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.

The Prison Reform Trust provides regularly updated statistical information on the prison population across the UK in a publication known as the Bromley briefings - prison factfile. These factfiles also include commentary on the prison system and penal policy on the whole as well as statistics and commentary on different age groups, and on specific aspects such as gender, minority ethnic groups, disability, mental health and the impact of drugs and alcohol (Prison Reform Trust 2012).  

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. 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 health care 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 2010).

The imprisonment of women raises particular issues about the suitability of custodial sentences and the context in which they are being applied because of the impact on children and families. “Instead of a punishment of last resort, women's prisons appear to have become stopgap providers of drug detox services, social care, mental health assessment and treatment and temporary housing - a refuge for those who have slipped through the net of local services” (Prison Reform Trust Women’s Justice Taskforce 2011, p.i).

The prison environment can pose challenges to encouraging and enabling offenders to make decisions about their own care, " to be treated as equal partners, be listened to and to have informed access” because “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 different kinds of 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 aimed 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 Health Scotland 2010).

In response to a report published on improving outcomes for women offenders in Scotland and an Audit Scotland report on reoffending a decision has been made to review options for redesigning the community justice system in Scotland. These options are out for consultation until 30 April 2013 (Scottish Government 2012a; Scottish Government 2012b).

The Women’s Justice Taskforce, established by the Prison Reform Trust in 2010, has published a report looking at the needs of women in the criminal justice system with the aim of maximising work already underway, for example following on from the recommendations and outcomes of the Corston report (Corston 2007), and in the context of the government’s proposed changes to the criminal justice system (Prison Reform Trust Women’s Justice Taskforce 2011)

The Centre for Mental Health in England through its campaign ‘a better way’, which ran from 2008 to 2010, has highlighted concerns about the approach taken to mental health in the CJS. The campaign included a range of publications which focussed 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 2013a). 

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 to other services and appropriate mental health care. 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 2010).

The Centre for Mental Health has set up an independent Commission to undertake a five-year-on review of the Bradley Report to be completed in 2014 (Centre for Mental Health 2013b). 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 12 March 2013.
Some of them are in PDF format - see how to access PDF files.

Centre for Mental Health (2010) Under the radar: women with borderline personality disorder in prison, London: Centre for Mental Health.

Centre for Mental Health (2013a) A better way for the criminal justice system, The Centre for Mental Health website.

Centre for Mental Health (2013b) The Bradley Report Revisited Commission. The 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.

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 Health Scotland (2010) Health checks being delivered by Scottish Prison Service. Keep Well Informed, Summer 2010, p.1.

Prison Reform Trust (2010) Seen and heard: supporting vulnerable children in the youth justice system, London: Prison Reform Trust.

Prison Reform Trust (2012) Bromley briefings prison factfile November 2012, London: Prison Reform Trust.

Prison Reform Trust Women’s Justice Taskforce (2011) Reforming women’s justice, 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.

Scottish Government (2012a) Redesigning the community justice system: a consultation on proposals, Edinburgh: Scottish Government.

Scottish Government (2012b) Redesigning community justice system consultation, Scottish Government website.