Hidden Homeless: prisoners, prison leavers and ex-offenders

Executive summary

Hidden homeless is a Healthwatch Essex report published in 2023 exploring the health, care and wellbeing needs of prisoners, prison leavers and ex-offenders in Essex. The research forms part of Healthwatch Essex’s wider Hidden voices programme, focusing on groups who face significant barriers to accessing support and achieving positive outcomes.

The study was carried out between January and May 2023 and is based on a mixed-methods approach, including surveys, focus groups, in-depth interviews and case studies. It captures lived experiences from people currently in prison, those recently released, and professionals supporting this cohort.

Key findings

The report highlights complex and interrelated challenges across housing, mental health, physical health and access to services:

• Housing insecurity was a central issue, with many prison leavers released without secure accommodation or clear pathways into housing, increasing the risk of homelessness and instability.
• Mental health needs were widespread and often severe, frequently linked to trauma, substance misuse and experiences within the criminal justice system. Many participants reported limited or no access to mental health support during or after custody.
• Continuity of healthcare was poor, with difficulties registering with GPs, dentists and opticians following release, particularly for those without fixed addresses or photographic ID.
• Medication gaps were common, with people running out of prescribed medication before being able to access community healthcare services.
• System complexity and poor communication between prison, probation, healthcare and local authority services often left individuals feeling unsupported and unsure where to turn.

The findings also show that many prison leavers rely heavily on voluntary and community sector organisations for support, with some reporting that these services were the only consistent source of help after release.

Implications

The report demonstrates that prisoners, prison leavers and ex-offenders experience overlapping disadvantages that place them at high risk of poor health and wellbeing outcomes. It highlights the need for:

• Earlier and more coordinated resettlement planning
• Improved continuity of healthcare before and after release
• Better access to mental health and substance misuse support
• Joined-up working across prisons, probation, health, housing and the voluntary sector
• A stronger focus on dignity, communication and trauma-informed approaches

Hidden homeless provides valuable insight for commissioners, system partners and service providers working to reduce inequalities and improve outcomes for people involved in the criminal justice system.