The effectiveness of the Engager Intervention for male prison leavers with common mental health problems, near to and following release: results from a randomised controlled trial.

Problem

Offenders have a high prevalence of common mental health problems (50-70%), along with co-occuring substance misuse, emotional lability and social problems, such as homelessness and relationship difficulties. Care in prison is suboptimal and discontinuity on release is the norm. Complex needs, chaotic lifestyles and services designed for single ‘disorders’ contribute to the lack of care normally provided. The UK NIHR funded Engager six year programme has developed and is evaluating a complex intervention to address this problem for male prison leavers.We developed the Engager intervention that aimed to provide both practical and emotional support for people with common mental health problems (CMHPs), near to and after release from prison. It incorporates an explicitly person centred approach to intervention delivery. We describe the recently completed randomised controlled trial to evaluate the effectiveness of the intervention, and present the main results of the trial.

Approach

Participants (n=280) were incarcerated men recruited from three UK prisons, randomised to receive either the Engager intervention plus standard care or standard care alone. Two teams of a team leader/supervisor and two Engager practitioners delivered the intervention in the north west and south west of the UK. Participants had between 4 and 20 weeks before release and had screened in as having current CMHPs or likely to have CMHPs following release. Baseline assessment was completed in prison, with follow-up assessments at 1, 3, 6, and 12 months post release. The primary outcome was the CORE-OM at 6-months post-release. Secondary outcomes included the Camberwell Assessment of Need and measures of quality of life, substance use, addiction and housing level.

Findings

A follow-up rate of 66% was achieved at the six-month primary outcome time-point. The intervention was delivered over a two year period with variable levels of engagement. Results will be presented comparing CORE_OM scores and scores across the range of secondary outcome measures. Analysis will be complete at the time of the conference.

Consequences

Implications for for practice will be discussed. This is the first reported randomised controlled trial of a mental health intervention for prison leavers with mental health problems worldwide and the methods for achieving high levels of recruitment and follow up are important in their own right. The theoretical problems of selecting outcomes for person centred interventions will be discussed.