Defining Optimal Post-prison Care for Those With Psychosis: A Delphi Study

Area of Science:

• Forensic Psychiatry
• Mental Health Services Research
• Correctional Health

Background:

• Early intervention and treatment retention are crucial for reducing reoffending in individuals with a history of psychosis.
• Understanding the specific care attributes needed for individuals with psychosis transitioning from prison remains underexplored.
• This study addresses the need for evidence-based models of care for this vulnerable population.

Purpose of the Study:

• To achieve consensus among experts and consumers on the attributes of an optimal model of care for individuals with psychosis transitioning from prison.
• To identify key components for effective community-based mental health services post-release.
• To inform the development of specialized care pathways to improve outcomes and reduce recidivism.

Main Methods:

• A Delphi method was employed, involving a panel of 25 experts and consumers.
• Multiple rounds of online scoring were conducted to generate consensus on 34 model of care attributes and 168 attribute levels.
• Participant retention was high (96% Round 1, 84% Round 2), with consensus reached on key attributes through rigorous validation including member checking.

Main Results:

• A final model comprising 32 attributes and 72 attribute levels was established across four key components: pre-release planning, community treatment, diversion, and evaluation.
• A person-centered approach, incorporating carer involvement and peer support, was strongly endorsed.
• Consensus was reached on the necessity of specialized teams operating independently to deliver targeted treatments and facilitate access to external supports.

Conclusions:

• An optimal model of care requires specialized, independent teams to deliver direct treatments and services to individuals with psychosis leaving prison.
• These teams should focus on facilitating access to essential social and economic supports, complementing existing community mental health services.
• The findings provide a framework for developing effective, integrated care strategies to improve community reintegration and reduce reoffending rates.