Choosing Health: Inside and Out'

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Choosing Health Inside and Out.

• Key Issues and Priorities within the East
  Midlands Prisons.
• University of Leicester01.12.2005

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Choosing Health

• .means an approach which respects the freedom
  of individual choice in a diverse, open and more
  questioning society, which recognises the
  realities of the impact of the consumer society
  on those choices which addresses the fact that
  too many people and groups have been left behind
  or ignored in the past
• With regards to mental health
• because mental well being is crucial to good
  physical health and making healthy choices
  because stress is the commonest reported cause of
  sickness absence and the major causes of
  incapacity, and because mental ill-health can
  lead to suicide.

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Some Views

• Prisons are bad for your mental health and if
  you have a pre-existing condition it is likely to
  be exacerbated. We need to go back to basics and
  ask what the mental health needs are, work out
  how to deal with different levels of severity,
  and promote how to look after your mental health
  (Peter Mason, Centre for Public Innovation).
• I should not be put in this position. People who
  are mentally ill should not be in prison. Im
  here to protect the public. (Prison Governor)

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Choice and the Institution.

• The legalistic aspect of the institutional
  culture of prisons requires prisoners to have
  medical consultations before adjudication
  proceedings.
• The institutional culture of prisons restricts
  prisoners ability to self care and almost
  eliminates their access to over the counter
  medication. This allows little opportunity to
  substitute informal and self care for primary
  health care services.
• Institutional culture may also affect the
  threshold at which prisoners are admitted to
  prison inpatient facilities. It is easy to admit
  patients to inpatient facilities as to arrange
  for self management with frequent review.
• On the supply side prisoners have easy access to
  primary care for even trivial complaints. The
  personal cost and inconvenience of seeking
  professional care is therefore low. Even simple
  health problems therefore become medicalised.
• Similarly, compared with the community, prisons
  are relatively well supplied with inpatient
  facilities. Access is clearly also a factor in
  the lower than expected NHS hospital admission
  rate.

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Context Prisons

• 136 prisons in England and Wales
• Approximately 8 high secure, 39 male local, 11
  Cat B, 32 Cat C, 10 male open, 12 female, 14 YOIs
• ADP around 75,000 plus. (77,702 in mid Oct 05)
• Over 200,000 people flow in and out of prison
  each year
• 60 prisoners are under 30 and more than 95 are
  male
• More than 50 in prison less than 6 months
• A prisoner might live in 6 establishments during
  a 12 month sentence.

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Health Of Prisoners

• 90 of all prisoners have a diagnosable mental
  health problem, substance misuse problem or both
• 80 of prisoners smoke
• About 0.3 of the male prisoners and 1.2 of
  females are HIV positive
• 24 of prisoners have injected drugs - of these
• 20 are infected with Hep B, and
• 30 with Hep C
• Around 2 of remand prisoners attempt suicide in
  any given week

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Health of Prisoners contd

• Suicide rates in prison and following release are
  at least six times as high as rates in the
  general community.
• It is estimated that 5,000 (7) prisoners are
  seriously mentally ill
• A fifth of prisoners who misuse illicit drugs by
  injection (about 16,000 prisoners) are infected
  with hepatitis B and 30 with hepatitis C
• Some 13 of the prison population has diagnosed
  asthma

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Suicide In Prison Facts And Figures 2005

• There have been 64 self-inflicted deaths in
  prisons in England and Wales so far this year. 13
  of these happened in the space of a fortnight in
  June.
• Figures collected by the Howard league for penal
  reform show that the 64 include
• Three women
• Two children Gareth price aged 16 who died at
  HMYOI Lancaster farms in January and Sam Elphick
  aged 17 died at HMYOI Hindley in September
• Five 18 year olds, two 19 year olds and three
  20 year olds
• Therefore 12 out of the 64 were aged 20 or
  under.
• The figures show that
• Over half (53) of those who took their own
  lives were on remand
• Hanging was overwhelmingly (97) the most
  common method used
• 19 had been assessed as at particular risk of
  self-harm and suicide and were subject to special
  prison service monitoring arrangements
• 52 were white, nine were black and two were
  Asian (prison service categories)
• The average age at which people took their own
  lives was 32

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Primary Care Consultation Rates

• Male prisoners consult doctors six times per
  prisoner year three times more frequently than a
  demographically equivalent community population.
• Male prisoners consult healthcare workers 23
  times per prisoner year 77 times more frequently
  than men in the community consult nurses (the
  nearest community equivalent to prison healthcare
  workers).
• Female prisoners consult doctors 14 times per
  prisoner year three times more frequently than a
  demographically equivalent community population.
• Female prisoners consult healthcare workers 59
  times per prisoner year, 197 times more
  frequently than women in the community.

