POLAR: The development of an integrated intervention pathway in prisons

Our next Seminar – ‘POLAR: The development of an integrated intervention pathway in prisons will be held on Tuesday 5th March 2024, 3-5pm.

This will be a free virtual event via Zoom. Spaces are limited on a first come basis.

To book your space please visit our Eventbrite page here:

People in the criminal justice system, including police custody, courts and prisons, have often experienced adverse and traumatic events in childhood, such as physical, sexual and emotional abuse and neglect. These developmental experiences in turn increase the likelihood of re-traumatisation in adulthood, through later experiences such as physical violence. They are also highly associated with substance misuse, mental health difficulties and complex social issues such as homelessness.

The estimated prevalence of post-traumatic stress disorder (PTSD) amongst people in prison is 7.7%, and for Complex-PTSD amongst people in prison it is 16.7% (Facer Irwin et al., 2021). People in prison and the criminal justice system who have experienced developmental trauma are often most in need of effective mental health services, but are also likely to face barriers that prevent access to this care (Home Office, 2007). These barriers include short stays and transition within the prison estate and into community services, being on remand and awaiting trial, and high levels of uncertainty about future charges (Forrester & Hopkin, 2009). In addition, there can be a lack of capacity within prison mental health services to provide the evidence based psychological therapies for PTSD and Complex-PTSD that is required to stabilise and manage these conditions (Forrester et al., 2014). Co-occurring substance misuse and complex mental health presentations often require specialist, individualised multi-disciplinary care. In addition, the prison environment can itself be counter-therapeutic and re-traumatising and may prohibit recovery from traumatic stress (Bradley, 2021).

There have been a number of programmes, pathways and initiatives within the Welsh prison estate and criminal justice system, as well as bespoke training programmes within individual services. Early scoping work has shown that there is variability in approaches offered and a disjointed picture across the system. In addition, there may be difficulties in ensuring sustainable implementation. There is also variability in whether interventions and approaches are evaluated; inconsistency in terms of the types of outcomes that are measured; and a lack of clarity about outcomes that are meaningful for service users and staff.

In collaboration with Welsh Government, Traumatic Stress Wales, Cardiff University and Greenwich University, we have been carrying out a project entitled ‘the development of an integrated intervention pathway in prisons’ (Polar). The aim of the current project was to survey existing services to understand what provision is currently in place and how this is delivered, to undertake qualitative work to complement this understanding, to describe gaps and barriers to implementation, and to understand views regarding an optimal pathway.


  • Andrew Forrester – Professor of Forensic Psychiatry at Cardiff University
  • Natasha Kalebic – research assistant in forensic psychiatry at Cardiff University
  • Jack Tomlin – Senior Lecturer in Criminology
  • Clare Crole-Rees – Consultant Psychologist within Oxford Health NHS Foundation Trust
  • Lewis Jones – Psychotherapist and High intensity Psychological Practitioner

Andrew Forrester

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Clare Crole-Rees

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Dr Jack Tomlin

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Lewis Jones

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Dr Natasha Kalebic

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Andrew Forrester

Professor of Forensic Psychiatry at Cardiff University, and a Consultant Forensic Psychiatrist with Swansea Bay University Health Board and Oxleas NHS Foundation Trust.

He has worked as a psychiatrist in prisons and other criminal justice settings for 25 years, and written over 1000 reports to the Courts, mainly in criminal proceedings. Professor Forrester’s clinical and research interests relate to mental health conditions as they present in the criminal justice system, including prisons, courts, police custody, probation, and other places of detention, with a focus on vulnerability and marginalisation.

Professor Forrester is also forensic lead at the National Centre for Mental Health, Director of the Offender Health Research Network Cymru, and chair of the Criminal Justice Steering Group Traumatic Stress Wales.

