CJS and Mental Health

Last month a major report was published on mental health issues people had whilst moving through the criminal justice system. No agency came out of this well as the press release outlines:-

Criminal justice system failing people with mental health issues – with not enough progress over the past 12 years

• Thousands of people with a mental illness are coming into the criminal justice system each year but their needs are being missed at every stage.
• “Broken” system for sharing information between agencies, with confusion over data protection rules and incomplete/inaccurate records.
• Shortage of services and long delays to access them – made worse by the pandemic.
• Unacceptable delays in psychiatric reports for court and in transferring extremely unwell prisoners into secure mental health hospital beds for treatment.

A major inspection has found poor support for people with mental health issues as they progress through the criminal justice system in England and Wales.

Inspectors labelled the findings “disappointing” and said too little progress had been made since the last review in 2009.

The inspection was conducted by:

HM Inspectorate of Constabulary and Fire & Rescue Services
HM Crown Prosecution Service Inspectorate
HM Inspectorate of Prisons
HM Inspectorate of Probation
Care Quality Commission
Healthcare Inspectorate Wales.

Inspectors looked at more than 300 cases from six regions, interviewed 550 professionals, and heard from 67 people with mental health issues who had been through the criminal justice system.

Speaking on behalf of all six inspectorates, Chief Inspector of Probation Justin Russell said: “The criminal justice system is failing people with a mental illness. At every stage, their needs are being missed and they face unacceptable delays in getting support. Not enough progress has been made since our last joint inspection 12 years ago to put right these critical shortfalls.

“Police forces, prosecutors, prisons and probation services all assess individuals in different ways, which leads to gaps and inconsistencies. Even when mental health needs are identified, the information is not always recorded fully or used to make effective decisions.

“There are significant problems in the exchange of information in every agency and at every stage of an individual’s journey in the criminal justice system. This part of the system is broken and needs to be fixed urgently.”

The lack of a common definition of mental ill health means nobody has an accurate picture of the numbers of people with mental health issues in the criminal justice system, or the collective needs or risks posed by these individuals.

Inspectors found a myriad of systems are used to screen and assess people as they are arrested, charged, sentenced and supervised. Incomplete or poor records mean individuals might not receive appropriate treatment, charging decisions are affected, and there are delays to court proceedings.

There is widespread confusion over confidentiality and data protection rules – leaving agencies unable to access pertinent information and leading to poorer mental health outcomes.

Inspectors interviewed police officers who said they were unclear when they could share information about an individual’s mental health with the Crown Prosecution Service. This was despite the Data Protection Act (2018) including an exemption for sharing data for justice purposes. This gap means prosecutors, defence lawyers, judges and magistrates can make decisions without crucial details.

Poor information-sharing hampers work in prisons and probation services too. As a result, prisoners transferring in and out of prison do not get seamless support with their mental health needs. Probation practitioners reported their work was often hindered because community mental health services would not allow them to access information about the individuals they supervised – despite the fact these requests are lawful.

The inspection found delays are common at every stage of the criminal justice system. Courts face long waits for psychiatric reports, which are used to make sentencing decisions.

The shortage of good-quality mental health provision leads to “unacceptable delays” for individuals accessing services.

Inspectors found extremely unwell prisoners were often left in prison instead of being transferred urgently to mental health hospitals. Delays were often caused by a lack of medium and high-security beds; the mental health of these prisoners often further deteriorated as they waited.

Inspectors have called for urgent steps to be taken to address the situation, to meet the 28 day targets from first assessment to transfer now laid down in NHS guidelines.

Black, Asian and minority ethnic people are both overrepresented at every stage of the criminal justice system and at comparatively higher risk of mental illness. Inspectors found a lack of specialist services for these individuals.

Inspectors concluded that not enough has changed in the 12 years since the last joint inspection. However, they did note improvements in some areas.

Inspectors welcomed the roll-out of mental health liaison and diversion services in police stations and courts, and recent initiatives to increase the number of Mental Health Treatment Requirements given by the courts. There has also been a significant fall in the use of police custody as a “place of safety” for people in mental health crisis.

Inspectors found police officers had a good understanding that minor crime – particularly crime caused by mental health issues – could be dealt with using a health care approach.

Mr Russell concluded: “Criminal justice agencies need to make major improvements to the way they work with people with mental health issues.

“If someone is charged, they need to understand and be able to participate in the criminal justice process. An individual may need additional support to understand the questions put to them during an investigation or may lack the mental capacity to plead or stand trial.

“The criminal justice process itself can have a severe and negative impact on someone’s mental health, especially if they are already unwell. Justice agencies should act in ways that do not make matters worse, for example they should help to reduce the risks of suicide and self-harm, which we know to be high in criminal justice populations.

“The Inspectorates have made 22 recommendations following our joint inspection. We urge police forces, the Crown Prosecution Service, prisons and the Probation Service to work with the government and NHS to improve delivery for people with mental health issues in the criminal justice system.”

Quotes from people with mental health issues who have been through the criminal justice system (all names have been changed to protect identities)

On arrest:

• Filip said he was left alone for three days in police custody. He spoke to a mental health nurse briefly about having suicidal thoughts. He said: “(Arrest) was the lowest point in my life. (It was) unbearable, shocking… full of worry and fear… I did not understand what was going on in my mind.”

• Marcus found the experience of being arrested: “exhausting, confusing and frightening.”

