@article{ref1,
title="Design of a treatment pathway for insomnia in prison settings in England: a modified Delphi study",
journal="BMJ open",
year="2018",
author="Dewa, Lindsay H. and Hassan, Lamiece and Shaw, Jenny and Senior, Jane",
volume="8",
number="8",
pages="e022406-e022406",
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. <br><br>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. <br><br>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. <br><br>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.<br><br>© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.<p /> <p>Language: en</p>",
language="en",
issn="2044-6055",
doi="10.1136/bmjopen-2018-022406",
url="http://dx.doi.org/10.1136/bmjopen-2018-022406"
}