The Engager project
The Engager project is a five-year programme to develop and evaluate a through-the-gate intervention for prisoners with common mental health problems, as well as associated personality and substance misuse problems. About 50% of prison leavers meet the criteria and most agreed to participate. The Engager trial involves recruiting 280 individuals from two prison clusters in the North West and South West and randomising to receive the intervention or not. Trial recruitment and follow up lasts over 2 years. Primary outcome is collected at six months. Researchers screened all prison leavers being released to relevant geographical locations, enrolled them within the trial and maintained follow up in the community. Outcomes cover mental distress, health and social needs, addiction and criminal justice involvement.
The result of the trial should have implications for the engagement and treatment / management of offenders as they leave prison. Currently most prison leavers receive virtually no mental health care. Delivery of the intervention required successfully setting up and maintaining two teams of three practitioners in highly adverse conditions. A supervisor/team leader and two support workers work across prison and community settings delivering flexible bespoke care. A positive result will have potential to influence policy, especially given the current focus on supporting prisoners’ social reintegration.
Conducting trials in a prison environment with participants who frequently lead chaotic lives is notoriously challenging. The model of engagement used for recruitment and follow-up and trial procedures could provide a vital framework for future trials in this setting.
Contribution of PenCLAHRC
The CLAHRC contribution remains significant. This PenCLAHRC project is working across Plymouth and Exeter Universities and is drawing in expertise from various PenCLAHRC academics as well as being led by Professor Richard Byng (PenCLAHRC Deputy Director). Richard’s non-clinical time is partially funded by the CLAHRC.
We have also drawn on the knowledge and expertise of other CLAHRC staff in the areas of:
- Statistical analysis
- Developing evaluation protocols
- Intervention modelling work
- Health Economic evaluation and economic modelling
- Peer Researcher mentoring and training
The CLAHRC environment with expertise in person-centred approaches and complex interventions contributed substantially to both bid and delivery.
What happened next?
Pilot work to develop the intervention and trial science was completed and the trial started in January 2016. Recruitment was completed in October 2017. Intervention delivery finished in March 2018.
Following the pilot trial, we were awarded a 5 month extension to deliver a fully powered trial. Following good rates of recruitment and follow up, we were awarded an additional 10 month extension to contract from NIHR for 12 month post-release follow up and cost consequence analysis.
West Midlands Mental Health Commission have taken up the Engager model and anticipate rollout later in 2018.