Study investigates issues faced by prisoners with mental health problems after release

Offenders, and especially prisoners, have a high prevalence of mental health problems. Rates for various mental health conditions range from 50 to 90 per cent. Prisoners released from prison with mental health problems face difficulty with family relationships, employment, long-term illness, self-harm, depression and re-offending.

An ongoing collaboration between Plymouth University Peninsula Schools of Medicine and Dentistry, the University of Manchester, University College London and the University of Exeter, has received funding in the region of -2 million from the National Institute for Health Research (NIHR) Programme Grants for Applied Research (PGfAR) to carry out a five-year programme investigating 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.

The project is also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care in the South West Peninsula (NIHR PenCLAHRC).

The 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.

Phase one will see researchers working closely with people who have previously been in prison, the prison service and community care providers, to develop the model for an integrated approach 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 would receive the new integrated approach while the others would receive the care that is usually available.

By collecting information related to people's health, the healthcare they have received, improvements in their social situation (including housing and employment) and their involvement or otherwise with the criminal justice system, the research team can evaluate the effectiveness of the new integrated approach by comparing it with the results achieved by the usually system of care.

As well as investigating the benefits to released prisoners with mental health problems, the research team will also assess the economic impact of the new integrated 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.

He said: "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. 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."

He added: "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."

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