Ruth Hussey

The growing prison population is a significant issue for both primary care and acute trusts. Just as general healthcare is moving towards prevention, so is criminality. We need to look at what the NHS and social care can do to stop people committing crimes.

Prisoners often come from poorer socio-economic backgrounds and may have experienced severe inequalities as they grew up.

A 2002 report by the Social Exclusion Unit said 27 per cent of the prison population had been taken into care as a child compared to 2 per cent of the general population. Thirty per cent regularly played truant from school compared to 3 per cent of the population, and 65 per cent had below average levels of numeracy, compared to 23 per cent of the general population.

It is no surprise to find equally concerning statistics on health in the same report. Seventy-two per cent of male and 70 per cent of female prisoners suffer from two or more mental health disorders, compared to 5 per cent of men and 2 per cent of women in the general population. Sixty-six per cent of male and 55 per cent of female prisoners have used drugs in the previous year, compared to 13 per cent of men and 8 per cent of women in the general population.

It is vital that once people come into the prison system, signs of ill-health - physical, mental or both - are identified as soon as possible.

We need a health system that can support people in a range of settings, including outside prison. This means different agencies agreeing on strategies to provide services and treatment that are coherent and co-ordinated for the individual. At the moment, a prisoner can lose a package of health and social care support when he or she leaves prison.

These issues are being addressed by the national and regional offender management services and others. So what can the NHS contribute?

First, the health service can ensure there are sound commissioning plans for this group.

Second, it can ensure there is a multi-agency approach to ensuring services are available.
Third, it can invest appropriately in developing the skilled staff needed to care for this population.

A 2006 report by the Sainsbury Centre for Mental Health advocated a new model of primary mental healthcare based on 'in-reach'. The centre has also joined forces with the Youth Justice Board and the Department of Health to look at effective interventions to meet the mental health needs of young people.

A further opportunity arises from the Commissioning framework for health and well-being, which provides a stimulus to all agencies to co-operate and develop a joint strategic needs assessment as a basis for commissioning.

It is crucial that we continue to work in close partnership to address the wider issues of criminal justice. We need to make sure appropriate and effective mechanisms are in place for early identification, intervention and treatment of this vulnerable group. This will be a major contribution to tackling health inequalities.

Ruth Hussey is NHS North West regional director for public health.