In an ideal world, prison should prepare inmates to live an independent, law-abiding life on their release. They should learn skills to successfully reintegrate into their local community. This is challenging for many, but especially for those with mental health problems.  

Unfortunately, many ex-offenders with mental health problems who have committed serious offences, find themselves without anywhere to go when they are released from prison. As a result, many end up back in low, medium, or high-security hospitals or alternatively re-offend again and are returned to prison. As well as being tragic for the individual, this also has a negative effect on the taxpayer as it costs much more to lock people up either in a secure hospital or in prison, than it does to rehabilitate them and prepare them for independent living.  

Results from our Forensic Support Services show ex-offenders with mental health problems can thrive in a community setting, and with the right frameworks in place, community mental health services can be safe, successful, and cost-effective. 

The issue of institutionalisation 

Delayed transfer of care meetings (DTOC), a time consuming and complex process, can result in people with mental health problems remaining in secure hospital units far longer than necessary. Many forensic in-patients remain in hospital for at least 6 months longer than required due to these delays.  

Those affected typically experience a poor quality of life. With no place to call home, feelings of isolation alongside the mental challenge of coping with being locked up or restricted movement, can compound existing mental health conditions as well as derail recovery. 

There is also little opportunity in these settings for individuals to learn the necessary life skills they need to live independent lives. This problem has been exacerbated by the pandemic. Social distancing makes using facilities such as hospital kitchens very limiting. This, combined with the reduced opportunities to engage in face-to-face activities, make recovery particularly challenging. 

There is a far better solution. Ex-prisoners can succeed out in the community with the right support in place and achieve far greater reintegration than can ever be hoped for as an in-patient. 

Tilt, a safe, residential facility for ex-offenders 

Our residential facility, Tilt provides proven recovery pathways for ex-offenders with mental health problems. It offers the opportunity for independent living in the community without putting either the client or the public at risk. Ex-offenders can take positive steps forward to independence and learn the practical skills they need to reintegrate back successfully and safely into their local community. 

Tilt is a modern, spacious environment, designed to feel like home, run by highly trained staff with 24-hour support available to all its clients.  

Operating within this high-risk environment means there is no luxury of trial and error. We have to get things right first time and here is how we do it: 

• Our early involvement in the assessment process of individuals, sometimes months or years in advance, helps us to understand a client long before their arrival, enabling us to provide a bespoke care and support plan.
• The service offers a staged integration back into the community, protecting both the client and the public from the potential effects of re-offending or relapse. 
• The purpose of our innovative ‘Trial Leave Period’ is twofold. It provides an insight into a client’s motivation and commitment to achieving greater independence; and enables us to assess their suitability to the project. 
• Staff training and relationships between our clinical staff and commissioners are crucial.  
• The on-call service is provided by our most senior managers. 

Cost-effective with proven outcomes 

We understand decisions about treatment pathways are driven by a multitude of factors.  

It costs £185,000 per person, per year to take care of someone in a medium secure hospital. The Tilt programme costs just £70,000 per client, per year. This translates to a staggering £115,000 per person, per year, potential cost saving. 

But we know cost savings can’t be the only driver. Measurable outcomes should also be part of the equation. 

Over 50% of people released from UK prisons reoffend in the first year. In contrast 1.58% of people who have been through a Tilt programme in the last 5 years have reoffended.  

But what about the recovery journey back to independence? Over 64% move on to independent or less supported accommodation. 

The facts and figures are indisputable. It makes no sense, from either an economic, clinical, or rehabilitative point of view, to continue to institutionalise ex-offenders with mental health issues. The Tilt programme is a community mental health service that provides innumerable benefits to the patient and effectively supports the recovery journey back to an independent life. All at vastly reduced costs to the UK taxpayer.  

Please help us raise awareness about this issue by sharing this post with your network. If you would like more information or have any questions about Tilt, our wider Forensic Support service, or any of our community mental health services, please either visit the Commissioner FAQ section on our website, or just get in touch. We’d love to hear from you. Thank you for your support.