Academic Review of “Inpatient Care…”

In their 2000 publication in the British Medical Journal, titled “Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections,” researchers John L. Reed and Maggie Lyne set out to investigate the quality of treatment that mentally ill people were receiving inside prison.

Research Question

Does the treatment quality that patients are receiving match the standards required by the National Health Service (NHS)? (Reed & Lyne, 2000). Hypothesis: For the purpose of this study, the researchers utilized a null hypothesis, anticipating that the level of care observed would not differ significantly from the guidelines put forth by the NHS (Reed & Lyne, 2000).

Methodology

Reed and Lyne selected 13 prisons (not based on specific health concerns) and proctored formal health care inspections on each of them. The inspections lasted 2-4 days and were conducted by Reed (a medical inspector) and Lyne (a nursing inspector), as well as “a professional standards inspector from the Royal Pharmaceutical Society, and a dentist from the Dental Practice Board” (Reed & Lyne 2000). The researchers visited each prison, conducted interviews with staff and inmates, and reviewed annual health care reports from each prison. The independent variable was the differing levels of health care among the prisons, and the dependent variable was how the differing levels of health care compared to the required standard described by the NHS.

Analytic Strategies

There were both qualitative and quantitative data to be compiled, so Reed and Lyne used several strategies to properly orchestrate their examinations. They used information from the interviews to gather an understanding of the attitude of the environment in which the prisoners were receiving their health care. They analyzed various components of care quality, such as the patients’ daily routine, staffing, management, and the size and structure of the facilities themselves. They interpreted the language of the NHS guidelines to pass judgment on the acceptability of the observed treatment. On the quantitative side, they measured overall prison inequality, the availability of beds in the prisons, the rate of proper qualification among staff, and the average length of various events in the average prisoner’s day (Reed & Lyne 2000).

Based on both the qualitative and quantitative sides of the data analysis, Reed and Lyne concluded that “the quality of services for mentally ill prisoners fell far below the standards in the NHS.” They asserted that the patients’ lives were unnecessarily restricted and that their access to the appropriate therapy was unacceptably limited (Reed & Lyne 2000). This study had widespread implications for practice in the field because the researchers used their findings to call for a change in the system. They attacked the current practice of sharing inpatient care between the prison systems and the NHS, stating that either the prisons need to adopt higher-quality care facilities, or they need to implement a system of transferring qualified patients to the NHS. Reed and Lyne also strongly suggested that the prisons create a way to ensure that patients are being cared for by professionals with the appropriate credentials and qualifications. They sought to guarantee uniform standards, and therefore quality health care (Reed & Lyne 2000).

This study is certainly not without fault, however, as there are slight errors and limitations in the procedure that could alter the significance of the data. First, it is difficult to be certain if 13 prisons compose an effective sample size to gain an understanding of the entire prison inpatient system as a whole. Also, it is entirely possible that the prison staff could have made temporary improvements to their facilities and staff to appear more competent to the investigators, which would distort the data in a way that could render the findings of this study incapable of properly depicting prison conditions.

Reference

Reed, J. L., & Lyne, M. (April 15, 2000). Inpatient care of mentally ill people in prison: Results of a year's programme of semistructured inspections. BMJ: British Medical Journal (International Edition), 320, 7241.).