1. Meeting the Health Needs of Offenders Dave Spurgeon Research & Development Manager, Nacro Transforming Rehabilitation Dave Spurgeon, Research & DVE

2. Background  Offenders are one of the least healthy & most socially excluded groups in society.  Many have complex or multiple needs.  While many of these needs may be ‘sub-threshold’ to access individual services/provision taken together they present a picture of considerable need and risk of harm to self or others.  Addressing the health inequalities can have a positive impact of reducing offending and re-offending and reducing social exclusion.  Most of what is known about the health needs of offenders relates mainly to studies and prevalence data collected in prison.  However, 2 studies on offenders on probation caseloads show health inequalities significantly worse than the general population & the health of female offenders is both significantly worse than their male counterparts and the general population

3. Higher Mortality Rates Data on all cause mortality among current and or ex-prisoners is difficult to identify and collect; However, in jurisdictions where such collections are possible, dramatic differences are evident between current or former prisoners and general population in relation to all cause mortality as well as accidental death and suicide. Data from the UK is shown as example.

4. Substance Misuse

5. Drug Related Deaths

6. Mortality rates: suicide Suicide rates are higher in prison populations than among peers in the community. WHO data shows a suicide rate which ranges from 0 (0.0%) to almost 300 (0.3%) per 100,000 prisoners, with an average of about 60 (0.06%) per 100,000 in the 47 WHO European Member States that belong to the Council of Europe. Data from the UK is shown as an example.

7. High Prevalence of disease: mental health Prisoners often have higher prevalence of mental health problems and behaviours, including personality disorder, depression and psychosis.

8. Learning Disability

9. Smoking prevalence

10. Physical health needs

11. Infectious diseases: BBV/HIV infection Many prison populations have high prevalence of infection with blood-borne viruses (BBVs) (Hepatitis B & C) and HIV due to large numbers of injecting drug users (IDUs) among incarcerated populations; Some evidence of onward transmission of infection in some European states due to injecting of drugs, tattooing and unprotected sexual activity- although definitive data is difficult to find.

12. Barriers to engagement  Not registered with a GP practice  Not engaged with services and/or services disengaged with the person  Multiple needs – doesn’t reach threshold for individual services; treated in silos and not holistically  Complications of funding and/or commissioning  Health and care not integrated  ‘Offender’ label denies access to services and/or increases ‘risk’  No accommodation, no health provision  Difficulties re continuity of care ‘through the gate’ and post-release

13. Dave Spurgeon Research & Development Manager Nacro, Park Place, 10 – 12 Lawn Lane London SW8 1UD Dave.spurgeon@nacro.org.uk davespurgeon@blueyonder.co.uk Tel: 07856 740679