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Professor Louis Appleby National Clinical Director for Health and Criminal Justice England. Rates (%) of mental disorder in prisoners. Males Males Females (sentenced) (remand) Psychosis 7 10 14 Personality disorder 64 78 50 Heroin in previous year 21 29 30
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Professor Louis Appleby National Clinical Director for Health and Criminal Justice England
Rates (%) of mental disorder in prisoners Males Males Females (sentenced) (remand) Psychosis 7 10 14 Personality disorder 64 78 50 Heroin in previous year 21 29 30 Hazardous drinking 63 58 38 Any 92 95 92 Source: ONS, 1998
Mental health needs of prisoners (%) All Males Females Young Short term Homeless/temporary accommodation 15 15 17 10 17 Unemployed in past year 48 46 67 37 50 Permanently excluded from school 40 41 30 52 42 Longstanding illness/ disability 27 26 31 12 26 Source: MoJ, 2008
Measures to improve prison health • Prison in-reach teams • Screening at reception • Integrated drug treatment system • NHS commissioning
I A T H Monitoring Unit Self-inflicted deaths in prisonEngland Year Source: HM Prison Service
Suicide after prison release No. suicides Time from release (28 day periods) Source: Pratt et al, Lancet 2006
Drug-related mortality in newly released prisoners Source: Home Office, 2003
Prison population rates Source: International Centre for Prison Studies, King’s College, London
Factors associated with reoffending • males • previous offences • short custodial sentences • poly-drug use • frequent drinking • childhood abuse • school exclusion • no qualifications • unemployment • homelessness Source: MoJ, 2010
Comprehensive liaison and • diversion services • NHS commissioning of custody • healthcare • Primary care in prisons • 14-day limit on prison • transfers
NHS Commissioning • Board • Devolved power • Plurality of providers • New priorities – public • health, clinical leadership, • outcomes
Health and Wellbeing • Boards • Directors of Public Health • Integrated commissioning • Outcomes e.g. suicide rate, • drug-free, alcohol admissions
reduce prisoner numbers • community alternatives to • short-term sentences • reduce re-offending • drug-free prison wings • more severe PD treatment in • prison • consultation on diversion
Key elements for change: • Statement of government priority • Strategic plan backed by consensus • Service models based on evidence • Resources and commissioning • Measurement and incentives • Workforce skills including leadership
National diversion initiative Phase 1 (2011-12) • Pathfinder sites • Clinical and economic data collection Phase 2(2012-14) • Clinical and commissioning model • National roll-out
“In some jails are confined the mentally ill, although it is probable that by medicines and proper regiment, some of them might be restored to their senses and usefulness in life.” John Howard, 1780