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Who's at risk and why?

Adults :: Offenders :: Who's at risk and why?

The cyclical nature of disadvantage is well recognised, culminating in the government paper Breaking the Cycle[1] which stresses the inability for one agency to tackle all of the issues and the great need for organisations, including health agencies, to work together to protect society, reduce criminal activity and improve the life chances for individuals. Medway has some of the most deprived communities in the South East of England, but partnership working has helped reduce re-offending. Medway is home to two prisons, HMP Rochester and HMYOI Cookham Wood.

Information from the local criminal justice agencies and the prison service indicates that approximately 46,000 people are detained in custody each year within the Kent and Medway area. According to the probation service, there are approximately 1,300 individuals under supervision of the probation service across Kent and Medway at any one time. There are about 150–160 young people under the care of the Youth Offending Team at any one time and there are about 560 families in Medway with complex and chaotic lives that lead them to be in contact with criminal justice agencies. The highest proportions of offenders live in Chatham. Approximately 10% of offenders are women, but they tend to have complex needs.

Prisons in Medway

HMP Rochester
• Operational capacity: 649
• There are currently 565 prisoners between the age of 18 and 21 years old and 94 between the age of 22 and 68 years old (November 2011).
• The prison holds convicted sentenced male offenders. It has some old accommodation and new purpose built accommodation which opened in 2008. The Chief Inspector of prisons commented[2][3] that the large area of the prison and some of the behavioural challenges encountered made this a difficult prison to operate.

HMYOI Cookham Wood
• Operational capacity: 143
• The age range of prisoners is 15–18 years
• Cookham Wood takes young men on remand or convicted, but not deemed suitable for secure local authority accommodation. There is a 60/40 split between sentenced and remanded prisoners. The turnover of population is estimated to be over 70%.
• Proposals to build two new wings on the site are being actively considered, and it is anticipated that the prison roll is likely to increase from 143 to approximately 200 within the next 18 months

High Risk of Suicide
• Prisoners have higher rates of suicide whilst in prison compared to the general population. Young offenders aged 15–17 are 18 times more likely to commit suicide.[4]
• Female ex-offenders are 35.8 times more likely, and male ex-offenders are 8.3 times more likely to commit suicide. The risk is especially high in the first month after release for older ex-offenders.[5]
• Some of these deaths are related to loss of tolerance upon returning to drug misuse, but the majority are related to high psychiatric morbidity combined with a high stress situation.
• Foreign National Prisoners (FNP) also experience high rates of suicide. There were over 20 apparently self-inflicted deaths of FNPs in prisons during 2007 compared to a historical annual average of 6. The Prisons and Probation Ombudsman (PPO) investigations into the deaths have not identified any clear link with immigration status (CSIP data 2007).
• The suicide rate for offenders in custody and recently released is nine times the rate found among similar population in the community.
• Hanging is the most common method (80%) associated with self inflicted deaths in prison.[6]

Poor Mental Health Prisoners and ex-offenders are a group at particular risk of mental health problems.
• Men and women in prison have a higher proportion of serious mental health problems, including psychosis.
• The majority of prisoners have some degree of learning difficulty, with over one in 10 remand prisoners having an IQ under 65.[7]
• For male and female prisoners, 27% have been in care as a child, compared to 2% in the general population.[8]
• Many prisoners are released without mental health support, drug service throughcare, housing or income support.
• Ex-offenders are more likely to suffer rejection and discrimination from families and wider society.
• Prisoners generally have higher rates of mental illness and self harm and other associated risk factors, such as drug and alcohol misuse.
• A high proportion of offenders have been found to suffer from drug and alcohol addiction.
• In the young offender population, alcohol misuse is often of greater significance than drug misuse.

Other conditions[9]
• The incidence of sexual health problems is known to be significant among young offenders.
• Chronic diseases such as heart disease and diabetes form a high proportion of the health care needs of prisoners. Incidence of such conditions is lower among young offenders. Early recognition and appropriate management of conditions such as asthma, epilepsy and diabetes are vital in preventing progression of these chronic conditions.
• The prevalence of learning disabilities, including autism and Asperger's syndrome, and such conditions such as attention deficit hyperactivity disorder (ADHD) may require particular interventions in the under 21 population.
• Poor oral health and dental disease is also a feature of prisoners, which requires the provision of a high standard and volume of care.


[1]   Ministry of Justice. Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders 2010; Ministry of Justice.
[2]   Shepherd G. A lifetime of exclusion? The psychologist 2010; 23:1: 24-25.
[3]   Bradley RHL. Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system Department of Health; 2009.
[4]   Fazel S, Benning R, Danesh J. Suicides in male prisoners in England and Wales, 1978-2003 Lancet 2005; 366: 1301-1302.
[5]   Pratt D, Piper M, Appleby L, et al. Suicide in recently released prisoners: a population based cohort study Lancet 2006; 368: 119-123.
[6]   Burrows T, Brock AP, Hulley S, et al. Safer Cells Evaluation 2003; Jill Dando Institute, UCL. .
[7]   Nurse J, Champion J. Mental Health and Well-Being in the South East 2006; Care Services Improvement Partnership, Department of Health. .
[8]   Social Exclusion Unit. Reducing re-offending by ex-prisoners 2002; HMG Cabinet Office. .
[9]   Norman S, Nayyar K. General Health Needs Assessment: HMYOI Cookham Wood and HMP YOI Rochester 2011; NHS Medway.