Offenders - good practice examples
We are highlighting examples of good practice. Some of these are described in (sometimes hard to find) documents. Others have been provided by nurses working with excluded groups.
You might also like to refer to the guidance, policy and voices sections for further information on offenders.
If you would like to send us an example of good practice please use the contribution form.
Heathfield Healthcare Centre in HMP Wandsworth
The project, which is described in a report made available by the FoNS Centre for Nursing Innovation, aimed to establish a health promotion clinic for vulnerable prisoners. It involved exploring the existing organisational culture; hosting staff focus groups; an audit of service user complaints; a service user survey and attending a prisoner forum. The data from these activities influenced the final direction of the project which culminated with the establishment of something close to a ‘walk-in’ centre.
The author comments that "at the time of writing the report, the HHC has now opened and is proving to be a success with an apparent great reduction in waiting times and an average of over 40 prisoners per day being seen by the new nurse led service". A comprehensive evaluation is planned for October 2012, see The establishment of the Heathfiled Healthcare Centre in HMP Wandsworth.
Anxiety management service
An article in the Nursing Standard describes how Johanne Tomlinson, Nursing Standard Nurse of the Year 2012, developed an anxiety management service at HMP Stafford. The service, which was launched in 2009, resulted from her observation of connections between high levels of anxiety, confrontational behaviour and self-harm. Prisoners experiencing anxiety attend weekly session in a ten week course and they are able to refer themselves. She further developed a service aimed specifically at helping ex-servicemen.
Source: Pearce L (2012) Breaking barriers. Nursing Standard 26(30) 28 March pp.16-18. The article is available full text from the RCN e-library via the E-journals [you will need your membership number to access].
See also Nursing Standard Nurse of the Year 2012 where there is a short film about Johanne’s work
Anawim mental health project
Anawim women's centre in Balsall Heath, Birmingham, is a day centre for vulnerable women. It acts as a one-stop shop into services for women with multiple problems such as substance misuse, poverty, homelessness and domestic violence. Increasingly, Anawim is also receiving female offenders who have been sentenced by the courts to undertake unpaid work or a specified activity at the centre.
The centre took part in a partnership project initially funded by Offender Health as part of Revolving Doors’ National Development Programme. The project aimed to work with local mental health services to help women with multiple and complex needs, including women who have had contact with the criminal justice system, access appropriate mental health support. The findings of the first year of the project were “highly promising” and funding for a second year was secured.
West Midlands Offender Health undertook an analysis of the early findings. The report of these findings highlights the difficulties some of these women have in accessing services such as their local GP because of chaotic or transient lifestyles and because they often do not meet the criteria to be seen by secondary mental health services. The report emphasises the importance of partnership working across statutory health and third sector agencies. It also underlines the importance of acknowledging the complexity of needs and understanding the experiences that have contributed to this and the difficulties faced by these women in accessing and engaging with services. To read the report, which includes case studies, see Women with complex needs: supporting their mental health needs.
An article about the project and its findings, originally published in Advances of Dual Diagnosis (Vol.4 issue 2 2011), is also available – see A way through the woods: opening pathways to mental health care for women with multiple needs.
The Revolving Doors Agency website has brought the information together about the Anwim mental health project.
Delivering better primary care, HMYOI Polmont, Scotland
HMYOI Polmont holds convicted young offenders aged between 16 and 21 years. The health of some of these young offenders is not good on arrival due to physical conditions, mental health problems or addiction problems.
The development of health care within the prison has changed from a system where a young offender reported sick, to a system that allows each one to specify which particular clinic they wish to attend. Specialist clinics are available to meet individuals with a wide range of health needs. The clinics include: asthma, diabetes, epilepsy, skin, well person, blood borne virus, smoking cessation, immunisation and sexual health.
Mental health needs are met through dedicated Mental Health Team, consisting of both psychiatric and learning disability nurses. While aiming to provide a setting encouraging positive mental health in all aspects of care, the mental health remit covers a wide variety of issues such as anxiety, low self esteem, depression and ADHD.
An addictions nurse provides ongoing support for those young offenders on a recognised programme of care and treatment. Close liaison is maintained with other agencies eg drug action teams, social work, mental health services, to ensure continuity and consistency of care. The addictions nurse also runs smoking cessation programmes.
The service provided mirrors that of the community and is mainly nursing led. By adopting the principle of self-care the prisoners become more involved in caring for themselves or at least sharing the responsibility for their care. The prisoners are more educated about their health and better prepared for accessing and dealing with health care services in the community once liberated.
Prisoners should be involved in the decision making process with regard to health care services. Young offenders are equal partners in the Health Care Committees and groups. They are outspoken in these groups and are excellent in providing ideas and suggestions. All prison staff need to be are of the services on offer and need to share in the care of prisoners.
The services at Polmont are assessed through clinical audits and by external assessors. Prisoners are involved in internal clinical audits and changes are made on the basis of the feedback. Targets with performance measures are displayed for the prisoners to see.
Source: Department of Health (2007) Good practice is prison health. London: The Department pp.31-33.