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The aim of this project is to provide the first detailed examination of how offenders’ narratives of their distress and well-being differs from the definitions used by the international classifications of mental disorders as well as practitioners’ own definitions of mental disorders; other contributory factors to distress and well being such as previous trauma, goals and ambitions will be explored.
How people understand the mental health and care or ‘perceive’it can have an affect on their health-seeking behavior. The culture in which people live provides the context within which these perceptions are acquired. Offenders and practitioners are likely to come from different social backgrounds. Social theorist, Pierre Bourdieu argued that an individual’s perception of social phenomena is affected by their position in society; particularly their accumulation of power, education and money. Using Bourdieu’s theory one can explore differences in perceptions of mental illness between offenders and practitioners and compare these with internationally recognised classifications of mental disorders (DSM-IV, ICD-10). These differences in perceptions can cause difficulties in providing mental healthcare, particularly for hard-to-reach groups such as offenders.
Adult offenders, serving prison or community sentences, are a population with increased prevalence, as defined by internationally recognised classifications (ICD-10, DSM-IV), of common (anxiety and depression) and serious mental disorders (bipolar disorder, personality disorders) when compared to general population. In addition, a large percentage of this population misuses substances, (drug and alcohol) suffers from more than one condition and faces severe social problems (low income, housing problems). The increased prevalence of social and psychological problems of this population coupled with the fear of stigma of mental illness and distrust towards health professionals make access and continuity of care a difficult task.
The use and integration of the biopsychosocial model by practitioners wanting to consider the whole person has considerably increased. This model, that is now being extended to incorporate an understanding of individuals’ internal and external resources or strenghts, goals and choices about treatment, has been subjected to little research.
The proposed research methodology is based on a mixed-methods research approach. It will be primarily qualitative with embedded contextual quantitative analysis. Furthermore, it will include visits to community based services, a literature review, initial screening, identification and categorisation of male adult offenders in probation and prison (if operational factors allow), followed by in-depth study of a purposively sampled sub-set of participants, observations of clinical encounters integrating in-depth interviews of both offenders and practitioners involved in their care.
This study will describe offenders and practitioners’ perceptions regarding their mental health problems and the care provided; how components of the biopsychosocial model of care are being used and finally the meaning and acceptability of these components. This description should inform the development of care for offenders.
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