Offenders with common mental health problems and their care : a multi-perspective and multi-dimensional study

• Main Author: Georgiadis, Alexandros
• Published: Exeter and Plymouth Peninsula Medical School 2015
• Subjects: 365
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.699432

Background: Adult male offenders have high rates of anxiety and depressive disorders, as defined by the psychiatric manuals (ICD-10, DSM-IV). The majority misuse substances, suffer from more than one (mental) health condition, and experience severe social problems. Despite their substantial mental health needs, their access rates to mental health services are low. This study explores how and why some offenders fall through the gap between services, with special focus on how offenders are defined in relation to diagnostic instruments, and what processes contribute to the label they receive. An analytical framework, based upon the works of Pierre Bourdieu and Michel Foucault, is employed for the investigation of how offenders and professionals' relationships may shape these definitions. Objectives: 1) To investigate differences in understandings of anxiety and depression between offenders and their professionals, involved in either their care or their management, and 2) to explore how offenders and their professionals eo-construct mental health care. Method: 100 adult male offenders, serving either prison or community sentences, were recruited and screened for the presence of anxiety (GAD-7) and depressive (PHQ-9) disorders. A purposive sub-sample of 20 participants were interviewed and followed-up for 12 months in the community and/or prison where the author observed their encounters with professionals and interviewed both groups separately at the end of the observation. Findings: Both offenders and professionals articulated a psycho-social model of illness that was in contrast with the assumptions underpinning the psychiatric manuals and service design. The co-construction of mental health care was primarily based on the relationship between offenders and their professionals, and the 'micro-therapy' that consciously or unconsciously occurred between them. Offenders accepted practices of care that acknowledged their emotional distress and that aimed to provide emotional and practical support. The developed framework could adequately explain some features of the process of co-construction of mental health care. A Goffmanian dramaturgical perspective was employed to interpret how offenders changed the context of their mental health needs when they interacted with different professionals. Conclusions: Professionals should treat offenders as equals, listen to their concerns, and acknowledge their impact to offenders' mental health. Offenders need to know that there are non-specialist professionals that they can go for support with their emotional problems. Services need to broaden their criteria of access and work to design better services for offenders.