• Sammy said: “It’s only reflecting back I realised how bad it was… It traumatised me for a long time, how I was handled (in the police station) and treated… I was disassociated, detached and suffering psychosis and anxiety. They (police) didn’t notice… they interviewed me anyway. For months after, I’ve had panic attacks and nightmares.”

On courts:

• George said: “Courts are eerie places, everything feels unnatural and on edge and that doesn’t help with anyone’s mental health, even if you consider yourself to have good mental health.”

• Luke said: “I was on remand for eight months, and going back and forth from court four or five times a month and always ending up with a new pad-mate (cellmate). It was a real struggle, as I didn’t know who I was going to get. It’s the last thing I need after having my life dragged out through court.”

In prison:

• Wilson described informing his block manager that he has Asperger’s syndrome. Wilson said: “They just gave me anti-depressants to shut me up and fob me off.” He wrote to the mental health team and was told he did not quality for help, despite being on medication for anxiety and depression for eight or nine years. Wilson said: “I asked to see a counsellor, which took five months to process – only to have an appointment where they didn’t show up… I sat in my cell full of anticipation and anxiousness.”

• Lilly commented that when a prison officer stopped and talked to them, it demonstrated that someone cared. She said: “Just having a trained officer to chat to for five minutes, to ask how you are doing and to talk to, really does make a big difference. It doesn’t have to be someone from the mental health team even.”

• Steven said: “The constant noise in prison forces tension on you, in an already hostile existence.” He described an incident where he had a mental health crisis: “My cell bell had been going off for over four hours… all I wanted to do was talk to somebody, a listener [this person resides in prison and has been trained by the Samaritans to offer a listening ear]… it was the lowest point of my prison mental health… (I) felt like I have been denied air to breathe.”

On probation:

• Several interviewees reported that they felt the Probation Service was “on their side”. Filip said: “She (probation practitioner) has taken into consideration my view and has given me the feeling that I have a voice… (this) impacted massively on my mental health”.

• Brian said: “Probation knew my struggles with drink and have played a key part in helping me stay sober and finding a healthier way to deal with my mental health.”

• However, others felt talking about their background with a probation practitioner could cause trauma. Cooper said: “There is no point bringing up shit from when I was a kid… this causes mental health problems.”

• Jakob said: “I have been moved from probation officer to probation officer and I sit there wondering if the (criminal justice) system has given up on me. I have no belief in the system or believe there is genuine care there for me and my mental health.”

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From the report:-

Probation practitioners are not mental health experts, but they do need transferrable skills that they can use to help individuals turn their lives around. We found that there were significant gaps in the knowledge and understanding of mental health work among probation practitioners and managers. In our survey, 70 per cent (38/54) of practitioners interviewed reported that they did not have access to effective mental health learning.

From our case reviews, we concluded that management oversight was either absent or ineffective in 64 per cent (34/59) of the inspected cases.

We found that senior leaders in the NPS were familiar with the overarching national strategy and priorities. In our opinion, however, this knowledge and intent was not actively driving local policy.

We found that just under half of the cases reviewed did not contain a comprehensive analysis of mental health needs. Practitioners need to be better equipped to talk to individuals about their mental health problems and understand their specific needs.

The cases reviewed showed that intervention plans needed significant improvement.

Individuals were not always given the opportunity to contribute and their diversity needs were often overlooked... We were not satisfied that enough time had been spent with individuals to help them to fully understand the requirements of their licences or community orders.

Inspectors from HM Inspectorate of Probation reviewed 60 pre-sentence reports prepared by NPS court staff in the inspected areas; 48 reports were on men and 12 were on women. The vast majority (83 per cent, 50/60) of the reports reviewed were short format reports completed without a full OASys assessment. The mental health conditions identified were assessed as having a considerable impact on day-to-day functioning in just over half of the reports reviewed. Almost a quarter of reports were prepared on the same day as the plea or
finding of guilt.

Overall, the quality of reports was insufficient.

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This was a recent blog contribution in response:-

For me this is an issue of poor investment in professional development and learning which probation has sorely devalued. In London prior to the pandemic we were subjected to "risk is everyone's business" sessions followed by even more sessions on risk assessment...then of course they invested in time and effort in OASYS QA which focused solely upon "what did you put in each box," prescribed guidance...then the focus has been on "outsourcing", getting your head around this new CRS referral process to outsource mental health work via "personal wellbeing services".

The mantra right now always seems to be about "referring people out"...we've been reduced to referral agents. The recent HMIP inspection on drugs pretty much mirrors the one on mental health. We don't know enough about these issues, how to asses them, or how to directly address them, because the organisational structure hasn't empowered us to address these problems..."refer substance abusers and those with mental health problems to another agency" is basically the bedrock of risk management plans. 

Do they equip and encourage us to deliver meaningful work to tackle these issues directly when confronted with them? Nope! Meanwhile the person is caught between attending a plethora of disparate agencies who each deal with their one issue badly, forced to attend under threat of recall. I'm frankly disgusted by how the service has denigrated the role of probation officer and those responsible in "the centre" don't see how responsible they have been for such poor HMIP inspections. We, the staff, shouldn't feel the burden of criticism here.

And another:-

70% staff lacking appropriate training
60+% cases without management oversight
~50% cases had no analysis of mental health needs

And these were cases prepared for & presented to the inspectors?!

Every time there's an inspection the lack of quality, competence & effectiveness never ceases to astound, yet nothing changes. It's as if operating at somewhere between 30%-50% efficiency/quality/competence is regarded as a triumph for which so-called 'leaders' are rewarded for their 'achievements'. Its shocking. And all paid for by the taxpayer.