Setting

This audit was conducted within the prison healthcare service, where prisoners may be receiving either in-patient or out-patient care for mental health problems.

Background

Significant changes in the delivery of healthcare in prisons have led to increased expectations of quality of care. Since April 2006, primary care trusts have been responsible for providing healthcare within prisons and these services are subject to the same clinical governance procedures as in the wider National Health Service, under the principle of ‘equivalence of care’.

Standards

Standards were obtained from guidelines for the treatment of depression and schizophrenia produced by the National Institute for Health of Clinical Excellence (NICE) (both 2009). Only some of the standards were selected, for their ease of assessment and importance.

Depression

ᐅ When initiating treatment there should be a documented assessment of symptoms and a risk assessment.

ᐅ A selective serotonin reuptake inhibitor (SSRI) should be prescribed as the first-line treatment.

ᐅ Anyone initiated on treatment should be reviewed in 2 weeks.

ᐅ For continuing treatment there should be regular review of the need for it.

Schizophrenia

ᐅ When initiating treatment there should be a documented assessment of symptoms and a risk assessment.

ᐅ Baseline weight and blood glucose level should be recorded.

ᐅ An atypical antipsychotic should be prescribed as the first-line treatment.

ᐅ For continuing prescription there should be regular documentation of symptoms and side-effects.

Method

Data collection

The medication cards for all of the inmates were reviewed and those prescribed antidepressants or antipsychotics identified. The inmate medical records of these patients were then reviewed to select those with a diagnosis of depression or schizophrenia; only these patients were included in the audit. The documentation of their first assessment on entry to prison was examined to determine whether the prescription was a new one (i.e. initiated in prison). The notes were examined to find entries relating to:

ᐅ documentation of symptoms and risk

ᐅ rationale for drug selection

ᐅ recording of baseline weight and blood glucose level (in schizophrenia)

ᐅ ongoing review of symptoms and treatment.

Data analysis

The percentages of patients with depression and schizophrenia whose care met the above standards were calculated.