How we manage offenders

Health

Offenders often experience significant problems gaining access to adequate health and social care services.

This can add to problems of social exclusion, and puts offenders at a greater risk of continued offending.

Improving access to primary and specialist health and social care services for offenders is a big challenge but one with considerable potential rewards in terms of improved health and wider social care system gains.

How we aim to help offenders deal with health issues:

ensure offenders have access to appropriate health services in custody and the community
ensure suspects and persons detained by the police under mental health provisions are able to access appropriate health & social care professionals at the appropriate time and in the appropriate place
divert offenders with serious mental healthcare needs to appropriate health services
improve health service links to other services working with offenders.

Significant progress has been made since 2000 to improve healthcare for offenders.

Health Services in custody

Prison Health, (a joint Prison Service / Department of Health unit), has been working since 2000 to improve health care provision for prisoners. Its aim is to ensure that prisoners have access to the same quality and range of health services as the public receive under the NHS.

It has:

improved mental health provision
supported improvements in primary care services
developed the prison health workforce
improved the prison health estate.

It has been particularly successful in the development of mental health provision. NHS-funded multidisciplinary mental health teams are now operating at 102 prison establishments and should become available in all prisons by April 2006. NHS mental health investment in prisons will reach £20 million in 2005/06.

Dangerous & Severe Personality Disorder provision

In partnership with the National Health Service, specialist provision is being developed for offenders with severe personality disorders who pose a significant risk of serious offending.

The Dangerous and Severe Personality Disorder programme has delivered 300 places in high security prison and hospital settings, and is on track to achieve an occupancy rate of 90 per cent by March 2007. More detail may be found at: www.dspdprogramme.gov.uk (new window)

Diversion from custody

There is a real need to divert offenders who have serious mental health problems away from prison and into the appropriate health service facilities.

The needs of those suffering from physical health problems and from substance misuse and abuse must also be addressed.

Providing suitable health and social care access is key to reducing repeat offending, in particular, prolific offending.

Primary Care Trust Commissioning

From April 2006 healthcare within prisons will be commissioned by Primary Care Trusts.

The drive to improve patient services through the new commissioning arrangements will provide opportunities for improving the way prison services are commissioned and delivered through better engagement with local clinicians in the design of services.

Prisons Partnership Boards need to ensure that local needs are incorporated in the development of local plans and that there is full consultation with all stakeholders involved in the design and delivery of services.

As part of this Strategic Health Authorities, working with PCTs will ensure that healthcare is delivered against a number of criteria including the high quality and safe services with a reduction in Health Inequalities.

Health case study - Luke

Luke, 19, first took crack cocaine when he was nine years old and has also taken heroin.

He had little schooling and cannot read or write very well. In 2005, he was arrested for shoplifting and some time later, in a police cell, he was found gouging lumps out of his arm with a plastic fork. He was taken immediately to A&E, and was seen there by a psychiatrist, who admitted him to a psychiatric ward.

Luke stayed there for 24 hours before discharging himself. He had become increasingly agitated and distressed, partly due to heroin withdrawal.There were no services working with him in the community at that time.

Luke was arrested the following day, again, for shoplifting and subsequently over the ensuing weeks, at least three times more for theft-related offences. He eventually ended up in prison again and was provisionally diagnosed with a borderline personality disorder and drug dependency.

This did not qualify him for support from statutory mental health services. A prison officer referred him to Revolving Doors – a charity working with people who have mental health problems, but who are ineligible for statutory mental health services.

Revolving Doors Link Workers supported Luke in prison and the community. They have tried to get him into drug-rehabilitation programmes but without drugs, Luke hears voices that tell him to hurt himself. He has already tried to hang himself twice whilst in prison and has taken overdoses. The team is currently offering him emotional and practical support in order to register him with a doctor and get him mental health treatment so he can lessen his dependency.

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