Transcript OFFENDER HEALTH IN WANDSWORTH

THE IMPORTANCE OF TACKLING
THE HEALTH NEEDS OF
OFFENDERS FOR LOCAL
COMMUNITIES
HOUDA AL SHARIFI
DIRECTOR OF PUBLIC HEALTH, WANDSWORTH
Revolving Doors and Probation Chiefs Association
workshop - 16 October 2013
OFFENDER HEALTHinsights and opportunities?
 CHANGES TO THE HEALTH LANDSCAPE:
- PHE & NHSE focused on health in the Criminal Justice System
- PH in the Town Hall
 NATIONAL TRANSFORMATION IN REHABILITATION
 HEALTH NEEDS ASSESSMENTS IN PROBATION & PRISON
Crime in Wandsworth
350
in prison
Approx. 1,000 people
on Wandsworth
probation caseloads
Estimated 2,500 offenders in the
community
24,437 reported crimes in Wandsworth in
2011/12
57,634 reported & unreported crimes 2011/12 (based on
British Crime Survey)
Cost of Crime in Wandsworth:
£111 million per annum
Economic Cost Estimates of Crime
(Wandsworth, 2011)
Other Costs (Policing,
Insurance, Loss of Property
etc.,), £28,941,407
Emotional/Physical Impact on
Victims, £43,573,490
NHS Costs, £9,868,969
Loss of Economic Output,
£12,102,140
Why health ? Why offenders not
victims?
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Child and family health interventions
Drugs and alcohol
Dual diagnosis
Mental illness
Poor general health
Health protection
PREVENTING FUTURE VICTIMS OF CRIME
Recorded Offences in Wandsworth
ROLLING 12 MONTH COMPARISON
Offence
Total Crime
Murder
Violence Against the Person (Total)
Rape
Other Sexual
Robbery (Total)
Robbery (Person)
Robbery (Business)
Burglary (Total)
Burglary Residential
Burglary Non-Residential
Gun Crime
Motor Vehicle Crime
Domestic Crime
Racist & Religious Hate Crime
Homophobic Crime
Anti-Semitic Crime
Islamophobic Crime
Sep 2012 - Sep 2011 %
Change
Aug 2013 Aug 2012
Change
24258
4
4001
121
228
1170
1054
116
3254
1773
1481
71
3603
1372
252
27
1
15
25301
5
4253
98
212
1142
1021
121
3210
1883
1327
84
4381
1348
262
40
1
4
-1043
-1
-252
23
16
28
33
-5
44
-110
154
-13
-778
24
-10
-13
0
11
-4.1%
-20.0%
-5.9%
23.5%
7.5%
2.5%
3.2%
-4.1%
1.4%
-5.8%
11.6%
-15.5%
-17.8%
1.8%
-3.8%
-32.5%
0.0%
275.0%
ROLLING 12 MONTH COMPARISON
Other MOPAC Crime
Theft Person
Criminal Damage
Violence with Injury
12 Months 12 Months
%
Change
to 24/09/13 to 24/09/12
Change
1572
1844
1417
1202
2141
1523
370
-297
-106
30.8%
-13.9%
-7.0%
ROLLING 12 MONTH COMPARISON
Other Strategic Concern(s)
Fraud & Forgery
12 Months 12 Months
%
Change
to 24/09/13 to 24/09/12
Change
725
1128
-403
-35.7%
Vulnerable Localities
source: Wandsworth Council Strategic Assessment; Jan 2013
Young Offenders - 1
 Serious Youth Violence
FY 2012/13
 50% of offences occurred
within Tooting Sector,
including 25% of all youth
GBH offences
 Other hotspots in
Battersea and around the
Henry Prince Estate
 Offending most likely to
occur in the 16:00 – 18:00
timeframe
Young Offenders
 A recent exercise to map
the home addresses of
known members of two
rival gangs based in
Wandsworth.
 Showed some correlations
with hotspots for youth
violence and/or high youth
population.
 Some additional correlation
with the Wandsworth
‘Aspiration’ areas.
Wandsworth Probation Health Needs
 1000 offenders supervised by Wandsworth probation
service
 Includes only those on long term (> 1yr) sentences
 Overrepresentation of men (90%) and BME (55%)
 Significantly higher prevalence of mental illness and drug
misuse
 Personality disorders don’t warrant access to services
 High risk health behaviour e.g. smoking, drugs and unsafe
sex
 Difficulty accessing primary care services complicated by
no fixed abode
 No discharge information, no sharing of health records
 Complex high needs using ‘bog standard’ services
Wandsworth Prisoner Health Needs
 Prison population profile: young, with BME over-represented. 100% male.
 Lifestyle factors: overweight & obese less than general population, 20% hazardous
drinkers, 78% smokers, 45% admitted drug dependency prior to prison
 23% with physical health problem (9.5% asthma) + higher than normal epilepsy, Hep C,
HIV
 Significant mental health problems: neurotic and psychotic disorders much more
common than in the general population
 Learning disabilities: disability liaison officer, but no care plans or reliable info on needs
for this group
 Communicable diseases (including STIs, Hepatitis, TB): screening, immunisation &
treatment available, supported by secondary care clinicians/clinics
 52% of prison healthcare staff felt that healthcare needs were only being met a little
 Management of long term conditions such as diabetes, hypertension, COPD, substance
misuse and mental health problems are perceived as healthcare priorities
 Prisoners had major concerns regarding handling of complaints, appointments, and
prescriptions
 Some concerns have been addressed through opening Heathfield Health Centre
 The prison has comprehensive health promotion action plan
The Challenges - 1
 Offender health in the community is everyone’s business
but nobody’s responsibility
 The pathways are not clear and no one is accountable
 There is no exchange of health information between
criminal justice institutions and health services in the
community
 Contrasting access to treatment inside and outside the
prison
 ‘Personality disorder’ is seen as an inferior and intractable
mental health issue not warranting attention - as a result
neglected, however it is wide-spread
The Challenges - 2
 Prisoners on immediate release and those without
supervision are top priority
 CMHTs will not take a referral for an offender without
an address, and neither will the GPs register them
 Lack of continuity in access to medication - this is
crucial for mental illness and drug misuse
 Appropriate accommodation is essential but the drive
is to discourage access
What is proven to work?
 Getting away from the financial ‘silo’ mentality
 Transitional case management
 Integrated care pathways
 IT connections and information exchange
Recommendations
1. Make offender health a priority
2. A multi-agency steering group – integration of effort and money
3. Review availability of mental health services for people with
personality disorders and lower level mental illness - a case for
health investment?
4. Pilot and evaluate a holistic case management, include mental
health and primary care professionals, bid for resources
5. Consider introducing the key worker scheme (triborough model)
6. Identify named GP (Feltham model)
7. Continue to strengthen the family recovery programme