Health inequalities in the criminal justice system
People in contact with the criminal justice system are far more likely to experience health inequalities than the general population, according a report published last month by the Revolving Doors Agency.
Evidence suggests that people who have offended or who are at risk of offending frequently experience multiple and complex health issues including mental and physical health problems, learning disabilities, substance misuse and are at increased risk of premature morbidity.
Directors of public health share responsibility for health inequalities among people in the community who are in contact with the criminal system and the briefing paper by the Revolving Doors Agency makes a number of recommendations on how directors of public health can tackle this challenge.
The report highlights some key issues:-
- Mental health needs among those in contact with the criminal justice system are often complex, with comorbidity the norm among this group. In a study of prisoners, 72% of male, and 71% of female prisoners were found to suffer from two or more mental disorders (including personality disorder, psychosis, neurosis, alcohol misuse and drug dependence). 20% suffered from four.
- Many people in contact with the criminal justice system have experience of interpersonal trauma, particularly women offenders. This has been linked to the onset of a range of mental health problems including posttraumatic stress disorder, depression, anxiety disorders and substance misuse.
- 29% of prisoners report having experienced emotional, physical or sexual abuse as a child, with the percentage much higher among women prisoners. Limited availability of trauma informed mental health services can lead to poor responses to this client group.
- People with learning disabilities are at increased risk of a range of physical health conditions, including respiratory disease, coronary health disease, as well as some mental health conditions, including schizophrenia. However, difficulties in understanding and communicating health needs, a lack of support to access services, discriminatory attitudes among health care staff and failure to make ‘reasonable adjustments’ can create significant barriers in progressing within mainstream healthcare services.
- Alcohol misuse is often directly linked to violent offending, domestic abuse and anti-social behaviour. Alcohol treatment services in the community have historically been under-resourced, and securing specialist treatment for offenders serving community sentences with alcohol treatment requirements attached is reported to be particularly problematic in some probation areas. Currently only 3% of community orders issued include an Alcohol Treatment Requirement.
- People in contact with the criminal justice system are recognised as a priority group within the current cross-government suicide prevention strategy and have proportionately more risk factors for suicide, including increased prevalence of mental illness, substance misuse and socioeconomic deprivation. Suicide risk is at its highest at key transitional points in and out of the criminal justice system, with risk among recently released prisoners at its highest within the first 28 days of release.
- Drug related mortality among recently released prisoners is at its highest during the first week following release emphasising the importance of through the gate support following release from the structured and relatively drug free prison environment.
The report makes a number of recommendations to directors of public health including understanding the specific health needs of people in contact with the criminal justice system who are living in the local community and building one existing partner relationships.
It also calls for directors to work with others to address common risk factors and determinants of poor health and offending and explore opportunities for joint commissioning.
The report concludes: “Directors of Public Health can be instrumental in delivering significant health improvements among this group. By addressing local health inequalities and improving access to services for those vulnerable to reoffending, this will help tackle one of the main causes behind offending behaviour and simultaneously make progress towards creating safer communities. In turn, a safer community brings wider health benefits to the overall population and reduces strain on local budgets.”