The Michael Stone case underlined the link between mental illness and crime, but what can be done to help ex-offenders with psychiatric problems? Lynn Eaton reports

The conviction of Michael Stone for the murder of Lin and Megan Russell has raised questions over whether someone with a severe personality disorder can ever get psychiatric treatment. But for many men and women held in our prisons who do suffer mental illness, much more could be done to help - particularly on their release.

It has been estimated as many as one-third of adult male offenders need psychiatric intervention. Psychosis is five times' higher among unconvicted male prisoners than in the general population.

'So what? Not our problem,' the NHS might say. But mentally ill ex-offenders may be the people making life difficult in accident and emergency departments on Friday nights, spending the night on a psychiatric ward for drug-induced psychosis, or referred to mental health services by the police after being held in a police cell for a minor offence.

In Leicestershire, the NHS, social services, probation and prison services have joined forces with the Mental After Care Association in an attempt to tackle the problem.

Leicestershire Prisoners' Project started in May 1996 by identifying high-risk prisoners in four prisons in the county, including Glen Parva young offenders institute. It then set up a care plan for the prisoners on their release and made sure the necessary community support would be available.

Leicestershire Mental Health trust provided a full-time community psychiatric nurse; social services a half time social worker, and MACA a project co- ordinator.

An evaluation of the project, published last week, has mixed findings. The reoffending rate among prisoners involved was 10.8 per cent - much lower than normally expected. But it is hard to evaluate the cost-effectiveness of the£80,000 a year scheme - how do you quantify what ex-prisoners might otherwise have cost the NHS or social services?

Adeshi Kaul, consultant forensic psychiatrist with Leicestershire Mental Health trust, believes that, for all its shortcomings, schemes like this are the only way out of the so called 'revolving door' for prisoners with a mental health problem.

'If people think a project like this is going to be a solution to mental

health care in prison or after care, they will be sadly mistaken,' he says . 'But this has the potential to crack it. It is the best bet we have.

These people don't necessarily go to see a GP and say, 'I have got a problem'. They don't have networks like their family to make sure they are getting the care they need. We can't depend on them to seek help.'

The lessons from Leicestershire include the need for a strong planning group from the start; using seconded staff from statutory services to ease acceptance of the project by those services; and identifying vulnerable prisoners early on in their sentence, rather than waiting until they are near discharge.

But Roger Ralli, principal medical officer at Glen Parva, believes the scheme is a major step forward. 'Seventy five per cent of our prisoners come from outside Leicester. Their health authorities don't have similar initiatives, and we have considerable difficulties getting health and social

care support and putting together packages for them.

'I certainly hope other authorities will take some interest in looking at this area of unmet need.'

Leicestershire Prisoners' Project Evaluation Report. MACA, 25 Bedford Square, London WC1B 3HW.£25 inc p&p.