Outpatient care in prisons
Studies conducted on prison populations worldwide since the 1990s conclude that incarcerated individuals are four to six times more likely to suffer from a psychotic disorder or severe depression, among other conditions, compared to the general population, and approximately ten times more likely to be diagnosed with antisocial personality disorder. In addition to this high incidence of mental health disorders among the incarcerated population in Spain (five times higher than the general population), it is worth highlighting the high comorbidity between mental health disorders and psychoactive substance use.
In Catalonia, this particularly vulnerable population receives care under a pioneering model at the national level, promoting comprehensive care at different levels to facilitate recovery and subsequent social integration. This model includes three levels of care:
- Hospital care , currently in the Brians 1 and Brians 2 units.
- Outpatient care is provided within the prison where the person resides, through the Prison Primary Care Support Program (PSP). Currently offered at Brians 1, Brians 2, Quatre Camins, Joves, Wad Ras, and Til·lers/Alsina/Can Llupià.
- Attention to the person when they are in the third degree or on parole , within the Community Mental Health network, from the Individualized Penitentiary Service Program (PSI).
The Individualized Service Plan (PSI), beyond prison
In this article we will talk about outpatient care in penitentiary centers, the so-called Penitentiary PSP (Primary Support Program).
This program was created in mid-2017 with the agreement of the Department of Health and Justice of the Government of Catalonia and was fully implemented in prisons at the beginning of 2018. It's worth noting that a similar model had existed for several years at the Quatre Camins Penitentiary Center. It's also important to distinguish the PSP (Psychiatric Support Program) from the psychiatric consultation service, which had always existed in the prisons but lacked the multidisciplinary intervention framework established by the PSP.
Outpatient care is based on a person-centered, comprehensive care model aimed at achieving maximum autonomy and recovery. It relies on a support and collaboration program between prison mental health teams, prison primary care teams, and prison treatment teams.
The World Health Organization (WHO) says that "it is essential to understand mental health problems as a part of our lives and another circumstance of the person and not as an element that cancels out the rest of our abilities" (WHO, 2001).
The concept of recovery refers to strengthening one's own capabilities and developing new skills focused on improving quality of life. It equips people with tools that facilitate the development of a life plan, according to their possibilities, expectations, and values. This occurs even if symptoms persist, with the goal of helping them regain active control over their own lives.
Anthony (1993) stated that “recovery is a way of living life satisfactorily, with hope and contributions, even with limitations caused by the disorder. Recovery involves developing a new sense of purpose in life, as the person grows beyond the catastrophic effects of the mental disorder.” And William Osler tells us “to listen to the person because they are explaining the diagnosis to you” (Becker, 2015).
The working philosophy of the Penitentiary PSP
The prison PSP is determined by the very essence of the community PSP; this new philosophy of work occurs when primary care and specialized care create bonds of union and shared work; it is here that opportunities for significant improvement in the care of people with mental disorders or addictions truly arise.
The Working Group document on the portfolio of mental health and addiction services in Primary Care. Promoting the care model: identifying effective actions (2010) establishes this communication as a central element to ensure continuity of care. From this relationship will emerge shared objectives for the well-being of the individual, such as consolidating the comprehensive care model, facilitating the more homogeneous and effective development of resources, identifying the most vulnerable individuals, etc. All these objectives will be detailed later in the objectives of the Penitentiary PSP (Personalized Service Plan).
Fernández de Sanmamed et al. (2020) emphasize the importance of cooperation between primary and secondary levels of care, assistance, and efficient resource management for the participation of mental health professionals in primary healthcare settings. They also underscore positive mental health as an essential element for human and social development, arguing that health and illness should be addressed as a continuum where the boundaries between what is normal and healthy and what is not are blurred. and depend on multiple social and personal factors, and even on the definitions made by the scientific community.
To understand the reason for this program, mention the document edited by the General Directorate of Health Planning (Department of Health), El procés assistencial en salut mental i addiccions a la xarxa d'atenció primària, in which We are told about the importance of creating an integrated and continuous health system, emphasizing prevention and promotion, chronicity and complexity, and above all, the community approach.
The objectives of the Penitentiary PSP
The Penitentiary PSP is made up of teams of professionals from various disciplines: psychiatry, nursing, psychology and occupational therapy.
These teams aim to:
- Improve accessibility to mental health services.
- Improve detection and comprehensive care.
- Improve the skills and problem-solving capacity of primary care teams.
- To provide continuity of care through networking to prevent relapses, primarily.
- Establish coordination spaces.
- Participate with the other agents in preparing the link to the community network when moving to open regime or freedom.
- Improve the detection and care of people at risk of suicide.
- Improve the care of problems related to physical health.
- Recover and maintain emotional bonds with the outside world (family, friends, etc.)
In addition to these objectives, the Prison Social Services Program (PSP Penitentiary) offers a range of services aimed at promoting and preventing mental health disorders and addictions, health education programs, daily living skills training, and psychosocial rehabilitation programs. It also includes participation in multidisciplinary teams, coordination with the community mental health network, and the organization of training, teaching, and research activities.
A key service in the person's recovery
Data on visits and follow-up care for individuals receiving treatment in residential units of prisons who do not require hospitalization have increased considerably year after year. The importance of the professionals in the Social Support Program (PSP) is key to the individual's recovery and a good indicator of their improvement. With the arrival of the PSP team, we can confirm that individuals have experienced fewer relapses and required fewer readmissions. This demonstrates the excellent work being done and the importance of daily monitoring and the therapeutic relationship established.
Key data points show that in the larger centers (Brians 1, Brians 2 and Quatre Camins) there are between 5,000-6,000 visits per year, and in the smaller centers such as Joves and Wad Ras the figures range between 1,500-3,000 visits.
Ahead of us lies a path that is conceived from the accompaniment and empowerment of the people we serve.
Many needs and difficulties arise when the longed-for freedom arrives. There is a disconnection from reality and the resulting isolation that comes with prolonged confinement. Added to this is the social exclusion experienced by people with mental health disorders, the loss of career prospects, family estrangement, and a lack of opportunities in a world that is sometimes intolerant and dehumanized, where differences and imperfections are rarely accepted.
It is imperative to overcome these conditions and overcome the situation of vulnerability so that people can feel productive again, participate, find their role and identify themselves within their family, social and work groups.
The need for support is at its highest and, in many cases, remains constant throughout their entire lifespan. Investment in specialized social and healthcare resources continues to be essential, with particular emphasis on strengthening community-based work and continuity of care through community service programs such as PSP, PSI, Mental Health Centers, and Open Environment programs, moving away from the traditional hospital-based model towards a community-based one.
"Hope is the most indispensable virtue inherent in the condition of being alive" (Erik Erikson)
"By seeking the good of our fellow human beings, we find our own" (Plato)
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