In 2014 ‘A Presumption Against Imprisonment: Social Order and Social Values’ stated that in place of incarceration, more offenders should be dealt with by means of financial penalties and community-based sanctions, emphasising that persistent offenders of low or moderate level crimes must be dealt with in the community. A promised reduction in expenditure has resulted in advocacy for the use of community sentences in place of incarceration. Offenders are more likely to smoke, misuse drugs or alcohol and have mental and physical health problems. Furthermore, community offender’s lives are often complicated by multimorbidities and complex social and personal issues.
There is a complex relationship between health and social influences on offending and re-offending behaviour. Therefore, there is potential to reduce reoffending behaviour by improving the health of offenders, for example by improving mental health or reducing substance misuse, but this cannot be achieved without understanding the health needs of this population group.
This HNA was conducted by the Public Health Department of Derbyshire County Council between July 2016 and July 2017. The HNA focuses on identifying the health needs of community offenders accessing rehabilitation services in the geographic areas of Derbyshire County Council and Derby City Council. An HNA is a systematic method for reviewing the health problems faced by a population and results in an agreed list of priorities to improve healthcare in a specific area. Health needs include immediate physical and mental needs but also extend to those needs affected by wider determinants of health such as social and demographic needs. The findings from this HNA will provide detailed information about the health needs of community offenders, their use of services and their health outcomes. The study was carried out using three methods of health needs assessment, epidemiological, corporate and comparative. The epidemiological needs assessment consisted of a quantitative analysis of the results from a survey of community offenders in Derbyshire and Derby City, plus a literature review that sought evidence of effectiveness for interventions to improve the health of community offenders.
The corporate (qualitative) needs assessment consisted of consultation with staff within the Derbyshire, Leicestershire, Nottinghamshire and Rutland Community Rehabilitation Company (DLNRCRC), the Youth Offending Service (YOS), Derbyshire’s National Probation Service (NPS) and local health services, plus interviews with community offenders. The comparative needs assessment compared existing and evidenced morbidity in Derbyshire’s community offenders against that of the general populations of Derbyshire wherever possible.
- To establish a clearly defined offender health strategy reporting to the Reducing Offending, Re-offending and Offender Health Board.
- Further research to explore offenders experiences of primary care, improve health literacy and empower offenders to navigate primary care services.
- To review the existing care pathways from prison, primary and specialist care services.
- To identify the role of probation services in providing advocacy for offenders in accessing healthcare services.