Healthcare services for offenders in the community are poor

Professor Charlie Brooker is the UK’s leading authority on offender health. His most recent research looks at how reforms of the NHS and probation have impacted on the healthcare of offenders in the community. His study relies on Freedom of Information requests sent to Clinical Commissioning Groups (CCGs) and mental health trusts about directly commissioned healthcare in probation services.

If you subscribe to the Probation Journal, you can read the research in full here.

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Context

Health commissioners normally undertake a health needs assessment before deciding which services to commission. In the NHS, before the recent reforms, this was the responsibility of Public Health Departments within Primary Care Trusts. Now healthcare for offenders is split between the NHS area teams who assess and commission health for those who are detained (in prison and police custody) and CCGs who are responsible for those serving community sentences. Last week’s post described how the Public Health England Health and Justice team provides specialist guidance and advice for healthcare commissioning for those in custody and has an overall responsibility for offenders in the community.

While almost every prison, secure children’s home and police force in England had been the subject of a health needs assessment in the two years prior to this research, only six out of 35 Probation Trusts had undertaken an HNA on their offenders.

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Findings

In autumn 2013 Professor Brooker used a Freedom of Information request to ask every CCG about the extent to which they commissioned healthcare in probation. The table below shows that only 5% did so:

CCGs often also stated that they didn’t know whether or not mental health services were funded directly to probation as their mental health services were subject to a block contract. In other words, this was at the discretion of the mental health service provider. So Professor Brooker sent FOI requests to the 53 Mental Health Trusts to ask them what mental health services they provided. 40% of Mental Health Trusts did not provide a specific service into probation. The majority did but often this was at a minimum level; typically attendance at MAPPA meetings and a half day clinic for advice, once a week in the local probation service. Only three teams provided an assessment and treatment service into probation hostels.

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Why is the mental health of probationers important?

Research shows that the prevalence of mental health disorders (often accompanied by drug and/or alcohol misuse) is disproportionately high amongst probationers (and prisoners). There is also a strong evidence base that offenders with mental health problems are more likely to reoffend.

In the US, many states have specialist mental health probation staff trained to deliver a case management service to those with serious mental illness. These staff have a lower caseload, manage integrated budgets and look after offenders’ range of needs including housing.

This is in stark contrast to the situation in England and Wales where there has been minimal use of Mental Health Treatment Requirements – the only dedicated sentence aimed at offenders with mental health problems which represented less than 1% of community sentences in 2011.

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Conclusions

Professor Brooker recommends that every CCG should undertake a systematic health needs assessment of the probation population, which would, almost inevitably, find very high levels of unmet mental and physical health needs.

He recommends that CCGs and NHS area teams should collaborate around which interventions should be prioritised and that new health care pathways would be needed to make sure that offenders could use new services.

Professor Brooker concludes with a plea that both the National Probation Service and the new private Community Rehabilitation Companies should be equipping their staff with training to at least recognise mental health disorders and to take some action in attempting to connect probationers to existing services.