Priorities for prison health and social care research Clair Chilvers Research Director Health and Offender Partnerships Director Forensic Mental Health R&D Programme

Outline Health and Offender Partnerships Research Strategy Current and recently completed prison health research: examples Best Research for Best Health Sources of Funding

Health and Offender Partnerships Research Strategy: Overview Process of consultation with heads of Units Formation of HOP Research Forum Priorities to be decided against policy priorities Identification of sources of funding

Characteristics of the prison & secure hospital population & disease prevalence What impact does the prison environment have on health and wellbeing? (Shaw; Taylor; Dolan) What are the positive impacts on health? What are the rates of suicide and self-harm in subgroups? How do they compare to the general population? What are the characteristics of prisoners who self-harm? (Pratt; Shaw) Development of an epidemiological overview to inform commissioning of secure hospital provision (Thornicroft)

Access to services How can prison healthcare services be organised to ensure continuity of care, for prisoners moving through the CJS? What role could offender managers have in facilitating care? (Shaw) How can waiting times for transfer of prisoners to hospital be reduced? What is the impact of health and social care services on ‘revolving door’ prisoners? (Shaw) What are the health and social care needs of particular groups (women, BME groups, young offenders) and how can they be met?

Models & organisation of service delivery How can primary healthcare services be organised to ensure equality of access? (Shaw) What are the most cost-effective ways of providing hospital care for prisoners? What can be done to ensure the interface with services on discharge from prison? What is best practice for learning disabled offenders? (O’Brien)

Staffing and training issues What are the minimum staffing and training levels for healthcare staff? (Jenkins) Can changing professional roles and delegation to non-clinical staff improve healthcare provision? How can recruitment be maximised? What are the occupational health needs of staff working in prisons?

Cultural & organisational issues: tension between CJS and NHS What is the impact of violence reduction strategies? What are the most effective ways of blocking drug supply into prisons: how does treatment affect demand (and supply)? Young offenders: what is the evidence base for a tiered model of mental health care? (Shaw; Clark) How can the evidence base be best disseminated throughout NOMS?

Assessment, screening and interventions What is the current provision and contribution of psychological services across NOMS? What individual interventions have proven efficacious in the prevention of suicide and self- harm? What is the impact of the ‘listeners’ scheme on suicide and self-harm? How is violence or threat of violence best managed? (Leitner) Young offenders: what is the effect of the mental health screen with follow-up plan of care?

Medico-legal, ethical & criminological issues What are the links between mental disorders and offending? (Taylor; Hodgins; Thornicroft) What are the pathways from local authority care to offending, and to self-harm both in prison and the community? How can escalation in offending be prevented?

Financial & resource issues Development of an economic model for the DSPD Programme: how cost effective is it? Economic modelling of health and social care systems across the CJS (development of standardised unit costs)

Current & recently completed prison health research: examples from the FMH R&D programme Evaluation of prison mental health in-reach services (Shaw) Assessing needs for psychiatric treatment in prisoners (Bebbington) Factors mediating the effect of the prison environment on mental health (Taylor) RCT of the efficacy of SSRIs in the treatment of sex- offenders (Grubin) Effect of prison on the mental health of young offenders in YOIs (Dolan)

Best Research for Best Health New strategy for R&D in the NHS Key points: –National Institute for Health Research Faculty –Funding more transparent –Small number of Biomedical Research Centres –Programme grants to consortia of NHS Trusts/Universities –New regional response mode funding scheme Research for Patient Benefit –Focus on the NHS

Sources of funding for Prison & Offender Research in Social Care & Health NHS R&D funding streams –Health Technology Assessment Programme –Service Delivery and Organisation Programme –Research for Patient Benefit response mode schemes –Research Capacity Development Awards Medical Research Council Wellcome Trust Prison charities Big Lottery Fund (through voluntary sector partners)