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Promoting offender health – peering into the future

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Last week I attended a conference on offender health commissioning which had a focus on the voluntary sector. The event was put on jointly by FaithAction, the Mental Health Providers Forum, Men’s Health Forum, NACRO and Action for Prisoners Families with the purpose of educating and encouraging commissioners to engage with the voluntary sector.

There is a host of evidence that, relative to the general population, offenders have greater physical, mental and social health care needs as confirmed in the National Delivery Plan of the Health and Criminal Justice Programme Board which summarised:

Whether in custody or under community supervision, offenders are much more likely than average to be subject to factors such as mental illnesses, personality disorders, learning disabilities, substance misuse, homelessness and poor educational achievement’

If you are interested in detailed information on a range of offender health issues check out the Offender Health Research Network.

I know from doing offender health needs assessments that many offenders catch up on their health needs in prison. This is particularly true since the NHS took over responsibility for health care in prisons in 2006. Prison dentists, for instance, are arguably the hardest working health practitioners in the country as they see a seemingly endless line of prisoners trying to make up for years of dental neglect exacerbated by drug use, smoking and poor diet. However, although healthcare in prison has improved in many ways, maintaining the health gains made by prisoners on their release is a key challenges as many individuals are not plugged into community health systems.


I have come across a number of projects recently which successfully help released prisoners resettle in the community and maintain the health gains they made inside. These initiatives all have one feature in common, the service is delivered by ex-offenders. The conference featured a presentation from Hestia about their Back on Track initiative which is a peer mentoring approach to helping released prisoners (particularly those with problems of homelessness and mental health) resettle in the community. The programme was carefully designed after consultation with service users and features four key components:

  • Insight into thinking and behaviour
  • Learning /regaining life skills
  • Strategies to cope with the shift from prison to outside
  • Overcoming barriers to accessing housing and employment

One of the project’s key findings was that: “peer-led initiatives break a massive barrier to engagement. They allow for a more honest exploration of how to stop offending.”

This a very similar finding to one that I made in a recent evaluation of an offender health trainer initiative run by Leicestershire Probation Trust which I have also written about in a post for the Innovation Unit. There are over 150 offender health trainers across England and Wales. In Leicestershire the Probation Trust made a conscious decision to recruit ex-offenders to do health promotion work in four main areas:

1. Helping offenders register with GPs and dentists.

2. One-to-one work with offenders developing a personal health plan and facilitating health improvement particularly around diet, fitness, smoking cessation and alcohol use.

3. Delivering group work sessions on general health and well-being issues to offenders attending under probation supervision.

4. Participating in multiagency health promotion campaigns.

The evaluation found the project to be very successful with a lot of significant health gains for offenders (and savings for the local health care system as offenders used primary care services instead of Accident and Emergency). Almost all the professionals and service users interviewed for this study shared the view that it was the health trainers’ personal experience which made them such effective workers. Three key aspects of this experience were identified:

  • The ability to empathise.
  • The credibility of health messages which are conveyed in appropriate language.
  • The impact of their own success in overcoming adversity and moving away from criminal behaviour.

In both these schemes, the ex-offenders providing the service were “experts by experience”. However,  they were effective because, in addition to their experience, they were carefully selected, trained, supported and supervised. In the case of the health trainers, Leicestershire Probation has a clear career development pathway for ex-offenders from peer mentoring on a voluntary basis, through to being “health champions” where they receive comprehensive training but are still not paid, to fully remunerated positions as offender health trainers. All the health trainers I interviewed were intending to continue to work in the social care field, most within the criminal justice system.

When done well, using ex-offenders for health promotion work is particularly effective. Not only do offenders hear the messages better from their peers in language they can understand and act upon, but the workers themselves gain confidence and skills, and, in the case of Leicestershire Probation, proper jobs.


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One Response

  1. I also like the Health Trainer through probation model. It nicely combines delivery of health messages, peer support on a wider basis than just compliance with orders, and career opportunities for the participants. That last bit is key; it helps separate out rehabilitation from punishment – the emphasis moves towards getting something out for what you put in, rather than putting in to repay the harm you did.

    Another big issue though is offender health itself. Because of a combination of demographic, lifestyle, and environmental (i.e. prisons are unhealthy places to live) reasons, the health of offenders, especially prisoners, is way behind the general population and getting worse. I heard today from Nigel Newcommen (prisons and probation ombudsman) at a Criminal Justice Alliance meeting, that the number of ‘natural’ deaths in custody is increasing, probably because the prison population, and age of the prison population, is increasing. That’s partly about lifestyle – which peer support can help with – but also about a need to address shortfalls in primary care and social care provision in custody, especially in the management of age-related long-term health conditions.

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