An investigation into the routes to inpatient care at the Pantang Hospital in Ghana via the criminal justice system

Abstract

Summary Objectives To develop knowledge of routes by which patients are admitted to Pantang hospital via the courts or police and to explore the factors that prevent discharge, rehabilitation or transfer to prison of these patients. Setting Pantang Psychiatric Hospital, Accra, Ghana, West Africa Design A cross-sectional exploratory qualitative study. Participants Adult patients with a psychiatric diagnosis who had been admitted to hospital following involvement with the criminal justice system and their families; and stakeholders (participants who had experience working with mentally disordered offenders). Methods A descriptive and ethnographic survey of patients plus interviews with key stakeholders in mental health and criminal justice. Data were analysed using hybrid thematic analysis. Results Patients arrived at Pantang Psychiatric Hospital following referral by the arresting police authorities, through court referral, or directly from prisons. All participants reported lack of understanding of the mental health and criminal justice systems, and interface between the two. Most patients and family members reported they feared the stigma of mental illness and patients' criminal charges would interrupt the patients' successful reintegration into the community. Conclusion This study revealed that forensic mental health patients in the Pantang Hospital entered through one of three ways; direct entry through the community-based policing system; on order through the court system; and referrals directly from the prison system. Inadequate staffing and other resources resulted in delays in completing the necessary psychiatric assessments. Funding The study was funded locally and by a grant received from the Faculty of Forensic Psychiatry, Royal College of Psychiatrists in the UK.

Delays in transferring patients from prisons to secure psychiatric hospitals: An international systematic review

“…This stated that the pressure on forensic psychiatry beds was so severe that transfers from prison are all but impossible and concluded that due to bed pressure, a review of transfer times was ‘currently unlikely to be feasible’ (Skipworth et al., 2019). Another study of the Patang hospital admissions in Ghana (Bone & Roberts, 2019) quantitatively reviewed 13 patients who met their inclusion criteria, exploring admission processes. Two prison transfers were reported with one waiting on remand for 4 years before transfer.…”

“…Another study of the Patang hospital admissions in Ghana (Bone & Roberts, 2019) quantitatively reviewed 13 patients who met their inclusion criteria, exploring admission processes. Two prison transfers were reported with one waiting on remand for 4 years before transfer.…”

“…In Scotland, there is some evidence of fewer transfer problems, with mean transfer times of 21.5 days (Okudo, 2020). We are aware of some research elsewhere in the world, also noting difficulties in ensuring timely transfers (Bone & Roberts, 2019; Skipworth et al., 2019). Despite increasing awareness of these problems, there has been no synthesis of international data on delays or reasons for these delays.…”

Management of ADHD in Prisoners—Evidence Gaps and Reasons for Caution

“…There are high rates of self-harm (46) and suicide (47,48), which though linked to ADHD in general population (49), are strongly associated with personality disorders, depression, substance misuse, and psychosis (50)(51)(52)(53)(54)(55)(56), and of violence (57-59), which is especially associated with ASPD (56,(60)(61)(62)(63)(64)(65). Despite this, prison mental health services remain chronically underresourced (66), with substantial delays in transfer to hospital for treatment in most countries where data is reported (67)(68)(69)(70), and limited access to and study of psychosocial and follow-up interventions that may be effective (27).…”