PPL blog: Designing a healthcare service fit for offenders
By Jonathan Oldershaw, Analyst, PPL
In line with the recent emphasis on the integration of health and social care services, the need to integrate mental health service delivery into the criminal justice system is brought sharply into focus. As a social worker with a history of experience in offending and mental health, I joined the world of consulting keen to explore further how health and social care services could be designed to best meet the needs of offenders, a complex, hard to reach and high-cost cohort of people.
In recent years, research has clearly evidenced a strong relationship between offending behaviour and health inequality, and the supporting statistics are somewhat concerning. For example, in the week following their release, female prisoners are 69 times more likely to die than females in the general population; male prisoners are 29 times more likely to die.
This cohort of people often lead chaotic lives. The prevalence of substance use and poor mental health amongst offenders leads to added health complications for these individuals. They are regular users of acute health care services (which are accessible 24/7) but have a history of poor engagement with community-based services (which currently require a more planned and methodical approach to setting and attending appointments).
On occasion, an offender with a community-based substance use care plan may enter the custodial setting to find that their care plan has been left locked outside the prison gates. The inconsistency in service provision may result in the offender returning to illicit substance use, thereby exposing them to wider implications for their own health and creating the potential for further societal costs.
So, given the fact that improving health outcomes for offenders will not only reduce re-offending rates but also bring societal benefits to a much wider population, how do we adapt the community health provision to best reach this target audience? What community services must be in place as an alternative to A&E? This question becomes even more important in the light of a growing trend towards more community sentencing.
It is clear that without well-defined and effective interfaces between the health, mental health and prison systems, supported by an innovative approach to community healthcare engagement, financial and societal costs will grow. Currently 35 percent of adults given a community sentence re-offend within a year.
However, there exists an opportunity for change as the Criminal Justice System seeks to work alongside the Health and Wellbeing Boards to review the delivery of healthcare for offenders. Opportunities exist to work creatively with the Prison Service, Youth Workers, Youth Offending Teams, Probation, Police, Housing and the Judicial System in both the identification of healthcare needs and the delivery of healthcare services. If successful, this level of integration could yield transformational results.
PPL has been instrumental in the redesign of healthcare services across London, placing an increasing emphasis on community provision. It is those same principles and means of novel multi-disciplinary working across organisational boundaries that could support local authorities to engage and treat this complex, hard to reach group of service users.
Department of Health (2012), Health and wellbeing boards and criminal justice system agencies: building effective engagement
Public Health England / Revolving Doors Agency, Balancing Act: Addressing health inequalities among people in contact with the criminal justice system