The potential of not having secure accommodation upon release from prison is a major problem for prisoners with mental health needs. This study focused on evaluating an intervention that supported prisoners upon their release from prison with the primary objective being to support them in finding accommodation release from prison service.
In September, 2019 there were 83,518 prisoners detained in England and Wales (Her Majesty’s Prison and Probation Service, 2019).
The period of transition from prison to the community has been acknowledged as a confusing and chaotic experience for many which is intensified by being homeless. A recent survey ascertained that 36% of people found rough sleeping had previously been in prison (CHAIN, 2018). Being homeless is viewed as a major factor in the likelihood of reoffending (Homeless Link, 2018) and not engaging with support services (health services, GP services, welfare benefits) (Williamson, 2007).
It has been estimated that over 90% of prisoners have one or more psychiatric disorders (psychosis, neurosis, personality disorder, hazardous drinking and drug dependency). The period directly before and following release from prison is a highly stressful and isolating experience that exacerbates mental health problems (Theurer & Lovell, 2008; The Mental Welfare Commission for Scotland, 2017). Hopkins & Thornicroft (2014) have also reported that prisoners with mental health problems have twenty-nine times the rate of all-cause mortality during the first two weeks after release compared to the general population and are 8.3 times more likely to commit suicide in the twelve months following release from prison compared to the general population. Hancock et al (2018) has proposed that secure housing is the most important factor in ensuring a positive transition from prison to the community for people with mental health problems due to:
• It is impossible to address mental health support and treatment before a person has stable accommodation
• without housing they are lost to care. If someone does not have a fixed address, they are difficult to locate and connect with which makes it hard to provide support
• housing helps break a cycle of returning to poor previous relationships and routines
Providing support for prisoners with mental health needs upon their release has the potential to be an important factor in helping reintegrate this cohort into the community through helping to find secure accommodation, improving health and wellbeing, engaging with services, re-establishing contacts with family and friends and reducing reoffending. The Bradley Report (2009) noted if prisoners receive the support they need inside prisons, they were more likely to engage with services outside prison. The report added for the resettlement of prisoners with mental health needs into the community to be successful, it was important to ensure that the engagement that had started in prisons continued once prisoners leave the prison gate.
However, the evidence for the effectiveness of existing services approaches is limited. Hopkin et al (2018) undertook a systematic review examining interventions for prisoners with diagnosed mental health conditions that targeted the transition period between prison and the community. Thirteen studies were found (with only two in the UK). The conclusions drawn were that there was some evidence that the interventions examined could improve contact between service users and mental health and other services. However, evidence that it reduced reoffending was equivocal and none on of the studies had examined whether the intervention improved access to secure accommodation.
During the period of the study, the standard care package offered to prisoners upon their release was based on the government’s Transforming Rehabilitation strategy aimed to reduce reoffending and to provide a seamless transition between prison and the community by developing “Through the Gate” services (Ministry of Justice, 2013). The Through the Gate service was delivered by the newly commissioned local Community Rehabilitation Companies (CRCs) to help prisoners maintain or find accommodation; aid with finance, benefits and debt; and to support them to enter education, training and employment. It has been noted that prisoners with mental health needs present different challenges, have multiple and complex needs and require a more focused approach than the support provided by the CRCs. In addition, limitations in the amount of support and assistance offered to prisoners with mental health needs and, in particular, the lack of planning and arrangements for suitable accommodation were identified by Her Majesty’s Inspectorate of Probation reports (HMIP, 2019).
To provide intensive support to those who had offended but also have identified mental health needs, Oxleas NHS Foundation Trust commissioned Clarion Housing (at the time known as Centra) and Nacro to provide a resettlement service for prisoners with mental health needs upon their release; the Supporting Prisoners upon Release Service (RESET) Intervention service. Clarion Housing worked from HMP Elmley, HMP Rochester and HMP Stamford Hill, while Nacro and Clarion Housing operated in London from HMP ISIS, HMP Belmarsh and HMP Thameside. The threshold for meeting the criteria for receiving support was that service users must have had limited community support in place, high rates of reoffending, and meet at least step 3 on the Oxleas stepped care model. The RESET service was based on the principles of the Critical Time Intervention (CTI) approach. CTI is a structured, time limited intervention developed in the USA in the 1990s to prevent recurrent homelessness in transient individuals with severe and mental illness moving from hospital care into the community. In CTI, case managers provided support for up to nine months to strengthen times with family, friends and service providers and to provide practical and emotional support during the transition in to the community. Studies had found significantly reduced number of homelessness for those users receiving CTI (Susser et al, 1997). The main elements of the RESET service were:
• A short-term (12 week) support service to prisoners with an identified level of mental health need
• The focus was in obtaining appropriate safe and secure accommodation, access to welfare benefits, re-engagement with health services and strengthening links with family and community support services
• Referrals to the service were made through the Mental Health Inreach team at each prison
• Work began before release to develop rapport with service user, to try to secure accommodation, and start to fill out necessary paperwork
• On the day of release, the support co-ordinator would meet the service user at the gate
• The main aim in first day is to ensure the individual has some form of housing
• Any released prisoner would be escorted to all crucial appointments on the day, such as probation and local authority housing
• Support was provided to ensure that the service users had all the essentials for the first few days i.e. correct medication, scripts and planned appointments
• The support co-ordinator worked intensively during the first week of service users release and then gradually reduced their level of contact
The overall aim of this study was to evaluate the impact of the RESET service.
The specified objectives were to examine the:
• Participants’ housing situation
• Rate of reoffending
• Number of hospital admissions
• Number on maintained benefits
• Number of contacts with mental health and GP services
• Level of engagement with services
• Number in employment or education
• The service user’s views of the RESET service