1. Health-seeking among community based male offenders A qualitative study

2.  Psychiatric morbidity in the male probationers population is higher compared to general population  Uptake of mental health services by the offenders in the community is poor  Consequences of low uptake of services: poor mental health among population; recividism  To date: there are no UK studies examining health- seeking among male offenders in the community with mental health problems. Background: offender population

3.  Understand the process of seeking mental health help for male probationers  Understand the factors that influence mental health seeking among male probationers  Understand the role of mental health practitioners in health seeking  Understand the role of criminal justice practitioners in mental health seeking Aim of the study

4.  A qualitative design study  Permission to undertake the study was granted by Greater Manchester Probation Trust & North West REC – GM North Study no: 11/H1011/7. R&D approval also given by 3 participating trusts.  Recruitment stage 1:community based male offenders (n=240) also mental health service users living in Gtr Manchester area, were sampled from a database of probationers under the supervision of Greater Manchester Probation Trust between march 2011 and June 2011 Methods (1)

5.  Stage 2: invitation to probation officers to discuss study with participants. Interested participants contacted researcher directly  Stage 3: Researcher arranged to meet participants and recruit into the study.  Participants: 11 expressed interest, 7 entered study, 2 declined (confidentiality concerns), 1 changed his mind & 1 was too unwell to interview. 1 additional participant recruited via his CPN. Methods (2)

6.  8 participants were recruited and interviewed about their experience of seeking mental health treatment.  Interviews were recorded and transcribed verbatim.  Data were analysed by clinician and researcher  Constant comparative/ grounded theory method  Themes were developed from the data to explain the mental health seeking process among the cohort Methods (3)

7. ParticipantAgeCurrent Mental Health InputEthnicityOffence A29PsychiatristWhite-BritishAssault B19PsychotherapistMixed-White-African- Caribbean Arson C29Assertive Outreach TeamWhite-BritishCriminal Damage D22GPWhite-BritishCriminal Damage/Assault E25Homeless MHTWhite-BritishUndisclosed F35Assertive Outreach TeamBritish-African-CaribbeanHarassment/Assault/Begging G26GPWhite-BritishUndisclosed H33CMHTWhite-BritishUndisclosed Participant characteristics (1)

8. Significant EventsWho Sought Mental Health Help Avoids Mental Health Services Criminal Justice Intervention Participant ConcernSubstance Misuse AWife leaving – aged 28FamilyPastProbation/CJLTBehaviour/losing marriage- contact with children Cannabis/ Alcohol BBullied/Arson/Break-up of relationships aged 13 Family/Voluntary Sector practitioner/Health Practitioner/CJS Practitioner/Self PastPolice/Probation/ CJLT Behaviour/Self harm/ShameAlcohol CNot disclosedFamily/Self/MH practitionerPastNot disclosedInterferenceNot disclosed DRelease from prison/Admission to hospital aged 19 Self/FamilyPastPrisonLoss of control/Family/losing children Cannabis ESelf harm aged 25Self/CJS PractitionerNot disclosed Police/ProbationLoss of control/fear of prison/Repeating life story Cannabis FDeath in family aged 16Family/MH PractitionerPastNot disclosedFamily roleCannabis GDeath in family aged 22Self/GPPresentPoliceInterferenceAlcohol HHead injury/Admission to hospital aged 19 SelfPresentPoliceMedication/InterferenceAlcohol Participant Characteristics (2)

9. The experience of making the choice to seek mental health help among participants was influenced by 5 factors: 1.Motivation 2.Family and practitioner support 3.Social Capital/Stigma 4.Empowerment 5.Helpfulness of services Results

10. Motivation now that I know there is help out there I am motivated now. I do know there are different avenues where you can get the help Mine is easy to access. I think its cause I’m in probation or I’m round to places that are official. If you are around official places, then you can get pretty good help, really can’t you?

11. Family and practitioner support my situation at home at the minute my mom and her partner argue all the time and it’s like I have no one to turn to because there are always arguing I can't talk to them. now. I just felt like I needed someone from the mental health services basically so probation made the referral to the Department of psychotherapy and psychology and I'm seeing them now.

12. Social Capital/Stigma every week we had a goal or a plan if you like “What’s our goal for next week?” And it’s things like that that made me feel better about myself I don’t tell anyone because they would just think I’m stupid

13. Empowerment I know psychologists have got degrees but to some extent they're working around you and they can't do the job without you basically and it's nice to be involved in the work that you got to be doing Going back to what I said before this is what I liked about the psychologist – they’re involving you in their work…and it’s nice to be involved in the work you’re going to be doing

14. Helpfulness of services There wasn't really a structure to it (CPN/psychologist) I was just and talking and basically they were just a counselling service and that is something that I didn't need because they like.... suppose I felt suicidal I would go to talk to someone to relieve the feeling of wanting to kill myself but then what about the underlying problem? He’s treating me fair, very good…..he’s like family innit, but that’s the thing coz my family don’t see me much. I see (CPN) as a companion, someone I can talk to if I got problems

15.  Previous experience of mental health services can affect lifelong attitudes towards mental health services.  Having a supportive social network enables male probationers to seek and access help.  Families and Criminal justice practitioners can be agents of support and empowerment for male probationers- MH practitioners need to work with probationers and their support network (social and statutory) to maintain access to healthcare and support  MH practitioners have a role to play in promoting social capital and empower male probations to seek help- practitioners need to adopt a problem solution focused approach to engagement and providing mental health help Implications for clinical practice

16.  Research led to successful completion of MClinRes  Plans for further work exploring practitioner support and engagement of male probationers  Any questions? Thabiso Nyathi Senior Mental Health Practitioner Manchester Offenders Diversion Engagement and Liaison [MODEL] Greater Manchester West NHS Foundation Trust Thabiso.Nyathi@gmw.nhs.uk Thabiso.Nyathi@gmw.nhs.uk Conclusion