1. “LIFE CHANCES SHOT TO PIECES FROM THE START”
PREDICTORS OF ILL HEALTH
ADULTHOOD INFANCY
“Raw pain of
abandonment”
PRE-BIRTH
ADOLESCENCE
Intergenerational
effects
Truancy
Abuse
Loss
Intimate partner
violence
Unemployment
Poor housing
Barriers to care

2. WOMEN AT RISK
HEALTH OF WOMEN IN THE
CRIMINAL JUSTICE SYSTEM
FATAL
OUTCOMES
MURDERED
SUICIDE
HIV/BBV
ACCIDENT
MATERNAL DEATH
DAMAGING HEALTH
BEHAVIOURS
SEXUAL &
REPRODUCTIVE HEALTH
PHYSICAL HEALTH MENTAL HEALTH
Smoking
Alcohol
Drugs & SM
Inactivity
Eating disorders
Unintended pregnancy
STI’s & HIV
Gynae problems
Low BW babies
Injury
Poor self reported health
Under/over weight
Low self esteem
PTSD
PDI psychopathy
Self harm
LONG TERM CONDITIONS
Asthma / COPD
Vascular disease / CHD
GI, skin, chronic pain

3. INCARCERATED WOMEN RATES OF SUBSTANCE ABUSE,
MENTAL DISORDERS & OTHER HEALTH PROBLEMS
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
S o u r c e : S t a t i o n , e t a l , 2 0 0 3

4. BARRIERS TO HEALTH AND HEALTH CARE
System geared towards the needs of men…
Lack of integration
Few models of care geared to people with multiple problems
Services not well suited to treating people with challenging behaviour
and/or poor social functioning
Residency requirements
Individual barriers
Women prisoners experience high levels of emotional & mental distress
!!!

5. CRIMINAL JUSTICE SYSTEM
INCREASE CONFIDENCE IN COMMUNITY ALTERNATIVES
Health
Local Authority
Schools
Employers
Liaison & diversion
Mental health
diversion
Co-production
(CCG/CRC)
Health & social care
Promoting public
health & well-being
COMMUNITY
DEVELOPMENT
PARTNERING
Police,
custody
& courts
Court
community
orders
CRC’s
MDT’s
“Health” in the
re-settlement plan
Co-commissioned
services
YOT’s
GENDER RESPONSIVE
BREAK THERAPEUTIC
MODEL
CONTINUITY
EARLY DIAGNOSIS &
INTERVENTION
PSYCHO/SOCIAL
STRENGTHEN THE HEALTH SYSTEM

6. PATHWAY TO HEALTH
STREET TRIAGE
LIASON &
DIVERSION
Specialist care
detox/psychiatric
Social care, CMHT,
voluntary sector,
community, family,
relationship
RECOVERYStep down
Secondary care
COURTS,
CRC, A&E
PRISON
Primary care
Coordinated drug
rehab, early assessment,
mental health, well being

7. IMPROVING HEALTH THROUGH PEER BASED INTERVENTIONS
CONTEXT INTERVENTIONS MECHANISMS
INTERMEDIATE
HEALTH OUTCOMES
LONG-TERM
OUTCOMES
Determinants of
offender health
Health
inequalities over
life course
Social exclusion
Peer
intervention
Prison health
service
Education &
welfare services
LIFE OUTSIDE PRISON LIFE OUTSIDE PRISON
Peer education
Peer support
Popular
opinion leaders
Bridging
Other modelsINCREASED CAPACITY?
COSTS?
REDUCING BARRIERS TO
HEALTH CARE
FACILITATINGACCESS TO
HEALTH INFORMATION &
CARE
FORMING THERAPEUTIC
ALLIANCES
Adoption of
healthy lifestyles
& reduction of
risky behaviours
Increase uptake
of health care,
e.g. screening
Improved mental
well-being &
resilience
Organisational
outcomes e.g.
better order in
prison
TARGET POPULATION PEER HELPERS
INDIVIDUAL LEVEL
▼Morbidity
▼Mortality
▲Quality of life
▲Rehabilitation
SOCIETAL
▼Health inequalities
▼Reoffending
▲Family support/health