The importance of literacy and numeracy skills in the secure care recovery pathway

Opening summary

As part of the Advanced Teacher Status (ATS) programme, participants are required to undertake a quality improvement project.

SET’s Professional Status team reviewed all 60+ Quality Improvement Projects submitted as part of the October 2020 ATS cohort shortlisting the top 12 using a scoring matrix, including the below from Helen Sonnenfeld, Education Lead at CNTW.

This editorial provides an overview of Helen’s improvement project which focused on the role of education for service users and in particular, the importance of literacy and numeracy skills in their recovery.

Research Context

Whilst the importance of therapeutic activities is generally accepted, the role of education and its impact for service users has not been formally evaluated in secure, forensic services within our hospital setting.

Current debates have highlighted that those who have mental health and/or learning disability diagnosis are more likely to have low skill abilities in English and maths.

It is difficult to estimate how service-users initial assessment results compare with those of the wider population within the current literature.

It is hoped that the findings will support colleagues and the wider organisational development of the service.


Aims and objectives

To ascertain the importance that service users assign to literacy and numeracy skills in their recovery


Project findings and recommendations


The table below shows the findings across secure services:

  English % English Maths % Maths
Pre-entry 4 14% 3 11%
Entry 1 10 36% 7 25%
Entry 2 7 25% 11 39%
Entry 3 5 18% 2 7.1%
Level 1 1 4% 1 3%
Level 2 1 4% 2 7%
Declined 0 0% 1 4%
Not attempted 0 0% 1 4%
Total 28   28  

The majority of service users are working at Entry 1 in English and E2 in Maths. Only 7% are working at Level 1 or above in English and 10% in maths.

Comparison with PIAAC and Skills for Life. Table shows the descriptors that the majority of the populatiion are working at:

  Literacy Numeracy
Forensic Services findings Entry 1 (Age 5-7) Entry 2 (age 7-9)
PIAAC findings Level 1 Level 2
Skills for Life findings Level 1 Level 1


Limitations include:

  • Covid restrictions
  • Differences in comparison with PIACC/Skills for Life
  • Change in functional skills curriculum
  • Measuring skills
  • Results may differ if the survey was completed again as the population changes – it is not static



  • The initial assessment results for secure care are well below the average for the wider population.
    • All staff could benefit from knowing service-users initial assessment results when preparing any programme of care and treatment.
    • Knowledge of initial assessment results can help professionals meet individual needs.
  • English and maths abilities still remain a priority in government policy and service-users should be given the opportunity to improve these to help in their recovery pathway and return and transition to the community.



  • A survey of initial assessment results in English and maths for secure services was undertaken
  • The BKSB Initial Assessment tool was used to collect the data
  • Cross site sample was chosen – 28 respondents identified: Mental health and learning disability populations
  • The results were compared to wider studies from Skills for Life and the Programme for the International Assessment of Adult Competencies (PIAAC)


Professional Standards covered

PS2.1, PS3.1, PS4.1, PS6.1, PS7.1, PS8.1, PS9.1, PS12.1, PS16.1, PS18.1, PS20.2

Professional reading

  • BIS Research Paper 81, The 2011 Skills for Life Survey: a Survey of Literacy, Numeracy, and ICT Levels in England, available at: for-life-survey.pdf (accessed 02/02/2021)
  • Dennan, G., Alred, D. (2012) Secure Recovery: Approaches to Recovery in Forensic Mental Health Settings, Routledge
  • Moser, C. (1999) Improving Literacy and Numeracy: A Fresh Start, HMSO, DfEE
  • OECD (2013), OECD Skills Outlook 2013: First Results from the Survey of Adult Skills, (Accessed 23/04/2021)
  • Paasche-Orlow, M., Parker, R., Gazmararian, J., Nielsen-Bohiman, L., Rudd, R., (2005) The Prevalence of Limited Health Literacy, Journal of General Internal Medicine, Volume 20, Issue 2, pp175-184
  • Repper, J., Perkins, R., (2013) Social Inclusion and Recovery: A Model for Mental Health Practice: Baillere Tindall
  • Simpson, A., Penney, S. (2011) The Recovery Paradigm, Forensic Mental Health Services, Vol 21, pp299-306
  • Svensson, I., Faith, L., Persson,. B. (2015) Reading Level and The Prevalence of a Dyslexic Profile Among Patients in a Forensic Psychiatric Clinic, The Journal of Forensic Psychiatry, Vol 26, No 4, pp532-555

Content from Poster Presentation - Viva preparation - Helen Sonnenfeld - 2022

Find out more about the Advanced Teacher Status (ATS) programme.