THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY

2020, VOL. 31, NO. 1, 76–89

https://doi.org/10.1080/14789949.2019.1665699

Critical Time Intervention: a qualitative study of the

perspectives of prisoners and staff
C. Lennoxa, C. Stevensona, D. Edge a, G. Hopkinsb, G. Thornicroftc,
E. Susserd, S. Conovere, D. Hermanf, J. Senior a and J. Shaw a
a
Division of Psychology and Mental Health, The University of Manchester, Manchester, UK;
b
Institute of Health Economics, Edmonton, Alberta, Canada; cCentre for Global Mental
Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK; dMailman School of Public Health,
New York State Psychiatric Institute, Columbia University, New York,, USA; eCenter for the
Advancement of Critical Time Intervention, Silberman School of Social Work, Hunter
College, City University of New York, New York,, USA; fCenter for the Advancement of
Critical Time Intervention, Hunter College, City University of New York, New York,, USA

ABSTRACT
Release from prison is a vulnerable period, especially for people with severe
mental illness. Critical Time Intervention (CTI) can be effective in improving
service access and reducing negative outcomes. Nested within a randomised
controlled trial of CTI, qualitative interviews were conducted with trial partici-
pants in both intervention (CTI) and treatment as usual (TAU) arms, CTI
managers delivering the intervention and associated professionals. Data
were analysed using a framework approach.
Four themes were identified: uncertainty about post-release plans; inade-
quate housing provision; support during transition; and continuity of care.
Interviewees shared common concerns about transition into the community but
CTI participants felt less anxious about release and reported receiving more support
with housing, access to services and community reintegration than during previous
periods of incarceration. Professionals raised concerns about the time-limited
nature of CTI and the impact of austerity measures on the availability of support
following CTI. Implications for service delivery will be discussed.

ARTICLE HISTORY Received 14 May 2019; Accepted 2 September 2019

KEYWORDS Transition; release planning; Critical Time Intervention; severe mental illness (SMI); prison

Background
Transitions of care are defined as changes in the level, location, or provider of
care. Such transitions are points of vulnerability that can lead to a range of
negative outcomes (Coleman, 2003; Jing, Young, & Williams, 2014). In the UK,
mental health policy has moved away from large psychiatric institutions
towards enabling individuals with severe mental illness (SMI) to live in the

CONTACT C. Lennox charlotte.lennox@manchester.ac.uk

© 2019 Informa UK Limited, trading as Taylor & Francis Group
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 77

community with greater personal autonomy. However, the transition to com-

munity living is not always straightforward, with many people needing proac-
tive support from a range of social and community agencies (Coid, 1994).
To address this challenge, case management was introduced, requiring
health and social care agencies to form multidisciplinary teams. Case manage-
ment aims to maintain client contact with community services to reduce the
risk of rehospitalisation and improve independent living skills. Although case
management has been adopted widely, its efficacy has been questioned (Joo &
Huber, 2017; Marshall, Gray, Lockwood, & Green, 1998; Marshall, Lockwood, &
Gath, 1995; Schmidt-Posner & Jerrell, 1998; Smith & Newton, 2007).
Critical Time Intervention (CTI) is a structured, time-limited form of case
management specifically developed to support those with SMI and a history of
homelessness transition from institution to community (Herman et al., 2011; Lako
et al., 2013; Susser et al., 1997). CTI has two key components: first, to strengthen
ties with service providers, family and friends; and second, to provide practical
and emotional support during transition. There is evidence that CTI can be
effective in improving continuity of support and that this leads to improved
mental health and social outcomes. Susser et al. (1997) examined the effective-
ness of CTI for 96 men with SMI discharged from a New York psychiatric
programme back into the community. They found that CTI significantly reduced
the number of nights spent homeless over an 18-month follow-up period.
More recently, Tomita and Herman (2015) investigated the impact of
CTI following discharge from an inpatient psychiatric treatment on per-
ceived continuity of care. Those receiving CTI perceived services to be
more readily accessible. Lako et al. (2013), in a study of Dutch women
leaving domestic abuse found CTI effective in reducing levels of unmet
need. In a qualitative study, the Downtown Women’s Centre (2014)
piloted CTI for homeless women. Clients reported feeling CTI managers
genuinely cared about them and facilitated engagement with other ser-
vices. They felt CTI managers helped them increase their community
connections and advocated for them until they were more independent
and able to help themselves.
There are similarities between those with SMI and a history of home-
lessness, and prisoners with SMI, with respect to levels of disengagement
from health and social care services (Susser et al., 1997). Lennox et al. (2012)
investigated whether those with SMI in contact with prison-based mental
health services then made contact with community services upon release. Of
53 people released, half (51%; n = 27) had any documented evidence of
planning for release and only 20 (38%) had direct documented evidence of
contract between the prison and a Community Mental Health Team. Of
these 20 only four (20%) then may actual contract in the community.
The transition from prison to community for those with SMI is associated
with a range of negative outcomes, including increased risk of homelessness
78 C. LENNOX ET AL.

