Engager

Overview

Engager is a novel intervention for supporting prisoners with common mental health problems to achieve their goals. 

University and peer researchers have developed a system of care that aims to help people in prison, leading up to and following release. We want to know how well this package of care is working and whether it can be improved.

Problem to be addressed

Offenders suffer from a range of health problems, both while in prison and after their release. More than half have a mental health problem of some kind. While prison healthcare has improved over the last decade, mental healthcare is minimal except for those with the most severe problems. Additionally, care after leaving prison is particularly lacking for those serving short sentences. Addressing offenders' mental health problems could lead to considerable gains: to the offenders' own health; to the wellbeing of their families and communities; along with wider economic and social benefits due to reductions in reoffending.

The Engager project is a five-year project, funded by the National Institute for Health Research (NIHR) Programme Grant for Applied Research (PGfAR), to develop and evaluate a collaborative care intervention for offenders with common mental health problems, near to and after release.

The project is based at two sites, one in the Northwest and one in the Southwest of England.

Aims

The aim of the Engager project is to develop a way of organising care for men with common mental health problems, as they approach being released from prison. We propose that the intervention will act as a bridge between a range of services inside and outside of the prison, which this group do not normally access. An Engager practitioner will work with each person to develop a shared understanding of their individual goals, and work with them to engage with services that will help them work towards achieving these goals.

The research

The project has been divided into two phases. During phase one (months 1-24) we developed and tested the collaborative care intervention (Workstream 1). We also created a set of outcome measures and the methodology to evaluate the intervention in a Randomised Controlled Trial (RCT) (Workstream 2). In addition, we developed an economic model to assess the potential costs and benefits of the intervention (Workstream 4). During phase two (months 25-60), we will undertake a RCT to evaluate the intervention (Workstream 3).

For the RCT, prisoners are asked to take part before leaving prison, and will be followed up in the community. Half will receive the intervention, and half will receive the care normally available. In this large scale trial, we are examining whether there is a significant difference between those who did, and did not, receive the intervention.

The research will tell us if the Engager intervention improves prisoners' common mental health problems and has wider social and financial benefits.

This study was funded by a National Institute for Health Research Programme Grant for Applied Research (PGfAR).

This study has been reviewed and been given a favourable opinion by the National Research Ethics Service (NRES). It has also been reviewed and approved by the Research and Development Offices of the appropriate NHS Trusts as well as the National Offender Management Service (NOMS). 

The intervention

Who is it for?

The Engager intervention is intended for men serving a prison sentence of up to two years who are within 4-12 weeks from release and who experience common mental health problems (depression, anxiety, PTSD), with or without comorbid substance misuse and personality disorder. 

The original intention was to develop an intervention to fill a gap in the provision of services to offenders. As such, the intervention is not designed to cater for men with serious mental illness, those with significant functional impairment, or those with severe personality problems, as these groups already have specialised services to address their specific needs.

What will it do?

The Engager intervention is designed to engage with individuals with common mental health problems who are close to release and to set up a pathway of care in preparation for discharge and for up to 16 weeks out in the community. The intervention aims to overcome a set of challenges that have been identified as being problematic for this group including:

  • Transition between prison and community
  • Fragmented services based on diagnosis (e.g. substance misuse, depression) and social problems (homelessness, unemployment) Rather than the reality of people with multiple and complex needs
  • Offenders' reluctance to trust services (or see themselves as having mental health problems).

How will it be delivered? 

The intervention is being delivered by practitioners supported by supervisors (senior health workers with experience of therapeutic work). They are working with offenders both pre and post-release. This work includes:

  • Developing a shared understanding between the practitioner and the offender and producing a plan for achieving individualised goals
  • Actively liaising with relevant services to support need based on a shared plan
  • Working with offenders in preparation for the ending of support. 

Patient and Public Involvement (PPI)

People serving sentences in the Criminal Justice System (CJS) often have substantially different backgrounds and life experiences from the general population. Patient and Public Involvement (PPI) of ‘seldom heard’ groups brings valuable lived experience, and enhances research by driving its relevance. 

 A Peer Researcher (PR) group was set up to ensure that Engager 2 was relevant to those who would receive the intervention. The PR group consisted of eight men, and meetings were held at a local substance misuse charity. They were fortnightly meetings, usually lasting around 2 hours. The PRs were involved in all aspects of the project, up until the start of a Randomised Controlled Trial (RCT). Most notably, they helped to refine research documents, ensuring that their language and length were acceptable.

Engager Peer Researcher film

A video telling the story of what it meant to the Peer Researchers to be involved in Engager, and the advice they would give to someone else considering being involved in a research project.

The South West team

The Northwest team:

Professor Jenny Shaw, University of Manchester 
Principal Investigator – Northwest Site

Dr Charlotte Lennox, University of Manchester
Senior Research Fellow; Project Manager for Northwest site

Roxanne Todd, University of Manchester
Research Assistant

Caroline Stevenson, University of Manchester
Research Assistant

If you wish to find out more please contact us at engager@plymouth.ac.uk or +44 1752 764230

Collaborators: Exeter University

Health Economics: 

Statistics and Trial Design:

Realist Review:

Qualitative Methodology:

Collaborators: other institutions

Professor Susan Michie
Director, UCL Centre for Behaviour Change

Dr Nat Wright
Associate Medical Director Specialist Services and Vulnerable Groups
Leeds Community Healthcare
n.wright@leeds.ac.uk 

Professor Mike Maguire
Professor in Criminology
University of South Wales

Dr Alex Stirzaker
IAPT Advisor and Specialist in PD and SMI
Avon & Wiltshire Mental Health Partnership NHS Trust
alex.stirzaker@nhs.net 

Dr Mark Haddad
Senior Lecturer in Mental Health
City University London

Dr Graham Durcan
Associate Director, Criminal Justice
Centre for Mental Health 
graham.durcan@centreformentalhealth.org.uk

Rachael Hunter​
Senior Research Associate
UCL

Dr Christine Brown
Consultant Forensic Psychiatrist 
Devon Partnership Trust
christinebrown1@nhs.net 

Dr Tirril Harris
Former Senior Research Fellow
King’s College London 

Engager

Developing and evaluating a collaborative care intervention for offenders with common mental health problems, near to and after release

Peninsula Clinical Trials Unit (PenCTU)

This research is a collaboration between Plymouth University Peninsula Schools of Medicine and Dentistry and The University of Manchester, along with several other institutions and individuals. It is being led by Professor Richard Byng at Plymouth and Professor Jenny Shaw at Manchester. It is managed by the Peninsula Clinical Trials Unit (PenCTU).