Safer prisons: the challenge of mental ill-health and wider dual diagnosis. Sean Duggan, Chief Executive 21 March 2013

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1 Safer prisons: the challenge of mental ill-health and wider dual diagnosis Sean Duggan, Chief Executive 21 March 2013

2 Dual diagnosis Dual diagnosis can mean A primary mental health problem that provokes the use of substances Substance misuse and/or withdrawal leading to psychiatric symptoms or illnesses A psychiatric problem that is worsened by substance misuse Substance misuse and mental health problems that do not appear to be related to one another Clinicians and prison staff need to be aware of comorbidity between behavioural disorders, mental disorders and substance misuse disorders

3 Principle of equivalence Prisoners should receive the same level and quality of health services as is available in the community May not mean providing the same care The prevalence of all illnesses, especially mental illness, is much higher in the prison population Prisoners typically experience multiple and complex needs e.g. learning difficulties; homelessness and unstable housing; debt; poor physical health; unemployment; previous experiences of trauma Should be about delivering the same health outcomes for prisoners as would want to deliver in the community Physical and social needs also need to be addressed

4 Mental healthcare in prison Mental health inreach teams have generally led to improved mental health care Support for common mental health problems remains underdeveloped A small number of prisons offer access to psychological therapies Limited staff and capacity funding no more than one-third of what is needed to deliver policy objective of equivalence Transfers from prison to hospital Transfer times from prison to hospital have generally improved but there are still delays in some areas Training for prison officers in recognising and supporting prisoners with mental health problems remains inadequate (Her Majesty s Chief Inspector of Prisons Annual Report 2011/12)

5 Primary mental health care Primary care is the foundation of prison health services Primary care staff can: Support other prison staff to develop an environment that supports mental health and wellbeing Identify prisoners with mental health problems and/or substance misuse problems Manage prisoners with common mental health problems e.g. depression Refer prisoners for appropriate assessment, advice or treatment Contribute to multi-disciplinary work to prevent suicide

6 Diversion Effective diversion can ensure e.g. earlier identification of needs and access to appropriate treatment and support 5 million invested in children and adult liaison and diversion services in 2011/12; 19.4 million for 2012/13 National Development Network for Liaison and Diversion Services and Offender Health Collaborative Over 120 liaison and diversion schemes in UK, ranging from practitioner working on their own to large, multi-disciplinary teams

7 A wellness and whole prison approach A wellness or social focus recognises the importance of social interventions for promoting mental health and wellbeing An illness focus risks limiting support to only those with the most severe mental health problems Need to encourage the whole prison to accept its responsibility for promoting and improving mental health and wellbeing This relates to addressing the wider social needs that most prisoners with mental health problems experience

8 Recovery Building a meaningful and satisfying life, as defined by the person themselves, whether or not there or ongoing or recurring symptoms or problems Relationship between clinician and patient moves from being expert/patient to being coaches or partners on recovery journey Peer support is often central for many people s recovery Role of peers and mentors in prison include: Meeting prisoners on their release and providing support to resettle into the community and engage with services In prison providing e.g. advice and guidance for new prisoners Mentors can be on a voluntary basis or employed by services and provide considerable value for money

9 Employment of offenders Offenders with mental health problems routinely excluded from programmes that provide vocational rehabilitation Improvements in mental health and reduced reoffending Effective practice and pathways into employment for offenders with mental health problems How can apply IPS principles in CJS context Pilot project to embed specialist Employment Support workers in prison mental health services Recent matched comparison study (MoJ, March 2013) found that offenders who got employment in the year after being released from custody were less likely to reoffend than those who did not

10 Mental health awareness As part of a whole prison approach all prison staff need to receive some form of mental health awareness training Some may require more extensive training but all should have at least basic training Outcomes of training e.g. Improved understanding of mental health and stigma Greater confidence to deal with people with mental health problems Improved workings with health and social services Successful practice Training involves awareness about drug and alcohol issues and learning disabilities and their links to mental health Involvement of service users Prisoners also receive awareness training

11 NHS Mandate Includes focus on treating and caring for people in a safe environment and protecting them from avoidable harm Small increase in suicide rates in last two years (ONS, 2010) Government s Suicide Prevention Strategy (2012) Focus on those groups who face highest risk NHSCB and CCGs should identify ways of improving mental health support to offenders in custody and at all stages in CJS

12 Concluding remarks To improve services for people in prison with mental illness/dual diagnosis, we need focus on: Recovery Joint commissioning Prison health care commissioned by NHS Commissioning Board Develop partnerships with drug and alcohol services, especially within prisons and at transition points Integrated treatment Coordinated approach from professionals both within prison and in community across health, mental health, substance use and settlement Address social needs as well as medical Access to treatment for people with less severe needs alongside substance misuse problems e.g. through IAPT

13 Thank you

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