(Binswanger et al., 2011; Lloyd, Page, McKeganey, & Russell, 2019; Woodall,
Dixey, & South, 2013); re-offending (Baillargeon et al., 2010; Wilson & Wood,
2014); and mortality (Farrell & Marsden, 2008; Merrall et al., 2010; Pratt,
Piper, Appleby, Webb, & Shaw, 2006; Zlodre & Fazel, 2012). Barrenger,
Draine, Angell, and Herman (2017) in a study of men with mental illness
being released from prison reported that participants often found it difficult
to find accommodation and employment. They found that being back in the
community often exacerbated psychiatric symptoms. This in turn led to
increased reliance on family members and strained relations with existing
support systems.
In our earlier study, the CTI model was adapted and piloted for use with
a prisoner population (Jarrett et al., 2012). Sixty prisoners were recruited, with
32 randomly allocated to CTI and 28 to treatment as usual (TAU). Of these, 23
were followed up 4–6 weeks post release. Those assigned to the CTI group were
more likely to be in receipt of medication and be registered with a GP.
Qualitative interviews are increasingly used to complement Randomised
Controlled Trials (RCT) of complex health-care interventions (Lewin, Glenton,
& Oxman, 2009). By exploring a range of stakeholder perspectives, qualita-
tive research can provide an effective means of improving understanding of
key components of interventions. People with SMI provide valuable insight
into understanding and improving the coordination of mental health and
mental health services, often providing a very different perspective to
professionals (Biringer, Hartveit, Sundfør, Rudd, & Borg, 2017).

Methods
The original CTI model was adapted to reflect the stages of transition for
prisoners in England. There was increased input in the pre-release period and
the post-release CTI period was shortened to 6 weeks, recognising the original
9-month period would be cost prohibitive to deliver (Jarrett et al., 2012).
CTI managers were existing members of prison mental health teams
trained to deliver CTI. The intervention was divided into four phases. During
phase 1, the CTI manager conducted a detailed needs assessment, formulated
a release plan and established links with relevant community services. Phase 2
covered the initial transition to the community with the CTI manager provid-
ing practical support and advocacy, e.g. attending appointments alongside
clients and offering help with issues such as housing and benefits. Phase 3
tested the strength of the new relationships, with the client supported by
both CTI manager and community service staff. At phase 4, care was wholly
transferred to community providers and the CTI manager withdrew. TAU
participants accessed all health services as would usually be the case. At all
sites prison mental health services acted as care co-ordinators, but compo-
nents of TAU varied across the different prison sites (Shaw et al., 2017).
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 79

Qualitative procedures
All trial participants were informed about the qualitative study. Purposive
sampling ensured representation from each arm of the trial. Those selected
for inclusion were asked to provide informed consent. Comprehensive con-
tact details, including discharge addresses, telephone numbers, and relative
and friends’ contact details were taken to maximise the likely success of
post-release contact (see Shaw et al., 2017 for detailed information about
the main trial recruitment process).
Participants were interviewed at two-time points: (i) within 3 weeks prior
to release and (ii) approximately 6–7 weeks post-release. A semi-structured
interview schedule was used covering previous experiences of support upon
release from prison; problems anticipated upon release; support received in
the community; and current wellbeing. In addition, those who received CTI
were asked about contact with CTI managers; the type and value of support
put in place; and what worked well and what did not. All interviews were
conducted by GH and CS.
In addition, CTI managers and other professionals who had worked with
CTI clients were invited to participate. CTI managers were asked for their
views on their role and regarding TAU and CTI service provision. CTI man-
agers and other professionals were asked about the value and impact of
implementing CTI and the barriers and facilitators encountered.
Data collection took place between January 2013 and October 2015.

