1. Health needs in prison Abby Jones Health and Justice Team North West/ 09/12/13

2. Key principles Consistent High quality Outcomes focussed Seamless transfer in provision of service and ensuring services are integrated Same standards and quality of care that could be expected in the community Reducing health inequalities and health risk factors Value for money 2

3. The NHS Outcomes Framework 2012/2013 ]3

4. The Secure Estate 120 prisons 16 Secure children’s homes (SCH’s) 4 Secure training centres (STC’S) 12 Immigration removal centres (IRC’S) Police Custody Suites Courts Sexual Assault Referral Centres (SARC’S) ]4

5. Poorer health than general population 81% of adult prisoners said they had used illicit drugs at some point prior to entering prison, including almost two-thirds (64%) within the month before entering prison. Rates of using heroin and crack cocaine were higher among women (44% and 49% respectively) compared to men (30% reported using both substances during the year before custody). In a recent survey of prisoners released from custody, 12% of prisoners said they had a mental illness or depression as a long-standing illness and 20% reported needing help with an emotional or mental health problem. 17% of prisoners had been treated or counselled for an emotional or mental health problem in the year before custody. Female prisoners are more than three times as likely to self-harm as male prisoners. ]5

6. Young people Children and young people in contact with the youth justice system have high levels of vulnerability: over one quarter have been looked after children at some point. The proportion of children and young people in custody who have experienced serious child maltreatment is at least twice that in the population as a whole. Children and young people in the youth justice system are at least 3 times as likely to have mental health problems than their non-offending counterparts, and interaction with the YJS, particularly being in custody, can exacerbate their mental health problems. The rates of smoking, drinking and use of illegal drugs are substantially higher among young offenders than among young people who do not offend. ]6

7. Needs and Circumstances a higher burden of disease(including infectious diseases, chronic illnesses) Damaged and chaotic families Substance dependence Mental Health and personality disorders (The Bradley Report 2009) Abuse and Domestic Violence Homeless or without settled accommodation Poor Physical and/or dental health Finance and debt Lack of education and skills Any mixture of the above ]7

8. The Female Estate Much more prevalence of complex issues in the Female Prison Estate (Corston Report Home Office 2007) 66% women sent to prison have children 95% of those children do not stay in the family home if their mum is sent to prison In terms of healthcare add: Gynaecology Maternity Care of babies 8

9. Barriers Poorer health than general population and complex Issues Significant premature mortality- 40% of natural deaths in custody are due to coronary artery disease, including those under 40, 25% of such deaths related to cancer. Sentence Length Delivery of health services in a prison regime Constraints Lock downs Enabling Out patient appointments Continuity of care and transfer back into the community- failure to engage 9

10. Prison as a health opportunity ? A truly captive audience People in prison use primary care services at greater frequency and intensity than their peers in the community, especially young men. This is completely reversed on return to the community, where their use of services is much lower than that of their peers. Prisons are fertile environments for recovery Positive health experience in custody CAN have a positive ripple effect on release on families and social networks North West – detox (we can barely keep up) ]10

11. Who Recovers? 1.Everyone CAN recover 2.Not everyone WILL recover 3.We don’t know WHO will recover 4.So, give everyone EVERY CHANCE Psycho therapeutic Social networks Bio Medical

12. Jobs Houses Friends ]12

13. Thank you. any questions? abbyjones@nhs.net 07796994586 Manager Through the Gate-Substance misuse ]13