Barriers in Accessing the Healthcare System
A summary report written by SALSABILLA ZAKI (Ignite intern)
Introduction
Individuals within inclusion health groups, particularly those involved with the criminal justice system, face significant obstacles in accessing primary and preventive care. Mental health issues are widespread in this demographic, with an estimated 39% experiencing disorder while in custody. Initial failures in care provision during incarceration lead to long-term health challenges, including anxiety, depression, substance abuse, and increased reliance on emergency services.
Challenges Faced by Inclusion Health Groups
People with inclusion health groups often encounter barriers to accessing primary and preventive care, leading them to depend on emergency services for acute health needs. Mental health problems are notably prevalent among those in contact with the criminal justice system, with 39% of detainees in police custody having some form of mental disorder. Remand prisoners have even higher rates of mental disorder compared to sentenced prisoners1. These initial care failures during incarceration result in long-term issues such as anxiety, depression, and substance abuse, exacerbating health inequalities and increasing the financial burden on emergency services.
(Barriers to accessing health care include poverty, education, cost of health insurance, income and jobs, discrimination, linguistic and cultural proficiency, as well as transportation.)
Issues Faced by People in Contact with the Criminal Justice System
People in contact with the criminal justice system, including those serving prison sentences and those under probation supervision1,often have complex histories involving:
Childhood abuse
Homelessness
Unemployment
High-risk behaviors
Poor management of existing health issues
These individuals experience severe health inequalities, with an average age of death in prison at 56 years compared to 81 years in the general population2.
Current Policies and Initiatives:
CORE20PLUS5: These initiative uses the Index of Multiple Deprivation to identify the 20% most deprived areas in the UK and guides actions to reduce healthcare inequalities among inclusion groups at both national and system levels, focusing on five clinical areas requiring accelerated improvement3.
SPOTLIGHT: Aims to improve the accessibility and visibility of data and evidence related to inclusion health populations across four themes4.
National Framework for NHS on Inclusion Health - Published in October 2023, this framework supports systems in planning, developing, and improving health services to meet the needs of people in inclusion health groups. It emphasizes the importance of partnership across sectors and within the Integrated Care System5.
Key Findings:
Learning Disabilities and Literacy: One-third of people in contact with the criminal justice system have a learning disability or difficulty, with 57% of adult prisoners having literacy levels below those expected of an 11-year-old6.
Mental Health: A lack of a common definition of mental ill health results in an incomplete picture of the mental health needs within the criminal justice system11. 71% of women and 47% of men in this system experience mental health problems2.
Substance Misuse: Substance misuse is a significant factor in re-offending. Over 55% of individuals identified with mental health needs in the criminal justice system also struggle with drug or alcohol use1 Women often receive drug treatments in prison that have been developed using male biological models which may not be optimal for female physiology, resulting in a health inequality7.
Women’s Health in Prison
Women constitute less than 4% of the prison population but face disproportionately higher health and social care needs8. Key issues include limited data and research on health and social care needs, high levels of trauma and substance abuse, inconsistent and gender-insensitive health services, and challenges in accessing appropriate care, such as missed midwifery appointments and inadequate sexual and reproductive health care.
Hospital Episodes Statistics (HES) data in 2019/20 showed that just under 30% of inpatient admissions by women in prison had a diagnosis of substance misuse9.
A review by NHS England found that health and social care services across women’s prisons are inconsistent, not always gender specific or sensitive to women with protected characteristics. Acutely mentally ill women are still being sent to prison10.
Women in prison often experience challenges and barriers around accessing health and care services including missed midwifery appointments due to lack of available escort staff, and a lack of understanding around sexual and reproductive health care needs including menopause10.
Recommendations
Education and Community Engagement: Health and offending are often interrelated. Health issues such as substance misuse or mental health problems can lead to contact with the criminal justice system. Addressing the health needs through education can reduce reoffending and improve overall community health.
Personalized Transition Services: Investing in personalized transitions from prison to probation services is crucial for continuity of care, especially for those with ongoing health needs or substance misuse issues. Based on “Several interviewees reported that they felt the Probation Service was “on their side”. Filip said: “She (probation practitioner) has taken into consideration my view and has given me the feeling that I have a voice… (this) impacted massively on my mental health”11.
Support for families: developing partnerships to support families with healthcare provisions can prevent the negative impacts of family separation on physical and mental wellbeing.
Funding for Mental Health Services: Prioritizing funding to close gaps in mental health services, across the range of needs including primary mental healthcare and specialist interventions for women who have experienced trauma, including sexual and domestic violence.
Addressing the healthcare needs of individuals in the criminal justice system is critical for reducing health inequalities and improving overall societal health outcomes.
References:
1 - NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE 1 Guideline title (no date). Available at: https://www.nice.org.uk/guidance/ng66/documents/mental-health-of-adults-in-contact-with-the-criminal-justice-system-final-scope2#:~:text=a)%20Mental%20health%20problems%20are.
2 - Inclusion health groups. Available at: https://data.southampton.gov.uk/media/kf2lpfth/inclusion-health-groups-se-datapack-hiow.pdf
3 - NHS England (2021) Core20PLUS5 – an Approach to Reducing Health Inequalities, www.england.nhs.uk. NHS England. Available at: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/
4 - (2018) Phe.gov.uk. Available at: https://analytics.phe.gov.uk/apps/spotlight/
5 - NHS England (2023) NHS England» A national framework for NHS – action on inclusion health, www.england.nhs.uk. Available at: https://www.england.nhs.uk/long-read/a-national-framework-for-nhs-action-on-inclusion-health/
6 - Functional Skills Impact on Prisoner Reoffending (2023) Novus. Available at: https://www.novus.ac.uk/news/functional-skills-in-prison-education/#:~:text=Prisoners%20have%20much%20lower%20levels
7 - Langan, N.P. and Pelissier, B.M.M. (2001) ‘Gender differences among prisoners in drug treatment’, Journal of Substance Abuse, 13(3), pp. 291–301. Available at: https://doi.org/10.1016/s0899-3289(01)00083-9
8 - Offender Management Statistics quarterly: April to June 2023 (no date) GOV.UK. Available at: https://www.gov.uk/government/statistics/offender-management-statistics-quarterly-april-to-june-2023
9 - Davies, M., Hutchings, R. and Keeble, E. (2022) Inequality on the inside Using hospital data to understand the key health care issues for women in prison. Available at: https://www.nuffieldtrust.org.uk/sites/default/files/2022-07/1658157477_inequality-on-the-inside-web.pdf
10 - NHS England» A review of health and social care in women’s prisons (2023) www.england.nhs.uk. Available at: https://www.england.nhs.uk/long-read/a-review-of-health-and-social-care-in-womens-prisons/
11 - Criminal justice system failing people with mental health issues – with not enough progress over the past 12 years. [online] Available at: https://www.justiceinspectorates.gov.uk/cjji/media/press-releases/2021/11/mentalhealth2021/#:~:text=The%2520inspection%2520found%2520delays%2520are