Table of contents


Adults :: Offenders :: Summary

For many years it has been clear that individuals who come in contact with the criminal justice agencies are far more likely to come from some of our most vulnerable and disadvantaged groups in society, with the worst outcomes and greatest inequalities in health. Many of the factors that impact on poor health are the same as those leading to increased criminality such as poor housing, unemployment and poor educational attainment.

Offenders and their families are more likely to have learning difficulties and disabilities, with poor educational attainment.[1] In a recent survey of young prisoners, most had been excluded from school with many failing to receive full time education after the age of 14 years.[2] Once they have been excluded it is easier to become part of groups who are engaged in disruptive and criminal behaviour, where taking drugs and abusing alcohol are commonplace. Risk taking behaviour will also include early sexual activity, with many becoming parents in their teenage years, continuing the cross generational cycle of disadvantage. It should not be surprising to find that this group is far more likely to suffer from mental health problems, which contribute to their problems.

Families of offenders can often be chaotic with high levels of substance misuse, alcohol problems, and mental health issues and higher than normal levels of domestic violence. Young offenders are more likely to have been taken into the care of local authorities at some point in their childhood, and are more likely to have other members of the family known to criminal justice agencies. Medway PCT has already identified some of their most challenged families and are starting to work with them to try and break the cycle of disadvantage and criminality.

Young men rarely take advantage of mainstream health services and are not commonly seen in primary care. Schools provide an important source of information on lifestyle choices, which lead to positive health outcomes, missed by those outside the mainstream schools. Contact with criminal justice agencies may provide the first opportunity for some of these young people to have their health needs assessed and addressed. It also could provide the opportunity to leave them, and their families, positive messages about how to improve their health in the future. NHS Medway is already contributing to this through their work with the Medway Youth Offending Team.

Key issues and gaps

The commissioning of healthcare in prisons should be equivalent level to that of the rest of the population, and Improving Health, Supporting Justice (November 2009)[3] sets very clear aims for each locality in terms of its offender health population.

This coupled with Lord Bradley's recommendations (April 2009)[4] refers to the ability for a strong commissioning structure to contribute to reducing inequalities and support the justice system in reducing reoffending through the provision of an integrated and dynamic model of health care.

• Commission the same range and quality of services for offenders as it does for general public

• Target resources at reducing health inequalities in order to improve morbidity and mortality rates in this vulnerable group

• Ensure that prison health services are appropriately reflected in the development and implementation of wider government policies, and the wider criminal justice system

• Ensure that there is continuous service development for offender health services

• Make the best use of available resources and ensure value for money in the commissioning of offender health services


[1]   Griggs J, Walker R. The costs of child poverty for individuals and society 2008; Joseph Rowntree Foundation.
[2]   Shepherd G. A lifetime of exclusion? The psychologist 2010; 23:1: 24-25.
[3]   Department of Health. Improving health, supporting justice: the national delivery plan of the Health and Criminal Justice Programme Board 2009; Department of Health.
[4]   Bradley RHL. Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system Department of Health; 2009.