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Social Exclusion of Prisoners

• Thirteen times as likely to have been in care
  as a child
• Thirteen times as likely to be unemployed
• Ten times as likely to have been a regular
  truant
• Twenty times more likely than the general
  population to
• have been excluded from school
• 80 have the writing skills, 65 the numeracy
  skills and
• 50 the reading skills at or below the level
  of an 11-year-
• old child.
• Two and a half times as likely to have had a
  family member convicted of a criminal
  offence
• Six times as likely to have been a young father

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Mainstreaming Prison Mental Health

• Womens Mental Health
• Child and Adolescent Mental Health Services
• Black and Minority Ethnic Mental Health
• Suicide Prevention
• Personality Disorders
• Social Exclusion
• Service User and Carer Involvement

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Prison Health Partnerships in East Midlands

• Dales and South Derbyshire PCT
• Newark and Sherwood PCT
• Bassetlaw PCT
• West Lincolnshire PCT
• East Lincolnshire
• Rushcliffe PCT
• Nottingham City
• Melton Rutland Harborough PCT
• Northamptonshire Heartlands PCT
• Daventry and South Northants PCT
• South Leicestershire PCT
• Eastern Leicester PCT

• HMP Sudbury HMP Foston Hall
• HMP Lowdham Grange
• HMP Ranby
• HMP Lincoln HMP Morton Hall
• HMP North Sea Camp
• HMP Whatton
• HMP Nottingham
• HMPs Ashwell, Gartree, Stocken
• HMP Wellingborough
• HMYOI Onley HMP Ryehill
• HMYOI Glen Parva
• HMP Leicester

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Key Review Areas East Midlands.

• Screening and assessment.
• Positive mental health promotion and awareness.
• Primary mental healthcare services
• Case management across the offender and health
  services within the prison
• Psychopharmacology and suicide prevention
  services.
• Effective management of transfer when required.

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Priority Areas

• The effective services and practices the review
  wishes to promote are intended to
• Reduce incidents of harm and attempted harm
• Help prisoners function in prison
• Decrease prisoners symptoms and prevent relapse
• Increase well being of both prisoners and staff.

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Priority Areas

• Management of risk, including violence and
  aggression
• Developing user and carer involvement in
  planning, delivering and monitoring services in
  prison
• Mainstreaming prison work within Local
  Implementation Teams

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Key Priorities

• Mental Health Awareness Training
• Supporting/developing Wing-based Mental Health
  Liaison Officer Role
• Assessment, Care, Custody and Team Work (ACCT)
• Implementation of Care Pathways good practice
  guidance
• Reception and mental health assessment
• Skills training in risk management
• Self harm and suicide risk assessment and
  prevention

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Other Priority Areas

• Young offenders mental health strategy
• Expansion of solution-focused/brief therapy
  approaches
• Improving recruitment and retention in prison
  mental health
• Focus and agree use of prison inpatient
  facilities
• Enrich therapeutic opportunities e.g. day
  services, employment, social inclusion

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Key Deliverables

• Each prison undertakes baseline assessment of
  needs and requirements
• Each PCT has realistic prison mental health
  development plan
• Promote cost-effective delivery across Region
• Co-ordinate and prioritise regional training and
  related initiatives
• Feedback to PCTs, StHAs, Prison Service Area
  Office etc
• Identify collective needs for development and
  modernisation
• Develop effective models of user and care
  involvement

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How Can We Deliver Choice in Prisons. Workshop
Discussion.

• What works and examples from current practice.
• What hinders.
• How to move forward in overcoming barriers