The psychiatric management of prisoners on hunger strike: developing a management algorithm using the Delphi...

Area of Science:

• Forensic Psychiatry
• Medical Ethics
• Legal Medicine

Background:

• Managing prisoners on hunger strikes presents significant challenges in custodial settings.
• Limited clinical guidance exists for psychiatrists dealing with these complex cases.

Purpose of the Study:

• To develop a management algorithm for the psychiatric assessment and care of prisoners on hunger strikes.
• To provide structured guidance for psychiatrists in complex custodial situations.

Main Methods:

• A Delphi method was employed, involving structured questionnaires distributed to Irish forensic psychiatrists, a legal expert, and an ethics expert.
• Expert elicitation was used to gather views and identify key themes for algorithm development.
• Consensus was reached on critical management considerations through a structured process.

Main Results:

• A consensus-based management algorithm for psychiatric care of hunger-striking prisoners was developed.
• Key psychiatric tasks identified include assessing mental disorder, capacity to refuse food, and motivation for refusal.
• The importance of multidisciplinary collaboration, including with prison general practitioners and legal advisors, was emphasized.

Conclusions:

• The study provides a novel management algorithm for a complex clinical scenario with limited existing guidance.
• While developed from an Irish context, the algorithm's principles are potentially generalizable to international jurisdictions.
• This framework supports informed psychiatric decision-making and care for prisoners undertaking hunger strikes.