Mental health – helping families to access support and services.

1. Mental health – helping families to access support and services. Matt Fossey Senior Associate

2. Pair work • What is mental health? • Think for 1 minute about what is meant by mental health • Discuss your thoughts with the person sitting next to you (5 mins) • Feedback

3. What is Mental Health? • "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." WHO • Therefore mental health is more than the absence of mental disorders or disabilities.

4. Determinants of Mental Illness • Social Factors: Rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence and physical ill-health and human rights violations. • Psychological Factors: There are also specific psychological and personality factors that make people vulnerable to mental disorders. • Biological Factors: e.g.Genetic factors and imbalances in chemicals in the brain.

5. Defining mental illness? • As with many physical illnesses, a mental illness is a symptom or a series or cluster of symptoms that affect the person’s ability to function • Common mental health problems: 1:4 • Depression, anxiety disorders (OCD, GAD, phobias, PTSD etc) • Severe mental illness: 1-2:100 • Schizophrenia, bipolar disorder etc.

6. Group Work:Discussion 20 mins then feedback • What do you know about the prevalence of mental illness in the prison population? • What services and interventions are available for the public with mental health problems? • What types of services are available for prisoners with mental health problems? • What do you know about the mental health of prisoners’ families?

7. Prevalence of mental illness in the prison population 1 • Up to 90% of prisoners have some form of mental health problem (including addictions and personality disorder – Singleton et al., 1998) • 10% of male and 30% of female prisoners have previously experienced a psychiatric acute admission to hospital (DH, 2007) • Rates of self harm and attempted suicide in prison are high. A total of 58 prison suicides and 26,983 self-harm incidents were recorded in 2010 (MoJ, 2011). Women represent 5% of the prison population, but account for nearly half of all reported self-harm incidents (MoJ, 2011). • …“women in custody are five times more likely to have a mental health concern than women in the general population” (University of Oxford, cited in Prison Reform Trust, 2008).

8. Prevalence of mental illness in the prison population 2 • BME communities represent about 10% of the UK population (ONS, 2001) but in prison this rises to 26%, a significant proportion of whom are foreign nationals (MoJ, 2008). Of these, 11% are black British, whereas black Britons represent 2.8% of the general population (Prison Reform Trust, 2011). • There are high rates of suicide among foreign nationals: 25% of all prison suicides in 2007/8 (HMIP, 2009) • The rate of diagnosed mental health problems in prison is lower in BME people than among the white population, this may reflect lower levels of identification and referral (Durcan & Knowles, 2006) • There is some limited evidence to suggest that black and other BME prisoners are underrepresented in prison mental health team caseloads by comparison with their representation in the prison population (Inreach Review Team, 2007; Offender Health South East, 2008; Offender Health South East, 2010).

9. Prevalence of mental illness in the prison population 3

10. Mental Health Interventions and Services • Voluntary sector: helplines, advice, counselling • Most clinical services are provided in primary care: “watchful waiting”, medication, counselling, access to talking therapies (IAPT), liaison psychiatry • Secondary care mental health services: psychiatry, psychology, CMHT, EI, HTT, social work • Private practice – often very good and professional but ??? Regulation and therapeutic efficacy • Self help: family, friends, social networks (?internet)

11. Interventions for prisoners • Equivalence of care • Services provided by the NHS • ?Continuity of care within the prison estate • Normalisation of mental illness – tolerance of symptoms (of course people swing the lead!) • Drug and alcohol detox • Psycho-therapeutic work (however, traditionally psychology within the prison context has been focused on risk) • IAPT interventions and service models – trials of CCBT etc.

12. Mental Health of Prisoners’ Families • Focus remains on the prisoners • Very little research carried out on the impact of imprisonment on the mental health of families, however…. • The increase in emotional strain on children with a parent in prison mean that they have a risk three times higher than that of their peers of developing mental health problems and engaging in anti-social behaviour (SCIE, 2008) • 65 per cent of boys with a convicted parent will themselves go on to offend in later life, thus increasing the likelihood of future crime in our communities (Social Exclusion Taskforce, 2005)

13. Further Reading • Centre for Mental Health (2011) Mental Heal Care and the Criminal Justice System: Briefing 39 London:CMH • Sainsbury Centre for Mental Health (2009) The chance of a lifetime: Preventing early conduct problems and reducing crime London:SCMH • Prison Reform Trust (2011) BromleyBriefings Prison FactfileLondon:PRT • The Centre for Social Justice (2009) Breakthrough Britain: Locked Up Potential: A strategy for reforming prisons and rehabilitating prisoners A Policy Report by the Prison Reform Working Group London:CSJ

14. Thank you Matt Fossey Email: matt.fossey@centreformentalhealth.org.uk