Offender Health: Why Should We Care? Dr Coral Sirdifield, Research Fellow, University of Lincoln csirdifield@lincoln.ac.uk Dr Rebecca Marples, Research Assistant, University of Lincoln rmarples@lincoln.ac.uk

Introduction and Aims Overview of key issues in relation to offender health and access to healthcare Overview of organisations’ roles and responsibilities Role of probation in offender health – make every contact count Benefits of focussing on offender health Principles for improving offenders’ health and engagement with health and social care services Overview of key issues – 5 mins Group activity one – 10 mins discussion, 5 mins feeding back, and depending on the group size, ask people to introduce themselves to each other

Systematic Review A systematic review: Answers a defined research question by completing an extensive literature review using specific criteria Our systematic review: Reviewed the existing studies of healthcare provision for probationers both national and international (western countries only) Main findings from our review: There is a paucity of studies in the literature on this subject The greatest volumes of research were on substance abuse and mental health

Overview of Key Issues Health Needs There is a high complexity of health problems in the offender population An estimated 39% of offenders experience a mental illness whilst on probation (Brooker et al., 2009) Many offenders have (multiple) substance misuse problems In the first two weeks after release, mortality rates are 12 times higher than for the general population (Binswanger et al., 2015) Access to Healthcare There is disproportionately low access to healthcare for a variety of reasons Many offenders are not registered with a GP Often offenders only access services at crisis point Recent Inspectorate reports show that there are problems with continuity of care Through the Gate

Overview of Organisations’ Roles and Responsibilities Clinical Commissioning Groups (CCGs): should be commissioning healthcare for offenders in the community* Public Health Departments: should be commissioning services for things like substance misuse, smoking cessation and sexual health Mental Health Trusts: 54 mental health trusts (including 42 foundation trusts)  *https://www.england.nhs.uk/wp-content/uploads/2016/10/hlth-justice-directions-v11.pdf (p.9) https://www.england.nhs.uk/wp-content/uploads/2017/01/hlth-justice-frmwrk.pdf (p11)

Role of Probation in Offender Health Policy documents outline a role for probation in offender health that includes: Working in partnership with health and social care agencies Providing information to the courts to inform sentencing decisions, including the use of Mental Health Treatment Requirements, Drug Rehabilitation Requirements, and Alcohol Treatment Requirements (See for example Reed, 1992; Bradley Report, 2009; MoJ, 2013)

Role of Probation in Offender Health Continued Research into how staff and offenders in one probation area see probation’s role in offender mental health showed that they see it as involving: Identifying and monitoring mental illness amongst offenders (within boundaries) Facilitating access to and monitoring offenders’ engagement with health services Managing risk (e.g. risk of self-harm, and relationship between health and risk of re-offending) A third of offenders described probation staff as providing a “listening ear” or acting like a “life coach” (Sirdifield and Owen, 2016)

Benefits of Focussing on Offender Health Improves compliance: studies in the USA of mental health specialist roles and caseloads suggest that they can help to reduce probation violations Reduces re-offending: The cost of re-offending is estimated to be between £9.5 and £13 bn per year (MoJ 2015) Produces systems savings: £10.7 bn is spent on substance misuse nationally (65% of prisoners report using drugs a month before entering prison and 46% report problem drinking) £34 bn is spent on mental health (90% of prisoners are reported to have a mental health or substance misuse problem)

Principles for Improving Offenders’ Health and Engagement with Health and Social Care Services We have written a Position Paper with the Probation Institute which includes the following principles: A national strategy for healthcare for probationers: clarifying agencies’ roles and responsibilities, introducing measures of improvement High quality healthcare based on clinical need (including tailored provision for women and people from BAME backgrounds): one way of working towards this would be to give probation a voice on commissioning groups Criminal justice and health agencies should work in partnership to monitor and improve the health of offenders in their area Cross-agency training should be provided to enable criminal justice staff to identify health issues and refer into appropriate agencies (http://probation-institute.org/position-papers/)

What Individuals and Probation Organisations Can Do Individual probation staff can be aware that the quality and continuity of the relationship between staff and offenders is key, and that there are numerous benefits to focusing on offender health CRCs and NPS areas may wish to introduce specialist workers or offender health leads that can be responsible for setting up and monitoring agreements between agencies, addressing barriers to inter-agency working through regular partnership meetings, improving knowledge of local service provision, seeking feedback from service users

Summary We have: Provided an overview of offenders’ health needs Outlined the roles and responsibilities of different organisations in relation to offender health Looked at the role of probation Looked at the benefits of focusing on offender health to offenders and probation staff Introduced some principles and ideas for how we can improve offenders’ health and engagement with health and social care services As part of our current research project we are building a Toolkit which will include some of this information and models of good practice – contact us if you would like to know more!

This presentation presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0815-20012). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health For more information about our project, please see http://cahru.org.uk/2017/02/28/improving-healthcare-commissioning-for-probation-mapping-the-landscape/

References Binswanger, I.A. et al., (2015) Clinical risk factors for death after release from prison in Washington State: A nested case control study, Addiction, 111(3): 499-510 Bradley, K. (2009) Review of people with mental health problems or learning disabilities in the criminal justice system, London: Department of Health Brooker, C., et al., (2012) Probation and mental illness, Journal of Forensic Psychiatry and Psychology, 23(4): 522-537 Ministry of Justice. (2013) Transforming Rehabilitation, A Revolution in the Way We Manage Offenders. London: The Stationery Office Ministry of Justice. (2015) 2010 to 2015 government policy: reoffending and rehabilitation. London: The Stationery Office Public Health England & Department of Health and Social Care (2018) Secure setting statistics from the National Drug Treatment Monitoring System (NDTMS) PHE publications. Reed, J. (1992) Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services, London: The Stationery Office Sirdifield, C., and Owen, S. (2016) Probation’s role in offender mental health, International Journal of Prisoner Health, 12(3): 185-199