Assessment of the need for and implementation of Mental Health First Aid (MHFA) in north-east England Paul Biddle University of Northumbria

1. The Presentation Findings from a research project that examined the need for and implementation of MHFA in north-east prisons. Funded by the North East Offender Health Commissioning Unit. Undertaken in Principal Investigator: Dr. Wendy Dyer

2. Background and Context Prisoners are at greater risk of experiencing poor mental health than the overall UK population. Since the 1980s the proportion of the prison population showing signs of mental illness has increased sevenfold. High rates of self-harm and suicide.

3. Background and Context The extent of mental health issues in the prison population has been increasingly recognized by policymakers and those commissioning and delivering services. Mental health services for prisoners have been expanded and improvements made: –Creation of Mental Health In Reach Teams –Development of the Care Programme Approach –Prior to the recent public expenditure cuts, funding for prison mental health in-reach had increased substantially.

4. Background and Context Ongoing policy commitment to improve outcomes: Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders’ (2010) and No Health without Mental Health’ (2011) recognised the importance of effective mental healthcare for offenders to reduce re-offending.

5. Background and Context Despite improvements, problems remain with mental health services for prisoners: –Under-staffed services –Difficulties achieving ‘equivalence of care’ to ensure prisoners receive interventions broadly comparable with those available in the community –Mental Health In Reach Teams struggle to cope with demand and lack clarity of purpose: Some focus on severe cases Some provide a more generalist service

6. Background and Context. –Wider prison staff lack sufficient capacity and training to intervene to support prisoners with mental health issues. –Limited integration, collaboration and partnership working between individuals, functions and prisons - and between community-based mental health services. –Security priorities can influence ability to deliver optimal services. –Unmet need - A cohort of prisoners exist with mental health issues just below the level of severity required to trigger an intervention. –Prisoners face difficulties accessing information, advice and guidance about therapies and medication options.

7. MHFA A course aimed at those with little or no knowledge of how to help someone who is suffering from a mental health problem. Designed to enable someone to help an individual experiencing a mental health problem prior to professional help being obtained. Provides information about recognizing and responding to a range of mental health problems including: –Depression –Suicide –Anxiety Disorders –Self Harm –Psychotic Disorders

8. MHFA Regulated by the National Institute for Mental Health in England and the Care Services Improvement Partnership. A 12 hour course to enable participants to: –Recognise distress –Have confidence to provide immediate interventions –Help and guide a person to wider support. Those participating in the training and qualifying (via successful completion of activities and assignments) become MHFA instructors who can train colleagues in their own organisations

9. Methodology 2 stages: –Stage 1 – Literature review Attendance at MHFA training Interviews with 35 individuals in who worked in a range of roles within the 3 prisons to explore existing levels of knowledge, capacity, responses across each prison –Stage 2 Interview with 5 staff who had received MHFA training (represents half of the 10 staff who were trained at the point stage 2 began) Explored impact and roll-out of MHFA –Stage 3 Currently undertaking a follow up to gain information to inform a journal article.

Evaluation Findings

10. Stage 1 - Needs Assessment Improvements to mental health services in all 3 prisons in recent years. Staff had received variable and limited training around mental health issues (focus on suicide, self harm and ACCT). Reliance on experience to identify prisons with mental health issues. Limited knowledge of mental health, how to recognise these conditions and appropriate responses. Limited time and resources to respond to prisoners with suspected mental health issues.

11. Stage 1 - Needs Assessment Wing staff often provide the initial response to inmates experiencing a mental health crisis. Response to suicide and self harm are increasingly effective. Responses to other mental health issues more variable and are influenced by: –Training and experience –Prisoner staff relationships –Time –Individual staff understanding of their role

12. Stage 1 - Needs Assessment Those prisoners whose conditions do not have implications for the smooth operation and good order of the prison can be missed.

13. Stage 1 - Needs Assessment MHFA could potentially assist prisons to: –Better identify prisoners with mental health issues –Give staff more knowledge of more conditions and how to respond appropriately to these –Increase institutional capacity to respond to the mental health issues of prisoners.

14. Stage 2 - Implementation Findings Core group of staff trained who had various roles in their respective prisons: –Wing Staff –Reception Staff –Staff with ACCT management responsibilities

15. Stage 2 - Implementation Findings Those trained reported: –Greater awareness and understanding of mental health problems that prisoners may have –Improved understanding of how to respond to inmates suspected of mental health problems –A greater awareness of community-based services inmates could be referred to

16. Stage 2 - Implementation Findings Instructors have trained colleagues in two prisons, with training planned in a third Instructors selected colleagues who were the easiest to organise training for, not those for whom training might have been most appropriate.

17. Stage 2 - Implementation Findings Lack of strategic management and delivery of MHFA across the regional prison estate Ltd commitment from senior management to roll-out MHFA??? Roll out of MHFA compromised by difficulties releasing staff for training. Participation in MHFA training not mandatory – crowded out by other training that has to be undertaken. Exacerbated by difficulties back-filling staff on training.

18. Stage 2 - Implementation Findings The details of MHFA-trained staff were not formally disseminated to colleagues so they could be contacted to provide information/advice to other prison staff. Maintenance of Instructor status is likely to be problematic as instructors cannot train sufficient colleagues in time periods required. Stage 3 findings suggest few, if any, instructors have delivered training since March 2012.

19. Conclusions MHFA can be a valuable part of a wider approach to improve responses to prisoners with mental health issues MHFA cannot replace specialist mental health services in prisons. A missed opportunity – the value of MHFA undermined by its roll out?

20. Recommendations Strategic management and commitment, with strong institutional messages about the importance of MHFA. Publicise details of those trained throughout each prison so relevant staff can be a resource for their colleagues. MHFA training for both staff AND prisoners. Explore delivery of shorter MHFA course

Assessment of the need for and implementation of Mental Health First Aid (MHFA) in north-east England Mr Paul Biddle University of Northumbria