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Design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study.

Abstract：

OBJECTIVE:Insomnia is highly prevalent in prisoners and is a risk factor for poor mental well-being, depression, suicidality and aggression, all common concerns in this vulnerable population. Improving sleep management options in prison offers the potential to impact positively on a number of these common risk factors. The study aim was to design a treatment pathway for insomnia in prisons informed by stakeholders with professional or lived experience of insomnia and prison-based interventions. DESIGN:A modified Delphi technique, adapted to the stakeholder (either receiving controlled feedback online or face to face on a series of statements), was used over three rounds to gain consensus on a final treatment pathway design. PARTICIPANTS:Academic sleep researchers, prison staff and prisoners were invited to develop the treatment pathway. RESULTS:Fifteen stakeholders took part in round 1 and thirteen in round 2. There were six statements of contention that comprised concerns over the inclusion of sleep observations, sleep restriction therapy and promethazine. Consensus was high (>80%). Thirteen stakeholders agreed the final pathway in round 3. The final treatment pathway comprised a standardised stepped-care approach for insomnia in prison populations. The pathway resulted in five main stages: (1) transition from community; (2) detection and assessment; (3) treatment for short-term insomnia; (4) treatment for long-term insomnia and (5) transition from prison to community or another establishment. CONCLUSIONS:The treatment pathway is designed to promote early detection of insomnia, potentially reducing unnecessary prescriptions and medication trading, misuse and diversion in the prison setting. It should make a substantial difference in reducing the large number of sleep complaints and positively impact on prisoners, staff and the prison environment. Specifically, improving sleep should have a positive impact on prisoners' mental and physical well-being and aid smooth running of the prison.

journal_name

BMJ Open

journal_title

BMJ open

authors

Dewa LH,Hassan L,Shaw J,Senior J

doi

10.1136/bmjopen-2018-022406

subject

Has Abstract

pub_date

2018-08-29 00:00:00

pages

e022406

issue

8

issn

2044-6055

pii

bmjopen-2018-022406

journal_volume

8

pub_type

杂志文章

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