ABSTRACT
It is widely acknowledged in both national and international literature that offenders represent a group with complex and multiple health needs (McSweeney & Hough, 2006), many of which are not addressed prior to custody (Department of Health, 2009a; Mair & May, 1997) and yet which place considerable cost and resource burden on health services (Rodriguez, Keene & Li, 2006). Prisoners have poorer physical health (Harris, Hek & Condon, 2006; World Health Organisation (WHO), 2007) and elevated levels of substance misuse, mental health problems and vulnerability to self-harm and suicide (Department of Health, 2009a; WHO, 2007), and approximately half of all male prisoners (Fazel, Bains & Doll, 2006), and two thirds of female prisoners report substance dependency prior to imprisonment (Social Exclusion Unit, 2002). Over 70% of the prison population in England and Wales have two or more mental health problems, and it is widely recognised that access to mental health and substance misuse services can contribute to a reduction in offending (Home Office, 2004; Social Exclusion Unit, 2002). However, despite growth in these services within prisons, many prisoners still do not engage with treatment (Stewart, 2008a).
