Released to the streets: changing the narrative for prisoners health.

Transcription

1 No health without justice, no justice without health. Released to the streets: changing the narrative for prisoners health. Friday July 17, 2016 Dr. Éamonn O Moore National Lead for Health & Justice, PHE Director UK Collaborating Centre for WHO Health in Prisons Programme (European Region)

2 Released to the streets. BBC Report April 13, 2016: Prisoners at a women's jail in Surrey were given tents and sleeping bags on their release because they had nowhere to live.. The disclosure follows an inspection by HMIP of HMP Bronzefield in Ashford, Kent: The number of women leaving the jail with settled accommodation dropped from 95.5% in 2014 to 83.7% in In the six months prior to last November's inspection, 103 women left with no fixed address. The lack of social housing stock and local authority housing department's downgrading of exoffenders to "low priority" were cited as "factors".

3 HMIP- situation had arisen despite prison s efforts. HM Inspectorate of Prisons said the "contributory factors" were outside the control of the prison. Prison said it worked with local authorities and other organisations to ensure as many women as possible had suitable accommodation on release. The number of women leaving with settled accommodation had dropped in recent months as a result of the lack of social housing and hostel accommodation. Despite this the prison continued to work proactively to secure accommodation for women being released. A Ministry of Justice spokeswoman said: "As part of our probation reforms we now provide unprecedented support for offenders to make sure all receive support on release, including those sentenced to less than 12 months. The responsibility for making sure there is housing available ultimately lies with the local authority."

4 Homelessness has a range of meanings: A person might be homeless* if they are: Sleeping on the streets (referred to as rough sleeping or rooflessness ) Staying with friends or family (referred to as sofa surfing ) Staying in a hostel or bed and breakfast hotel Living in overcrowded conditions At risk of violence in their home Living in poor conditions that affect their health Living in a house that is not suitable for them because they are sick or disabled. There is evidence that both offending and imprisonment increase the risk of homelessness. *Adapted from: from:

5 Multiple complex needs among people in prisons Compared with peers in the community, people in prisons often experience multiple pathologies : a higher burden of infectious diseases (including HIV/AIDS, BBVs, TB & other respiratory infections, and STIs) & poorer vaccine coverage; A higher burden of chronic Over illnesses 75% (including homelessness services epilepsy, asthma, coronary heart disease, in England support clients musculo-skeletal problems); who are prison leavers. Higher rates of substance One misuse in five (including clients using drugs, alcohol and tobacco homelessness smoking) services has links with the 49% have an identifiable mental health problem probation service (including depression/anxiety & psychosis); Homelessness, joblessness, poor education. High Prevalence of Infectious Diseases High Prevalence of Chronic illnesses Higher levels of learning disabilities- 47% have no qualifications Poorer access to treatment and prevention programmes*. Poly- Substance Misuse Poor Mental Health/Learning Disabilities 24% of those in prison have been in care as a child. High rate of homeless and insecure accommodation. 5

6 Prison population rate/100,000 6 Source: Council of Europe Annual Penal Statistics SPACE I

7 Top Ten Europe : Prison Population Rate per 100,000 Ranking Title Prison Population Rate /100,000 1 Russian Federation Belarus Lithuania Georgia Latvia Turkey Azerbaijan Moldova (Republic of) Estonia Czech Republic Source: International Centre for Prison Studies:

8 Top Ten Europe : Prison Population- Absolute Numbers Ranking Title Prison Population Total 1 Russian Federation Turkey United Kingdom: England & Wales Poland France Ukraine Germany Spain Italy Belarus Source: International Centre for Prison Studies

9 Prison population projections E & W 9 Source: Ministry of Justice Prison Population Projections: Published November

10 Prison population growth rate since 1945 (E&W) 10 Source: Ministry of Justice: Story of the prison population England & Wales (January 2013)

11 Most people in prison have short sentences 11 Source: Criminal Justice Statistics Quarterly Update MoJ February

12 Re-offending data 25% of adults and 38% of juveniles reoffend. 12 Source: Ministry of Justice Proven Reoffending Statistics Published January 2016:

13 High frequency of reoffending 13 Source: Ministry of Justice Proven Reoffending Statistics Published January 2016:

14 The links between reoffending, imprisonment & homelessness- the evidence? Accommodation, homelessness and reoffending of prisoners: Results from the Surveying Prisoner Crime Reduction (SPCR) survey-(k Williams, J Poyser, K Hopkins, Ministry of Justice March 2012): This report summarises the accommodation backgrounds and needs of newly sentenced prisoners, and the links between these and reoffending on release. Data for this report come from Surveying Prisoner Crime Reduction (SPCR) (a longitudinal cohort study of 1,435 adult prisoners sentenced to between one month and four years in prison in 2005 and 2006), the Police National Computer (PNC), and the 2003 general population survey the Offending, Crime, and Justice Survey (OCJS).

