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Offender health: the next frontier

  • Louis Appleby (a1)
Summary

Offender health is an important part of general mental healthcare. To improve the health of offenders, we need reforms similar to the reforms in community care of the last decade – early intervention, alternatives to the institution and multi-agency community services. Front-line clinicians are in a key position to bring about such reforms. It will be crucial to argue that improvements in offender health will help bring about broader government aims such as reduced reoffending.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Louis Appleby (louis.appleby@dh.gsi.gov.uk)
Footnotes
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See commentary, pp. 411-412, this issue.

Declaration of interest

L.A. is National Clinical Director for Health and Criminal Justice.

Footnotes
References
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1 Singleton, N, Meltzer, H, Gatward, R, Coid, J, Deasy, D. Psychiatric Morbidity among Prisoners. Office for National Statistics, 1999.
2 Stewart, D. The Problems and Needs of Newly Sentenced Prisoners: Results from a National Survey. Ministry of Justice, 2008.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Offender health: the next frontier

  • Louis Appleby (a1)
Submit a response

eLetters

Don�t forget offenders with a learning disability

Dr Claire Royston, Medical Director
08 November 2010

Louis Appleby’s editorial on how best to tackle offender health, particularly mental ill health and substance misuse, was a stimulating read.

However it contained no reference to the estimated 5,800 prisoners with a learning disability within the prison system. This group of offenders are effectively excluded from interventions within prisons aimed at reducing re-offending. Moreover, research from the Prison Reform Trust indicates that individuals with a learning disability in prison suffer routine human rights abuses, are five times more likely to be restrained and three times more likely to be segregated compared to the non-learning disabled prison population. These are harrowing statistics (1).

Louis Appleby highlighted three essential service provision aims for offenders with mental ill health. These were early intervention, alternatives to prison, and multi-agency packages when leaving prison. Any services and interventions established to meet these aims for individuals with mental illness would not necessarily meet the needs of offenders with a learning disability. It is essential that thought is given to the means of providing appropriate support for them.

Throughout British psychiatric and mental health history - from the closing of the Victorian asylums to community care and revisions to the Mental Health Act - policy has always been weighted more towards people with mental heath problems than those with a learning disability. We should redress this imbalance.

Since Lord Bradley’s report (2), important steps have been taken to try and improve away-from-prison diversion schemes for offenders with a learning disability. These include piloting a screening questionnaire for learning disability, due to be available in prisons next year.

It is vital that the coalition government continues to support the development of strategies for learning disabled offenders, as well as those with mental health problems. Budgetary restrictions should not be allowed to impede this work.

Many people appear unaware of the role of the independent sector in providing care and treatment for an increasing proportion of this patient group. The thirteenth Biennial Report of the Mental Health Act Commission revealed that in 1998 15% of individuals with a learning disability were detained within hospitals in the independent sector. This had grown to 46% of individuals (545 of 1184) in 2008. Moreover, in 2007/2008 a total of 67 section 37 Hospital Orders were made (restricted and unrestricted) of which 42 individuals were placed within the independent sector. (3).

Collectively the independent sector has immense expertise in how best to provide tailor-made and specialist care to this patient group. However, at a strategic level the independent sector is only consulted at a superficial level regarding the future development of services to meet the needs of this patient group. This may reflect a guardedness in relation to the commercial foundations of the independent sector This might be linked to a misunderstanding of the funding basis of the independent sector. In regard to the provision of services to patients with a learning disability all care is funded from the NHS or social services, not by the individual receiving care. In effect the independent sector works in clinical partnership with the NHS as its agency to develop and provide such care. Given this level of co-operation and the expertise of the independent sector it seems surprising that the input from the independent sector is missing from the strategic development of services for this very vulnerable group of individuals.

1. Prison Reform Trust. No One Knows, 2007

2. Lord Bradley. Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system, 2009

3. The Mental Health Act Commission 13th Biennial Report 2007-2009.
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Conflict of interest: None Declared

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Changing offender mental health services

rafiq a memon, psychiatrist
08 November 2010

Very occasionally, I awake at night worrying about a patient. This arises from a sense of emotional commitment and personal responsibility. It's the way I was engineered.

Appleby, in his editorial on offender health describes six steps to reform. He presents a rational argument for change. I agree a rational approach is needed. But, I submit, there needs to be an emotional argumentas well. It seems to me a combined rational and emotional approach is morelikely to work. To change minds is one thing, but to change their attachedhearts is another.

Perhaps when influential people awake at night worrying about offender health then services will change in the daytime. I say this out of hope and sincerity.

Declaration of interest: The author is a medium secure hospital psychiatrist and was for five years also a prison psychiatrist.

Dr Rafiq MemonConsultant Forensic PsychiatristReaside ClinicBristol Road SouthRednalBirminghamB45 9BE

tel: 0121 678 3000fax: 0121 678 3089
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Conflict of interest: None Declared

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