People in contact with the criminal justice system suffer from some of the starkest health inequalities in the country, with higher health needs and poorer health outcomes than the general population. Many in this group engage in high risk behaviour, have limited contact with primary care services and do not manage existing health issues effectively. They are over represented in the use of emergency services, resulting in greater cost to the system and less positive outcomes.

Self inflicted deaths are five times more likely in prison than in the general population. 15% of men and 25% of women in prison report symptoms of psychosis, compared to just 4% of the general public. Nearly a third have a learning disability or difficulty. 80% of older people in prison are estimated to have a long standing illness or disability. In a 2009-10 study, 35% of adults starting community orders reported having a formal diagnosis of a mental health problem. Of those who received a formal assessment, 32% were identified as having a drug misuse need and 38% an alcohol problem. 

These health inequalities intersect with other disparities faced by people in the criminal justice system. For example, people from black and minority ethnic communities, who are overrepresented in the criminal justice system, are 40% more likely than non BAME people to access mental health services via a criminal justice route, but underrepresented in prison mental health caseloads. For people with multiple and complex needs, health is one of a number of vulnerabilities for which they will need holistic support.

Despite these high levels of need, they are less likely to access mainstream health services. When they do, they may have to overcome stigma and other barriers in order to access the care they need.

Organisations tell us that the mental health needs of their clients are becoming more acute as a result of not being able to access the support they need from community mental health providers, who have either reduced their services or have raised their threshold for services.

This can have a big impact on voluntary organisations, who are increasingly required to meet the mental health needs of their clients, as the safety net provided by public services continues to reduce.

Health and offending are also often interrelated. Health issues such as substance misuse or mental health problems can lead to contact with the criminal justice system. Addressing the health needs of this group can reduce reoffending, and have a positive impact on the overall health of their communities.