15 Findings: Prevalence of Homelessness: 15% of prisoners in the sample reported being homeless before custody (including 9% sleeping rough) Vs 3.5% of the general population reported having ever been homeless; Insecure accommodation prior to imprisonment: 44% of prisoners reported being in their accommodation prior to custody for less than a year ; 28% reported living in their accommodation for less than six months. Help to find accommodation post-release: 37% of prisoners stated that they would need help finding a place to live when they were released. Of these, 84% reported needing a lot of help.

16 Findings cont d: Risk factors among prisoners for homelessness/need for help : Reoffending: Prisoners who had been sentenced to prison, probation or community orders before; Reoffenders were also more likely to have been homeless before entering prison. 11% who had served a previous custodial sentence were sleeping rough prior to custody, compared to 3% of those who had not been in prison before Problematic drug and/or alcohol use; Re-offending & homelessness: 60% of prisoners believed that having a place to live was important in stopping them from reoffending in the future. 79% who reported being homeless before custody were reconvicted in the first year after release, compared with 47% of those who did not report being homeless before custody.

17 Risk groups among prisoners*: Evidence has highlighted four groups that face particular barriers: Remand prisoners and those on very short-term sentences (Loucks, 2007; Gojkovic et al, 2012) Women (Sapouna et al, 2011; Commission on Women Offenders, 2012) Young people (Glover and Clewett, 2011; Gojkovic et al, 2012) Those who were homeless on entering prison (Williams et al, 2012) The families of prisoners are also affected by the imprisonment and can find their housing situation at risk. *Source: Prison leavers and homelessness- Published: May 2015 IRISS Insights, No 29http://

18 Homeless people more likely to be victims of crime.. Homeless people are also significantly more likely to be victims of crime, which can leave them traumatised and living in fear, affecting both their physical and mental health. Compared to the general public, rough sleepers are 13 times more likely to have experienced violence and 47 times more likely to be victims of theft. Almost one in 10 of 336 homeless people interviewed by the London School of Economics had experienced sexual assault in the previous year and around half had experienced damage to property (Newburn and Rock, 2005). Source: Prison leavers and homelessness- Published: May 2015 IRISS Insights, No 29http://

19 Complex multiple needs For many prison leavers, addiction, breakdown in relationships, poor physical or mental health and social isolation can perpetuate homelessness or make tenancies difficult to sustain. While any one of these could cause difficulties, evidence shows that for many prisoners, these issues are interlinked and often cumulative (Social Exclusion Unit, 2002; Reid Howie, 2004; Audit Scotland, 2011). For example, a study of transitional care in Scotland identified housing as one of the main challenges encountered by prisoners with drug problems on release, and that lack of stable housing made it more likely that they would resume drug misuse (MacRae et al, 2006). Source: Prison leavers and homelessness- Published: May 2015 IRISS Insights, No 29http://

20 Location, location, location.. Significant concern for people leaving prison: being away from negative, and being close to positive influences. Clean break : Relationships with anti-social associates : one of the most potent predictors of re-offending (Andrews and Bonta, 2003). But prison leavers are offered social housing in areas with the highest turnover of tenants, and where properties become available more regularly- the worst areas (Reid Howie, 2004): with the highest crime rates and increased risk of reoffending. Finding accommodation close to positive social networks can reduce offending behaviour (McHardy, 2010). The most frequently cited reason for change in study of persistent adult offenders in Ireland was the formation of strong social bonds with parents, partners and children (Healy, 2010). Maintaining positive social networks is also key to preventing recurring homelessness (Tabner, 2013). Source: Prison leavers and homelessness- Published: May 2015 IRISS Insights, No 29http://

21 Community Dividend for public health interventions in prison populations: In E&W, underserved populations passing through prison estate ~160,000 per year (incl. ~100,000 unique admissions ; Often belong to wider social groups and networks contributing significantly to health inequalities generally; Delivering health interventions in prisons not only benefits prisoners- community dividend in addressing issues in underserved populations generally. This model works particularly well for health protection issues like TB. 21

22 TB prisons & homelessness.. Tuberculosis in the UK: 2015 report*: The majority of TB cases occurred in large urban centres, amongst young adults, those from countries with high TB burdens, and those with social risk factors for TB. Among cases with information on social risk factors : 3.3% (201/6,031)) had a history of problem drug use; 3.3% (198/5,988) had a history of alcohol misuse/abuse, 3.4% (206/6,062) had a history of homelessness 3.3% (192/5,903) had a history of imprisonment: 41 cases were in prison at time of notification. 9.4% of cases (538/5,708) had at least one of these social risk factors- 78.5% of cases with at least one social risk factor had pulmonary TB. * e/492431/tb_annual_report_v2.6_ pdf

23 TB: social risk factors & prisons. A cohort study was undertaken of all patients with TB living in London (2) who were or should have been on treatment on 1 July, Nearly 2,000 eligible patients were included giving an overall point prevalence of 27 per 100,000. The prevalence of TB among risk groups: 788 per 100,000 in the homeless; 354 per 100,000 in problem drug users; 208 per 100,000 in prisoners. PHE report an incidence of TB amongst the general population of 12.0 cases in England per 100,000 (3) 2. Tuberculosis in London: the importance of homelessness, problem drug use and prison. A Story, S Murad, W Roberts, M Verheyen, A C Hayward, for the London Tuberculosis Nurses.Network 3. Tuberculosis in the UK: 2015 report. PHE *

