Paul Biddle University of Northumbria

1. Assessment of the need for and implementation of Mental Health First Aid (MHFA) in north-east England Paul Biddle University of Northumbria

2. 1. The Presentation • Findings from a research project that examined the need for and implementation of MHFA in north-east prisons. • Funded by the North East Offender Health Commissioning Unit. • Undertaken in 2010-11 • Principal Investigator: Dr. Wendy Dyer

3. 2. Background and Context • Prisoners are at greater risk of experiencing poor mental health than the overall UK population. • Since the 1980s the proportion of the prison population showing signs of mental illness has increased sevenfold. • High rates of self-harm and suicide.

4. 3. Background and Context • The extent of mental health issues in the prison population has been increasingly recognized by policymakers and those commissioning and delivering services. • Mental health services for prisoners have been expanded and improvements made: • Creation of Mental Health In Reach Teams • Development of the Care Programme Approach • Prior to the recent public expenditure cuts, funding for prison mental health in-reach had increased substantially.

5. 4. Background and Context • Ongoing policy commitment to improve outcomes: • Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders’ (2010) and • No Health without Mental Health’ (2011) recognised the importance of effective mental healthcare for offenders to reduce re-offending.

6. 5. Background and Context • Despite improvements, problems remain with mental health services for prisoners: • Under-staffed services • Difficulties achieving ‘equivalence of care’ to ensure prisoners receive interventions broadly comparable with those available in the community • Mental Health In Reach Teams struggle to cope with demand and lack clarity of purpose: • Some focus on severe cases • Some provide a more generalist service

7. 6. Background and Context. • Wider prison staff lack sufficient capacity and training to intervene to support prisoners with mental health issues. • Limited integration, collaboration and partnership working between individuals, functions and prisons - and between community-based mental health services. • Security priorities can influence ability to deliver optimal services. • Unmet need - A cohort of prisoners exist with mental health issues just below the level of severity required to trigger an intervention. • Prisoners face difficulties accessing information, advice and guidance about therapies and medication options.

8. 7. MHFA • A course aimed at those with little or no knowledge of how to help someone who is suffering from a mental health problem. • Designed to enable someone to help an individual experiencing a mental health problem prior to professional help being obtained. • Provides information about recognizing and responding to a range of mental health problems including: • Depression • Suicide • Anxiety Disorders • Self Harm • Psychotic Disorders

9. 8. MHFA • Regulated by the National Institute for Mental Health in England and the Care Services Improvement Partnership. • A 12 hour course to enable participants to: • Recognise distress • Have confidence to provide immediate interventions • Help and guide a person to wider support. • Those participating in the training and qualifying (via successful completion of activities and assignments) become MHFA instructors who can train colleagues in their own organisations

10. 9. Methodology • 2 stages: • Stage 1 – • Literature review • Attendance at MHFA training • Interviews with 35 individuals in who worked in a range of roles within the 3 prisons to explore existing levels of knowledge, capacity, responses across each prison • Stage 2 • Interview with 5 staff who had received MHFA training (represents half of the 10 staff who were trained at the point stage 2 began) • Explored impact and roll-out of MHFA • Stage 3 • Currently undertaking a follow up to gain information to inform a journal article.

11. Evaluation Findings

12. 10. Stage 1 - Needs Assessment • Improvements to mental health services in all 3 prisons in recent years. • Staff had received variable and limited training around mental health issues (focus on suicide, self harm and ACCT). Reliance on experience to identify prisons with mental health issues. • Limited knowledge of mental health, how to recognise these conditions and appropriate responses. • Limited time and resources to respond to prisoners with suspected mental health issues.

13. 11.Stage 1 - Needs Assessment • Wing staff often provide the initial response to inmates experiencing a mental health crisis. • Response to suicide and self harm are increasingly effective. • Responses to other mental health issues more variable and are influenced by: • Training and experience • Prisoner staff relationships • Time • Individual staff understanding of their role

14. 12. Stage 1 - Needs Assessment • Those prisoners whose conditions do not have implications for the smooth operation and good order of the prison can be missed.

15. 13. Stage 1 - Needs Assessment • MHFA could potentially assist prisons to: • Better identify prisoners with mental health issues • Give staff more knowledge of more conditions and how to respond appropriately to these • Increase institutional capacity to respond to the mental health issues of prisoners.

16. 14. Stage 2 - Implementation Findings • Core group of staff trained who had various roles in their respective prisons: • Wing Staff • Reception Staff • Staff with ACCT management responsibilities

17. 15. Stage 2 - Implementation Findings • Those trained reported: • Greater awareness and understanding of mental health problems that prisoners may have • Improved understanding of how to respond to inmates suspected of mental health problems • A greater awareness of community-based services inmates could be referred to

18. 16. Stage 2 - Implementation Findings • Instructors have trained colleagues in two prisons, with training planned in a third • Instructors selected colleagues who were the easiest to organise training for, not those for whom training might have been most appropriate.

19. 17. Stage 2 - Implementation Findings • Lack of strategic management and delivery of MHFA across the regional prison estate • Ltd commitment from senior management to roll-out MHFA??? • Roll out of MHFA compromised by difficulties releasing staff for training. • Participation in MHFA training not mandatory – crowded out by other training that has to be undertaken. Exacerbated by difficulties back-filling staff on training.

20. 18. Stage 2 - Implementation Findings • The details of MHFA-trained staff were not formally disseminated to colleagues so they could be contacted to provide information/advice to other prison staff. • Maintenance of Instructor status is likely to be problematic as instructors cannot train sufficient colleagues in time periods required. • Stage 3 findings suggest few, if any, instructors have delivered training since March 2012.

21. 19. Conclusions • MHFA can be a valuable part of a wider approach to improve responses to prisoners with mental health issues • MHFA cannot replace specialist mental health services in prisons. • A missed opportunity – the value of MHFA undermined by its roll out?

22. 20. Recommendations • Strategic management and commitment, with strong institutional messages about the importance of MHFA. • Publicise details of those trained throughout each prison so relevant staff can be a resource for their colleagues. • MHFA training for both staff AND prisoners. • Explore delivery of shorter MHFA course

23. Assessment of the need for and implementation of Mental Health First Aid (MHFA) in north-east England Mr Paul Biddle University of Northumbria