Data analysis
Interviews were digitally recorded, where possible, and transcribed verba-
tim. Four interviews (1 TAU and 3 CTI) could not be recorded; notes were
taken during the interviews and full descriptions written up immediately.
Data were managed using QSR International’s NVivo 10 Software for quali-
tative analysis.
Data were analysed using framework analysis (Ritchie & Lewis, 2003). This
allowed for both deductive and inductive coding to be used concurrently;
enabling important a priori themes or concepts to be combined with
themes that emerged from the data.
Five key stages of analysis were undertaken.

(i) Familiarisation: CS and CL read and re-read all interview transcripts,

making notes on inductive and deductive codes. Five transcripts were
also read by DE to ensure all key codes were identified with no
significant omissions.
(ii) Identifying a thematic framework: The thematic framework was devel-
oped iteratively. The first analytical framework drew on a priori issues,
80 C. LENNOX ET AL.

based on the interview questions and phases of CTI intervention, e.g.

multiagency working, establishing links with community services,
accommodation, medication, money and benefits, substance misuse,
employment, education and training, family relationships and social
networks, physical health and life skills.
(iii) Indexing: CS and CL independently indexed the same five transcripts
and met to discuss and agree codes and the coding framework.
Coders also met with the wider research team (JJS, JS, DE, AW) to
further refine codes. All data were then indexed by CS and checked
for consistency by CL. Any disagreements were resolved by discussion
and arriving at a consensus with the wider team.
(iv) Charting: Data were entered into a Framework Matrix. The matrix was
a spreadsheet containing cells into which summarised data were
entered. There were separate rows for each theme and separate
columns for each group of interviewees, e.g. CTI, TAU, professionals.
(v) Mapping and interpretation: The matrix was then used to develop,
define and discriminate concepts; ensuring that these encapsulated
the full range of participants’ views. The data were finally reassigned
to these themes producing interpretive concepts that describe and
explain the final output of the dataset.

Ethics
Ethical approval was granted by the Research Ethics Committee (REC) for
Wales in January 2012 (reference number 11/WA/0328). National Offender
Management Service (NOMS) research approval was given in February 2012
(reference number 184–11).

Results
A total of 19 interviews were conducted with 14 trial participants: eight CTI and
six TAU recipients. Five people approached refused to take part in the interviews.
Nine participants did not complete a post-release interview (TAU = 5; CTI = 4);
seven were uncontactable and two refused to meet. Table 1 provides an over-
view of participant demographics, which are similar to the demographics for the
whole sample (see Shaw et al., 2017).
Three of the five CTI managers were recruited. Twelve other profes-
sionals were approached and agreed to participate in interviews; how-
ever, ultimately, only five interviews were undertaken with other
professionals. The remainder were either unable to commit to a time
for interview because of work pressures (n = 5) or did not respond when
followed up (n = 2).
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 81

Table 1. Participant demographics and characteristics.

Total (n = 14)
n (%)
Ethnicity White British 8 (57)
BAME 6 (43)
Relationship Status Single 13 (93)
Employment Status Unemployed 11 (79)
Accommodation Status House/flat 8 (57)
Homeless/no fixed abode 3 (21)
Prison Status Convicted and sentenced 10 (71)
Remand 4 (29)
Previous Imprisonment Yes 12 (86)
BAME: British, Asian and Minority Ethnic

Four themes were identified in the data: uncertainty about post-release

plans; inadequate housing provision; support during transition; and conti-
nuity of care.

Theme 1: uncertainty about post-release plans

All participants talked about a lack of clarity about post-release plans. The
pre-release period was characterised as one in which they experienced
stress, worry and anxiety.

“Leaving prison is stressful enough, but when you don’t know what’s happening it
makes it worse” (CTI, Prison 1).

This level of uncertainty made it difficult to implement meaningful release

plans:

“I don’t know when I’ll actually be leaving and that means they [accommodation
provider] won’t keep somewhere open waiting for me if I’m not actually going to
be there.” (TAU, Prison 1).

