Probationers, mental health problems and substance misuse

Almost four in ten probationers have a formal mental health problem. Five out of ten have a personality disorder. More than five out of ten have are problem drinkers. Twelve percent of the people under probation supervision have a substantial or severe drug problem. These are the main results of the study ‘An investigation into the prevalence of mental health disorders and patterns of health service access in a probation population’, carried out by professor Charlie Brooker of the University of Lincoln. “I had been working for more than twenty years in the field of regular mental health care. In the year 2000 I won a tender to undertake a systematic review of mental health problems in prisons. I was immediately hooked on the subject. The prevalence of mental health problems was very high, while access to mental health services was extremely limited.”

Prevalence
Later professor Brooker’s focus shifted from prisons to probation. “In a study commissioned by the NHS we first tried to identify the health needs assessments of offenders under probation supervision. In a second study, that was recently published, we investigated the prevalence of mental health disorders of people under probation.* As far as I know, this is the first study on this topic. That is in fact quite unbelievable. The prison population in Britain is under half the size of the probation population. Anyway, our results show that the mental health problems are widespread. Prevalence is very high and so are the barriers to effective help.”

Barriers
These barriers to effectively addressing mental health problems in the probation population are discussed elaborately in professor Brooker’s latest report. “A big problem is getting probationers into services. Our study showed that offenders didn’t always meet the referral criteria. Some services didn’t accept people with a dual diagnosis (for example both a substance misuse and a mental health problem). Probationers often have more than one problem. On the other side, it is difficult to motivate offenders to go to services. This is especially the case when these services are located far away, or when probation officers don’t explain very well to probationers what their mental health problem is and how they might benefit from treatment. You also have to take into account that many probationers live a (somewhat) chaotic life and they don’t always turn up for appointments. Last but not least, our study showed that probation staff did not always identify mental health problems or wasn’t able to refer in the correct way to the correct service.”

Training
In order to tackle this last problem professor Brooker set up a two-day training for probation officers in the county of Lincolnshire. “We taught them how they could better recognize mental health problems, what services existed and how they could best access them. We could prove that their knowledge on these topics improved significantly. However, our study also showed that this knowledge was washed out six months later. So, we had to come up with a better model. Our solution is twofold. In the first place we must not train probation officers when they’re already working. We must pay more attention to mental health problems in the initial training. In the past you had to be a social worker before you could become a probation officer. Social workers are trained to focus on mental health problems. Nowadays you don’t need to be a social worker in order to follow the two years training to become ‘offender manager’, as it is called now. Only half a university module, approximately 10 teaching hours, [For the Continental reader: how much is that in hours or days?] centres around mental health problems and substance misuse. That is simply not enough and needs to be changed on the national level.”

Community mental health nurses
The second part of professor Brooker’s solution is to get expertise on mental health problems into the probation services. “Community mental health nurses can support probation officers very effectively. Take a probation officer that notices that a client acts in a bizarre way, seeing things that aren’t there for example. If he says ‘I think you have a mental health problem and you should see Dr. Jones in two weeks at this address’, the outcome will most probably be that the probationer will not go there. If this probationer can talk to a community mental health nurse in the same building at the same day, referral to the most suitable service can be organized much more effectively. Community mental health nurses can also do part of the treatment themselves. Alcohol misuse for example. This is a huge problem, much more so than drug misuse, not only among probationers, but in the general public as well. Nevertheless, the British government spends seven times more resources on drugs than on alcohol in probation services. Access to services that treat alcohol misuse is absolutely inadequate at this moment. Especially for probationers, who quite often don’t ‘just’ have a drinking problem, but also a personality disorder and maybe another mental health problem.”

Results
The probation service in Lincolnshire has adopted professor Brooker’s new approach. What are the results? “It’s a bit too early to tell. We just published the report that proves there is a big problem regarding the mental health of probationers and their access to services. I feel very strongly that all people have the same right to health care access. That means that we should do something if we know – as we do now – that people under probation supervision have only limited access. I hope my report and the recent experiences in Lincolnshire can contribute to that. There may be self-interest for the community involved as well. It could well be that reoffending reduces if we treat probationers with mental health problems and substance misuse better. We don’t know that, because it has never been studied. I see this topic as the logical next step of our research. That is, if we can win the competition for resources from more attractive areas like coronary care and paediatric diseases…”