What are the key inequalities?

Prisoners

A report on the health needs of prisoners by NEPHO states that people in prisons, whether sentenced or on remand, have high levels of morbidity, particularly mental health problems and substance misuse. The rapid turnover of prisoners means that this is a problem for all communities and needs recognition by all primary care trusts.

There is a wealth of research around the health of prisoners, but very little relating to the health of offenders in the community even though the National Probation Service manages over 175,000 offenders in the community; over twice the number of prisoners.

Prison healthcare has improved in recent years, however it is likely that the poor health of prisoners does not suddenly remit on release and may even get worse. Department of Health policy guidance has suggested that offenders in the community seem to have difficulty accessing health services and tend to over-use crisis services such as Accident and Emergency. The few studies that have examined the health of offenders within community settings have indicated that the health of this group is worse than that of the general population. Reviews have suggested that the health needs of offenders in the community would be similar to those of prisoners.

Further outcomes are awaited from the Department of Health consultation paper Improving Health, Supporting Justice and from the Bradley Review of the diversion of individuals with mental health problems from the criminal justice system

Demographic changes in the general population and sentencing policy are set to bring about significant changes to the age profile of offender population.

- A Health Needs Assessment Of Offenders On Probation Caseloads In Nottinghamshire and Derbyshire, Report Of a Pilot Study (April '08)

Offenders on community orders

Data reviewed to date demonstrates that offenders in the community also report significant levels of morbidity including mental health problems and substance misuse.

What are the key gaps in knowledge/services?

Diversion from custody

There is a real need to divert offenders who have serious mental health problems away from prison and into the appropriate health service facilities. The needs of those suffering from physical health problems and from substance misuse and abuse must also be addressed. Providing suitable health and social care access is key to reducing repeat offending, in particular, prolific offending.

Healthcare

Healthcare within prisons is commissioned by Primary Care Trusts. Prisons Partnership Boards need to ensure that local needs are incorporated in the development of local plans and that there is full consultation with all stakeholders involved in the design and delivery of services. As part of this Strategic Health Authorities, working with PCTs will ensure that healthcare is delivered against a number of criteria including the high quality and safe services with a reduction in health inequalities.

Department of Health policy guidance has suggested that offenders in the community seem to have difficulty accessing health services and tend to over-use crisis services such as Accident and Emergency. The few studies that have examined the health of offenders within community settings have indicated that the health of this group is worse than that of the general population. Reviews have suggested that the health needs of offenders in the community would be similar to those of prisoners.

Continuity of care

Key requirements in ensuring the development of continuity of care will be in tackling attrition at key stages of the assessment and treatment process and in developing the workforce of the future. 

Research

There is a wealth of research around the health of prisoners, but very little relating to the health of offenders in the community even though the National Probation Service manages over 175,000 offenders in the community; over twice the number of prisoners.

Elderly prisoners

More research is required to understand more clearly the health needs of elderly prisoners and their resettlement and care needs on release.

Dual diagnosis

The term refers to people diagnosed with mental health problems, who also use illicit drugs or alcohol. It may, for instance, include someone diagnosed with a psychotic illness who uses street drugs, or someone who is depressed and drinking heavily or using stimulant drugs (such as amphetamine or cocaine) in order to feel more socially confident. More research is required to the explore issues for individuals in this situation.

What are the risks of not delivering our targets?

• Increasing crime rates
• Increasing local concern about anti-social behaviour
• More people re-offending

Is what we are doing working?

Drug Intervention Programmes and drug treatment systems have a strong evidence base of effective practice.

Evidence from Court Diversion is required

Data from the Housing Gateway is beginning to show increased retention and satisfactory move-on for offenders with additional health related issues

(Northumbria Probation Service, 2007)

What is coming on the horizon?

• The population of Newcastle upon Tyne is predicted to increase including an increase in the number of people aged 65 and over who are likely to require greater healthcare resources.
• The National Offender Health and Social Care Strategy is likely to be published in spring 2009.
• ACE project has provided more detailed information regarding the relationships between homelessness, mental health and substance misuse.
• A need to develop more robust alcohol treatment pathways
• A need to prioritise routes away from addiction and towards social re-integration
• DWP; Reforming welfare to reward responsibility. Implications for substance users and offenders
• Re-launch of the HARP Protocol will place more responsibility on local agencies (to be led by the Council's strategic housing team) for ensuring that agencies and systems are able to meet the housing and support needs of offenders, including those leaving prison and those in the community.

What should we be doing next?

1) Healthcare for offenders

In the past, the prison health service has been very separate from the NHS, which has made it difficult to provide effective services. Now that the prison health service is coming under the aegis of the NHS there are opportunities to improve the health and health care of prisoners.

2) Greater partnership working

The proportion of offenders and ex-offenders with mental health needs is far higher than that found within the general community. This is also the case for children and young people in contact with the youth justice system. In addition, mental health needs in this population are often associated with issues of drug and/or alcohol misuse and social exclusion. Addressing these complex, multiple needs, requires active and effective partnership working across the range of health, criminal justice and social care agencies

3) Employment

The Council's Employment Action Plan identified the need for additional activity to support the employment prospects of a number of priority groups (e.g. incapacity benefit claimants, lone parents, older people, ex-offenders, homeless people and those from Black and Minority Ethnic groups) including:

• Pre-employment engagement of unemployed/inactive residents who are not involved in Jobcentre Plus's mainstream activities;
• Active customer management of clients. This would involve the provision of a sustained 1-2-1 support with individuals receiving a personalised, tailored package of help and support with the same adviser;
• Offering a menu of 'Support and progression' packages, tailored to individuals' needs; and, post-employment support.

4) Improved data collection

There is also the opportunity to improve data collection and communication - to ensure, for example, continuity of care when people enter or leave prison and a better understanding of the needs and movements of this population.

5) Social inclusion

The need for effective local partnership work is self evident20 through, for example, Crime and Disorder Reduction Partnerships and Local Strategic Partnerships. The best way to improve the health of this vulnerable group is to prevent them going to prison by tackling underlying problems in our communities.

Housing and homelessess

Alongside the priorities listed above the Supporting People Sector Briefing on Homelessness, ex-offenders and people with drug and/or alcohol problems (2008) has also highlighted the following priority system improvements:

• Establish accommodation standards for supported housing;
• A supported housing 'Gateway' to improve access to temporary or supported accommodation;
• Greater clarity about the differences and similarities about services;
• Improved management information to inform commissioning;
• Services offering meaningful occupation, with employment and enterprise opportunities for vulnerable people;
• Services able to respond to the needs of couples;
• Floating support and advice services which operate across tenure;
• Services able to support women with a history of offending with complex needs;
• Increased numbers of people who move on positively from emergency access accommodation and reduced evictions;
• Improve move on from approved premises through the pathways process;