Developing and evaluating a collaborative care intervention for prisoners, with common mental health problems, near to and after release (Engager 2)

Aims and Objectives The key research questions relate to whether the intervention has an impact on care received (and therefore has a potential to be effective), how it has impact and the potential economic benefits. Background and Rationale Prisoners near release have significant mental health needs and the majority receive minimal mental health care in prison or in the community. Mental illness, social exclusion and criminal activity are closely intertwined. Improving mental health of prisoners is justified in itself and could have significant economic and other benefits to society. Collaborative care, as an organisational framework for delivering care, has the potential to deliver integrated care and ensure continuity once released from prison. Given the potential benefits this hypothesis should be tested. Research Environment: Peninsula College of Medicine & Dentistry has a rapidly growing Institute of Health Services Research and Manchester University has an international reputation for mental health research. The core team are based in the same building as the Clinical Trials Unit. Experience and Expertise The core team are experienced at delivering research in justice settings. Methodological and subject experts will ensure rigour and relevance. Research Plan The research will be carried out in two phases and involves four work streams (WSs). Evaluation and Intervention Preparation Phase (Months 1- 24) Theoretical modelling of the intervention (WS1) Realist Review Six best practice mini case studies Support development of intervention in 2 sites Formative evaluation of intervention Methodological development (WS2) Select outcome measures, Develop process of care framework Develop randomisation and follow up procedures Initial economic modelling (WS4) Evaluation Phase (Months 19-60) Exploratory RCT of ICCI in 2 sites (WS3) Recruit and follow up 400 prisoners with common mental health problems from 2 sites Process evaluation of the care received Assess impact Refine intervention (WS1) Draw conclusions about future trial or evaluation (WS2) Modelling of economic and research implications (WS4) Outputs and Dissemination: Significant outputs will include: A theoretically sound, practical and discrete intervention to improve care for prisoners near release. Knowledge about the impact and potential health and economic benefits. Increased understanding about whether further evaluation is desirable. Dissemination will be delivered through the project website (including interim briefings and reports), peer review journals, conference proceedings and by working with policy makers and those redesigning services. Justification Health status is poor, service provision negligible and evidence base inadequate for those designing services. These factors justify a focussed programme of research for prisoners with mental health problems nearing release. Management and Governance The proposed programme has comprehensive lines of responsibility to ensure delivery to time and budget. Ethics Significant ethical considerations are limited. Patient and Public Involvement Peer researchers have been and will be involved in planning, carrying out, interpreting and disseminating findings. Potential Impact Calls have been made for improved mental health care (including IAPT services) for prisoners, both before and after release. A clinical and organisational intervention, with demonstrable better outcomes, would provide the blueprint to develop primary care mental health and an IAPT service for offenders in and leaving prisons. This would lead to improved: Health of offenders Resettlement of offenders – employment, stable housing, better relationships and reduced re-offending. And in turn potentially reduced stresses and better outcomes for: Dependants Other prison inmates Wider communities And reduced costs