This was accompanied by levels of uncertainty from professionals working

with them:

“You very rarely find any community nurse coming into visit prisoners whilst
they’re with us and they very rarely turn up as part of the CPA (Care Programme
Approach). You’re always anxious whether they are going to pick that person up
and are they going to see them” (Lead Prison Mental Health Nurse)

Receipt of CTI appeared to have alleviated some uncertainty and associated

anxiety prior to release through having someone supporting the link with
community services before release:

“I found it easier with the CTI manager. I was getting help that I didn’t get before
and found everything less stressful. It’s a big help. CTI has taken the stress away”
(CTI, Community 4).
82 C. LENNOX ET AL.

Theme 2: inadequate housing provision

Issues around housing provision were highlighted by almost everyone
interviewed. Participants voiced concerns about the availability and stan-
dard of housing. Many reported serious flaws in the application process,
such as a lack of timely pre-release work, often resulting in release without
confirmed housing:
“[the] system works really badly. When someone’s released they need somewhere
to sleep that same day. We’ve sat at the council with people until 8pm just waiting
to see if someone has a hostel that night or not . . . people who’ve just come out of
prison probably aren’t a priority . . . they should be processing applications before
release.” (CTI Manager – Prison Mental Health Nurse).

Additionally, experience had taught participants, echoed by professionals,

that a lack of housing increased the risk of reoffending and incarceration:
“if you don’t have a hostel then that’s it, you’ll be back in a week. That’s why
I keep coming back, you don’t get somewhere to live you don’t have any chance.”
(TAU, Prison 3)

Interviewees also felt that some options could exacerbate mental health and
substance misuse issues:
“[hostels] aren’t even that much better than prison . . . the rooms aren’t good and . . .
they take drugs, they drink. Which I do too. But we shouldn’t be all together should
we. Load of mad men all together. It’s not a good idea.” (CTI, Community 1)

There was evidence that CTI managers were liaising with housing providers
and helping to secure accommodation on release:
“I’ve had a lot more help. I’m sure that’s to do with your project. Things have
gone a lot smoother than they ever have before.” (CTI, Community 2).

Theme 3: support during transition

From the perspective of those with previous experience of prison, services
seemed to lack a coherent focus on the needs of prisoners:
“No one helps with that [benefits], it’s down to you. You get the forms when you
go, and you sort that out when you can . . . There isn’t really any support . . . it’s
always like that.” (TAU, Prison 2)

In the absence of effective transitional support, it often fell to families to

provide the transitional support required. This reliance was reported as
a source of embarrassment, as well as signalling a lack of independence.
Participants reported that families were often ill-equipped to provide sup-
port with mental health problems. Some participants required more specia-
list support and felt that mental health problems put a strain on family
relationships:
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 83

“My mum and dad do most things . . . [but] to be honest, this whole mental thing
is affecting that because they’re getting stressed with it as well and it’s not good
for our relationship.” (TAU, Community 1)

Participants in the TAU group were more likely to characterise their current
situation as lacking in support. In contrast, CTI recipients predominantly
reported receiving positive support in the lead up to release, on the day
of release and also in the community.
Examples of valued support included being met at the prison gate on
release day and help managing appointments in the community:
“[CTI Manager] was there waiting outside the gate and she’d checked where we
need to go so we could get . . . to this hostel together. That was something I was
worried about because I get so anxious about being on buses, being with other
people in public. I think it would have been too overwhelming but [CTI Manager]
was there saying it’s ok.” (CTI, Community 3)

CTI managers also helped people reintegrate through support with joining
gyms, sports teams and other community activities. Participants reported that
CTI managers acted as advocates and helped improve access to, and engage-
ment, with other services on release. Both participant and professional inter-
viewees saw the benefit of this aspect of the intervention:
“CTI is a good extension of normal services and can help people more seamlessly
into the community.” (CTI Manager – Mental Health Nurse)

Theme 4: continuity of care

Participants in the TAU group frequently reported a lack of continuity both
between and within health and criminal justice services. For those who had
been imprisoned several times, a lack of continuity of care was associated
with reoffending and re-imprisonment. They reported a pattern of unful-
filled promises:
“I get told I need this service or that service, then I go there and they change their
mind. They’re always promising this and that and then it never happens . . . I’ve
been released so many times and this or that was meant to happen and it never
does and I just end up back in here.” (TAU, Prison 2)

Health professionals were frustrated with their inability to deliver care when
other agencies failed to consider the importance of planning and
collaboration:
“One of the difficulties we sometimes encounter is the Prison Service does not do
‘joined-up thinking’ and they are not involved really in the planning of the
aftercare. Very often they will, for arbitrary reasons, transfer a prisoner to another
prison with no notice whatsoever and that makes it very difficult then to follow
up and ensure that services are following them and planning for their release.”
(Prison Liaison Specialist)
84 C. LENNOX ET AL.

