Social work, criminal
justice and mental
health – the business
of all social workers
BASW Seminar
Date: 31st May 2013
Facilitator: Linda Holt
Values:
• HCPC: Standards of
Conduct, Performance
and Ethics
• HCPC: Standards of
Proficiency for Social
Workers in England (15
standards)
Mental Health Social Work
(Scie workforce development report 32)
• Understanding and ameliorating mental
health problems which diminish the state of
well being requires
“a life course perspective along with a broad
social view of mental health problems
especially in regard to concerns about
discriminatory practice, civil rights and social
justice”
Why Social Work Business?
Needs and social issues frequently identified in
the offender population
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Homelessness
Poverty
Unemployment
Social Exclusion
Childhood Abuse
Domestic Violence
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Learning Difficulty
Mental Illness
Substance Misuse
Alcohol misuse
Vulnerable Adults
Victims
Risk
“Socially excluded”; “Complex Needs”;
“Chaotic Lifestyle”
Revolving Doors Agency Service User Forum preferred the
phrase ‘people with multiple problems’.
• While every person’s experiences are unique, people
often describe some of the following experiences: early
adversity, behavioural problems giving rise to low
educational attainment, low skill levels, and
subsequent unemployment with associated poverty
and debt problems. Many of the group experience poor
physical and mental health, often in conjunction with
drug and/or alcohol misuse. Problems with housing
and or homelessness are also common.
Stats from “Making the Difference” briefing paper produced by: Adass, CfMH,
Prison Reform Trust, Revolving Doors Agency
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• 39% of adult offenders under supervision in one probation area had a current
mental illness; 49% had a history of mental health problems (Brooker et al, 2011)
• 75% of adult prisoners have a dual diagnosis of mental health problems and
substance misuse (Offender Health Research Network, 2009)
• 7% of adult prisoners have an IQ below 70 and a further 25% have an IQ in the
range 70-79 (Mottram, 2007); it is generally acknowledged that between 5 and
10% of the offender population has a learning disability
• 15% of newly sentenced prisoners reported being homeless before custody;
37% said they would need help finding somewhere to live when released; 60%
said that having a place to live would help them stop reoffending (Ministry of
Justice, 2012)
• 40% of young people in custody have previously been homeless (YJB, 2007)
• 43% of children and young people on community orders have emotional and
mental health needs (Healthcare Commission, 2009)
• 25% of children and young people who offend have an IQ below 70 (Harrington
& Bailey, 2005), and 60% have communication difficulties (Bryan, Freer and
Furlong, 2007).
What is Stigma?
‘Children acquire attitudes about mental health at an early age’
Wahl, 2002
‘Stigma is a societal reaction which singles out certain attributes,
evaluates them as undesirable and devalues the persons who
possess them’
Miles, 1981
‘ Stigma can increase the complexity of mental health problems and the
impact they have on the individual’
Social Inclusion Unit, 2004
‘Stigma operates at a number of levels within individuals, families,
education systems, healthcare, the media and social policy’
Hinshaw, 2005
Inequality
• Guardian 12.6.12: “Police up to
28 times more likely to stop and
search black people” Under 3% of
Stop and Search leads to arrest
• Rates of admission to and
detention in hospital are
proportionally higher for Black
African, Black Caribbean
• There is a higher prevalence of
mental health problems in the
homeless population, both for
common mental disorders and
more severe conditions.
• The history of mental health
services in relation to LGBT
people persists with a history of
aversion therapies and hormone
therapies. This reinforces the
impact of shame and stigma on
LGBT mental health
• Scotland’s See Me antidiscrimination campaign found
that more than half (57%) of
people who had experienced a
mental health problem had
concealed the fact when applying
for a job.
Ethnicity
• People from Black and minority ethnic (BME)
communities represent about 10% of the UK
population (ONS, 2001) but in prison this rises to 26%,
a significant proportion of whom are foreign nationals
(MoJ, 2008). Of these, 11% are black British, whereas
black Britons represent 2.8% of the general population
(Prison Reform Trust, 2011).
