People in contact with the criminal justice system suffer from some of the starkest health inequalities in the country, with higher health needs and poorer health outcomes than the general population. Many in this group engage in high risk behaviour, have limited contact with primary care services and do not manage existing health issues effectively. They are over represented in the use of emergency services, resulting in greater cost to the system and less positive outcomes.
Self inflicted deaths are five times more likely in prison than in the general population. 15% of men and 25% of women in prison report symptoms of psychosis, compared to just 4% of the general public. Nearly a third have a learning disability or difficulty. 80% of older people in prison are estimated to have a long standing illness or disability. In a 2009-10 study, 35% of adults starting community orders reported having a formal diagnosis of a mental health problem. Of those who received a formal assessment, 32% were identified as having a drug misuse need and 38% an alcohol problem.
These health inequalities intersect with other disparities faced by people in the criminal justice system. For example, people from black and minority ethnic communities, who are overrepresented in the criminal justice system, are 40% more likely than non BAME people to access mental health services via a criminal justice route, but underrepresented in prison mental health caseloads. For people with multiple and complex needs, health is one of a number of vulnerabilities for which they will need holistic support.
Despite these high levels of need, they are less likely to access mainstream health services. When they do, they may have to overcome stigma and other barriers in order to access the care they need.
Organisations tell us that the mental health needs of their clients are becoming more acute as a result of not being able to access the support they need from community mental health providers, who have either reduced their services or have raised their threshold for services.
This can have a big impact on voluntary organisations, who are increasingly required to meet the mental health needs of their clients, as the safety net provided by public services continues to reduce.
Health and offending are also often interrelated. Health issues such as substance misuse or mental health problems can lead to contact with the criminal justice system. Addressing the health needs of this group can reduce reoffending, and have a positive impact on the overall health of their communities.
Voluntary sector organisations are key to providing effective health and social care for people in the criminal justice system. They play a vital role in reducing health inequalities. They work hand in hand with local health services to provide flexible, holistic support for people who face significant barriers to getting the health and care services they need. Our members continue to successfully develop and deliver flexible and person-centred approaches to supporting people who have offended and who wish to stop.
As well as delivering frontline health services, they support people to access and engage with health providers, provide holistic support, accompany people to appointments and assist them to understand and manage their health needs.
Are you looking for voluntary organisations working in health and justice? Browse our Directory.
Read Clinks case studies showcasing the innovative work of our members working in health and justice.
People in the criminal justice system must have equity of health and social care with the wider population and their health inequalities should be recognised.
Statutory health and social care services must meet the needs of people in contact with the criminal justice system, including those in prison, to reduce health inequalities and improve outcomes. This should include investment in prevention, early identification of physical and mental health needs, learning from people using services, training for sentencers on community drug, alcohol and mental health treatment options and continuity of care for people as they enter prison, move between different prisons or back into the community.
Government should ensure that the commitment that ‘Prisoners get the same healthcare and treatment as anyone outside of prison’ becomes a reality. That means commissioners and providers in the health and criminal justice systems must work together to prioritise improving health and wellbeing and continuity of care.
Voluntary organisations should use evidence about health and wellbeing needs to inform their service design and influencing work and ensure joined up working to signpost people to health services.
What Clinks is doing
Clinks supports the voluntary sector working in health and justice. We advocate for health services to better meet the needs of people in contact with the criminal justice system and for recognition of the role of the voluntary sector.
VCSE Health and Wellbeing Alliance (HW Alliance)
Clinks is a member of the VCSE Health and Wellbeing Alliance, jointly managed by the Department of Health and Social Care (DHSC), the UK Health Security Agency and NHS England. The HW Alliance is made up of 18 VCSE Members that represent communities who share protected characteristics or that experience health inequalities and a VCSE coordinator. Through their networks, HW Alliance Members can link with communities and VCSE organisations across England.
This year, Clinks will be building a network of organisations working with older people in contact with the criminal justice system, looking at opportunities for social prescribing with people in and leaving prison, and developing self-help and peer support resources for black men in prison around epilepsy, PTSD and neurodiversity. Please contact our health and justice lead Olivia Dehnavi if you'd like to be involved in any of this work.
Health and justice bulletin
Members can keep up-to-date on health and justice developments with our monthly bulletin for voluntary sector organisations involved, or with an interest, in the health and wellbeing of people in contact with the criminal justice system and their families.
Advising the Ministry of Justice
Clinks provides the chair and secretariat for an advisory group to the Ministry of Justice (MoJ). The Reducing Reoffending Third Sector Advisory Group’s (RR3) purpose is to build a strong and effective partnership between the voluntary sector and the MoJ.
How to get involved with the Clinks group that advises the Ministry of Justice
Summary note of the RR3 Future Regime Design SIG meeting
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Other sources of support
NHS England Health and Justice commissioning
Rebalancing Act: A resource for Directors of Public Health, Police and Crime Commissioners, the police service and other health and justice commissioners, service providers and users. (Public Health …
Centre for Mental Health has produced a range of publications and research in mental health and criminal justice
Prevalence, patterns and possibilities: The experience of people from black and ethnic minorities with mental health problems in the criminal justice system. (Nacro, 2014)
RECOOP have produced a series of easy-read leaflets for people in prison with social care needs. Register for free.