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Offenders with mental health problems need improved and on-going access to health care, according to the first study to systematically examine healthcare received by offenders across the criminal justice system.

A new report from Peninsula College of Medicine and Dentistry, Plymouth University, and the Centre for Mental Health, suggests that prison and community sentences offer the best opportunities to provide this. If improvements to mental health are to contribute to breaking the cycle of repeat offending, unemployment and ill-health, advantage should be taken of the new commissioning opportunities to develop innovative healthcare solutions.

The study was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) programme with support from the NIHR Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC).

The COCOA (Care for Offenders: Continuity of Access) research study shows that support for offenders with mental health problems falls substantially short of the treatment available for those with addictions. Offenders reported low levels of health care contact for common mental health problems and comparatively high levels of contact with specialist drug services, particularly those using heroin. Analysis of the interview data also showed that offenders contributed to low take-up of care by not always understanding how accessing healthcare could support their housing, employment and relationship goals.

Researchers interviewed 200 offenders, passing through police stations, courts, prison and the probation service, to document both their health needs and the care provided. It also examined two whole system, and six best practice, organisational case studies in order to incorporate the practitioner perspective. The most successful of the initiatives studied allowed offenders to get support that they saw as relevant to their own situation; they also created strong links, between the health and criminal justice systems, as well as across the prison/community divide.

The report concludes that liaison and diversion services, now being developed across England will need to provide a degree of on-going care and not just simply divert people to existing, hard pressed, specialist mental health services.

Dr Richard Byng, GP and Clinical Senior Lecturer at Peninsula College of Medicine and Dentistry, Plymouth University, said: "We know that access to, and continuity of, health care for offenders is poor. Many do not trust public services or do not want to admit to having a mental health problem."

"It is not enough simply to divert individuals with mental health needs to mental health services. We need to work with offenders under prison or probation supervision to help them to take steps to improve their health alongside support for housing, employment and relationship needs."

Centre for Mental Health Chief Executive Sean Duggan said: "Most prisoners, and many people on the probation caseload, have a mental health condition. It is important that these people are able to get access to mental health support as part and parcel of help with their most urgent needs. This should include equal access to Improving Access to Psychological Therapies (IAPT) services for offenders."

Source: The Peninsula College of Medicine and Dentistry