An investigation into aftercare planning for those remitted to prison from secure services.

Research question
How can the ‘return to prison’ care pathway from secure psychiatric services be improved to ensure entitlement to aftercare is upheld?

Background
Return to prison from medium secure services increased in 2010/11 and were observed to represent over 20% of all discharges. This transition is a time of elevated risk and vulnerability and up until recently, it was unclear what degree of aftercare was available in the prison estate for those returning following treatment. We have just conducted the first study both nationally and internationally to examine the remittal care pathway from secure psychiatric services (SPS’s) to mental health in reach services (MHIT’s). We found that that just 18% of patients remitted to prison had their care managed through the Care Programme Approach upon return to prison. At present, there is no formal national targeted post-discharge service for prison remittals in the United Kingdom, and no comprehensive guidance for effective return to prison exists.

Aims and objectives
The study will use a mixed methods approach to achieve the following objectives:

1. To identify current national discharge/after-care-planning processes and procedures in SPS/MHIT’s for return to prison in England and Wales.
2. To gain insight into clinicians’ experiences of managing discharge/after-care-planning for return to prison
3. To develop guidelines for future clinical practice regarding discharge/after-care-planning for return to prison from SPS’s.

Methods
We will adopt a sequential-explanatory mixed methodological design which incorporates both quantitative and qualitative research methods. This consists of three separate pieces of work, each with clearly defined aims and anticipated outcomes:

Phase 1: National survey to identify current discharge/after-care-planning process and procedures for return to prison in SPS/MHIT’s in England and Wales

Phase 2: Qualitative interview study of clinicians’, criminal justice professionals and experts by experience to explore discharge/after-care-planning for return to prison.

Phase 3: Stakeholder nominal-consensus groups to develop guidelines for future clinical practice regarding discharge/after-care-planning for return to prison from SPS’s.

Anticipated impact and dissemination
Our findings will have an important impact on NHS policy in England and Wales. For the first time, data will be available on discharge and aftercare planning practices for return to from SPS’s in England and Wales. Good practice guidance will be produced. A comprehensive strategy will be employed to ensure that findings are disseminated to key stakeholders and a wide range of professional and patient groups. Key outputs will include; good practice guidance; peer-reviewed articles in high impact journals and conference presentations at key academic and policy events. All anticipated outputs have the potential to promote rights to aftercare for those returned to prison, and should optimise the processes required for this to be achieved. Any uptake of the guidance produced will be a step towards achieving equivalent access to care for those returned to prison compared to people discharged to the community. We plan to apply for subsequent external funding to establish the feasibility, and acceptability of guidance key components and to implement and evaluate the impact of this guidance.