Research on Improving Health Outcomes for People on Probation: A Narrative Systematic Review

This article is written by Dr Coral Sirdifield, and Professor Charlie Brooker.

As part of a wider research study, researchers from the University of Lincoln, and Royal Holloway, University of London, UK, conducted a systematic review of the literature to identify studies on the most effective ways of providing healthcare for adults on probation to achieve good health outcomes. Articles from this study, which present findings on mental health, suicide, and substance misuse respectively, are being submitted for publication. The first of these can be accessed on the website of Science Direct. A probation healthcare commissioning toolkit was also developed for this project.

The article presented here provides an overview of the entire systematic review, which encompassed a broad definition of health. The search, included nine databases, the grey literature, and hand-searching of key journals. Overall, we identified 45 research papers. Given the real world difficulties associated with conducting research on interventions with criminal justice populations, we did not assign low quality ratings to studies with small sample sizes. Nevertheless, we were only able to identify 33 papers that were rated as high quality, the majority (n=27) of which were about treatment for substance misuse. Given the high prevalence of mental illness and suicide in probation populations, it is disappointing that we were only able to include four research studies in our mental health paper, and one research study in our paper on suicide. Clearly probation practitioners are encountering people with mental illness and suicidal ideation on a daily basis, and practical guidance on how best to manage these issues and get people into treatment is sorely needed.

These studies point to potential value in particular forms of treatment, partnership working, appropriate location of services, specialist approved premises, and basing roles such as Health Trainers within criminal justice settings to improve engagement with treatment and achieve positive health outcomes. However, further research would be needed to establish the generalisability of findings from many studies. Heterogeneity within the identified studies makes it difficult to draw firm conclusions on what the most effective ways of improving health outcomes for adults on probation are. For example, whilst there is some evidence of positive outcomes from drug courts, there is also variation between the courts that have been studied in terms of the content of their programmes, their eligibility criteria, and their referral procedures.

Overall, our review highlights that internationally, there is a lack of research on this important topic. If we are serious about achieving the goal of rehabilitating and reintegrating offenders, then we need substantial investment in high quality research into their health needs, and how best to meet them.

We believe that the construction of a European probation research network is necessary and that health, especially mental health should be an initial priority for such a network. In particular, research is needed into ways of reducing suicide and self-harm amongst people on probation, and into ways of improving engagement with mental health services.

This article presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0815-20012). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.