Offenders, and especially prisoners, have a high prevalence of mental health problems. Rates for various mental health conditions range from 50 to 90 per cent. Prisoners released from prison with mental health problems face difficulty with family relationships, employment, long-term illness, self-harm, depression and re-offending.
An ongoing collaboration between Plymouth University Peninsula Schools of Medicine and Dentistry, the University of Manchester, University College London and the University of Exeter, has received funding in the region of £2 million from the National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) to carry out a five-year programme investigating the issues faced by prisoners with mental health problems near to and after release, and to develop and evaluate a system of care to address those issues.
The project is also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care in the South West Peninsula (NIHR PenCLAHRC).
The project aims to develop and evaluate a way of organising care based on an integrated approach involving therapy, medication, housing, training and employment, and ensuring that care continues after release.
Phase one will see researchers working closely with people who have previously been in prison, the prison service and community care providers, to develop the model for an integrated approach to identify and engage prisoners before release and then set up and deliver care after release. The approach will be tested, and elements of it 'road tested', to ensure the best chance of benefitting prisoners.
The second phase will be a randomised control trial in which half the prisoners would receive the new integrated approach while the others would receive the care that is usually available.
By collecting information related to people's health, the healthcare they have received, improvements in their social situation (including housing and employment) and their involvement or otherwise with the criminal justice system, the research team can evaluate the effectiveness of the new integrated approach by comparing it with the results achieved by the usually system of care.
As well as investigating the benefits to released prisoners with mental health problems, the research team will also assess the economic impact of the new integrated approach to see if it results in savings to the public purse.
The project is led by Dr. Richard Byng, Clinical Senior Lecturer at Plymouth University Peninsula Schools of Medicine and Dentistry and a GP with a special interest in primary care mental health.
He said: "With other colleagues in the team we have already produced a report, Care for Offenders: Continuity of Access (COCOA) which shows that offenders with mental health problems need improved and on-going access to mental health interventions. This was the first systematic examination of the healthcare received by offenders across the criminal justice system. It was obvious to us that action needed to be taken."
He added: "Having so comprehensively identified the need, we wanted to build on our findings by investigating how an integrated system of care could be developed and evaluated for prisoners with common mental health problems. While prison healthcare has improved in the last decade, mental health care is minimal except for those with the severest problems. Care after leaving prison is especially lacking for those serving short sentences - offenders often don't want to admit they have problems and services are not always equipped to deal with their complex problems. Our research will tell us if the proposed intervention improve prisoners' common mental health problems, improve other aspects of their lives and have wider social and financial benefits."
COCOA was funded by the NIHR Health Services and Delivery Research (HS&DR) Programme.
8th August 2013.
Notes to Editors
In England and Wales, a major Office of National Statistics Survey conducted in 1997 found the following:
- Personality Disorder: 64% in male sentenced prisoners, 78% in male remands.
- Neurotic disorders (mainly depression and anxiety): 40% in male sentenced prisoners, 55% in male remands; female prisoners exhibited significantly higher levels: 63% and 76%, respectively.
- Drug dependency: 43% in male sentenced prisoners, 51% in male remands; and similar levels for women.
- Hazardous alcohol use: 63% in male sentenced prisoners, 58% in male remand prisoners.
- Functional psychosis: 7% of male sentenced prisoners, 10% of male remands, and 14% of female prisoners.
High levels of self-harming behaviour and suicidal thoughts were also reported. The age-adjusted risk of suicide for male offenders leaving prison is eight times the national average. Cognitive deficits are common and post-traumatic stress disorder (PTSD) is particularly over represented within the prison population.
While costs of provision will not be insignificant, the potential benefits to individuals and communities, as well financial savings, are great. For example criminal justice costs of an average domestic burglary were estimated in 2005 at £1,137 and a serious wounding at £14,345.
Benefits could accrue in a wide range of domains. In the COCOA study, 37% reported problems with their family relationships; the majority were unemployed or on long term sickness benefit (65% in prison and 70% in the community sample); and 26% had on-going legal or criminal justice issues. These results echo previous surveys of prisoners, including the 1991 National Prison Survey, the 2001 national resettlement survey, the 2002 Social Exclusion Unit Report on short-term prisoners, and the on-going Surveying Prisoner Crime Reduction (SPCR) study, based on regular interviews with a cohort of prisoners before and after release. For example, two-thirds reported that they had been unemployed before going into custody, and 37% that they would need help finding somewhere to live on release.
NIHR- PenCLAHRC aims to bring together local universities and their surrounding NHS organisations to test new treatments and new ways of working in specific clinical areas, to see if they are effective and appropriate for everyday use in the health service. Where potential improvements are identified PenCLAHRC helps NHS staff to incorporate them into their everyday working practices, so that patients across the local community receive a better standard of healthcare.
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (http://www.