Design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study. Issue 8 (29th August 2018)

• Record Type: Journal Article
• Authors: Dewa, Lindsay H; Hassan, Lamiece; Shaw, Jenny; Senior, Jane
• Is Part Of: BMJ open. Volume 8:Issue 8(2018)
• Publication Date: 2018-08-29
• Subjects: insomnia -- sleep -- prison -- delphi study -- treatment pathway; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-022406
• Languages: English
• ISSNs: 2044-6055

Abstract

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.