• There is some limited evidence to suggest that black
and other BME prisoners are underrepresented in
prison mental health team caseloads by comparison
with their representation in prison population
Women in Prison (June 2011)
• total prison population in England and Wales was
85,374, of which 4,185 (5%) were female
• foreign national women in the prison population has
fallen in the last five years, from 22 % to 16 % (in part
can be explained by fall in number in prison for drug
offences)
• 59 % aged 30 or older (compared with 54 % of men)
• 21 % serving a sentence of 12 months or less compared
with 10 % of men, and 15 % serving a sentence of six
months or less compared with seven % of men.
Women in Prison
Many women offenders with mental health issues still end up in
prison when there may be a case for treatment within the
community.
Up to 80% of women in prison have diagnosable mental health
problems. The comparable figure in the community is less than
20%.
Approximately 50% of all self-harm incidents in prison are
committed by women, even though they comprise only 5% of
the total prison population. Women recently released from
custody are 36 times more likely than the general population to
commit suicide.
• Women’s Diversionary Fund in 2010, jointly provided by the
Corston Coalition (charitable funders) to support alternatives
to custody for women, particularly the one-stop-shop model.
Learning Disability
• Average IQ of Population = 100
• Approx 30% prisoners < 80 (50% young
offenders)
• Mental Health Probs more common in people
with LD
• Some people with LD also have ASD but they
are separate conditions
Young Offenders
• Of the 87,531 people in prison on 31 March 2012,
9,198 were young people (aged 15-20).
• Children who end up in custody are three times
more likely to have mental health problems than
those who do not. We also know they are very
likely to have more than one mental health
problem, to have a learning disability, to be
dependent on drugs and alcohol and to have
experienced a range of other challenges. Many of
these needs go unrecognised and unmet.
Skills/knowledge
• Legislation: Mental Health Act, Mental Capacity Act, Children Act, PACE
• Complexity in working with offenders: Working across transitions of
age/service/need
• What barriers are there and how can they be overcome? – service
configuration, separate and distinct services for service user groups,
differing priorities between agencies and services; different quality
monitoring and targets; professional language;
• Impact of offending on people’s lives and impact of life experience on
offending
• Challenges in information sharing/confidentiality
• Report Writing
• Risk Assessment and Management
Key Legislation
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MH Act 1983 (as amended by MH Act 2007)
Domestic Violence, Crime & Victims Act 2004 – fitness to plead
Mental Capacity Act 2005
Children Act 1989 and 2004
United Nations Convention on the Rights of the Child
P.A.C.E. - Appropriate Adult provisions
Human Rights Act 1998
Disability Discrimination Act 1995 & 2005
Equalities Act 2010
Health and Social Care Act 2012
Legal Aid, Sentencing and Punishment of Offenders Act 2012
Criminal Justice Act 2003 – s207 provides for the MHTR
Criminal Justice System
• Includes police, courts, prisons, probation,
secure hospitals, community sentences
• How do we operate with it?
• Where are our responsibilities?
• What are our challenges and opportunities?
• What can we influence?
• What’s happening in practice?
Part III (1983 MH Act) –Sections for
Court / Prisons
• S35 – Remand to Hospital for a Report
• S36 – Remand to Hospital for Treatment
• S48 – Transfer to Hospital of Remand Prisoners, civil prisoners,
detainees under Immigration Act
• S47 – Transfer to hospital of sentenced prisoner
• S38 – Interim Hospital Order
• S37 – Hospital Order
• S41 – Restriction Order
• S45a – Transfer and Limitation Order
• S49 – Restriction Direction for transferred, sentenced prisoner
Mental Health Treatment Requirement
s207 Criminal Justice Act 2003
• One of 12 options for courts considering a community
sentence or suspended sentence
• Treatment from Psychiatry or Psychology
• For people not meeting criteria for hospital or guardianship
order
• Fixed time period
• Treatment can be provided in community, hospital, care
home
• Treatment must be available
• Offender must consent
• See Centre for Mental Health papers e.g. “A Missed
Opportunity”
DV Act 2004:
Fitness to Plead = understanding
• The nature of the charge
• The difference between guilty and not guilty and
their likely consequences
• Properly instruct a legal representative
• Able to follow the trial, challenge a jury and
understand details of the evidence
Sir Keith Pearson said in February 2011
“The Government is committed to reducing the prison population and
improving the support offered to offenders with mental health problems.
It is also planning a major reform in the justice system alongside big
changes in the NHS and social care. Achieving these simultaneously will be a
big challenge for all involved and community services - probation, adult
mental health, CAMHS and drug and alcohol services - will need to provide
better support to people they have not always supported well.
