Evidence-based treatment pathway for insomnia in prison: a feasibility study

Prisoners are at least twice as likely to have insomnia as the general population; the majority have poor sleep quality, and almost all of those have chronic, long-term sleep problems. This negatively impacts quality of life and is linked to mortality, suicide, depression, anxiety, aggression and poor cognitive functioning – all of which can affect the safe running of the prison and prisoners’ rehabilitation.

There is a lack of standardised care for prisoners with sleep problems, and a need to modernise insomnia management in prisons in England and Wales.

This project is jointly led by CareUK, an independent provider of health care in prisons in England and Wales, and Imperial College London. User Voice, a charity led by ex-offenders supporting the rehabilitation of offenders, will have an active role during each research stage.

The project involves implementing a treatment pathway for insomnia in prison patients, with a stepped-care approach that provides ongoing support for sleep problems. Central to the pathway are self-management, peer group involvement and psychological therapies.

The key stages will involve different levels of support, for example stage one being the transition from the community, at which point the prisoner would receive a medication review, a short assessment for insomnia and a self-help sleep pack; and stage four, which is treatment for long-term insomnia, which involves cognitive behavioural therapy for insomnia (CBTi).

The pathway will be delivered to 30 prisoner-patients by a multidisciplinary team. Current prisoners will be trained in good sleep health, how to adapt to the prison environment and how to support new prisoners in relation to their sleep. They will provide this support to prisoners throughout their time in prison alongside IAPT (Improving Access to Psychological Therapies) workers who will be trained in CBTi.

Contacts

For more information about this project, please contact Dr Sarah Bromley, National Medical Director, Health in Justice, CareUK or Dr Lindsay H. Dewa, Research Associate, Imperial College London.