Friday, 20 November 2015

What Health Care?

Here's an interesting LSE blog that contains information long known to all probation staff, but that may come as news to the privateers now running 70% of probation:- 

Healthcare policy for those on probation operates on a wing and a prayer.

Over 200,000 offenders on are probation in the UK. Recently, probation has been extended to all those released from prison. Offenders are often socially excluded, deprived and highly vulnerable, with a high prevalence of physical and mental health problems compared to the general population. Here, Charlie Brooker outlines how this vulnerable population can fall through gaps in healthcare policy.

Comin’ in on a wing and a prayer
Comin’ in on a wing and a prayer
Though there’s one motor gone
We can still carry on
Comin’ in on a wing and a prayer
(Adamson and McHugh [1943] – songwriters)

Previous research estimates that 39 per cent of offenders experience a mental illness whilst on probation. Suicide rates in prison rightly receive much media attention, yet suicide rates in probation are also much elevated in comparison to the general population but receive little consideration. Mental health treatment requirements exist as a sentencing option for the courts when considering prison or probation for an offence, but they’re rarely used. Nationally, they constitute 0.1 per cent of all requirements.

The health of probationers compares highly unfavourably with the general population, and even with the more unhealthy of the population (the lower social classes). This is the case for both physical and mental health.

Many offenders have (co-occurring) substance misuse problems. In the first two weeks following release, mortality rates are 12 times higher than for the general population. In a nested case control study, Bingswanger and colleagues established some of the clinical risk factors involved. These included: injecting drug use; tobacco use; cirrhosis; panic disorder and use of psychiatric medications. Probationers also experience elevated levels of long-term illness and disability.

The need for continuing and integrated healthcare is clear.

However, issues like mistrust of healthcare professionals, transient lifestyles, negative attitudes amongst healthcare staff towards offenders, problems with inter-agency communication, and inflexible/insufficient service provision mean that offenders’ access to healthcare is less than their needs. Many offenders are not registered with a GP and only access healthcare during crises.

To improve the health of this population and reduce health inequalities it is essential that they have access to health services which meet their needs. This would also enable us to uphold the principle of equivalence and reduce both re-offending and the use of crisis services (and the costs associated with this).

Probation services and arrangements for commissioning healthcare for offenders have both been the subject of recent reforms. Probation provision is now split into the National Probation Service – a public-sector service managing high-risk offenders; and Community Rehabilitation Companies – a mix of private and voluntary sector agencies managing medium and low-risk offenders.

Clinical commissioning groups should now commission healthcare for offenders on probation, but previous research suggests that many of them are unaware of this responsibility. The most recent study found that in 2013, 7 per cent of these groups directly funded healthcare in probation, a figure that declined to 1 per cent in 2014. Such commissioning should be informed by Joint Strategic Health Needs Assessments overseen by Directors of Public Health. It is iniquitous that all 136 prisons in England and Wales have been subject to local health needs assessments by either NHS England Area Teams or local public health groups whereas the same is true of only 25 per cent of probation services.

Some Mental Health Trusts do fund ‘own account’ mental health services into probation from their block contracts, but again this proportion has declined from 70 per cent in 2013 to 61 per cent in 2014. The two most likely services provided were clinics in probation offices and support for multi-agency public protection arrangements – the latter being a statutory responsibility. Clinic services vary but often consist of two hours per week where a mental health professional is available to give advice. There has also been a recent national initiative to provide professional support in probation for those with personality disorder. However, the impact of this scheme has yet to be reported.

Previously, government has outlined a role for the probation service in England and Wales in offender health involving advising the courts on alternatives to prison, and working in partnership with other agencies to ensure that offenders’ health and social care needs are addressed. There are links between health and offending, and health interventions can reduce crime. Improved health has been cited as a pathway out of re-offending, and considering offenders’ physical and mental health needs in sentence planning using the Offender Assessment System screening tool is an established part of probation staff’s role. However, there are concerns that local-level partnerships between probation and health services may break down following the restructure of probation and (for the reasons stated above), improving offenders’ health and access to healthcare remains a challenge.

Due to this high level of health needs and disproportionately low level of service access, the NHS, through clinical commissioning groups, should be commissioning healthcare locally for probationers with an in-depth understanding of needs and with a view to removing current barriers to service access for this population. Until then ‘we’re comin’ in on a wing and a prayer’.

