Some Facts about Probation

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Some Facts about Probation

• 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 handling

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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.

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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

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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

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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 prisoners
• Problems of alcohol/Drug misuse and suicide
  exceeded those in prisons
• 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

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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

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An Investigation into the Prevalence of Mental
Health Disorder and Patterns of Health Service
Access in a Probation Population

• Professor Charlie Brooker Royal Holloway,
  University of London

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Stage One
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Stage 1 Aims

• Stage one investigated
• The prevalence of mental health disorder and
  substance misuse in a probation population

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Stage 1 Method
All participants interviewed up to the Amended
PriSnQuest Those screening positive on this tool
a sub-sample for a false-negative check
complete the remaining tools
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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

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Stage 1 Findings Prevalence
Disorder Weighted Estimate ()
Current mood disorder 18.0
Current anxiety disorder 27.0
Current psychotic disorder 11.0
Current eating disorder 5.0
Any current disorder 39.0
Past/lifetime mood disorder 44.0
Past/lifetime psychotic disorder 18.5
Any past/lifetime disorder 49.0
Likely case of PD 47.0
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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

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Comorbidity

• 72 of those assessed to have a current mental
  illness also had a substance misuse problem
• 89 of those with a current mental illness also
  had a personality disorder

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Needs

• 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 plt0.05 level

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Access to Services

• Overall low levels of service access were
  reported
• No mental health service access was reported by
• 60 of current mood disorder cases
• 59 of current anxiety disorder cases
• 50 of current psychotic disorder cases
• 75 of current eating disorder cases
• 55 of likely cases of PD

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Stage 2
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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

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Stage 2 Findings Recording of
Disorders/Substance Misuse

• Findings for complete files suggest that the
  following proportions of cases identified in
  stage 1 interviews were also recorded in
  probation files
• Any current mood disorder 73
• Any current anxiety disorder 47
• Any current psychotic disorder 33
• Any current eating disorder 0
• Any likely PD 21
• 11 on DAST 83
• 8 on AUDIT 79

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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

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Derbyshire Example of Good Practice
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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
  outcomes?

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Implication for MH CrisisConcordat

• 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 its Parity of Esteem
  programme will produce effective tool/resources
  for commissioning

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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 community

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Models of MH Intervention in Probation

• 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.

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(Continued)

• 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

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Contact Details

• Professor Charlie Brooker
• cbrooker_at_rhul.ac.uk
• 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