CTI participants suggested that continuity of care compared favourably

with previous incarcerations. Of value was having the same person
throughout the release and post-release period, able to link with all
other services:

“Things have been more planned. Last time my community team were pretty
bad . . . [CTI Manager] has seen me in prison and here [community], she can
explain a lot more to [community staff]. She knows me better. And I don’t want to
have to keep meeting new people.” (CTI, Community 3)

A lack of continuity of care was also perceived as having public safety

implications. This case illustrates again the importance of having the same
individual who knows the individual well and who is at the centre of the
collaborative care process. In this case, CTI was able to ‘plug the gap’,
thereby helping avert potentially serious consequences:
“We had a guy that was very high risk . . . there was difficulties pre-release in
terms of the community team . . . we assumed that they’d picked him up but then
it looked like they hadn’t . . . This was a [person in the CTI group] and it did get
resolved. Otherwise, we wouldn’t have known anything about it, we certainly
wouldn’t have been able to follow him up . . . I think potentially things could have
gone horribly wrong there.” (Lead Prison Mental Health Nurse)

However, there were aspects identified that may impact upon the efficacy of
CTI, most commonly whether the required resources would be available for
the intervention to operate on a larger scale:

“Well, the major question is who’s going to pay for it isn’t it? When budgets are
being cut I’m not sure who’s going to have the money to fund that and keep it
going”. (Community Psychiatric Nurse)

Limited recourses were an issue for all services, resulting in stricter eligibility
criteria due to recent austerity measures. This impacted CTI managers’
abilities to refer people onto other services.
Although trial participants made no mention of the time-limited nature of
CTI and any continuity issues, professionals did highlight this as a potential
issue. Some felt there was potential to create dependence on CTI:

“They can actually become quite dependent. Every little thing they’ll be calling
and in contact with you and maybe then when they get to 6 weeks they’ve got
used to that and can’t do things for themselves” (CTI Manager- Prison Mental
Health Nurse).

Some professionals suggested that a step down in intensity over a longer

time might be more appropriate than a six-week cut-off point. This view was
endorsed by one of the CTI managers who felt that flexibility was required
to meet reflect individual needs:
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 85

The CTI period should be flexible as people have different circumstances. Needs to
be long enough but, if too long, then this can also create some dependence in the
service user” (CTI Manager – Mental Health Nurse).

Discussion
The interviews identified four main themes. There was uncertainty about
post-release plans, which caused stress and anxiety. Inadequate housing
provision was suggested to be linked to reoffending and exacerbations in
mental health and substance misuse issues. Support during transition per-
iods was vital but often fell on families to provide, often with negative and
unintended consequences. Continuity of care was generally lacking across
prison and health services, and had public safety implications.
Poor levels of release planning had been highlighted previously by
Lennox et al. (2012). Our results here suggest little improvement over
time. Poor release planning was also highlighted by Lloyd et al. (2019) and
by the recent HM Chief Inspector of Prisons for England and Wales Annual
Report (2018). There is a pressing need for prisons and prison mental health
teams to develop and maintain pro-active links with community services
that will be responsible for care and support on discharge.
Almost everyone interviewed highlighted inadequate housing provision
as a core problem. Securing good accommodation is a vital part of the
resettlement process and no or inadequate accommodation was perceived
to increase the likelihood of early reoffending (Baillargeon et al., 2010;
Binswanger et al., 2011; Woodall et al., 2013). Like our participants, Lloyd
et al. (2019) found that the fundamental source of recovery capital needed
by ex-prisoners is housing. This is further echoed by the professionals
interviewed by Hancock, Smith-Merry, and Mckenzie (2018). While the find-
ings from this study suggest that CTI was perceived to better support
housing access, this must be prioritised during phase 1, when the person
is still in prison.
The findings from this study suggest that, in the absence of effective
transitional care, it fell to families to provide housing, financial and emo-
tional support. However, this was often a source of embarrassment, rein-
forced stigma and put a strain on relationships. The importance of family
was also highlighted by Lloyd et al. (2019), but here family support was
strained by the period of incarceration and not after release. Related
research has shown that maintaining prison visits is associated with
improved family relations and a decreased likelihood of reconviction
(Brunton-Smith & McCarthy, 2017). There remains, however, a knowledge
gap around how to best help families post-release to provide long-term
support for their loved ones.
86 C. LENNOX ET AL.

