cell doorA programme to investigate the issues faced by prisoners with mental health problems near to and after release, and to develop and evaluate a system of care to address those issues, has been launched.

Offenders, and especially prisoners, have a high prevalence of mental health problems. Offenders released from prison with mental health problems also often face difficulty with family relationships, employment, long-term illness, self-harm, depression and re-offending.

To investigate these issues, an on-going collaboration between Plymouth University Peninsula Schools of Medicine and Dentistry, the University of Manchester, University College London and the University of Exeter has received about £2 million funding from the National Institute for Health Research Programme Grants for Applied Research. The five-year project aims to develop and evaluate a way of organising care based on an integrated approach involving therapy, medication, housing, training and employment, and ensuring that care continues after release,

In phase one of the project, researchers will work closely with people who have previously been in prison, the prison service and community care providers, to develop the integrated approach model to identify and engage prisoners before release and then set up and deliver care after release. The approach will be tested, and elements of it ‘road tested’, to ensure the best chance of benefitting prisoners.

The second phase will be a randomised control trial in which half the prisoners receive the new integrated approach while the others receive the care that is usually available. Information relating to people’s health, the healthcare they have received, improvements in their social situation (including housing and employment) and involvement or otherwise with the criminal justice system will be collected so the research team can evaluate the effectiveness of the new approach by comparing it with the results achieved by the usually system of care.  

Systematic examination of criminal justice healthcare
As well as investigating the benefits to released prisoners, the research team will also assess the economic impact of the new approach to see if it results in savings to the public purse.

The project is led by Dr Richard Byng, clinical senior lecturer at Plymouth University Peninsula Schools of Medicine and Dentistry and a GP with a special interest in primary care mental health.

“With other colleagues in the team we have already produced a report, Care for Offenders: Continuity of Access (COCOA) which shows that offenders with mental health problems need improved and on-going access to mental health interventions,” he said. “This was the first systematic examination of the healthcare received by offenders across the criminal justice system. It was obvious to us that action needed to be taken.

“Having so comprehensively identified the need, we wanted to build on our findings by investigating how an integrated system of care could be developed and evaluated for prisoners with common mental health problems. While prison healthcare has improved in the last decade, mental health care is minimal except for those with the severest problems. Care after leaving prison is especially lacking for those serving short sentences – offenders often don’t want to admit they have problems and services are not always equipped to deal with their complex problems.

“Our research will tell us if the proposed intervention improve prisoners’ common mental health problems, improve other aspects of their lives and have wider social and financial benefits.”