“LIFE CHANCES SHOT TO PIECES FROM THE START”

PREDICTORS OF ILL HEALTH

ADULTHOOD INFANCY

“Raw pain of abandonment”

PRE-BIRTH

ADOLESCENCE

Intergenerational effects

TruancyAbuseLoss

Intimate partner violence

UnemploymentPoor housing

Barriers to care

WOMEN AT RISKHEALTH OF WOMEN IN THE CRIMINAL JUSTICE SYSTEM

FATAL OUTCOMES

MURDEREDSUICIDEHIV/BBVACCIDENTMATERNAL DEATH

DAMAGING HEALTH BEHAVIOURS

SEXUAL & REPRODUCTIVE HEALTH PHYSICAL HEALTH MENTAL HEALTH

SmokingAlcohol

Drugs & SMInactivity

Eating disorders

Unintended pregnancySTI’s & HIV

Gynae problemsLow BW babies

InjuryPoor self reported health

Under/over weight

Low self esteemPTSD

PDI psychopathySelf harm

LONG TERM CONDITIONS

Asthma / COPDVascular disease / CHD

GI, skin, chronic pain

INCARCERATED WOMEN RATES OF SUBSTANCE ABUSE, MENTAL DISORDERS & OTHER HEALTH PROBLEMS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

S o u r c e : S t a t i o n , e t a l , 2 0 0 3

BARRIERS TO HEALTH AND HEALTH CARE

System geared towards the needs of men…

Lack of integration

Few models of care geared to people with multiple problems

Services not well suited to treating people with challenging behaviour and/or poor social functioning

Residency requirements

Individual barriers

Women prisoners experience high levels of emotional & mental distress

!!!

CRIMINAL JUST ICE SYSTEMINCREASE CONFIDENCE IN COMMUNITY ALTERNATIVES

Health

Local Authority

Schools

Employers

Liaison & diversion Mental healthdiversion

Co-production(CCG/CRC)

Health & social care

Promoting publichealth & well-being

COMMUNITYDEVELOPMENTPARTNERING

Police, custody & courts

Court community

ordersCRC’s

MDT’s

“Health” in there-settlement plan

Co-commissionedservices

YOT’s

GENDER RESPONSIVE BREAK THERAPEUTIC MODEL CONTINUITY EARLY DIAGNOSIS &

INTERVENTION PSYCHO/SOCIAL

STRENGTHEN THE HEALTH SYSTEM

PATHWAY TO HEALTH

STREET TRIAGE

LIASON & DIVERSION

Specialist care detox/psychiatric

Social care, CMHT, voluntary sector,

community, family, relationship

RECOVERYStep down

Secondary care

COURTS, CRC, A&E

PRISON

Primary careCoordinated drug

rehab, early assessment, mental health, well being

IMPROVING HEALTH THROUGH PEER BASED INTERVENTIONS

CONTEXT INTERVENTIONS MECHANISMS INTERMEDIATEHEALTH OUTCOMES

LONG-TERMOUTCOMES

Determinants of offender health

Health inequalities over

life course

Social exclusion

Peerintervention

Prison healthservice

Education &welfare services

LIFE OUTSIDE PRISON LIFE OUTSIDE PRISON

Peer education

Peer support

Popularopinion leaders

Bridging

Other modelsINCREASED CAPACITY?COSTS?

REDUCING BARRIERS TO HEALTH CARE

FACILITATING ACCESS TO HEALTH INFORMATION &

CARE

FORMING THERAPEUTIC ALLIANCES

Adoption of healthy lifestyles & reduction of

risky behaviours

Increase uptake of health care, e.g. screening

Improved mental well-being &

resilience

Organisational outcomes e.g. better order in

prison

TARGET POPULATION PEER HELPERS

INDIVIDUAL LEVEL▼Morbidity▼Mortality▲Quality of life▲Rehabilitation

SOCIETAL▼Health inequalities▼Reoffending▲Family support/health