Many participants and professionals identified a lack of continuity of

care within individual services and also between health and justice agen-
cies, as highlighted by Lennox et al. (2012). More recently, Barrenger et al.
(2017) were the first to highlight specific environmental barriers to suc-
cessful community transition such as employment norms and practices
and housing policies which disadvantage people with criminal justice
system contact. The authors highlighted that more research was needed
to make the direct link to reoffending for those with SMI and how this
may be positively influenced through structural interventions to improve
community tenure.
The qualitative findings suggest that CTI partially addresses the above
issues. Most notably, members of the CTI group reported less uncertainty
about their release and a sense that care would be/was more integrated,
thus reducing stress and anxiety. The CTI group reported better continuity
of care and improved access to services attributed, at least in part, to CTI
managers advocating on their behalf.
This study supports the increasing evidence that CTI-based service provi-
sion is effective in supporting periods of transition and reducing negative
outcomes (Draine & Herman, 2008; Lako et al., 2013; Susser et al., 1997). In
line with Tomita and Herman (2015) quantitative study, the current study
found that those in receipt of CTI perceived greater continuity of care,
compared with previous spells of imprisonment. Echoing the results of Los
Angeles Downtown Women’s Centre (2014) study, we also found that CTI
bolsters feelings of community tenure, providing welcome support and
advocacy through a difficult transition period. Therefore, it may be advanta-
geous for prisons and specialist prison mental health teams to develop CTI-
like service provision.
On the whole, participants were very positive about the potential bene-
fits of CTI, but this needs to be balanced with some uncertainties which
were highlighted. In the prison adaption of CTI, its post-release duration was
shortened to 6 weeks, recognising that 9 months would be cost-prohibitive
to deliver. However, professionals highlighted the need for flexibility in the
period of post-release support. The impact of a decade of public sector
austerity in the UK led to concerns being expressed that CTI managers may
need to ‘hold on’ to people for longer, due to shortfalls in other services.
This was also highlighted in a similar study by de Vet et al. (2017) which
concluded limited availability of routine community services resulted in
over-reliance on the CTI manager in the final phase of the intervention.
The current study has some limitations. Firstly, despite comprehensive
contact details being taken for participants to try and maximise post-release
follow-up, 10 participants were unable to complete their post-release inter-
view. The main trial findings were collected from file information, meaning
that participants were not in regular contact with the research team
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 87

following release. TAU participants were less likely to be successfully fol-

lowed up; CTI participants were easier to contact as they had only just
finished receiving the intervention and were often well engaged with
known services. This may have biased the results as we had no TAU
participants who reported positive outcomes post release. Additionally,
interviews were only conducted within the first 6 weeks of release, therefore
the qualitative interviews are unable to shed light on whether CTI was
effective in the longer term. More interviews with professionals were
planned but were cancelled due to their work commitments. Thus, it may
be that data saturation was not reached, although there was significant
commonality in the small number of interviews conducted.
In conclusion, release from prison is a vulnerable period for those with
severe mental illness. Based on the qualitative interviews nested within our
randomised controlled trial of CTI, participants in receipt of the intervention
reported feeling less anxious about release and experienced more support
and service integration than they had received previously. We concluded
that it would be advantageous for prisons and specialist prison mental
health teams to develop CTI-based services, as better engagement with
services on release may reduce chaotic lifestyles and positively impact
upon re-offending.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This research was funded by the National Institute for Health Research, Service
Delivery and Organisation Programme (Ref- 09/1004/15).

ORCID
D. Edge http://orcid.org/0000-0003-1139-6613
J. Senior http://orcid.org/0000-0002-7133-4898
J. Shaw http://orcid.org/0000-0003-2569-7687

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