?

When i say that a full range of options isn't available it is 'maintenance' that is the sticking point. In a lot of cases the restriction is purely on time, we are only allocated a maximum number of patients because of the restriction on how long we have to dispense (this is enforced by the prison). Therefore if say your restriction is 60 patients you couldn't have 60 people on maintenance because then you could only take on new patients when say somebody is discharged or transferred. The guidelines state that if somebody has longer than 13 weeks to serve detoxification is the default treatment option (there are a few exceptions to the rule)

I understand the background to the limitations, but is seems to be extra limits are being set in prison that would not apply for other conditions. If you had 70 diabetics, would the prison only allow you to treat 60?

There seems to be a stubborn resistance to see opiate dependency as a condition that needs individualised treatment. Detox may be fine for many, but for some it may create more problems than it solves, not least of which is being drawn into the prison drug-scene, because addiction is not treated by detox alone. A similar blind spot seems to exist in relation to this long standing issue of access to street drugs in prison.

This message has been edited. Last edited by: jimjones,

Its about money jim, giving controlled drugs in prison is always going to be supervised, so is incredibly resource intensive. I believe ways to deal with this are being explored but not holding my breath...

If prison health care came out and said we are doing this for financial reasons it would be more honest, rather than claiming addiction in prison is somehow clinically different and so protocols do not follow accepted good practice. Resources are not adequate in many places, this is made clear and not fudged for fear of litigation or upsetting vested interests.

I am concerned not to lose sight of the 'more, better, fairer' rubric, especially the fairer bit.

we are commisioned and are given a figure of how many patients we should get in treatment every year.... if we don't reach that target we might not get the commision again... a very simple explanation from a simple nurse. I don't particularly care about this bigger picture as i just want to offer good quality care, the very best i can for all my patients because they deserve it, i wave my substance misuse banner whenever i can and try to educate people wherever i see the possibility. I feel i need to stop questioning the 'bigger picture' because i'm not sure i'll ever understand or change anything!! I'll just beaver away at the bottom end and do my best!!