Health needs in prison
Abby Jones
Health and Justice Team North West/
09/12/13
Key principles
• Consistent
• High quality
• Outcomes focussed
• Seamless transfer in provision of service and
ensuring services are integrated
• Same standards and quality of care that could be
expected in the community
• Reducing health inequalities and health risk
factors
• Value for money
2
The NHS Outcomes Framework
2012/2013
3 ]
The Secure Estate
• 120 prisons
• 16 Secure children’s homes (SCH’s)
• 4 Secure training centres (STC’S)
• 12 Immigration removal centres (IRC’S)
• Police Custody Suites
• Courts
• Sexual Assault Referral Centres (SARC’S)
4 ]
Poorer health than general population
•
81% of adult prisoners said they had used illicit drugs at some point prior to entering
prison, including almost two-thirds (64%) within the month before entering prison.
•
Rates of using heroin and crack cocaine were higher among women (44% and 49%
respectively) compared to men (30% reported using both substances during the
year before custody).
•
In a recent survey of prisoners released from custody, 12% of prisoners said they
had a mental illness or depression as a long-standing illness and 20% reported
needing help with an emotional or mental health problem. 17% of prisoners had
been treated or counselled for an emotional or mental health problem in the year
before custody.
•
Female prisoners are more than three times as likely to self-harm as male
prisoners.
5 ]
Young people
• Children and young people in contact with the youth justice system have high levels of
vulnerability: over one quarter have been looked after children at some point.
• The proportion of children and young people in custody who have experienced serious
child maltreatment is at least twice that in the population as a whole.
• Children and young people in the youth justice system are at least 3 times as likely to
have mental health problems than their non-offending counterparts, and interaction with
the YJS, particularly being in custody, can exacerbate their mental health problems.
• The rates of smoking, drinking and use of illegal drugs are substantially higher among
young offenders than among young people who do not offend.
6 ]
Needs and Circumstances
• a higher burden of disease(including infectious diseases, chronic illnesses)
• Damaged and chaotic families
• Substance dependence
• Mental Health and personality disorders (The Bradley Report 2009)
• Abuse and Domestic Violence
• Homeless or without settled accommodation
• Poor Physical and/or dental health
• Finance and debt
• Lack of education and skills
• Any mixture of the above
7 ]
The Female Estate
• Much more prevalence of complex issues in the Female
Prison Estate (Corston Report Home Office 2007)
66% women sent to prison have children
95% of those children do not stay in the family home if
their mum is sent to prison
• In terms of healthcare add:
• Gynaecology
• Maternity
• Care of babies
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Barriers
• Poorer health than general population and complex Issues
• Significant premature mortality- 40% of natural deaths in custody are due to coronary artery
disease, including those under 40, 25% of such deaths related to cancer.
• Sentence Length
• Delivery of health services in a prison regime
• Constraints
• Lock downs
• Enabling
• Out patient appointments
• Continuity of care and transfer back into the community- failure to engage
9
Prison as a health opportunity ?
• A truly captive audience
• People in prison use primary care services at greater frequency and intensity than their
peers in the community, especially young men. This is completely reversed on return to
the community, where their use of services is much lower than that of their peers.
• Prisons are fertile environments for recovery
• Positive health experience in custody CAN have a positive ripple effect on release on
families and social networks
• North West – detox (we can barely keep up)
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Who Recovers?
1.
Everyone CAN recover
2.
Not everyone WILL recover
3.
We don’t know WHO will recover
4.
So, give everyone EVERY CHANCE
Bio Medical
Psycho
therapeutic
Social networks
•Jobs
•Houses
•Friends
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Thank you.
abbyjones@nhs.net
any questions?
07796994586
Manager
Through the Gate-Substance misuse
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