Every day, vulnerable people, many with undiagnosed mental health and
learning difficulties, are picked up by the police, to appear before the courts
and many will ultimately go to prison. Without effective diversion and
robust community services, the prison population will simply carry on
drifting upwards. “
“Diversion”
NLDDN are currently consulting on this working definition of ‘liaison and diversion' :
‘Liaison and Diversion’ is a process whereby people of all ages
passing through the criminal justice system are assessed and
those with mental health, learning disability, substance
misuse and other vulnerabilities are identified as soon as
possible in the offender pathway.
Identified offenders are provided with access to appropriate
services including, but not limited to, mental and physical
health care, social care, substance misuse treatment and
safeguarding.
Information gained from assessments is shared with relevant
criminal justice agencies to enable key decision makers to
make more informed decisions on diversion, charging, case
management and sentencing.
Diversion should be interpreted in its wider sense, referring to
both diversion ’out of’ and ‘within’ the criminal justice system.
Practice issues and Diversion
• What might be appropriate alternatives to
custody?
• Sentence planning for short term prisoners?
• Do commissioners consult with practitioners?
• Separation anxiety – particularly women and
young offenders
• Employment and education support
• Tenancy support
• Managing risks
• Out of hours help
Children visiting policies
• National Guidance for High and Medium
secure which outlines process and
responsibilities of patients, hospital managers,
Local Authorities, those with PR and the
clinical team
• Local Psychiatric hospitals should refer to this
framework
Elements of Risk Assessment
• What is the risk? – e.g. Self Harm; self neglect; suicide;
vulnerability to harm from others; harm to others; violence;
crime
• Where is the evidence of risk? – self disclosure; information
from records and people; observation
• How reliable is the evidence and are there any conflicting
reports? Opinion or facts? Discrimination? Hearsay? MYTHS?
• Circumstances of the risk – Who? When? Where? How? Any
triggers? “unpick the risk”
• Is the risk Past, Current or Future?
Risk Management – reducing, eliminating or
promoting
• Team approach NB Clarity of roles of care
team and service user and carers
• CPA, Safeguarding Procedures, MAPPA, Case
conferences
• Care planning including contingency planning
• Victims considerations?
• Sharing information
• Recording with care
Sharing Information
WRITTEN:
• Information for Magistrates
Court
• Information for the receiving
prison
• Care Programme Approach
• Ward rounds
• Ministry of Justice – download
up to date formats for Social
Supervisor report and Mental
Health Tribunals
• Information to Victims
• Safeguarding
VERBAL:
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MAPPA
MARAC
Information to Victims
Safeguarding
Information for Magistrates
Court
• Information for the receiving
prison
• Ward rounds
Deciding how and what information to
share
• What information would you be prepared to
share?
• What information would you want to know?
• Justify your actions!
• Duty to Co-operate?
Consider
• Duty of confidentiality
• Duty of public safety
• Duty to cooperate
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Seek consent of individual (if possible)
Record reasoning and circumstances
Case-by-case
Proportionate
Relevant
Sharing information with Victims
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Probation has a statutory requirement to
inform victims of release arrangements
Responsible Authority has duty of care
towards victims
Remember that Victims contribute to
assessment and management of risk
Victims have right to be kept informed of
certain information relating to those sentenced
to S37 or S37/41 (see DV Act 2004 amended
by 2007 MH Act))
No Health Without Mental Health: Implementation
Framework. July 2012
• The National Diversion Programme is to roll out liaison and diversion
services for mentally ill offenders by 2014
• Intensive treatment based alternatives to custody are being tested as
part of the National Diversion Programme,
• A new reception screen and health assessment tool, the Comprehensive
Health Assessment Tool (CHAT), will better assess and identify the health
needs of children and young people in the secure estate and in the
community.
• Work is underway to provide and evaluate alternatives to custody for
young offenders
• A programme to improve the management and psychological health of
offenders who present a high risk of serious harm to others with severe
personality disorders.
