Review

Releasing the potential

CROSSING BOUNDARIES: accessing community mental health services for prisoners on release
Rachel Lart
The Policy Press, 1997, £14.25

This book is an account of the Wessex Project, a demonstration project looking at prisoners’ long-term access to mental health services.

It has shown that there are no cheap solutions, no ‘quick fixes’ for this group of men with ‘complex needs and potentially chaotic lives’. They have multiple and overlapping problems, all of which are the concern of separate agencies.

One in four sentenced prisoners and one in three on remand reported a history of mental health problems, the major problems being depression, frequently associated with self-harm, and psychoses. Of these men, about a third had, in the past, been admitted for inpatient care and 17 per cent for outpatient and community care.

Initially the project aimed to access appropriate services through existing Care Programme Approach arrangements. These revealed some of the fundamental problems for discharge. Housing is a central issue; not only the need for housing in itself but because an address is a first step to accessing community services. Accommodation was a key issue in 20/21 cases where CPA was started, yet there is no single agency responsible for housing issues. This meant that the project team spent a considerable amount of time arranging accommodation.

There was difficulty in obtaining key workers for some prisoners on release, and the complexity of the men’s situations meant that, in effect, project team members became the equivalent of more than one key worker, remaining involved for extensive periods, and travelling far beyond the original prison in order to provide post-release services and support.

In addition to professional issues among staff in the social and probation services, there was further misunderstanding with mental health services which treat substance misuse as the primary problem when it overlaps with mental health problems. Among the men themselves, there was also some reluctance to recognise that they were mentally ill.

It was obvious that multidisciplinary ward rounds were necessary to identify and address the needs of prisoners on release. The project shows that to bridge the gap between prison and community, staff must be flexible in their ways of working and be funded flexibly from several sources. Most significantly this requires more than a single individual in post.

This project illustrates the dynamics required in multi-agency working and the distinct advantages of being able to take on overview. The project team itself included the three major agencies for this group — health, social services and probation — headed by a full-time manager. Their ways of working within prison and within the community were unique: they were autonomous, practised assertive outreach, were generous with their time, and developed a shared identity, rather than emphasising their separate professions. The chosen methodology provided feedback which allowed the project to evolve leading to findings and realistic recommendations, well within the reach of existing resources.

The key characteristics of the project team and other relevant issues in relation to prisoners on release are clearly discussed in the report. In summary, team members were able to show that planned and sustained intervention, access to appropriate services and engaging the co-operation of offenders can successfully prevent re-offending.

The Wessex Project was funded by the Department of Health, South and West regional health authority, Hampshire social services, Hampshire probation service, the Mental Health Foundation, the Gatsby Charitable Foundation and HMP Winchester.