England and Wales spends an estimated £18.1 billion each year on re-offending, much of it driven by people cycling through a criminal justice system that fails to address their health and social care needs. This research tackles a fundamental gap: while prisons integrate health and justice services, the links between the criminal justice system and community-based care—mental health support, housing, social care—are weak or harmful. People involved in the system are disproportionately likely to be poor, neurodivergent, or from minoritised ethnic backgrounds, and poor integration can reinforce stigma rather than reduce it. The project will build a consortium of four northern universities to study how health and justice systems currently interact, and how they could be reorganised to reduce harm. Researchers will follow four groups—young adults, women, neurodivergent people, and older adults—over 12 months using interviews, observation, photography, and other methods. They will also analyse hospital and GP data to measure whether criminal justice involvement worsens health inequalities. If successful, the work could reshape how health and justice services are joined up outside prison walls, potentially cutting re-offending costs and improving care for some of the most marginalised people in society.
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What is the problem? England and Wales (E&W) has one of the highest rates of imprisonment worldwide, with re-offending estimated to cost the economy £18.1bn every year. People who are involved in the criminal justice system (CJS) are more likely to experience health and care inequality and be marginalised/minoritised for reasons such as their race/ethnicity, extreme disadvantage/poverty, substance use, mental ill health and neurodiversity. Integrating health and justice (H&J) systems could provide a vital response to health and care inequalities. However, beyond custody and prison sites, integration of H&J is less clear-cut, with links to adult social care, mental health services, access to housing and third sector organisations lacking. Inadequate integration of H&J systems also has the potential to reinforce stigma and harm for those in positions of marginality/exclusion. This ambitious project will take a bold approach in order to explore whether current H&J systems could be disentangled and organised differently in order to 'put the pieces back together better' for people within them. We contend that it is not integration per se that is harmful, but the ways in which integration and relationships currently exist. What does this research aim to do? This large project brings together researchers from social sciences, public health and health inequalities disciplines across four universities (Newcastle, Durham, Northumbria, Manchester) working in partnership with policy, practice and public collaborators to establish a Northern H&J research consortium. It aims to: 1. Understand and evaluate health and care inequalities and social harms experienced by marginalised/minoritised communities within the CJS in E&W; 2. Explore how H&J systems could be improved to reduce harm, stigma and inequality experienced by marginalised/minoritised communities involved in the CJS. How will this research be conducted? This study will use a number of different research methods: 1. We will conduct a literature review to explore how H&J systems come together in different countries and the impact these systems have on marginalised or minoritised communities. 2. We will use multiple qualitative research methods (such as observation, interviews, walking methodologies, photography, poetry, sketching, letters/diary extracts) to understand the experiences of four 'case study' marginalised or minoritized groups involved in the CJS over the course of 12 months. These groups will be young adults, women, neurodivergent people and older adults. 3. Data regularly collected within hospitals, GP practices and social care services will be examined to determine whether CJS involvement has any impact on health inequalities. 4. We will co-analyse data with public members and use this information to co-develop a suite of creative resources to increase public and stakeholder understanding of the experiences of marginalised/minoritised communities within the CJS, and to underpin mechanisms for change, such as critical consciousness raising and/or political pressure. Involvement of public members This project is rooted in principles of equity, partnership, co-creation, complexity science and a feminist ethics of care and empathy. This will be embedded via the following important mechanisms: 1. Regular meetings, workshops and dialogue with co-researchers. 2. An international stakeholder panel who will help guide project decisions and meet with the project team every six months across the project duration. This panel will be co-chaired by an academic and a representative from the voluntary sector. Dissemination The main outcome from this research will be explanatory 'frames', outlined across a suite of co-developed resources and events. Articles will be published in academic journals and presented at conferences, and findings will be summarised for policy-makers, practitioners and the public throughout using accessible formats.
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