Understanding mental health and substance use service utilisation by people released from prison: A mixed-methods study

Lay summary: In Scotland about 15,000 people are released from prison each year. They are more likely than other people to die by suicide, drug overdose, and illnesses linked to mental health and substance use (drugs/alcohol). This suggests they are not getting the right help in the community, including from NHS services. This study has two parts. Part One will help us understand if and how people released from prison use NHS services for mental health and substance use. In Part Two we will explore the reasons for using services this way.

Part One. How much do people released from prison use NHS services for mental health and substance use? To answer this, we will use anonymised NHS data (data with personal details removed). We will compare people released from prison to people who have not been in prison and look at differences based on sex, age, and local area. For people released from prison, we will consider other characteristics too (e.g. ethnicity).

Part Two. Why do people released from prison use NHS services the way they do, or why don’t they use NHS services? To answer this, we will share results from Part One with small groups of people with expertise, and discuss their views of why this might be. Groups will include people who have experienced prison, and people who have worked in health and justice in different roles.

People with prison experience are involved in all stages, including on the project team and in the Lived Experience Advisory Panel.

Research questions:

RQ1. Which NHS services are accessed by people released from Scottish prisons for mental health and substance use support, and how does this compare to a general population sample matched on age, sex, and postcode?

RQ2. Amongst people released from prison, how does service access differ by demographic characteristics (age, sex, postcode derived deprivation/rurality variables, ethnicity and other protected characteristics) and liberation types?

RQ3. Considering results from RQ1&2: what are stakeholders’ (with lived, professional and policy expertise) views about the factors driving observed patterns of NHS service use for mental health and substance use in people released from prison?