Prisoners experience a high incidence of varying mental health problems. Our recently completed COCOA study found that 53% reported drug misuse, 36% alcohol misuse, 15% severe and 59% moderate mental health problems. In addition comorbidity between mental health problems, substance misuse and personality disorder was the norm rather than the exception.
Importantly, whilst over half of prisoners reported common mental health problems, few engage with services to address their mental healthcare needs. Prisoners released from prison with mental health problems face difficulty with family relationships, employment, long-term illness, self-harm and re-offending.
An ongoing collaboration focusing on mental health care for prisoners between University of Plymouth, Faculty of Medicine and Dentistry and the University of Manchester has received funding in the region of £2 million from the National Institute for Health Research to carry out the Engager Project. The project aims to develop and evaluate a collaborative care intervention for offenders with common mental health problems near to and after release based on an integrated approach including therapy, medication, housing, training and employment.
Working with prisoners, the Engager project aims to develop a way of organising care for men with common mental health problems as they approach being released from prison. We propose that the intervention will act as a bridge between a range of services not usually accessed by this group, inside and outside of prison. An Engager practitioner will work with each person to develop a shared understanding of their individual goals, and to help them to engage with services to help them achieve them.
Phase 1 – Developing the intervention
The project is split into two phases. During Phase 1 we developed and tested an integrated approach to organising care involving therapy, medication, housing, training and employment, and ensuring that care continues after release from prison. We created a methodology and set of measures needed to evaluate this intervention in a randomised controlled trial and developed an economic model to asses the potential costs and benefits of the intervention.
Phase 2 – Randomised controlled trial
During Phase 2 a randomised controlled trial was conducted to evaluate the clinical, social, and economic impact of the intervention. Prisoners were asked to take part in the trial before leaving prison and were followed up in the community. Half received the intervention and half received the usual available care. The results will enable us to assess whether the Engager intervention improves prisoners’ common mental health problems and has wider social and financial benefits. The final report will be available in 2020.
You can read more about the Engager project and the intervention developed on the project website, or contact the project team via the link below.
Patient and public involvement
People serving sentences in the Criminal Justice System (CJS) often have substantially different backgrounds and life experiences from the general population. To ensure that the Engager intervention was relevent to those who would receive it a Peer Researcher (PR) group was set up. The group, consisting of eight men, met fortnightly at a local substance misuse charity.
The PRs were involved in all aspects of the project up until the start of the Randomised Controlled Trial (RCT). Most notably they helped to refine research documents, ensuring that their language and length were suitable. Hear from three Peer Researchers about their involvement in Engager in the video above by the University of Plymouth.
News stories related to the project:
- Project receives extension and additional funding
- Professor Richard Byng discusses offender mental health with Western Morning News
- Ex-offenders play key role in prisoner mental health research
The Engager approach has been adopted and implemented by West Midlands Combined Authority Mental Health Commission.
The Engager model is being taught on the Plymouth GP vocational training scheme and to community and practice nurses in training.
Our work on Offender Mental Health was included as a case study in the 2014/15 PenCLAHRC Annual Report.
Additionally, the Engager team received ‘highly commended’ in the NIHR CRN Mental Health McPin MQ Service User and Carer Involvement in Research Award 2018.
Kirkpatrick T, Lennox C, Taylor R, Anderson R, Maguire M, Haddad M, Michie S, Owens C, Durcan G, Stirzaker A, Henley W, Stevenson C, Carroll L, Quinn C, Brand SL, Harris T, Stewart A, Todd R, Rybszynska-Bunt S, Greer R, Pearson M, Shaw J, Byng R (2018). Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial. BMJ Open 8(2):e017931
Lennox C, Kirkpatrick T, Taylor RS, Todd R, Greenwood C, Haddad M, Stevenson C, Stewart A, Shenton D, Carroll L, Brand SL, Quinn C, Anderson R, Maguire M, Harris T, Shaw J, Byng R (2017). Pilot randomised controlled trial of the ENGAGER collaborative care intervention for prisoners with common mental health problems, near to and after release. Pilot and Feasibility Studies 2 4:15