He chairs the Quality Network for Prison Mental Health Services, Royal College of Psychiatrists, and am Academic Secretary to the Faculty of Forensic Psychiatry, Royal College of Psychiatrists. Professor Forrester is Editor-in-Chief of the BJPsych Bulletin, Editor in Chief of the SAGE journal Medicine, Science and the Law, and sits on the editorial board for the journal Criminal Behaviour and Mental Health. He also sits on the executive committees of the Forensic Faculty of the Royal College of Psychiatrists, the British Academy of Forensic Sciences, and the charity Crime in Mind.

Professor Forrester chairs the World Psychiatric Association's prison mental health task-force, is  a member of the Howard League’s advisory board for sentencing principles for young adults a member of the Society of Expert Witnesses, the Medical and Dental Defence Union of Scotland, and the Royal Society of Medicine.

He is a Fellow of the Royal Society of Arts, an honorary member of the World Psychiatric Association, and a former member of the Royal College of Psychiatrists’ Working Group on the Mental Health of Refugees and Asylum Seekers.

Clare Crole-Rees

Clare is a Consultant Psychologist within Oxford Health NHS Foundation Trust, and is Psychological Therapies lead within Oxfordshire Primary Care Mental Health.

She holds Honorary Senior Lecturer and Honorary Research Associate roles at Cardiff University, and teaches on the D Clin Psy and CBT Programmes.

She is an active researcher at Cardiff University, where she researches the design and implementation of trauma-informed pathways within custodial and mental health settings.

She has several publications in peer reviewed journals and book chapters and has presented her work at conferences nationally.

Previously to her current role, she was Psychological Therapies Lead within Traumatic Stress Wales, and has been Principal Psychologist within tertiary services for Military Veterans and Traumatic Stress, as well as involved in the development of a first-wave IAPT service in South London. She is passionate about supporting psychologically-informed ways of working across teams in different settings.

Dr Jack Tomlin

Dr Jack Tomlin is a Senior Lecturer in Criminology. Prior to this he was a post-doctoral research fellow at the Department of Forensic Psychiatry at Rostock University Medical Centre, Germany.

He has an LL.B and an LL.M from Maastricht University in the Netherlands a PhD from the University of Nottingham, UK.

He is Associate Editor of the International Journal of Forensic Mental Health and has received funding from German, UK and EU bodies.

Lewis Jones

Lewis Jones (BSc PGDip MsC) is a practicing Psychotherapist and High intensity Psychological Practitioner who has worked with those affected by addiction for over 10 years.

He has developed a number of outreach and therapy services across South Wales (The Re-engagement Service, Homelessness MDT Therapeutic Outreach, Homelessness MDT Counselling Service, Buvidal Psychological Support Service).

Lewis is published as a lead and co-author on several research papers involving subjects such as novel psychoactive substances and tiered trauma-informed psychological support. He is currently developing a tiered, trauma-informed psychological support service for clients on long-acting injectable buprenorphine (LAIB) treatment in South Wales.

He also works as a part of the Polar (PrisOn WAles TrAumatic StRess II) project, developing Trauma-informed training for prison staff in Wales.

Dr Natasha Kalebic

Natasha Kalebic is a research assistant in forensic psychiatry at Cardiff University.

She has experience in leading systematic reviews, data collection and led on the survey of Welsh prisons for the POLAR study.

Natasha has led and co-authored on research papers examining subjects including PTSD, homicide, psychosis and violence, and adolescent forensic services.

She sits on the editorial board for the journal Criminal Behaviour and Mental Health.


  • 3.00pm – 3.10pm Andrew Forrester – Introduction
  • 3.10 – 3.20pm Natasha Kalebic – Survey of Welsh Prisons
  • 3.20 – 3.35pm Jack Tomlin – A discussion of the qualitative findings from the POLAR study
  • 3.35 – 4.00pm – Clare Crole-Rees– Consensus report
  • 4.00 – 4.10pm – Coffee Break
  • 4.10 – 4.35pm – Lewis Jones – Trauma-informed Training in Wales
  • 4.35 – 5.00 pm – Questions and discussions

Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.

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