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The news has been awash with stories relating to the high rates of mental ill-health amongst those serving a custodial sentence since the publication of the mental health and criminal justice report. 




It’s not surprising that many are talking about the findings. After all, it’s been almost two decades since the large scale study of psychiatric morbidity in prisons (Singleton et al., 1998) and since then there’s only been a few robust smaller-scale studies. 

It’s interesting then, to take a look at what the Department of Health (DoH) and the Ministry of Justice (MoJ) commissioned report has to say about the mental health support available to offenders. 

The report comes from an informed place. Its author is the Centre of Mental Health’s very own Dr Graham Durcan, and it draws directly on the knowledge of 200 contributors who have knowledge of or work in the criminal justice system and mental health services arena.

It presents what feels like a very real and direct account of the current issues around mental health care provision, but also sets out exactly what could be done to address these. Below are some of the key issues and recommendations made:

Commissioning 


The report observes that there are still few clinical commissioning groups (CCGs) that give priority to the health of those leaving prison, courts or police custody or for those on probation. 

In addition, where commissioning organisations are responsible for offenders with mental health issues, there’s often more than one group involved. This, the report found, often leads to gaps in service. 

Recommendation: CCGs should take the lead in commissioning health services for those leaving custodial settings in their local areas and that this could be written in the form of an NHS Mandate. 

Impact of cuts 


There’s a clear observation regarding the relationship between budgetary cuts and mental health service delivery. In particular, the report talks about there being less resources for prison officers to be able to escort prisoners to appointments, amongst other factors. 

Recommendation: The report calls for ‘joint working, joint budgets and creative thinking’. Core to this will be determining how CCGs and local authorities work together to meet the needs of offenders. 

Training in mental health awareness 


Whilst training in mental health awareness is offered at a number of prisons for general prison staff, attendance is often low. With other agencies, the uptake of such courses was reported to be better, with both the police and probation services reporting the courses to be helpful to them. 

Recommendation: The report calls for a joint commitment from the MoJ, Home Office, DoH, NHS England and the Welsh Assembly that all professionals in criminal justice should receive mandatory mental health awareness training that “helps to achieve a psychologically informed approach to managing offenders”.

Information sharing 


Interestingly, the report cites that information exchange between mental health and criminal justice services has vastly improved where Liaison & Diversion services are in place. Where the processes are in place, those with mental health problems, a learning disability, substance misuse problems and other vulnerabilities are identified and assessed earlier as they pass through the youth and criminal justice systems. Where such services were absent, delays in receiving the right offender healthcare were reported to be commonplace by those participating in the research. 

Primary mental health care 


Although there were just 20 prisons represented in the report, few of them reported being able to offer psychological interventions; a key element in primary mental health care. In part this is due to the complex mental health needs of prisoners, and the ability of the healthcare provider to provide a broad range of suitable interventions.  

Recommendation: It would be helpful for NHS England and the Welsh Assembly to develop a national framework for prison mental health care, similar to the English Liaison & Diversion services. This could involve a stepped-care model, offering primary as well as secondary care and NICE approved psychological therapies. 

Transfers to hospital 


There’s also the issue of the speed of transfers from a custodial setting to hospital. Many reported waits of up to 3-4 months, especially when seeking an ‘out of area’ bed. 

Recommendation: NHS England, the Welsh Assembly and the MoJ should take urgent steps to speed up transfers from prison to secure care. A single competent gateway assessment could take place rather than multiple assessments. If an assessment shows there is a need for transfer, this should happen in a set time limit (14 days). 

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