Some Facts about
• In March 2013 there were 222,000 people serving a probation order
in 35 Probation Trusts. Prisons hold 85,000 people and retain 75% of
the budget overall (probation three times less money three times
more offenders)
• 89% of these were male
• The most common offence for both genders serving a community
order was 'theft and handling'
• The most common offences for those given deferred sentences were
for men 'violence against the person' and for woman 'theft and
Some Facts about
Probation in the Future
• About 70% of the probation population will become managed by the
private and voluntary sector over the next 6-9 months.
• Those serving short sentences will be included for the first time
• Payment will be linked to reductions in re-offending
• Current probation trusts are barred from tendering for business
although some staff have been transferred.
Some Facts about
NHS Reforms
• Since April 2013 healthcare has been commissioned by two bodies NHS England and 211 Clinical Commissioning Groups
• As far as healthcare for offenders is concerned there is a
fundamental split
• NHS England commissions healthcare for offenders who are
detained (prison, police custody and secure children's homes).
• The CCGs are responsible for commissioning health care for local
communities (each has a population of 250,000) thus explicit
guidance that they purchase healthcare for those on probation
• The function of Public Health also fragmented between LA's, Public
health England and NHS England
What is known about the
healthcare needs of those
serving probation orders?
• Health needs Assessments are limited in probation only eight
nationally (8/35) whereas there will be at least one for every prison
(130/130) and police custody setting (38/38 forces )
• Role of the Inspectorates (Prison and police examine health,
probation do not include health in inspection)
• Amount of research small, i.e. prevalence of mental health disorders
only two studies world-wide, however 250 plus in prisons
• Seminal study by Binswanger et al showing that SMRs are elevated
x 12 in the first two weeks after leaving prison (based on 30,000
released from Washington State Corrections centre) main causes of
death are overdose, CHD, homicide and suicide.
• Little made of official suicide statistics in probation
The Derbyshire and
Nottinghamshire HNA
This study was reported in 2008 and the review of the literature led to
some tentative conclusions:
• The prevalence of MH problems appeared similar to that of
• Problems of alcohol/Drug misuse and suicide exceeded those in
• Recently-released offenders especially vulnerable in terms of
mortality and substance misuse
• Those on probation have significantly higher health needs than the
general population and are less likely to access primary healthcare
Main Results
• 27% had been formally seen by a MH service mostly for depression
and anxiety mostly for depression and anxiety
• 83% smoked
• 44% at risk of a serious drinking problem
• 39% had a high risk of substance misuse
• The physical and mental health component scores of the SF-36 were
significantly worse than social class V of the general population
An Investigation into the Prevalence of
Mental Health Disorder and Patterns of
Health Service Access in a Probation
Professor Charlie Brooker – Royal Holloway,
University of London
Stage One
Stage 1: Aims
• Stage one investigated:
– The prevalence of mental health disorder and
substance misuse in a probation population
Stage 1: Method
All participants interviewed
up to the Amended
Those screening positive on
this tool + a sub-sample for
a false-negative check
complete the remaining
Selection Tools
• Tools were selected based on the
following criteria:
– Previous use in criminal justice settings
– Quick to use
– Suitable for use by ‘lay’ persons
– Good rates of sensitivity and specificity
Stage 1: Findings:
Weighted Estimate (%)
Current mood disorder
Current anxiety disorder
Current psychotic disorder
Current eating disorder
Any current disorder
Past/lifetime mood disorder
Past/lifetime psychotic disorder
Any past/lifetime disorder
‘Likely’ case of PD
Substance Misuse
• 55.5% scored 8+ on AUDIT – strong likelihood
of hazardous/harmful alcohol consumption
• 40% of the above participants reported
accessing a substance misuse service
• 12.1% scored 11+ on DAST – substantial/
severe levels of drug use
• 88% of the above participants reported
accessing a substance misuse service
• 72% of those assessed to have a current
mental illness also had a substance misuse
• 89% of those with a current mental illness
also had a personality disorder
• Those with a current mental illness had a
higher mean level of need than those
without (mean CANFOR-S scores of 10.53
and 4.59)
• There was a statistically significant
difference between these two groups in
terms of their ‘met’ and ‘unmet’ needs
scores at the p=<0.05 level
Access to Services
• Overall low levels of service access were
• No mental health service access was
reported by:
– 60%
– 59%
– 50%
– 75%
– 55%
current mood disorder cases
current anxiety disorder cases
current psychotic disorder cases
current eating disorder cases
‘likely’ cases of PD
Stage 2
Stage 2: Aim
• Compare findings from stage one
interviews to information in probation case
files to determine:
– the extent to which probation staff were
aware of and recording offenders’ mental
health and substance misuse problems
– What is recorded about offenders’ access to
health services in probation files
Stage 2: Findings: Recording
of Disorders/Substance
• Findings for ‘complete’ files suggest that the following
proportions of cases identified in stage 1 interviews were
also recorded in probation files:
current mood disorder: 73%
current anxiety disorder: 47%
current psychotic disorder: 33%
current eating disorder: 0%
likely PD: 21%
– 11+ on DAST: 83%
– 8+ on AUDIT: 79%
Access to Services
• In a third of cases participants told a researcher
that they were accessing a mental health service
but this was not recorded in their file
• Qualitative data highlighted the following
barriers to service access:
– Motivation
– Dual diagnosis
– Services’ referral criteria
Derbyshire Example of Good
The Situation in Derbyshire
• One of few areas to have an HNA but now eight
years out of date (2008)
• From series of FOIs to MH Trusts one of the
better models in operation
• Consisting of m-d support from CJ MHT to
probation both face-to-face and by phone
• Weekly clinics at 6 probation offices
• Does the resource impact on MHTRs? Improve
Implication for MH Crisis
• CCGs are required under the Crime and
Disorder Act (1998) to work in partnership with
the police in Community Safety Partnerships
• These partnerships should make strategic
assessments of crime, anti-social behaviour,
substance misuse and develop local strategies
• NHS England as part of it’s Parity of Esteem
programme will produce effective tool/resources
for commissioning
Probation and the Concordat
• Need an integrated response to mental health
crisis across the CJ system
• How? The Concordat states ‘through preventing
crisis through early intervention and prevention’
• ‘Meeting the needs of vulnerable people in
urgent situations’
• An element of this has to be improved MH
services for those who are offenders in the
Models of MH Intervention in
• The Lincolnshire Model ? Health support service
offering connection with services and some
intervention. No impact on uptake of MHTRs
• The US model? Training probation staff to be
specialist mental health practitioners – needs
evaluation in UK context
• The Northern Ireland model ? six clinical
psychologists working full-time on assessment
and treatment – unaffordable.
• The Milton Keynes model? Clinical
psychology input for people on MHTRs
• Requires magistrate training and clinical
psychology resources (IAPT?)
• Indication are a tenfold increase in MHTRs
in first six weeks (from 3 in 2013 to 30 in
first six weeks)
• Outcomes and re-offending rates unknown
Contact Details
• Professor Charlie Brooker
[email protected]
07540 307525
This PowerPoint presents independent research commissioned by the National Institute for Health Research (NIHR)
under the Research for Patient Benefit Programme. The views expressed in this presentation are those of the
authors and not necessarily those of the NHS, the NIHR or the Department of Health

Probation and Mental Health - Office of the Police and Crime