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1 Offender health Setting the Scene Offender Health Research Conference Jenny Shaw

2 Prison Health Research Network  Department of Health funded initiative  Established August 2004  Collaborators  University of Manchester  University of Southampton  University of Sheffield/Lincoln  Institute of Psychiatry

3 PHRN  1999 formal partnership between HM Prison Service and the National Health Service “prisoners should have the same range and quality of healthcare as the public receives from the NHS”

4 PHRN  PHRN to contribute to the work of the NHS/HMPS partnership  focal point for the prison healthcare research agenda  Support quality research in prison settings to address the particular needs of prisoners

5 PHRN What Have We Achieved

6 PHRN  Research prisons  Establish network of academics and clinicians  Commissioned reviews of the existing literature  Research priorities, lobbying funding bodies  Website with research/training/funding information  Involvement of service users and carers in research  Staff research capability building  Go directly to jail project

7 PHRN The Future of the Network

8 PHRN Offender Health

9 Offender Health Aim  To widen our research remit to include Police, Police Custody, CPS, Courts, Probation, Release and Resettlement  Support development of regional research networks

10 Offender Health What do we currently know about Offender Health?

11 Offender Health  Police  First point of contact – 1.3 million arrests each year  43 police services  603 custody suites

12 Alcohol and drugs  Alcohol Between 22% and 25% detainees ‘drunk’ on arrival at police stations (Robertson et al, 1995; Bennett, 1998) 86% of custody deaths have been associated with recent alcohol consumption  Drugs 69% of arrestees positive urine sample for at least one drug, 44% opiates and 32% cocaine. (Stark and Gregory 2005)

13 Offender Health  Learning Disability  (n=9014) 1 in 10 (Scott, et al. 2006 )  Mental Health  1.9-2.7% Mental illness (Keyes,1995 - Pearson, 2000)  1.4% demonstrating symptoms of a serious nature.  Section 136(Greenberg, 2002) (Lowe- Ponsford 1996) (IPCC due)

14 Deaths in police custody  Deaths in Police Custody  43 deaths in custody 2001-2002. 18 of the 43 had evidence of mental health issues, 5 psychoses, 5 self-harm and 8 depression. (Best and Kefas 2004)

15 Offender Health  Pathways to care Health Screening and assessment  No standardised format  Patchy –variation between forces,  no standard definition of terms,  limited police training in health,  lack of privacy in custody suite  few avenues to seek further support  No research evaluation of screening and pathways

16 Offender health Police health input  Forensic Medical Examiner  Training Reluctance to inquire about alcohol use (Franklin 2004) Reluctant to prescribe for substance misuse (Stark 2005) Mental health training variable and limited  Cost effective?  Little or no evaluation of the service they provide.

17 Offender health Other models of health input: Police custody nursing service  6 month  6 nurses first-contact care and triage assessment in parallel with a team of experienced FMEs  nurses demonstrated faster response times, comparable consultation times, more approachable than their medical colleagues Bond, et al. 2007.

18 Offender health Diversion-Drugs  Arrest referral schemes  Drug testing  Conditional cautioning  Evaluation of outcomes Diversion-mental health  Limited, in association with court liaison and diversion  Little evaluation of effectiveness

19 Police So what don’t we know?  Prevalence of physical and mental health problems  Pathways to care  Efficacy of current models of care,  Health care needs, feasibility of screening and assessment  New models and evaluation  Training needs evaluation

20 Offender health Courts  650 courts  150 court diversion/liaison schemes

21 Offender Health  Courts  Prevalence  Greenhalgh, et al. 1996- 77 % psychiatric disorder;  Flander and Bartlett, 1997 - 100 individuals 35 alcohol misuse, 25 history of deliberate self-harm.  Shaw et al. 1999 - SMI 1.31% defendants in court direct and 6.57% in custody overnight. Only 14 of 96 SMI detected by court staff and referred to court liaison

22 Offender health  Court Diversion/Liaison  Nacro 2005; The Centre for Public Innovation  Schemes  No clear aims, objectives and targets  no performance management.  weak integration with local mental health services.  decrease in staffing levels,  reduction in funding,  no sessional input from a psychiatrist or psychologist and trouble obtaining psychiatric reports.  Lord Bradley review 2008  Numerous studies in single courts  No widespread evaluation

23 Offender health What don’t we know? Up to date prevalence Pathways to care Service needs Review of models and evaluation of what works Training needs

24 Offender Health  Probation  Prevalence  1213 offenders on probation. 49% currently long-term health problems. Common problems were musculoskeletal, respiratory and mental health problems. 42% cannabis, 24% amphetamines, 8% heroin, 10% drink problem. (Mair and May 1997)  London Probation, 2002 – 20%-30% mental disorder.  48% mental health concerns (Solomon and Rutherford, 2007)

25 Offender Health  Approved Premises  12 month cohort study  Just over a quarter of all residents had a known psychiatric diagnosis,  One in five had physical health problem  5% had a Learning Disability,  One third had a problem with alcohol misuse  One third had a problem with drug misuse. (Hatfield, 2004)

26 Offender Health What don’t we know? Prevalence of health problems Service needs Pathways to care Models of service provision Training needs

27 Offender Health What will we do

28 Offender Health  Communication 1.Conference 2.Expanded website  Research literature  Training  Research calls

29 Offender health  Research network of academics and clinicians  Go directly to jail equivalent  Research capability building in staff  Literature review  Research priorities and lobbying commissioners

30 Offender Health Research Priorities This is where we need your help!! TODAY What are the gaps in healthcare provision for offenders and what should we be researching?

31 Offender Health Remember Research is fun!  Sign up on  Contact us

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