19 comments:

  1. Before I left the Probation Trust I had worked at for a number of decades I prepared a paper for a local authority public health board on this very topic.It made depressing reading as then funding was being clawed back on modest but effective projects.I am now working in a NHS funded post and seeing the same issues from the other side.
    Former Anon SPO no 2

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  2. Guess what? One former probation trust pioneered several joint initiatives with the NHS before TR. Ex offender peet mentor health trainers, IAPT CBT counselling clinics for cases suffering from depression, regular clinics where a CPN was able to do a mental health screen and refer straight to local services and a dedicated PD service staffed by a forensic psychologist to advise Om's on the management of people with complex PD's and provide training. Awards have been won and plaudits rightly gained for these initiatives. They carry on in various guises post TR. The point is that these INNOVATIVE PARTNERSHIPS WITH OTHER AGENCIES were pioneered by a Trust who were meant to be rubbish at that sort of thing. Charlie Brooker's excellent article highlights some massive problems and a clear link between health and desistance. At least one Trust, and I'm sure many more, recognised and acted on this without the need for the skills and innovation of the private sector. Can any of the occasional CRC flag wavers cite any similar activities post TR. I hope they can.

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  3. This plethora of articles, "names" & publicly expressed opinions about probation are very welcome but somewhat belated. However, mustn't grumble. The TR process only cost me my job, my career & my health.

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    1. Really sorry to hear this. It's a big ask, but could you consider writing something to publish as a guest blog, anonymised obviously?

      Thanks.

      Delete
  4. BTW Jim, no blog on the NPS people survey yet? It's a shocker. Three quarters of NPS staff unhappy with pay, career progression and training and with the ability of the centre to run the service. Tiny confidence that their voice will be heard if they speak out and a fear of doing so. Shockingly, 25% of the respondents in one LDU say they want out in the next 12 months. These kind of numbers in a private sector organisation would prompt shareholder panic, changes at the top and some proper reform to ensure profitability. What will the NPS do? Probably nothing If the survey is anything to go by. Very few respondents believe action will be taken on the results. Don't get me started on bullying numbers. They're shocking too. Come on Jim and NAPO and UNISON make some hay with this.

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    1. It's on my list of things to address - but it would be really helpful if some kind person could knock something together in the form of a guest blog - or forward the document, or link to the document.

      Thanks.

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    2. have been trying to find survey results, not available in my area where do I look???

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    3. The raw data is here: https://www.gov.uk/government/collections/civil-service-people-surveys

      I haven't seen any report on the results - the 2014 report was published in Feb this year.

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  5. If your unhappy in the NPS then cone join the party in the CRC!

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    1. Which CRC do you work for?

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  6. What party would that be? PO's and PSO'S leaving our CRC in droves

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  7. Replies
    1. I'm in the CRC and whilst no 'party' do appear to be having a smoother time than my colleagues in the NPS. One can only guess at the responses to the staff survey given the lack of information coming out. Is this an issue that the Unions could investigate?

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    2. 15.35 How dare you accuse me of lying.

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    3. 23.57 I just did. Deal with it

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  8. The link between vitamin D (sunlight deficiency) and depression is well known, the why is not understood completely. We know that there are vitamin D receptors in areas of the brain that are linked to depression. Many anti-depressant medicines work by increasing the amount of chemicals called mono-amines in your brain, there is a theory that triggering the D receptors increases the natural production of mono-amines.
    Studies in the USA found that most prisoners incarcerated for a year had blood samples deficient in vitamin D. The deficiency was proportional to the time that the regime allowed outside, all being on the same diet.
    Vitamin D supplement would cost 80 pence per person per day, fresh air and sunshine is cheaper.

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  9. I am always desperately trying to get MH requirements but it seems no one wants to provide the treatment!! I'm on with one case since July back and forth to Crown Court trying my level best with no success ! I don't know how those with mental illness cope with the frustrations I've encountered

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  10. I am having to raise one of mine to MAPPA level 3 to try and secure mental health treatment despite having 5 different psychological reports suggesting treatment necessary to manage clinincal risk and need �� the amount of time spent on referrals and chasing had been massive.

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  11. Hope Probation Officer doesn't mind this link - maybe someone can get the image on here?

    https://mobile.twitter.com/PoOfficer/status/668077149203652613?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Etweet

    ReplyDelete