Assessment of the need for and implementation of Mental Health First Aid (MHFA) in north-east England

Paul Biddle

University of Northumbria

1. The Presentation

• Findings from a research project that examined the need for and implementation of MHFA in north-east prisons.

• Funded by the North East Offender Health Commissioning Unit.

• Undertaken in 2010-11

• Principal Investigator: Dr. Wendy Dyer

2. Background and Context

• Prisoners are at greater risk of experiencing poor mental health than the overall UK population.

• Since the 1980s the proportion of the prison population showing signs of mental illness has increased sevenfold.

• High rates of self-harm and suicide.

3. Background and Context

• The extent of mental health issues in the prison population has been increasingly recognized by policymakers and those commissioning and delivering services.

• Mental health services for prisoners have been expanded and improvements made:

– Creation of Mental Health In Reach Teams

– Development of the Care Programme Approach

– Prior to the recent public expenditure cuts, funding for prison mental health in-reach had increased substantially.

4. Background and Context

• Ongoing policy commitment to improve outcomes:

• Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders’ (2010) and

• No Health without Mental Health’ (2011) recognised the importance of effective mental healthcare for offenders to reduce re-offending.

5. Background and Context

• Despite improvements, problems remain with mental health services for prisoners:

– Under-staffed services

– Difficulties achieving ‘equivalence of care’ to ensure prisoners receive interventions broadly comparable with those available in the community

– Mental Health In Reach Teams struggle to cope with demand and lack clarity of purpose:

• Some focus on severe cases

• Some provide a more generalist service

6. Background and Context.

– Wider prison staff lack sufficient capacity and training to intervene to support prisoners with mental health issues.

– Limited integration, collaboration and partnership working between individuals, functions and prisons - and between community-based mental health services.

– Security priorities can influence ability to deliver optimal services.

– Unmet need - A cohort of prisoners exist with mental health issues just below the level of severity required to trigger an intervention.

– Prisoners face difficulties accessing information, advice and guidance about therapies and medication options.

7. MHFA• A course aimed at those with little or no knowledge of how to

help someone who is suffering from a mental health problem.

• Designed to enable someone to help an individual experiencing a mental health problem prior to professional help being obtained.

• Provides information about recognizing and responding to a range of mental health problems including:

– Depression

– Suicide

– Anxiety Disorders

– Self Harm

– Psychotic Disorders

8. MHFA

• Regulated by the National Institute for Mental Health in England and the Care Services Improvement Partnership.

• A 12 hour course to enable participants to:

– Recognise distress

– Have confidence to provide immediate interventions

– Help and guide a person to wider support.

• Those participating in the training and qualifying (via successful completion of activities and assignments) become MHFA instructors who can train colleagues in their own organisations

9. Methodology

• 2 stages:

– Stage 1 – • Literature review

• Attendance at MHFA training

• Interviews with 35 individuals in who worked in a range of roles within the 3 prisons to explore existing levels of knowledge, capacity, responses across each prison

– Stage 2• Interview with 5 staff who had received MHFA training (represents half

of the 10 staff who were trained at the point stage 2 began)

• Explored impact and roll-out of MHFA

– Stage 3• Currently undertaking a follow up to gain information to inform a journal

article.

Evaluation Findings

10. Stage 1 - Needs Assessment

• Improvements to mental health services in all 3 prisons in recent years.

• Staff had received variable and limited training around mental health issues (focus on suicide, self harm and ACCT). Reliance on experience to identify prisons with mental health issues.

• Limited knowledge of mental health, how to recognise these conditions and appropriate responses.

• Limited time and resources to respond to prisoners with suspected mental health issues.

11. Stage 1 - Needs Assessment

• Wing staff often provide the initial response to inmates experiencing a mental health crisis.

• Response to suicide and self harm are increasingly effective.

• Responses to other mental health issues more variable and are influenced by:

– Training and experience

– Prisoner staff relationships

– Time

– Individual staff understanding of their role

12. Stage 1 - Needs Assessment

• Those prisoners whose conditions do not have implications for the smooth operation and good order of the prison can be missed.

13. Stage 1 - Needs Assessment

• MHFA could potentially assist prisons to:

– Better identify prisoners with mental health issues

– Give staff more knowledge of more conditions and how to respond appropriately to these

– Increase institutional capacity to respond to the mental health issues of prisoners.

14. Stage 2 - Implementation Findings

• Core group of staff trained who had various roles in their respective prisons:

– Wing Staff

– Reception Staff

– Staff with ACCT management responsibilities

15. Stage 2 - Implementation Findings

• Those trained reported:

– Greater awareness and understanding of mental health problems that prisoners may have

– Improved understanding of how to respond to inmates suspected of mental health problems

– A greater awareness of community-based services inmates could be referred to

16. Stage 2 - Implementation Findings

• Instructors have trained colleagues in two prisons, with training planned in a third

• Instructors selected colleagues who were the easiest to organise training for, not those for whom training might have been most appropriate.

17. Stage 2 - Implementation Findings

• Lack of strategic management and delivery of MHFA across the regional prison estate

• Ltd commitment from senior management to roll-out MHFA???

• Roll out of MHFA compromised by difficulties releasing staff for training.

• Participation in MHFA training not mandatory – crowded out by other training that has to be undertaken. Exacerbated by difficulties back-filling staff on training.

18. Stage 2 - Implementation Findings

• The details of MHFA-trained staff were not formally disseminated to colleagues so they could be contacted to provide information/advice to other prison staff.

• Maintenance of Instructor status is likely to be problematic as instructors cannot train sufficient colleagues in time periods required.

• Stage 3 findings suggest few, if any, instructors have delivered training since March 2012.

19. Conclusions

• MHFA can be a valuable part of a wider approach to improve responses to prisoners with mental health issues

• MHFA cannot replace specialist mental health services in prisons.

• A missed opportunity – the value of MHFA undermined by its roll out?

20. Recommendations

• Strategic management and commitment, with strong institutional messages about the importance of MHFA.

• Publicise details of those trained throughout each prison so relevant staff can be a resource for their colleagues.

• MHFA training for both staff AND prisoners.

• Explore delivery of shorter MHFA course

Assessment of the need for and implementation of Mental Health First Aid (MHFA) in north-east England

Mr Paul Biddle

University of Northumbria