Priorities for prison health and social care research

Clair ChilversResearch Director

Health and Offender PartnershipsDirector

Forensic Mental Health R&D Programme

Outline

• Health and Offender Partnerships Research Strategy

• Current and recently completed prison health research: examples

• Best Research for Best Health

• Sources of Funding

Health and Offender Partnerships Research Strategy:

Overview

• Process of consultation with heads of Units

• Formation of HOP Research Forum

• Priorities to be decided against policy priorities

• Identification of sources of funding

Characteristics of the prison & secure hospital population & disease

prevalence

• What impact does the prison environment have on health and wellbeing? (Shaw; Taylor; Dolan)

• What are the positive impacts on health?

• What are the rates of suicide and self-harm in subgroups? How do they compare to the general population? What are the characteristics of prisoners who self-harm? (Pratt; Shaw)

• Development of an epidemiological overview to inform commissioning of secure hospital provision (Thornicroft)

Access to services

• How can prison healthcare services be organised to ensure continuity of care, for prisoners moving through the CJS? What role could offender managers have in facilitating care? (Shaw)

• How can waiting times for transfer of prisoners to hospital be reduced?

• What is the impact of health and social care services on ‘revolving door’ prisoners? (Shaw)

• What are the health and social care needs of particular groups (women, BME groups, young offenders) and how can they be met?

Models & organisation of service delivery

• How can primary healthcare services be organised

to ensure equality of access? (Shaw)

• What are the most cost-effective ways of providing

hospital care for prisoners?

• What can be done to ensure the interface with

services on discharge from prison?

• What is best practice for learning disabled

offenders? (O’Brien)

Staffing and training issues

• What are the minimum staffing and training levels

for healthcare staff? (Jenkins)

• Can changing professional roles and delegation to

non-clinical staff improve healthcare provision?

• How can recruitment be maximised?

• What are the occupational health needs of staff

working in prisons?

Cultural & organisational issues: tension between CJS and NHS

• What is the impact of violence reduction strategies?

• What are the most effective ways of blocking drug supply into prisons: how does treatment affect demand (and supply)?

• Young offenders: what is the evidence base for a tiered model of mental health care? (Shaw; Clark)

• How can the evidence base be best disseminated throughout NOMS?

Assessment, screening and interventions

• What is the current provision and contribution of psychological services across NOMS?

• What individual interventions have proven efficacious in the prevention of suicide and self-harm?

• What is the impact of the ‘listeners’ scheme on suicide and self-harm?

• How is violence or threat of violence best managed? (Leitner)

• Young offenders: what is the effect of the mental health screen with follow-up plan of care?

Medico-legal, ethical & criminological issues

• What are the links between mental disorders and

offending? (Taylor; Hodgins; Thornicroft)

• What are the pathways from local authority care to

offending, and to self-harm both in prison and the

community?

• How can escalation in offending be prevented?

Financial & resource issues

• Development of an economic model for the DSPD

Programme: how cost effective is it?

• Economic modelling of health and social care

systems across the CJS (development of

standardised unit costs)

Current & recently completed prison health research: examples from the

FMH R&D programme

• Evaluation of prison mental health in-reach services (Shaw)

• Assessing needs for psychiatric treatment in prisoners (Bebbington)

• Factors mediating the effect of the prison environment on mental health (Taylor)

• RCT of the efficacy of SSRIs in the treatment of sex-offenders (Grubin)

• Effect of prison on the mental health of young offenders in YOIs (Dolan)

Best Research for Best Health

• New strategy for R&D in the NHS

• Key points:– National Institute for Health Research Faculty– Funding more transparent– Small number of Biomedical Research Centres – Programme grants to consortia of NHS

Trusts/Universities– New regional response mode funding scheme

Research for Patient Benefit– Focus on the NHS

Sources of funding for Prison & Offender Research in Social Care

& Health

• NHS R&D funding streams– Health Technology Assessment Programme– Service Delivery and Organisation Programme– Research for Patient Benefit response mode

schemes– Research Capacity Development Awards

• Medical Research Council• Wellcome Trust• Prison charities• Big Lottery Fund (through voluntary sector partners)