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Theme: Mental Health & Dementia
Click here for a BITE sized summary of this project.
Prisoners have a high prevalence of many mental health problems. Our recently completed COCOA study found that 53% reported drug misuse, 36% alcohol misuse, 15% severe and 59% moderate mental health problems. In addition, comorbidity between mental health problems and substance misuse and personality disorder was the norm rather than the exception.
Importantly, whilst over half of prisoners reported common mental health problems, few engage with services to address their mental healthcare needs. Prisoners released from prison with mental health problems face difficulty with family relationships, employment, long-term illness, self-harm and re-offending.
An ongoing collaboration focusing on mental health care for prisoners between University of Plymouth, Faculty of Medicine and Dentistry and the University of Manchester has received funding in the region of £2 million from the National Institute for Health Research to carry out the Engager project, to develop and evaluate a collaborative care intervention for offenders with common mental health problems, near to and after release.
Working with prisoners, the Engager project aims to develop a way of organising care for men with common mental health problems, as they approach being released from prison. We propose that the intervention will act as a bridge between a range of services inside and outside of the prison, which this group do not normally access. An Engager practitioner worked with each person to develop a shared understanding of their individual goals, and worked with them to engage with services that helped them work towards achieving these goals.
The project is split into two phases. During Phase 1 we developed and tested an integrated approach to organising care involving therapy, medication, housing, training and employment, and ensuring that care continues after release from prison. We created a methodology and set of measures needed to evaluate this intervention in a randomised controlled trial, and developed an economic model to asses the postential costs and benefits of the intervention.
In Phase 2, a randomised controlled trial was conducted to evaluate the clinical, social, and economic impact of the intervention. Prisoners were asked to take part in the trial before leaving prison, and were followed up in the community. Half received the intervention, and half received the care normally available. The results will enable us to assess whether the Engager intervention improves prisoners' common mental health problems and has wider social and financial benefits, results should be available from February 2019.
You can read more about the Engager project and the intervention developed on the project website, or contact the project team via the link below.
People serving sentences in the Criminal Justice System (CJS) often have substantially different backgrounds and life experiences from the general population. To ensure that the Engager intervention was relevent to those who would receive it, a Peer Researcher (PR) group was set up. The PR group consisted of eight men, and meetings were held fortnightly at a local substance misuse charity.
The PRs were involved in all aspects of the project, up until the start of the Randomised Controlled Trial (RCT). Most notably, they helped to refine research documents, ensuring that their language and length were suitable. Hear from three Peer Researchers about their involvement in Engager in the video above by the University of Plymouth.
News stories related to the project:
Our work on Offender Mental Health was included as a case study in the 2014/15 PenCLAHRC Annual Report.
Additionally, the Engager team received ‘highly commended’ in the NIHR CRN Mental Health McPin MQ Service User and Carer Involvement in Research Award 2018.
Kirkpatrick T, Lennox C, Taylor R, Anderson R, Maguire M, Haddad M, Michie S, Owens C, Durcan G, Stirzaker A, Henley W, Stevenson C, Carroll L, Quinn C, Brand SL, Harris T, Stewart A, Todd R, Rybszynska-Bunt S, Greer R, Pearson M, Shaw J, Byng R (2018). Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial. BMJ Open 8(2):e017931
Lennox C, Kirkpatrick T, Taylor RS, Todd R, Greenwood C, Haddad M, Stevenson C, Stewart A, Shenton D, Carroll L, Brand SL, Quinn C, Anderson R, Maguire M, Harris T, Shaw J, Byng R (2017). Pilot randomised controlled trial of the ENGAGER collaborative care intervention for prisoners with common mental health problems, near to and after release. Pilot and Feasibility Studies 2 4:15
NIHR CLAHRC Greater Manchester
The South West team - University of Plymouth
Dr Lynne Callaghan
Dr Lauren Carroll
University of Manchester
Professor Jenny Shaw (Project Lead)
Dr Charlotte Lennox
UCL Centre for Behaviour Change
Professor Susan Michie - Director
Leeds Community Healthcare
Dr Nat Wright - Associate Medical Director Specialist Services and Vulnerable Groups
University of South Wales
Professor Mike Maguire - Professor in Criminology
Avon & Wiltshire Mental Health Partnership NHS Trust
Dr Alex Stirzaker - IAPT Advisor and Specialist in PD and SMI
City University London
Dr Mark Haddad - Senior Lecturer in Mental Health
Centre for Mental Health
Dr Graham Durcan - Associate Director, Criminal Justice
University College London
Rachael Hunter - Senior Research Associate
Devon Partnership NHS Trust
Dr Christine Brown - Consultant Forensic Psychiatrist
King’s College London
Dr Tirril Harris - Former Senior Research Fellow