Offender health

Improving health is an essential part of reducing re-offending. Offenders have complex health needs and poor health outcomes and it is important this is recognised in both commissioning and providing health and social care services. This is true across the whole range of health services, but particular attention has to be paid by commissioners of mental health, learning disabilities and addictions services.

The majority of offenders enter prison with a range of health and social problems, including poor mental health, drug and alcohol misuse and low levels of literacy and numeracy. The health needs of young offenders also need to be recognised and addressed by commissioners of health services.

Although there are no prisons in Slough, a number of ex-offenders as well as those supervised by the probation service are residents of Slough, many of whom will have significant health needs. The probation service supervises both those being released from prison on parole as well as those serving community sentences.

What do we know?

Evidence indicates that the health of offenders both in and out of custody is significantly worse than that of the non-offending population and currently many offenders are not receiving an equivalence of service in relation to their health needs.

  • Offenders and ex-offenders generally experience greater health inequalities and social exclusion.
  • Offenders generally come from more disadvantaged backgrounds and communities. They have higher risks of suicide and poor mental health than the general population.
  • Offending has wide ranging personal, social and economic impacts that continue to affect individuals throughout their lives, as well as their families and the communities in which they live.
  • Offenders frequently report finding it difficult to articulate their symptoms, so they therefore avoid what they would perceive as potentially embarrassing situations with mainstream health professionals. These anxieties are often reinforced when they, particularly drug users, experience less than sympathetic responses when seeking symptomatic relief.
  • An estimated 20-30% of offenders have learning disabilities/difficulties.

Mental health issues are common among offenders. The risk of suicide in those recently released from prison has been estimated at over 8 times higher than the general population in men and up to 35 times higher than the general population in women (Source: Lancet 2006)

Facts, figures, trends

Thames Valley health and wellbeing needs assessment (2015)

The Thames Valley Community Rehabilitation Company (TV-CRC) now supervises more than 70% of offenders previously supervised by the previous TV Probation Trust. The remaining 30% are supervised by the National Probation Service (NPS) which works with the high risk violent and sexual offenders. In addition to this cohort, the TV-CRC also supervises a new cohort of those serving less than 12 months in custody who are now (under changes to the Offender Rehabilitation Act in 2015) required to be supervised for probation services for 12 months.

A needs assessment undertaken over 2013-14 for the Thames Valley surveyed all offenders in the region including those supervised under both new systems. The findings of this report are detailed below:

Disability

23% of female offenders and 14% of males reported having a disability. The most common disability in those aged under 45 was dyslexia (32%) the proportion in Slough was higher than the 17% average across the Thames Valley. In those aged over 65 years reduced mobility was the most common disability (30%).

Mental health and emotional wellbeing

A quarter of probation service users in Slough had an issue with emotional wellbeing. Of those, 42% had problems with self-harm, 36% were unemployed, and 52% had an alcohol problem. There were 2,602 incidents relating to a fear for personal welfare in Slough from April to December 2014. Over 40% of these incidents were related to mental health issues. Over the same period there was an almost 10% increase in detentions under the Mental Health Act.

Alcohol

35% of all probation service users were recorded with an Alcohol Need. This represents 29% of female and 36% of male service users. Of those with an alcohol need, the majority were aged 26-35 (34%). In addition to this, 27% recorded violent behaviour as being related to alcohol use.

Substance misuse

Similarly, 35% of probation service users were recorded with a substance misuse issue, though almost two thirds (65%) admitted having ever misused substances. This represents 25% of all females and 36% of all males. Of those recorded with a substance misuse issue the majority (34%) were aged 26-35, and almost three quarters reported financial problems.

Accommodation

Almost a fifth of service users in Slough had an accommodation issue and 9% were recorded as No Fixed Abode (NFA). It was a common trend across Thames Valley that the age group 26-35 year-olds had the most accommodation issues except in Bracknell Forest, West Berkshire and Slough, where more 36-49 year olds had housing problem.

National and local strategies (current best practices)

National

The Bradley Report 2009 makes a number of recommendations in terms of recognising and meeting the needs of people with mental health problems or learning disabilities in the criminal justice system

The Tri-partite National Partnership Agreement between the National Offender Management Service, the National Health Service England and Public Health England for Prisons in England, recognises the need for a shared strategic intent and joint corporate commitments in commissioning to enable and deliver services.

Prisons and Probation Guidance – Healthcare for offenders (2014)

  • Priority area 1: Early health screening
  • Priority area 2: Commissioning of targeted health services for offenders, including short-term prisoners
  • Priority area 3: Access to health records at pre charging stage
  • Priority area 4: Appropriate adults
  • Priority area 5: Consistent provision of mental health services
  • Priority area 6: Consistent provision of drug and alcohol services
  • Priority area 7: Seamless health care provision from custody to community
  • Priority area 8: Learning Disability provision

Local

Currently Berkshire has a Bradley Group that meets and works to fulfil the recommendations contained in the Bradley Report.

What is this telling us?

More work needs to be done to improve communication and assessment of offender health issues between the professionals who assess and manage offenders in and around the Criminal Justice System.

Improving Offender health and well-being can have wider community benefits. It is central to successful rehabilitation and resettlement and can reduce the risk of re-offending, reduce inequalities in health for offenders and their families and therefore improve community wellbeing.

What are the key inequalities?

Health inequalities among service users in the criminal justice system are widely acknowledged. Compared to the general population they are more likely to have a disability, experience mental health problems, misuse drugs and alcohol, self harm, smoke, attempt suicide and die prematurely.

What are the unmet needs/service gaps?

  • Commissioning of targeted and proactive health care provisions for offenders, including short-term prisoners
  • Screening for alcohol misuse
  • Information sharing between partners and access to health records by involved professionals (for example Police and Health staff based in non-Health buildings)
  • Availability of Appropriate Adults for MDOs in police custody
  • Learning Disability support
  • Mental Health Support Requirement

Recommendations for consideration by other key organisations:

  • Consistent provision, including access to health records, for screening offender health needs as early as possible following arrest would enable timely and accurate assessment for determining the right pathway responses.
  • Commissioners of health and social care services need to ensure that commissioned services reflect the fact that offenders have complex health needs and structured disadvantages which require pro-active targeting of health provision.
  • Standardised communication of offender health needs between releasing prisons and relevant community operations would enable easier transition from the former to the latter.

Related pages

Offenders come from all groups and communities within Slough. Therefore this section will have links with many others within the Joint Strategic Needs Assessment including: