Improve cooperation to tackle criminal justice system’s health inequalities

The mortality rate for prisoners is 50 per cent higher than for the general population, according to a new report from the Revolving Doors charity in partnership with Public Health England, NHS England and the Home Office.

Around 15 per cent of prisoners had been homeless immediately before custody and more than 40 per cent suffered from depression, says Rebalancing act, compared to a 3.5 per cent lifetime experience of homelessness and 10 per cent rates of depression among the wider population.

People in frequent contact with the criminal justice system are also four times more likely to smoke and often have ‘the biological characteristics’ of those ten years older, the document says. Aimed at local decision makers such as directors of public health and police and crime commissioners, it urges better use of existing resources such as joint commissioning or pooled budgets.

Mortality rates are much higher for prisoners than for the general population, says the new report.

The criminal justice system is ‘uniquely placed’ to tackle substance misuse and break the cycle of reoffending, it stresses, but adds that those in contact with the system ‘may be the bearers of multiple labels which carry or are perceived to carry stigma: “offender”, “mentally ill”, “homeless”, “substance abuser”, “personality disordered”. Such labels can lead to negative attitudes from professionals and act as a barrier to access or engagement with healthcare.’

PHE will be publishing revised guidance on coexisting substance misuse and mental ill health this year, the report adds, while restating the need for assessment and intervention pathways to be as integrated and streamlined as possible and, ‘where practicable, based on the principle of “no wrong door”’– that someone presenting with a mental health or substance misuse need, or combination, should be able to ‘receive a service or to be seamlessly referred no matter which service’ they access first.

‘People in touch with the criminal justice system are more likely to smoke, experience depression and have overall poorer health than the general population,’ said PHE chief executive Duncan Selbie. ‘This is not right and it doesn’t have to be this way. Crime prevention and the prevention of ill health go hand in hand. This resource will help local health and crime prevention experts end this travesty, improve health across local populations and reduce re-offending rates.’

PHE has also published guidance on designing and delivering programmes to reduce TB in ‘under-served populations’ such as people with substance misuse problems or those in contact with the criminal justice system, including examples of good practice from across the country.

Rebalancing act at

Tackling tuberculosis in under-served populations at