Title: Developing and evaluating a collaborative care intervention for prisoners, with common mental health problems, near to and after release (Engager 2)
Funder: Department of Health and Social Care

Abstract: Aims and Objectives The key research questions relate to whether the intervention has an impact on care received (and therefore has a potential to be effective), how it has impact and the potential economic benefits. Background and Rationale Prisoners near release have significant mental health needs and the majority receive minimal mental health care in prison or in the community. Mental illness, social exclusion and criminal activity are closely intertwined. Improving mental health of prisoners is justified in itself and could have significant economic and other benefits to society. Collaborative care, as an organisational framework for delivering care, has the potential to deliver integrated care and ensure continuity once released from prison. Given the potential benefits this hypothesis should be tested. Research Environment: Peninsula College of Medicine & Dentistry has a rapidly growing Institute of Health Services Research and Manchester University has an international reputation for mental health research. The core team are based in the same building as the Clinical Trials Unit. Experience and Expertise The core team are experienced at delivering research in justice settings. Methodological and subject experts will ensure rigour and relevance. Research Plan The research will be carried out in two phases and involves four work streams (WSs). Evaluation and Intervention Preparation Phase (Months 1- 24) Theoretical modelling of the intervention (WS1) Realist Review Six best practice mini case studies Support development of intervention in 2 sites Formative evaluation of intervention Methodological development (WS2) Select outcome measures, Develop process of care framework Develop randomisation and follow up procedures Initial economic modelling (WS4) Evaluation Phase (Months 19-60) Exploratory RCT of ICCI in 2 sites (WS3) Recruit and follow up 400 prisoners with common mental health problems from 2 sites Process evaluation of the care received Assess impact Refine intervention (WS1) Draw conclusions about future trial or evaluation (WS2) Modelling of economic and research implications (WS4) Outputs and Dissemination: Significant outputs will include: A theoretically sound, practical and discrete intervention to improve care for prisoners near release. Knowledge about the impact and potential health and economic benefits. Increased understanding about whether further evaluation is desirable. Dissemination will be delivered through the project website (including interim briefings and reports), peer review journals, conference proceedings and by working with policy makers and those redesigning services. Justification Health status is poor, service provision negligible and evidence base inadequate for those designing services. These factors justify a focussed programme of research for prisoners with mental health problems nearing release. Management and Governance The proposed programme has comprehensive lines of responsibility to ensure delivery to time and budget. Ethics Significant ethical considerations are limited. Patient and Public Involvement Peer researchers have been and will be involved in planning, carrying out, interpreting and disseminating findings. Potential Impact Calls have been made for improved mental health care (including IAPT services) for prisoners, both before and after release. A clinical and organisational intervention, with demonstrable better outcomes, would provide the blueprint to develop primary care mental health and an IAPT service for offenders in and leaving prisons. This would lead to improved: Health of offenders Resettlement of offenders &ndash; employment, stable housing, better relationships and reduced re-offending. And in turn potentially reduced stresses and better outcomes for: Dependants Other prison inmates Wider communities And reduced costs to society: Less Criminal Justice System (CJS) costs Reduced benefits payments Potentially reduced healthcare costs longer term In summary, the public health benefits are potentially great if an effective intervention can be developed.

Lay abstract: Prisoners, while in prison and after release, suffer from a range of health problems. More than half have a mental health problem of some kind, with many having two or more. While prison healthcare has improved in the last decade, mental health care is minimal except for those with the severest problems; care after leaving prison is particularly lacking for those with short sentences. We suggest addressing prisoners mental health problems would lead to considerable gains: to prisoners own health; to the wellbeing of their families and communities; along with wider economic and social benefits. Our Programme Development Grant has enabled us to develop ways of engaging prisoners, demonstrating that it is possible to follow up a majority of those with mental health problems after release. The research team has the expertise to develop and evaluate an intervention for this group. The aim of this application is to develop a way of organising care, bringing together therapy, medication, and resettlement interventions (housing, training, employment support), and ensuring treatment can be continued after release; which we call the intervention . We propose that this intervention will act as a bridge between a range of services in and outside of the prison which this group do not normally access. The project will be based in Devon and the North West and will be divided into two phases. The first includes developing the intervention and research methods. The researchers will work closely with people who have previously been in prison, along with prison and community health care providers, to develop the model for the intervention. We will keep testing and trying out different bits of the intervention until we are confident that it is working efficiently and has the best chance of benefitting prisoners. We will also make sure that participating in the research is as acceptable as possible to people. The second phase will involve an exploratory randomised controlled trial, asking prisoners to be involved before leaving prison, and following them up in the community. Half would receive the intervention, and half would receive the care normally available. Evaluating whether it s working will involve collecting information related to people s health, the healthcare they have received, improvements in their social situation such as housing and employment and their involvement with the criminal justice system. We will examine if there is a significant difference between those who did, and did not, receive the intervention. Finally, we will work out how much could be saved if more prisoners received the intervention. Overall, the research will tell us if the proposed intervention improves prisoners common mental health problems, improves other aspects of their lives and has wider social and financial benefits.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH