Reducing Offending, Reducing . - NHS Health Scotland

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Reducing offending, reducinginequalitiesAchieving ‘better health, better lives’through community justice

This resource may also be made availableon request in the following formats:0131 314 ublished by NHS Health Scotland1 South Gyle CrescentEdinburgh EH12 9EB NHS Health Scotland 2017All rights reserved. Material contained in thispublication may not be reproduced in wholeor part without prior permission of NHSHealth Scotland (or other copyright owners).While every effort is made to ensure thatthe information given here is accurate, nolegal responsibility is accepted for any errors,omissions or misleading statements.NHS Health Scotland is a WHO CollaboratingCentre for Health Promotion and PublicHealth Development.

ContentsContents . 1Writing group membership and acknowledgements . 3Writing group membership . 3Contributors . 3Acknowledgements . 4Chapter 1: Introduction and rationale . 5NHS Health Scotland: our approach . 6The social pattern of offending . 8Reducing offending and reducing inequality . 15Community justice: an opportunity to reduce inequalities . 17Chapter 2: Increasing the opportunities for earlier intervention . 21Preventing violence . 23Reducing the impact of alcohol and drug use. 25Improving mental health . 31Reducing trauma . 36Chapter 3: Mitigating the impact of offending and sentencing . 41Reducing victimisation . 41Working with families as assets . 45Opportunities in police custody and liaison. 48Increasing alternatives and diversion from prosecution . 53Increasing community-based sentencing . 58Optimising custodial care . 65Chapter 4: Building resilience and sustaining change . 79Maximising individual resilience . 79Improving the delivery of custodial services . 85Strengthening community justice . 91Chapter 5: Proposed opportunities for action . 97Opportunities for earlier intervention . 97Mitigating the negative impact of offending and sentencing . 97Building resilience and sustaining change . 98Appendix 1: Scottish examples of evidence-based violence-prevention programmes . 991

Appendix 2: Scottish agencies and initiatives which build resilience in families, children and young people. 100Families Outside. 100Family Nurse Partnership (FNP) . 101Families affected by imprisonment . 101Family visitor centres and help hubs . 102Scottish Families Affected by Alcohol and Drugs . 103Useful policy links . 103Children and Young People (Scotland) Act 2014 . 104The Early Years Framework . 104Early Years Change Fund . 105GIRFEC . 105The National Parenting Strategy: Making a positive difference to children and young people throughparenting. 106References . 1072

Writing group membership andacknowledgementsWriting group membershipPhil Eaglesham: Organisational Lead for Community Justice, NHS Health Scotland(lead author/editor).Louise Gallagher: Health Improvement Lead for Community Justice, NHS GreaterGlasgow & Clyde (lead author/researcher).Willie Kennedy: Planning Officer, North Strathclyde Community Justice Authority/Scottish Government (author).Beth Macmaster: Planning and Development Officer, Glasgow Community JusticeAuthority/Prison Monitoring Coordinator, HMIPS (author/researcher).Janet Tobin: Health Improvement Programme Manager, NHS Greater Glasgow &and Clyde (author).ContributorsDr Philip Conaglen: Consultant in Public Health, NHS Lothian.Katie Cosgrove: Organisational Lead (Gender Based Violence), NHS HealthScotland.Ruth Dryden: Public Health Adviser (Evaluation), NHS Health Scotland.Tina Everington: Health Improvement Lead, Scottish Prison Service/NHS ForthValley.Katy Hetherington: Organisational Lead (Community Child Health), NHS HealthScotland.Dr Andrew Fraser: Director of Public Health Science, NHS Health Scotland.Dr Lesley Graham: Information Services Division, Scotland.Emma Hogg: Organisational Lead for Improvement, NHS Health Scotland.Sharon Hardie: Health Improvement Lead, NHS Ayrshire and Arran.Tom Jackson: Chief Officer, Glasgow City Community Justice Authority.Prof. Nancy Loucks: CEO, Families Outside.3

Megan McPherson: Public Health Adviser, Public Health Observatory, NHS HealthScotland.Mhairi McGowan: Women’s Aid/ASSIST.Nicola Merrin: Policy Officer, Victim Support Scotland.Justina Murray: Chief Officer, South West Scotland Community Justice Authority.Dr Mark Robinson: Senior Public Health Information Manager, Public HealthObservatory Division, NHS Health Scotland.Grant Scott: Senior Charge Nurse & Police Custody Practice Lead, NHS GreaterGlasgow & Clyde.Fiona Young: Chief Officer, Lothian and Borders Community Justice Authority.AcknowledgementsRuth Parker: Head of Health & Wellbeing, Scottish Prison Service.Lee Knifton: Mental Health Foundation.4

Chapter 1: Introduction and rationaleNHS Boards in Scotland are all-purpose organisations: they plan, commission anddeliver NHS services and have a duty and responsibility for the health of theirpopulations. The vision for health and care in Scotland is that:‘by 2020 everyone is able to live longer, healthier lives at home, or in a homelysetting’.Underpinning this are core values committed to by NHSScotland. These values arecollaboration, co-operation and partnership working across NHSScotland, with staff,patients and with the voluntary sector; continued investment in the public sectorrather than the private sector; increased flexibility, provision of local services; andopenness and accountability to the public.NHS Boards work closely with their partners including patients, staff, local authoritiesand the voluntary sector to deliver effective healthcare services and to safeguardand improve the health of their residents and individuals under their care. This careincludes individuals with a number of complex needs (see Figure 1), for example:people with histories of trauma and violence; people with substance use and mentalhealth issues (often in tandem); people who are at risk of homelessness or who arehomeless; refugees and asylum seekers; and those in contact with justice services.These needs cannot be addressed by health interventions alone.In considering the drivers and consequences of offending, the social patterns andinequalities behind this challenge provide a common series of drivers and leverswhich a range of partners both within community justice and beyond in wideruniversal public services can utilise as a rationale for collective action. Thisdocument, while not a systematic review, collates some of the evidence across arange of highly varied determinants related to health and offending to provide afoundation for increased focus on health, justice and inequality. This first sectionintroduces and frames the relationship between offending and inequalities acrosskey domains as our impetus for more collective local action on health and communityjustice.5

Figure 1: Example of complex needs of people in the healthcare system.Reproduced from Scottish Government. National Strategy for Community Justice;2016. www.gov.scot/Resource/0051/00510489.pdf, under the terms of the OpenGovernment Licence v3.0NHS Health Scotland: our approachNHS Health Scotland is a national Health Board working with and through public,private and third sector organisations to reduce health inequalities and improvehealth. We are committed to working with others and provide a range of services tosupport our stakeholders take the action required to reduce health inequalities andimprove health. Our vision1 is a Scotland in which all of our people and communitieshave a fairer share of the opportunities, resources and confidence to live longer,healthier lives. Our mission is to reduce health inequalities and improve health. Todo this we influence policy and practice, informed by evidence, and promote actionacross public services to deliver greater equality and improved health for all inScotland.6

Health inequalities2 are the unfair differences in people’s health across social groupsand between different population groups. They represent thousands of unnecessarypremature deaths every year in Scotland, and for men in the most deprived areasnearly 24 fewer years spent in ‘good health’. These circumstances disadvantagepeople and limit their chance to live a longer, healthier life. We believe that healthinequalities are unfair and avoidable. To reduce health inequalities we need to actacross a range of public policy areas, with policies to tackle economic and socialinequalities alongside actions with a specific focus on disadvantaged groups anddeprived areas.Health inequalities do not exist in isolation. The broader pattern of income inequality,the state of the economy, welfare reform and the impact of recession on poverty andhealth provide an important context for our work. Building on the inherent strengthsof communities and individuals must also, therefore, be part of the solution, as wellas providing better support for the integration of local services and the involvementof communities, families and individuals in those services. We also need to shift thefocus from meeting the cost of dealing with health or social problems after they havedeveloped to prevention and early intervention. At the same time, our population ischanging and people are living longer. We need to make sure that longer life meanslonger, healthy life – adding quality of life to years as well as years to life. We needto make sure that the benefits of investing in prevention and early intervention areunderstood and acted on.In order to achieve this, key actions we promote include a drive towards a fairershare of income, power and wealth through policy, legislation, regulation andtaxation. We should ensure fair and equitable access to good-quality housing,education, health and other public services. To deliver this we must also ensure allpublic services are planned and delivered in proportion to need.This, therefore, makes community justice everyone’s business to improve, and NHSHealth Scotland in planning current and future work increasingly recognises thatforging new links with this policy area and making best use of the new andestablished frameworks which drive this agenda will be crucial to our success inreducing inequality in Scotland.7

The parallels with our approach to reducing inequality and the opportunities the newvision for community justice present are exciting. The experience of individuals incontact with the justice system is all the more acute, compounded or chronic in itsnegative inequalities impact. The wider impact should also be noted on victims,families and communities. This is borne out in the following section describing someof the social patterns found within individuals who offend.The social pattern of offendingWhile a sizable population of those who offend in Scotland are sentenced throughnon-custodial and community disposals, the health and social care needs of those inprison custody are an indicator of some of the social patterns that health and justicetogether might impact on. While many of the findings below are recorded at differenttimes and from both Scotland and the wider UK prison population and are constantlybeing updated, they contribute to a complex picture of rights and needs.As at April 2017 there were just under 7,500 prisoners (excluding home detentioncurfew) in prison custody.3 The average daily prison population for 2014/15, as anexample, was 7,731. Just over 1,500 (20%) of those were prisoners on remand –either awaiting trial or sentencing. Just over 6,200 (80%) were prisoners withsentences, of which 55% were serving sentences of less than four years in length.The current prison population projections suggest that the daily prison population inScotland will remain stable, with an annual average of 7,800.4 This equates to a rateof around 141 per 100,000 – the second highest in Western Europe after Englandand Wales.5The risk factors that increase an individual’s likelihood of offending and receiving acustodial sentence are defined by wider societal inequalities. The social patternsfound within prisoners indicate both inequalities and missed opportunities tointervene and prevent offending. There are, for example, very high correlationsbetween income inequality, low social mobility, teenage births, imprisonment, levelsof trust, mental health problems and, as an indicator of poor physical health, highlevels of obesity.68

IncomeScotland’s prison population predominantly reflects our most socially deprivedcommunities. Although less than 1% of all children are in care in Scotland,looked-after children account for more than 25% of all people in prison.7 At UK level,the families of those imprisoned relatives have stated their debts increase during theperiod of incarceration. Where families have a poverty of aspiration, the likelihood ofgenerational offending within family groups will be high. The experience of povertydoes not directly lead to a prison sentence but rather the interrelationship betweenpoverty, social exclusion and other socially restrictive factors enhances this risk.In England and Wales, around 50% of all prisoners have a history of debt, withone-third never having had a bank account.8 In a study of English and Welshprisoners’ experiences of education, 47% of all those sampled had no formalqualifications compared with 15% of the general population.9 More than 20% of thisprison population needed support with reading, writing and basic arithmetic. A totalof 41% of men, 30% of women and 52% of young men in the English and Welshprison system were permanently excluded from school.10When also considering the prison population in relation to the legally protectedequalities characteristics of the Equality Act 2010,11 the relationship between prisonand experience of inequality becomes even starker.AgeAs at 30 June 2013 (the latest available publication date) around 59% of prisonerswere under the age of 35 and just over one-fifth of prisoners were under the age of25.4 There are over 300 older Scottish prisoners (over 65, with the oldest in 2015aged 8712) who are likely to have a physical health status 10 years older than theircounterparts in the community13 and will experience life-reducing health concerns ata younger age.14 A total of 54% of older prisoners have also been estimated to havea disability.15 Given people aged 60 and over are the fastest-growing age group inthe prison estate,16 the challenges associated with responding to the needs of olderprisoners is likely to become more pressing in the future.9

DisabilityAround 20% of prisoners have a physical disability.16 An estimated 20%–30% of allprisoners also have a learning difficulty/disability that interferes with their ability tocope with the criminal justice system17 (75% of prisoners with a learning disabilityhave difficulty reading prison information18). A Scottish Prison Service (SPS) Healthand Social Care Needs Assessment has recently been published to determine howbest to meet growing need around both age and disability within prisonestablishments.

Public Health Adviser, Public Health Observatory, NHS Health Scotland. Mhairi McGowan: Women’s Aid/ASSIST. Nicola Merrin: Policy Officer, Victim Support Scotland. Justina Murray: Chief Officer, South West Scotland Community Justice Authority. Dr Mark Robinson: Senior Public Health Information Manager, Public Health

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