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 Plymouth University Peninsula Schools 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 will work with each person to develop a shared understanding of their individual goals, and work with them to engage with services that will help them work towards achieving these goals.
Phase 1 - Developing the intervention
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.
Phase 2 - Randomised controlled trial
In Phase 2, a randomised controlled trial will be conducted to evaluate the clinical, social, and economic impact of the intervention. Prisoners will be asked to take part in the trial before leaving prison, and will be followed up in the community. Half will receive the intervention, and half will receive 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.
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.
Patient and public involvement
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 Plymouth University.