Celebrating and promoting the best in UK prisons, probation and youth justice
This workshop, held by the Butler Trust in association with the Centre for Mental Health, focused on best practice in supporting and supervising offenders with mental health issues in the community.
[For further examples of good practice in this area see the mental health interest group on good-practice.net.]
[Sean Duggan – Centre for Mental Health]
Sean Duggan, Chief Executive of the Centre for Mental Health, opened the day by giving a background of some of the current issues, as well as outlining some implications for practice. Thirty-nine per cent of offenders supervised by probation services had a current mental health condition, and one in six had a psychotic illness – which was roughly ten times the national average.
The Offender Rehabilitation Bill outlined that there had to be a 12-month compulsory supervision for all prisoners who had a sentence under two years, and the privatisation of the Probation Service meant that those at high risk would still be monitored by a slimmed down national Probation Service. This was compounded by the limited research on mental health within the Criminal Justice System.
He also bought attention to street triage, where the Police and local Mental Health Trusts worked together to deal with Section 136 calls, which enabled Police to remove people from a public space and take them to a place of safety. There was no evidence that it worked, he said, and suggested that it needed to be thoroughly researched.
Because of these reasons, liaison and diversion services were to be based in police custody and courts for adults – commissioned by the NHS, it would be their job to properly screen and identify those at risk. Offenders would then be put on a pathway, either within the CJS or beyond it.
Further reading from the Centre for Mental Health:
[Chris Martin – Greater Manchester Probation Trust]
Butler Trust Award winner Chris Martin gave insight into working with difficult to engage clients who had a possible diagnosis of mental illness, from his experience of working on the MO:DEL (Manchester Offenders: Diversion, Engagement and Liaison) project.
Funded by the NHS, the project worked across the CJS to improve health and social care outcomes. It aimed to engage residents from Manchester with a history of exclusion from services, who were currently involved in the CJS and had a diagnosis of probable mental disorder or complex co-morbidities.
Inclusive support was provided for this group by the project, which worked within the Recovery Model to identify clients and encourage them back into mainstream services by means of mental health screening, assessment and intervention – as well as engagement with offenders in Police custody cells.
The aim was to reduce criminal activity by addressing the clients’ underlying mental health issues, and encourage positive lifestyle changes to break the cycle of offending behaviour and minimise the risk posed to themselves and others. MO:DEL worked to promote equal access to Health and Social Care Services and to facilitate multi-agency working, bridging the gaps between Mental Health, Criminal Justice and Social Care Agencies.
Linda Bryant, Head of Criminal Justice Services at Together, spoke to the workshop attendees about what had been achieved by their Forensic Mental Health Practitioner Service. Together, a national mental health charity, had worked with the London Probation Trust since 1993 to provide support for individuals with mental health issues across 16 London boroughs.
Linda outlined the service’s objectives – to improve identification and assessment of offenders, ensuring access to the full range of Community Justice, Health and Social Care Services, and to enhance offenders’ social participation in local communities.
Their model reflected many of the guiding principles of the delivery plan of the Health and Criminal Justice Programme Board and the National Division Programme, with a focus on proactive screening and a liaison, referral and follow-up system, as well as an integrated service delivery with local NHS Foundation Trusts that would promote a multi-agency approach.
A Court Liaison Service was provided five mornings a week, with the remaining time spent supporting offenders under the offender management of London Probation Trust, where Practitioners were co-located with Probation Officers in local delivery units.
The service meant that offenders were diverted away from custody and towards effective community management of their needs. Offender engagement was enhanced, said Linda, as well as the access to health and social care agencies. The multi-agency response was improved as well, with a dedicated response to specific populations, such as women.
The partnership with London Probation Trust had proven hugely successful across all areas, in no small part because of Together’s staff, who were trained to work with offenders with complex needs and to offer support and clinical supervision to Probation colleagues in their management of offenders.
The teams took a common sense approach, with services delivered where offenders were likely to access them. Using knowledge of local services, resources and partnerships, the service took a needs-based and responsive approach, with development based around understanding the needs of different offender cohorts.
[Sue Whitaker – Northamptonshire Probation Trust]
Sue Whitaker, Project Development Manager at Northamptonshire Probation Trust, gave a substance misuse perspective on the challenges of supervising offenders’ mental and physical wellbeing. NPT provided a service to improve health by transmitting relevant information across the criminal justice pathway, to bring about a reduction in reoffending and have positive outcomes for the NHS.
NPT provided a dedicated Substance Misuse Intervention Programme, screening all detainees in Police custody for substance and offending links. Detainees could then be assessed by Substance Recovery Workers and considered for Restrictions on Bail or Conditional Bail applications, while relevant information would be communicated to the court.
A Criminal Justice Mental Health Team was also offered by NPT, with a Dual Diagnosis Pilot and Personality Disorder Services that would provide a Link Worker based in Probation, supported by a Psychologist. This resulted in a reduction of reoffending and severity of reoffending, and less pressure being applied to Custody and A&E services. NPT found that administrative support was crucial to cope with the workload, and that strategic leadership and assessment of provision and identification of pathways made the process easier.
[Stuart John Chuan – Camden and Islington NHS Foundation Trust]
Stuart John Chuan, Forensic Psychologist with Camden and Islington NHS Foundation Trust, talked to attendees about supporting frontline workers more effectively, referring to his work with the PICT (Psychologically Informed Consultation and Training) service.
The model that PICT used was one of consultation, training and joint direct working aimed at being client-centred. It focused on building the capabilities of staff members, improving knowledge, skills and confidence. Joint working and liaison with other statutory and non-statutory services was also provided to strengthen case management – and ultimately, overall organisational culture and system change was the goal.
The benefits of the service, said Chuan, was that service users’ needs could be met earlier, as they were being better understood and engaged, and that practitioners were better informed about what to do.
Attendees of the workshop were asked to give feedback on the day, identifying challenges and action points with their own organisations in mind.
Recognising needs was identified as a stumbling block – there was poor support for offenders with low IQs and offenders with short sentences (less than 12 months). Offenders with learning disabilities were also not getting the right help, and neurological impairments were not being taken into consideration. This was due to a number of reasons – the necessary resources were not always available and access to services was sometimes poor, as well as there being a general lack of staff knowledge about dealing with individuals with mental health needs.
Delegates also said that MAPPA (Multi-Agency Public Protection Arrangement) was ineffective – services were not joined up, so information sharing was not always continuous, and clients often found it challenging to get access to high quality support. Offender health was found to not be a priority in the Probation Service, with it not being a part of providers’ contracts.
A number of suggestions for improvement were put forward by the workshop’s discussion groups. The mainstream services and schemes should be improved, with a view to taking a more joined-up approach and ensuring mental health representation within MAPPA. Offenders should be provided with an NHS number and be registered with a GP to ensure their healthcare was not overlooked. More opportunities for networking were needed, as well as co-location of staff, making sure that staff had better training to improve their understanding of how to deal with complex needs.
Peer support and mental health groups were suggested as being beneficial, with support and mentoring for staff dealing with difficult cases. It was also identified that weekend cover was necessary, with liaison and diversion services being important.
Going forward, attendees took away several action points that they would be taking with them to implement within their own organisations. Putting together a strong business case was key, alongside highlighting benefits of supervising and supporting offenders with mental health issues – part of which would be pulling together statistics to prove the successes.
Arranging meetings with crucial partners and building strategic links with partnership agencies would also be part of the action plan, with funding being obtained for services through these connections. Identifying senior managers and making strategic assessments was seen as a way to get things moving, and encouraging better training for staff would be important to drive services forward.