The Impact of the Critical Time Intervention for People with Severe Mental Illness in the Transition from Prison to the Community

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: There are high rates of mental health problems among prisoners and the prevalence of severe mental illness is far higher than in the community. Although mental health services have become well established within prisons in England and Wales, the transition from prison to the community presents difficulties for the provision of care and there are negative outcomes during this period.
Methods: Participants were recruited from eight prisons in London and the North West of England and randomised to receive either the Critical Time Intervention or treatment as usual. They were followed up at six weeks, six months and 12 months and a number of variables were measured at each time point. A sub sample of these participants and members of prison and community staff also completed qualitative interviews.
Results: One hundred and fifty participants were recruited and follow up data were collected for 116 participants at six week follow up and 98 and 85 participants at six months and at 12 months. Participants in the CTI group had significantly higher levels of contact with; (I) any mental health professional, (II) allocation of a care co-ordinator and; (III) contact with a care co-ordinator compared to the TAU group. These differences were not significant at six month or at 12 month follow up. Legal status and problem drug use were associated with better outcomes at six weeks after release from prison and GP involvement in care on entry was associated with worse outcomes. Themes relating to needs and problems after release, the perceived benefits and problems of the Critical Time Intervention, and provision of care in this period were identified in qualitative interviews.
Conclusions: The Critical Time Intervention is effective in improving outcomes in the early transition from prison to the community and should be considered by decision makers at the national or regional level. Further research should determine whether the CTI is effective as a service and whether it has a beneficial effect on other important outcomes.
Date of Award2017
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorGraham Thornicroft (Supervisor) & Sara Evans-Lacko (Supervisor)

Cite this