The health needs of offenders

5 Dec 2022
This week's blog in the series by independent consultant, Russell Webster, explores Ingeus’ innovative health trainer model.

There has been growing concern about the health needs of people in contact with the criminal justice system. Official reports identify a wide range of health needs including:

•    Higher prevalence of infectious diseases, and poorer vaccine coverage;
•    Higher prevalence of long-term conditions;
•    Higher prevalence and rates of substance misuse;
•    Higher prevalence of mental ill health; and
•    Higher levels of learning disabilities and lower educational attainment.

Service users’ life experiences and lifestyles put them at additional risk of a wide range of physical and mental health conditions and many are not engaged with helping services. All this was well known before the Covid pandemic which has obviously put our entire NHS under severe pressure.

Historically, there have been very few health-specific initiatives targeted at people on probation to try to address these health inequalities. However, Ingeus has been working in this space for over a decade, drawing on its belief in the value of lived experience. 

The health trainer approach

The Ingeus health trainer model is designed to support people on probation to access appropriate health services and promote healthier lifestyles. The service is delivered on a completely voluntary basis, to ensure that people can keep their healthcare information confidential and to encourage uptake of the service. The service offers a wide range of health-related services including:

•    Support in registering with a G.P and Dentist. 
•    Accessing mental health services. 
•    Buddying up to appointments and advocating when required. 
•    Substance misuse education/advice and referral to relevant services. 
•    Smoking cessation. 
•    Heathy eating and promoting good physical health. 
•    Sexual health advice and free condom distribution/registration. 

The Ingeus approach is based on all health trainers having lived experience of the criminal justice system to be more effective at gaining the trust of people on probation and supporting them to access helping services. 

My evaluation of the service found that a large majority of people who engage with the health trainer service succeed in achieving their health goals. Service users identified four key aspects of the service which they

1.    The supportive nature of the work; 
2.    The availability of health trainers; 
3.    Their non-judgmental approach; and 
4.    Their reliability.

It is perhaps easier to get a sense of the impact of the health trainer service by hearing the views of the people the service was helping; the quotes below are all from different individuals:

“She has given me confidence, she is down to earth, easy to talk to. She has the same past as me.” 

“You can text him and he will get back to you straight away if you’re having a crisis. It keeps me motivated” 

“If she says she is going to do things, she will always do them. If she can’t do them, she rings me and explains why” 

“It really helped having the Health Trainer attend hospital with me as I was really anxious.”

“I am homeless and struggle to keep my appointments but my health trainer always made me feel there was light at the end of the tunnel.”

“I like the fact that he can go to appointments with me and is always on the end of the phone if I need help.”

My evaluation also found that people with persistent and complex needs, typically involving mental ill health and or substance misuse, were also much more likely to successfully complete their period of probation supervision.

Going forwards

The knowledge and experience gained by Ingeus through the operation of the health trainers team has been taken forward in a new service being delivered in Chesterfield. 

Ingeus has now created a proven, cost-effective model to engage vulnerable people, including people not in contact with the criminal justice system, into mainstream health provision with substantial individual gains in terms of health and quality of life and considerable long-term savings to the health service which is able to provide planned rather than emergency care and intervene much earlier in the progression of a range of physical and mental health conditions.  

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