Concern about epilepsy deaths in prison

Context and knowledge

To grasp the educational from epilepsy-related deaths in prisons, the PPO group thought of three classes of demise varieties.

Group 1: The place the first reason behind the prisoner’s demise was epilepsy (as recorded within the autopsy) (25 circumstances). Group 2: The place the secondary reason behind the prisoner’s demise was epilepsy (as recorded within the autopsy) (12 circumstances). Group 3: The place the prisoner was identified with epilepsy, however their main or secondary reason behind demise was not epilepsy-related (88 circumstances). 

Previously 10 years, the PPO has investigated 125 deaths that fell into one in all these three classes. For every group, the PPO report and medical overview was analysed. 

Key findings 

The PPO analysis has recognized the next areas that should be explored additional: 

The variety of SUDEPs is larger in jail than locally. 

It’s estimated that sudden and surprising deaths in epilepsy (SUDEPs) make up round 0.15% of deaths a 12 months within the UK. From autopsy reviews of deaths in prisons from the previous 10 years, 0.64% of deaths in jail had been SUDEPs. 

The prognosis of epilepsy inside prisons may very well be improved. 

In 11% of the circumstances from group 1 and a couple of (the place the first or secondary reason behind demise was epilepsy) the prisoner had not been identified with epilepsy. 

There’s a decrease remission price in jail than locally.  

From the 125 demise investigations, the PPO discovered solely 18% had not skilled a seizure prior to now 12 months, 56% had, and for the remaining 26% of prisoners it was unclear. 

In circumstances the place care plans had been talked about within the PPO report or the medical overview and the prisoner had an epilepsy prognosis, solely 38% of prisoners had a documented care plan.   

In 40% of circumstances the medical overview commented on the equivalence of epilepsy care the prisoner obtained, it was discovered to be equal in solely 58% of circumstances. 

74% of prisoners on this pattern had a psychological well being situation, nervousness and melancholy had been the most typical. 

In lots of circumstances, the PPO noticed a relationship between a prisoner’s poor psychological well being and a disruption to their epilepsy care.  In 75% of the circumstances reviewed, there was proof that the prisoner had skilled stress referring to their imprisonment. Present analysis means that stress can negatively influence a person’s epilepsy, making seizures and fatalities extra possible. 

There are larger charges of self-inflicted deaths amongst prisoners with epilepsy. 

Of a pattern of 88 deaths investigated the place the prisoner had a prognosis of epilepsy, 30 had been self-inflicted deaths. Compared, 26% of all deaths in jail had been self-inflicted within the final 10 years, suggesting the next prevalence of suicide for these identified with epilepsy. Earlier exterior analysis has additionally discovered that individuals with epilepsy are twice as prone to die by suicide as individuals with out epilepsy. 

Drug use is a possible danger issue for SUDEP. 

In 65% of the 125 investigations the prisoner had a historical past of substance use. NICE pointers record alcohol and drug misuse as a possible danger issue for SUDEP. Substance use may also trigger seizures and there was some indication of seizures not being taken as critically the place the person used substances and, in some circumstances, workers didn’t comply with native protocols. 

 There may be typically not applicable monitoring of seizures. 

The PPO discovered some examples the place a prisoner’s seizure frequency elevated. Regardless of this, healthcare groups didn’t monitor the seizures or think about whether or not to refer the prisoner for specialist therapy. The PPO discovered 11 examples the place a prisoner’s seizure frequency elevated, and the medical overview decided that motion might have been taken to handle this.  

In some circumstances the place protocols for treatment adherence had been in place, they weren’t all the time adopted. 

Of the 125 circumstances reviewed, 34% had been taking their treatment, 28% weren’t and for the remaining 37% it was unclear. The NICE guideline lists non-adherence to treatment as a danger issue for SUDEP. 

The place cell sharing was talked about and the place the prisoner had an epilepsy prognosis, the PPO discovered that in 69% of circumstances the prisoner was not sharing a cell. 

There’s a clear profit in a prisoner with epilepsy sharing a cell as their cell mate can shortly increase an alarm if a prisoner is having a seizure. NICE pointers counsel that sleeping alone with out supervision is a danger issue for SUDEP.  The PPO additionally discovered just a few examples the place prisoners with epilepsy, or prisoners experiencing seizures, had been positioned on the highest bunk of beds – this will increase the potential danger to the prisoner and ought to be prevented. 

Conclusion

We should hope that jail medical groups and uniformed workers can now act on these these clear danger components, lots of which will be addressed with minimal sources and for free of charge.