Sean Duggan, chief executive of the Centre for Mental Health, discusses mental health in the criminal justice system, and how improvements can be made.
T
hat mental health problems are wide- spread among the prison population in England and Wales has been known for some time. Mental ill-health, combined with a range of related disadvantages in life, is the norm rather than the excep- tion among people of all ages in custody. Nine out of ten prisoners have at least one mental health problem, whilst a quarter have a severe enough condition to warrant specialist treatment were they out in the community.1
What has been less well-known is that rates of mental ill-health among the pro- bation caseload are very similar to those of the prison population. Some 8% of offend- ers in probation services have a psychotic illness: about eight times the national av- erage. About half have the symptoms of a personality disorder; more than half have the signs of hazardous or harmful alcohol consumption; and 12% have the signs of serious drug misuse.2
Lack of treatment
In both prisons and probation services, only a minority of those with mental health problems receive treatment for them. Whilst all prisons now have dedi- cated mental health ‘in-reach’ teams, many struggle to offer care and support to the large numbers of people who need them, in a very challenging environment for mental health services. Primary mental health care for those with less severe conditions is seldom offered in many establishments, piling more pressure on in-reach teams.
Among the probation caseload, some 60% of those with a mood or anxiety disorder say that they are not receiving any treat- ment. Only half of those with a current psychosis were receiving any support from mental health services and while 88% of those with a drug problem are receiving treatment for this, only 40% are getting help for serious alcohol problems.3
These extremely high rates of poor health and untreated illness reinforce the need for urgent action to implement the Govern- ment’s pledge to extend effective diversion
96 | national health executive Nov/Dec 11
system and their chances of successful re- habilitation.
Diversion services are then able to inform decision-making by the police and the courts, potentially avoiding lengthy delays for psychiatric reports later in the judicial process. Importantly, good diversion ser- vices will ensure that the right forms of support are offered and that individuals whose lives can be complex and chaotic are properly linked with services before ‘letting go’ of them.4
Expansion and investment
Some diversion teams are making a big dif- ference and showing what can be achieved for relatively little investment. With Gov- ernment support, services like MO:DEL in Manchester and the Youth Justice Liaison and Diversion schemes have now expand- ed from their original six pilots to 37 locali- ties across England and are leading the way in offering a proactive, robust and effective form of diversion.
arrangements to all police stations and courts in England and Wales over the next four years.
Diversion services
Liaison and diversion services at their best are able to identify people at the earliest opportunity when they come into contact with the justice system. They are able to screen for a range of difficulties including not only mental ill-health but drug or al- cohol problems, learning disabilities and speech and communication difficulties: all of which may not just have affected their offending but which will have a large im- pact on their ability to cope with the justice
The NHS now has the opportunity to in- vest in diversion services across England. These will deliver most value if they link to a wide range of community-based services to ensure, for example, that someone di- verted from custody receives the support they need in their community. If diversion achieves its potential, one of the starkest inequalities in health care can begin to be redressed even in these toughest of times for all public services.
References
1. Centre for Mental Health, 2011, Mental health and the criminal justice system: Briefing Paper 39 (second edi- tion). London: Centre for Mental Health 2. Brooker C et al, 2011, An investigation into the preva- lence of mental health disor- der and patterns of health service access in a proba- tion population. Available at
www.tinyurl.com/RfPB- Summary 3. Ibid.
4. Centre for Mental Health, 2009, Diversion. Available at www.centreformentalhealth.
org.uk/publications/diver- sion.aspx?ID=59
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www.centreformentalhealth.org.uk Sean Duggan
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© BBC North East Wales
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