Current Policy and service
developments
• “I can confirm that there will be a dedicated Minister in any future
Ministry of Justice of which I am Secretary of State specifically tasked with
the job of guardian of mental health issues across our courts, prisons and
probation service.” Sadiq Khan Labour MP July 2012
• Francis report 290 recommendations – Govt response “Patients first and
foremost”
• National Liaison and Diversion Programme
• “Swift and Sure Justice”
• Health Needs Assessments – CCGs
• SARCS – sexual assault referral centres
• Commissioning – Joint commissioning panel for mental health (JCP-MH)
has launched guidance for commissioners in 3 areas (perinatal MH, rehab
services, public MH) and more will follow by this June
Policy/developments continued
• Section 15 of the Health and Social Care Act 2012 - NHS CB to commission
“services or facilities for persons who are detained in a prison or in other
accommodation of a prescribed description.” “Other” includes - a) Secure
children‟s homes; (b) Secure training centres; (c) Immigration removal
centres; (d) Police custody suites; and (e) Courts
• NICE guidelines for Offender Health topics (in development): Guidance for
those working in health, youth and criminal justice, education and social
care sectors on the cost effectiveness of interventions for the prevention
and early treatment of the mental health problems of offenders, taking
account of the whole offender pathway
• Change to forensic commissioning arrangements – financial responsibility
for individuals is where they actually are and not where they are from
• Appointment of Chief Inspector of Hospitals and Chief Inspector of Social
Care
Policy/developments continued
• 14.3.13 – Report from MPs on Youth Justice
• Evaluation of youth justice liaison and diversion pilot schemes 9/3/12 at
www.gov.uk
• Report from RCPsych “Whole person care: from rhetoric to reality”
Norman Lamb, Minister for Care and Support, said: I will consider these
findings and recommendations carefully to think through what more the
Government can do. Promotes notion of “parity of esteem” between
mental and physical health. The report makes a series of key
recommendations for government, policy-makers and health
professionals, as well as the new NHS structures coming into force on 1
April including the NHS Commissioning Board, Clinical Commissioning
Groups and Public Health England.
Policy/developments continued
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Alternatives to Custody for Women and Young Offenders
Proposal from several quarters to increase age of criminal responsibility to
14yrs
• National Health and Criminal Justice Board which has cross government
representation from Department of Health (DH), Ministry of Justice, Home
Office (HO), National Offender Management Service (NOMS) and Association
of Chief Police Officers (ACPO).
The Board currently manages two deliverables that affect the way that the
NHS interacts with policing, namely: • The transfer of commissioning and
budgetary responsibility for police detainee healthcare, forensic provision and
Sexual Assault Referral Centres (SARC) to the NHS and • The development of
mental health Criminal Justice (CJ) diversion schemes
Staffordshire is one of the Early Adopter areas for the two developments
emanating from the Bradley Review – see North Staffs Combined HC and Staffs
Police liaison and diversion project at Stoke central custody suite
Policy/developments continued
• Consultation on Standards for Community Forensic Mental
Health services – RCPsych Quality Network – has been raised
in the Knowledge Hub and social workers need to ensure they
are getting involved.
• “Improving Mental Health Services in the Criminal Justice
System Conference” This conference chaired by Graham
Beech, Offender Health Collaborative Programme Lead, on 29
April, aimed to provide an opportunity to prepare for the new
health commissioning landscape and meet the deadline of
implementing effective liaison and diversion services at all
police custody suites and criminal courts by 2014
Convergence
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Of mental health and criminal justice policy
Of legislation
Of systems
Of Practice
See “Blurring the Boundaries” Centre for Mental Health 2010
Convergence: Good
• improvement to mental health treatment and care in the
criminal justice system
• Information-sharing is improving between health and
criminal justice agencies
• We have a cross-government, multi-department National
Delivery Plan
• Increased multi-agency provision of services
• Improved commissioning between criminal justice and
health agencies
• A national network of criminal justice liaison and diversion
services
• Engaging the police with health services
...and Bad?
• Black and Minority Ethnic (BME) groups are overrepresented
in both the criminal justice system and the secure forensic
mental health services
• fundamental differences between the objectives of health
and criminal justice agencies can be challenging
• The lines between prisons and hospitals may become overly
blurred
• danger that convergence could increase stigma for offenders
with mental health problems, who may receive a dual
labelling of ‘criminal’ and ‘mentally ill’.
• It is important that health and criminal justice staff retain
their individual identities, and in particular that clinical and
ethical principles are not eroded.