FocusOn: Continuity of Care for Prison Leavers

What is ‘Continuity of Care’ for prison leavers?

Individuals transitioning from a prison to a community environment can often feel overwhelmed by the number of appointments and tasks they’re required to do to secure housing, access benefits and continue their medication. Having the right people and processes in place to facilitate this transition – particularly for those leaving prison with ongoing drug / alcohol treatment needs – is a vital component for not only reducing reoffending, but also minimising the risk of accidental overdose that can occur after a period of sustained abstinence. 

The need for robust referral pathways from secure settings to community was highlighted in the Government’s 10yr Strategy – From Harm to Hope. The first Annual Review of this strategy noted that “… since the drugs strategy funding was put in place … the percentage of prison leavers with an identified substance misuse need who engage with community treatment within three weeks of release now stands at 40.7%” – this is a more than a 10% increase in less than a decade, where figures from 2015/16 stood at just 30.3%. 

Although this represents significant progress, it is still some way off the government’s target of 75%.

This article will Focus On the importance of providing continuity of care for prison leavers, the challenges for both treatment providers and service users, and what help is needed to better support services in offering a co-ordinated, joined-up approach that can ‘maximise opportunities for engagement’.

Why is it important?

The 2018 to 2021 National Partnership Agreement for Prison Healthcare – an agreement between MoJ, HMPPS, DHSC, NHS England and PHE – sets out three core objectives:

• “To improve the health and wellbeing of people in prison and reduce health inequalities”
• “To reduce re-offending and support rehabilitation by addressing health-related drivers of offending behaviour”
• “To support access to and continuity of care through the prison estate, pre-custody and post-custody into the community”

To this end, in November 2023, the Public Health Outcomes Framework – which sets targets and measures outcomes against specific public health indicators at a national level – set an ambitious target that 75% of ‘…adults released from prison (into the Local Authority Area) with substance misuse treatment need (will) go on to engage in structured treatment interventions in the community within 3 weeks of release’.

This goal highlights the government’s commitment to addressing the many issues linked to problematic drug and alcohol use and offending behaviour, and is a significant step towards breaking the cycle of trauma, substance misuse and high rates of reoffending – in 2019, for example, ‘nearly two-fifths (39%) of the offending population included adults with a history of repeat offending.

Often, those convicted of drug-related, non-violent crime are given short custodial sentences of less than six months – it is thought that this makes up around 50% of the prison population. The most common offences that result in short sentences are theft and drug-offences, key drivers of which are poverty and addiction. It is therefore often the case that people with the most complex issues around mental health, homelessness, neurodiversity and substance misuse issues are also those most impacted when continuity of care processes fall down. 

Without a coordinated approach which ensures better reintegration to the community, sadly many are falling through the gaps. 

The key challenges around provision of continuous care for prison leavers stem from a range of factors, most notably the lack of coordination between prison healthcare teams and community treatment providers. As highlighted in a report by the Ministry of Justice (MoJ) on National Health Partnership, this disjointed approach leads to significant gaps in support during the transition from secured settings to the community. The report emphasises that where these pathways aren’t planned collaboratively, crucial information about an individual’s medical history, mental health needs, history of trauma or other relevant factors may not be effectively shared. This lack of communication can hinder the timely delivery of important interventions.

Public Health England initiated a project to investigate the barriers to seeking treatment following release from prison. They performed an audit on London-based prison and community treatment providers between June 2017 and August 2017. The results of this audit found:

• Only 50% of referrals made by prisons were received by the community treatment providers 
• Where referrals were received, attendance by those referred were very low
• The contact details for the individual were often unclear or inadequately filled in, making any follow-up with the client difficult

Consistent care is crucial for prisoners facing complex issues such as neurodiversity, poor mental health, or substance abuse. Without ongoing support, there’s a greater risk of these individuals reoffending. This not only impacts the wellbeing of the individual, but has wider financial implications on government resources. For example, 48% of those who spend time in one of His Majesty’s Prisons will go on to reoffend within a year, with the estimated cost of reoffending over a 12-month period a significant £4.9 billion.  In addition, £5.5 billion is spent annually in England alone on the criminal justice costs of drug-related crime.

There are multiple initiatives currently being undertaken by the government and treatment services to help tackle the ongoing challenges of offering continuity of care for prison leavers.

One such initiative is the delivery of prison ‘in-reach’ teams. Typically, in-reach workers will meet clients prior to release, assess their support needs in the community and develop a coordinated plan with multiple agencies that provide a framework of support on release. Comprehensive assessments conducted with the client in prison will evaluate mental health needs, specific healthcare concerns and treatment requirements to maintain abstinence and prevent relapse.

Results have shown that in London, the involvement of in-reach services from community providers substantially boosts the probability of a prisoner participating in community-based treatment by nearly 3 times. The above report found that prisoners who were contacted prior to release were 80% more likely to engage with community services.

One example is Doncaster Prisons, who deliver a departure lounge service in which they work with community treatment providers to give advice, guidance and support to at least 90 percent of prisoners immediately on release.

How can ILLY Help?

At ILLY our mission is to make a meaningful impact on our communities through technology , and the continuity of care for prison leavers is one area where we can help.

We offer a versatile range of digital tools, including our adaptable Dashboards through which the transition of individuals between community and secure settings can be presented. Such data is crucial for councils and commissioners to assess the time lapse between release and engagement with treatment services.

Within our suite of Digital Tools, we have an electronic referral system which can inform community services about clients leaving prison, ensuring a proactive approach to post-release care.

Our LINKS CarePath system offers a dedicated criminal justice module with an in-built DIRDET form that prison in-reach workers can use as part of their assessment process, where the client requires ongoing case management by the CJIT team.

This is just one of many ways in which we can use technology to help contribute towards improving the continuity of care for prison leavers entering back into the community.

We would welcome the opportunity to discuss with you further about how we can support the good work already being done. If you have any questions or would like to find out more, please get in touch with our Client Services Team and we’ll be happy to help.