More likely to re-offend? by Graham DurcanA study published this week in the Lancet Psychiatry journal has sparked debate about the links between mental health and criminal justice. The study, using data from Sweden, concluded that both male and female prisoners diagnosed with ‘common mental health problems’ were more likely than other former prisoners to commit violent offences in the decade after they were released. The study raises a range of issues for both health and justice policy. Its authors, based at Oxford University, called for improved identification and treatment of mental health problems in prison and following release. In a commentary on the study, meanwhile, others including Prof Louis Appleby warned against drawing simple conclusions and said improved mental health support should be accompanied by “comprehensive packages of treatment and social support” that recognise “the complexity and adversity of offenders’ lives”. The implications of this research, and other evidence in this area, are far-reaching. We know that a large proportion of people who end up in prison have longstanding, complex and multiple needs including mental ill health. Many have long histories of trauma, neglect, abuse and bereavement. Brain injury, developmental disorders and a history of being in the care system are highly prevalent among people in the criminal justice system. Women prisoners have especially high levels of unresolved trauma and consequent personality disorders. And a large proportion of people in custody have had intermittent contact with mental health services, both as children and adults, often finding themselves rejected by services for having ‘sub-threshold’ needs. Intervening early to help children and young people at risk of offending can help to prevent problems from escalating as well as improving health and future life chances. We also know from evidence that prison is not a conducive environment in which to treat mental ill health. Many people with mental health problems could be diverted at the point of arrest or in courts and provided with care and support alongside a non-custodial sanction for their offences. The development of liaison and diversion services across England is a vital step to identify and support people who need not go into custody. Access to local mental health support, alongside help with housing, finances and other needs, will be essential to ensure people can be diverted appropriately by these new teams. For those who must be in prison, it is important to create an environment that is conducive to recovery for those with a mental health problem and to offer treatment that is equivalent to what we expect in the community. And we need to achieve a step change in the support people get when they leave prison to rebuild their lives, focusing on health, housing, work and other key aspects of life. Vulnerable people need much more than a standard rehabilitation package to help them to recover – they require targeted, personalised support that starts with basic needs. Improving mental health care and support throughout the criminal justice system is essential if we want to reduce health inequalities and improve community safety. But we also need to intervene much earlier to protect young people’s mental health, and we need to offer better support to people who have been in the criminal justice system to build healthier and more productive lives.