Critical Time Intervention for Severely Mentally Ill Released Prisoners: A Randomised Control Trial (CrISP)

It is known that there is a higher proportion of people in prison with mental health problems than in the community. There have been changes over recent years to improve mental health services for people in prison, however there are still problems, especially when people leave prison. We found that, even if appointments are made with community based mental health services, very few people actually make contact when they are released. If people stayed in contact with health services when they leave prison, they may be more likely to stay well, could get help to sort out things like finding somewhere to live and making contact with their families. They may also be less likely to commit further crimes. The aim of this project is to see if a promising innovation in the way mental healthcare services are delivered, Critical Time Intervention, can help people released from prison stay in contact with community services and possibly reduce reoffending. We will also see whether it is cost effective compared to how services are usually provided. This project will take place in three male prisons in England. We will approach all male prisoners with severe and enduring mental illness under the care of prison mental health in-reach teams who have either less than six months to serve on their sentence, or who are likely to be released within six months, if on remand. We developed a method of predicting the latter in a previous study, based on offence type and likely length of sentence. We will ensure all possible participants understand what taking part in the study would involve, and that they are under no obligation to take part. If they are happy to take part, they will be randomly allocated to the new service, Critical Time Intervention, or will receive Treatment As Usual. No-one will be denied treatment as a consequence of taking part in the study and people can change their mind and withdraw at any time. We will train three members of NHS staff to deliver the Critical Time Intervention; they will be known as CTI managers and will be based in the prison mental health teams at each of the three sites. They will work with the participants allocated to CTI before and after release from prison to meet needs on issues such as mental health, physical health, substance misuse management, housing, finances and family ties. The other members of the prison mental health team will provide Treatment As Usual to the other participants. The CTI managers will tailor services to people's individual needs. On release, they will work with service users and community mental health teams to ensure that prompt and appropriate services are provided and stay in touch with both the participant and community staff for up to six months following discharge. They will work with the service user and community staff to develop ongoing care plans and, when everyone is sure that these are right, the CTI manager will withdraw. Therefore the intervention is a short term but intensive model, linking prison and community health and social care services with the intention of ensuring that no-one finds themselves released from prison without adequate support. The project will look at several outcome measures to determine how effective CTI is. Following release from prison we will establish if participants made contact with a named community mental health team. We will examine whether this form of support is helpful by comparing how many people stay in contact with community mental health services following CTI compared to the similar group discharged from prison with the 'usual' level of support. In the event that no contact is made, we will use national NHS data sources to see if contact has been made with any other mental health service nationally. We will establish whether they have been admitted to hospital and if so, for how long, and whether they were detained under the Mental Health Act. We will also establish if there are any differences in reoffending rates and the amount of time spent in prison between the two groups using information from the Police National Computer. The project will also look at the cost-effectiveness of the intervention. This is important as it is likely that CTI will cost more than Treatment As Usual as it is more intensive, involving more contact with staff and services than usual care. We will see if the additional costs are worth it in terms of benefits to people, including being able to access services which meet their needs and a possible reduction in reoffending, as crime has a financial impact upon the whole of society. The research group has extensive expertise in conducting research with people in contact with the Criminal Justice System. The group has pioneered research in prisons, conducting the first trials of different types of mental health treatments in this setting. We have specific expertise in obtaining informed consent in an imprisoned sample, user involvement in research, researcher safety and the limits of confidentiality relating to risk. The team has good experience in trial management, qualitative methods, health economics and statistics.