Offenders
One way to understand the impact of inequalities is to look at how social exclusion impacts on a specific group:
- discover the issues affecting offenders in the overview below
- find information on relevant agencies and communities
- see how others are turning principles into action in the good practice examples
- check credible sources for guidance
- track the social inclusion programme in the U.K in policy
- hear from the experiences of people from this group in voices.
Overview
Who are they?
The term 'offender' refers to people who come into contact with the criminal justice service (CJS) because they have committed - or are suspected of committing - a criminal offence. This is not a precise term, as a significant proportion of this population will not in fact receive a custodial sentence.
In December 2011 the prison population in England and Wales was 87,297. In Scotland the figure stood at just over 8,000 and in Northern Ireland the total prison population stood at 1,828 (Prison Reform Trust 2011). England and Wales has an imprisonment rate of 156 per 100,000 of the population and Scotland 155 per 100,000. The prison population is growing in each country. There is a significant increase in the number of women in prison (Prison Reform Trust 2010a). People over 60 are now the fastest growing age group in the prison population but the number of young people in custody is less than it was ten years ago (Prison reform Trust 2011).
In the last decade there have been significant changes to the way in which health care is delivered in the CJS. In 2006 responsibility for health care in prisons was transferred to the NHS and became the responsibility of primary care trusts. Similarly in Northern Ireland the Health and Social Care Trusts are responsible for health care in prisons. Current government policy for offender health care is based on the principle of equivalence. This means that standards of health care for people in custody should be at least the same as for those in the wider community.
How are they affected by social exclusion?
Poor access to healthcare prior to being in prison linked with social, economic and cultural factors means that many offenders have pre-existing health problems (Mathis and Schoenly 2008). In addition the prison environment can pose its own health risks. The specific health needs of offenders are wide ranging but the most common ones are: long term medical conditions; mental illness; drug and alcohol misuse and sexual health, blood borne viruses and communicable diseases (Royal College of Nursing 2009). Mental health problems are common and there is a complex relationship between mental illness where social circumstances and support are poor, and risks for offending and re-offending (Royal College of Nursing et al 2010). One woman prisoner in four struggles with personality disorder (Centre for Mental Health 2010a).
“A particular challenge for anyone working in this area of health care is that there is a requirement for offenders to be involved in making decisions about their own care, to be treated as equal partners, be listened to and to have informed access” as “the custodial environment is often seen as one of control and authority, leading to competing priorities of health care and custody/security” (Royal College of Nursing 2009, p.4).
What is being done?
In response to issues raised and recommendations made in reports and reviews various initiatives have emerged.
For example, as part of the 'Equally well' strategy in Scotland a year long Keep Well programme was launched in May 2010 by the Scottish Prison Service. The programme aims to check the health of all prisoners aged over 34 with a sentence of six months or more and provide support, care and treatment and enhanced care arrangements to help prisoners in accessing health services on release (NHS Scotland 2010).
In England and Wales, in response to the Corston review (Corston 2007) women’s centres have been funded and further developed offering one-stop-shop services to women offenders and women at risk of offending to support and divert them away from offending (Epstein 2010).
As a further example the Centre for Mental Health in England through its campaign ‘a better way’ is highlighting concerns about the approach taken to mental health in the CJS. The campaign includes a range of publications which focus on aspects of care such as: the convergence of mental health and justice systems; how the police and health and social services can work better together; continuity of care for people leaving prison; securing employment for offenders with mental health problems (Centre for Mental Health 2010b).
Lord Bradley’s review (Department of Health 2009) made recommendations to improve the implementation of a policy of diverting people with mental health problems or learning disabilities away from prison. Some of the issues raised around screening and assessment, and about training and the need for specialist mental health workers have also been highlighted in the Prison Reform Trust’s report based on a survey of Youth Offending Teams (Prison Reform Trust 2010b). The implications for achieving improved diversion and liaison services are far-reaching and it is important to learn from what has been achieved already (Sainsbury Centre for Mental Health 2009; Royal College of Nursing et al 2010).
References
Most of the items in this reference list are available online. They were last accessed on 31 January 2012.
Some of them are in PDF format - see how to access PDF files.
Centre for Mental Health (2010a) Under the radar: women with borderline personality disorder in prison. London: Centre for Mental Health.
Centre for Mental Health (2010b) A better way for the criminal justice system. Centre for Mental Health website.
Corston Jean, Baroness (2007) The Corston Report: A review of women with particular vulnerabilities in the criminal justice system. London: The Home Office. (Made available on the National Archives website).
Department of Health (2009) Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: DH.
Epstein R (2010) The Corston agenda: supporting women at risk of offending. Criminal and Justice Weekly 28 August.
Mathis H and Schoenly L (2008) Healthcare behind bars: what you need to know. Nurse Practitioner (33(5) May pp.34-41 [You can access the full text of this article via the RCN e-library with your membership number].
NHS Scotland (2010) Health checks being delivered by Scottish Prison Service. Keep Well Informed Summer 2010, p.1.
Prison Reform Trust (2010a) Women in prison August 2010 (PDF 878.4KB). London: Prison Reform Trust.
Prison Reform Trust (2010b) Seen and heard: supporting vulnerable children in the youth justice system. London: Prison Reform Trust.
Prison Reform Trust (2011) Bromley briefings prison factfile December 2011. London: Prison Reform Trust.
Royal College Nursing (2009) Health and nursing care in the criminal justice service: RCN guidance for nursing staff (PDF 523.9KB). London: RCN.
Royal College of Nursing et al (2010) Prison mental health: vision and reality (PDF 493KB) . London: RCN.
Sainsbury Centre for Mental Health (2009) The Bradley Report and the Government's response: the implications for mental health services and offenders. London: Centre for Mental Health.