Improving inmate attendance at a male psychiatric housing unit in a national prison

ABSTRACT

In Singapore, there are Psychiatric Housing Units located within correctional facilities that play an important role in the treatment and rehabilitation of inmates with mental disorders. These units are staffed by forensic psychiatrists, nurses and allied health practitioners. However, the daily attendance rate for classes in the male unit is only about 70%, out of which 15% of inmates are absent from classes without a valid reason. Our quality improvement project sought to increase the daily attendance rate. We followed WHO guidelines for quality improvement, determined the root cause of poor attendance, and devised five Plan–Do–Study–Act cycles over 12 weeks from February to May 2019. A brief survey of inmates in the unit was done to gather their opinions about the rehabilitation programme. We focused on inmates who were absent from classes without valid reasons and sought to persuade them to attend using motivational interviewing within the structure of individualised care plans. Following the implementation of our strategies, the attendance rate rose to 85%. However, without continued efforts to incorporate the strategies into standard operations, attendance rates were unsustainable. This is one of the few quality improvement projects to be done outside of the traditional hospital setting.

KEYWORDS:

• Quality improvement
• forensic psychiatry
• psychiatric rehabilitation
• prison

Acknowledgments

The authors would like to thank the Singapore Prison Service for their kind assistance in facilitating this quality improvement project. We would also like to thank Dr Daniel Poremski from the Health Intelligence Unit, Clinical Governance and Quality, IMH for his assistance with the data analysis for this project.

Disclosure statement

The authors declare that no competing financial or personal interests exist.