24 Continuity of care: DOT, DOT, DOT. Biggest challenge to successful treatment is continuity of care from custody to the community; Most people in prison have short sentences, majority less than three months- too short a time to complete treatment; Increasing evidence of people falling off care pathways on release- esp. due to homelessness/insecure accommodation. NICE recommend need for contingency plans to manage prisoners on release- should take account of social circumstances and need for DOT in the community. Over half (56.6%, 277/489) of cases with at least one social risk factor received DOT in The highest proportion of cases receiving DOT was among those with current or a history of alcohol misuse (71.6%, 131/183), followed by those with current or a history of homelessness (64.3%, 117/182), imprisonment (64.0%, 114/178) and drug misuse (62.8%, 120/191).

25 Public Health Model for Health & Justice: Address upstream determinants e.g. ACE, Troubled Families Programme, Truancy, Youth Offending, Liaison & Diversion, Drug & Alcohol dependence, unemployment etc. REDUCING OFFENDING Address down stream determinants e.g. support recovery from drug/alcohol dependence, address mental health problems, ensure access to primary care, support through training, education, employment, housing etc. REDUCING REOFFENDING 25

26 What works? Early intervention Partnership work Advice & information Support after release Addressing health needs *Adapted from Source: Prison leavers and homelessness- Published: May 2015 IRISS Insights, No 29http://

27 Early intervention, advice & information: Early Intervention: Assessment of housing need should start at entry and throughout detention to enable a more planned approach to resettlement (James et al, 2004). Can identify those requiring assistance in maintaining or closing down tenancies in order to prevent unplanned accommodation loss. Can give early warning re: help in finding & sustaining accommodation on release. Community Rehabilitation Companies (CRCs) or National Probation Service (NPS) have to support offenders in securing accommodation on release. Advice & Information: Need for appropriate specialist information, advice and support on housing issues; A House of Commons Library review (2014) highlighted the UK Government s recommendation that all prisons should have a specialist housing advice centre, or, at least, ready access to specialist housing advice. Housing advice must be proactively publicised in ways that are accessible to prisoners, many of whom have poor literacy skills. Prisoners need to know how to give up their tenancy, what will happen to their belongings and how they can find a new home. *Source: Prison leavers and homelessness- Published: May 2015 IRISS Insights, No 29http://

28 Addressing Health Needs: Health & Justice Care Pathway Reoffending behaviour 28

29 Support after release Some prison leavers will have poor basic skills and high levels of need, which can impact on their ability to sustain accommodation. Ensuring tenancy sustainment for prison leavers requires holistic assessment processes that identify the full range of housing-related and wider support needs. The support required can range from budgeting to cooking skills, and organisations that deliver this support can be crucial in enabling someone to stabilise in independent accommodation. (Homeless Link, 2011). Engaging with housing providers around tenancy support: can reduce anxieties about actual and perceived risks associated with housing this group and thus increase offenders housing options; *Source: Prison leavers and homelessness- Published: May 2015 IRISS Insights, No 29http://

30 Partnership Work Criminal justice agencies alone are not able to provide or guarantee effective resettlement for prison leavers. The roll out of Integrated Offender Management (IOM) offers a framework which places partnership and cross sector working at its core, an approach which can re-imagine the role and responsibilities for all local partners at a local level, including housing; Community based rehabilitation, including mental health and drug treatment for ex-offenders, will necessitate a greater role for community and voluntary sector providers and a shift in how these services are delivered and linked in with other local requirements. Payment by results marks a radical shift in criminal justice policy and presents opportunities for the homelessness sector in designing and implementing such a system; Source: Better Together: Preventing Reoffending and Homelessness, September Homeless Link

31 Partnership Work cont d At Local Level: At National Level: Organisations must ensure that staff have the right knowledge to address housing and offending needs. Every IOM should involve the homelessness sector as a key partner ; All agencies should make better use of data: as Payment by Results models develop, we need to be smarter about the data we collect and analyse. Local authorities must protect longer term funding for homelessness services: homelessness services help to reduce reoffending. The Ministry of Justice- clear message to every prison and probation trust about the importance of improving partnerships with homelessness organisations. The Home Office should promote the importance of integrating homelessness providers throughout the rollout of the IOM programme. The DWP must recognise exoffenders as a potentially vulnerable group who face multiple barriers to the labour market, and as such require greater support in their journey to employment.

32 PHE working in partnership in Health & Justice National Partnership Agreements between PHE, NHS England and National Offender Management Service (NOMS) -delivery-healthcare-prisons2015.pdf Home Office Immigration Enforcement (HOIE) Youth Justice Board (YJB) 32

33 Contact details & resources: Health & Justice web pages: #PHEprisonhealth WHO Health in Prisons Programme: