Cutting crime: the case for justice reinvestment - Justice Committee Contents


Examination of Witnesses (Questions 329 - 339)

TUESDAY 28 OCTOBER 2008

ANGELA GREATLEY AND PROFESSOR JONATHAN SHEPHERD CBE

  Q329  Chairman: Ms Greatley, Professor Shepherd, welcome. We decided that we would try to draw on your expertise in a rather different way and instead of going through a formal question process we have asked you each to give us a short introduction, and we told you in advance some of the key things we are trying to assess or find out, and then we may have some points we want to raise when you have done so. Can I invite you to do that and who would like to start?

  Angela Greatley: Thank you very much for the opportunity to speak with the Committee. The thing that we were asked to look at from the Sainsbury Centre for Mental Health, which of course is a research and development organisation, was the top five priorities that we might come up with for reinvesting money in and around the criminal justice system, given our particular interest in mental health problems. I think the first one is to make it possible for people to be diverted to mental health treatment at all stages of the criminal justice pathway. If I use the "pathway" word is that okay with everyone? You know we are talking about the various stages that people might go through. And not just that but to do it as early as possible. There is a great deal of discussion about the meaning of the term "diversion". If I use it here I am thinking principally of two things. Firstly, people with severe mental health problems should be diverted away from the criminal justice system as early as possible, and that means at the police stage as well as the court stage and of course later on if they become unwell in prison they need to be transferred for health care. It is also in a sense diverting people particularly from short sentences of custody to more appropriate community sentences with mental health treatment that might avoid the dislocations that occur in people's lives and in their mental health and other health treatments from short sentences. We would advocate investing significantly in the evidence-based early years work. I know it is not particularly the remit of this group but if people are interested in the Committee we could write more about the considerable evidence that exists for investing very early on with children and families.

  Q330  Chairman: That is children for whom a mental health problem has been identified?

  Angela Greatley: No, that would be with families who might well be identified as having problems that we could sum up as dislocation from society, multiple difficulties, poverty, social exclusion, and the children who are brought up in those families will often require some extra support, so there is some considerable evidence where we might intervene. The third point I would make is about young people where problems have been identified.

  Q331  Mrs James: Would we identify them through crime mapping, through established methods? How would we identify those young people? I think we understand how but it might be worth putting it down on the record.

  Angela Greatley: Where we are talking about very early interventions with children we would be looking for families in schools, we would be looking at the very early services that mean that if we identify families are not coping well with what people will call parenting that we very quickly intervene with those families because the evidence we have of things like developing conduct disorders during early life are that they have quite poor outcomes for young people in later life. For young people we would be particularly concerned, if we are talking about the teenagers through to the later teens, to have youth justice services and youth teams where the police are beginning to identify difficulties in the community so that very early on those young people are identified, particularly at the point where they have been identified in the youth justice system and come to the notice of the police. If they come into a police station, there should be positive screening for their various mental health difficulties that might be underlying, and then there could be an assertive engagement with them. "Assertive" is a very polite word for making sure that people who do not want to engage and do not want to use services necessarily are made aware that there are real opportunities and those services are offered in a very positive way.

  Q332  Mr Heath: Could I just pick up this interaction with the police because I think it is a very interesting thing that we have not discussed previously. One of my observations from working with the police for many years is that since the institutions no longer exist, the mental hospitals no longer exist that what a PC on the beat used to do with someone he felt probably had mental health problems, which was to simply drop them at the door effectively of the hospital and ask them, "Would you look after this person and assess them?" is now not available, there is nothing in the community. Should we be thinking beyond screening in custody to providing places of safety in communities that the police could interact with to provide help for those who may have a mental health problem which is at the root of any anti-social or other behaviour?

  Angela Greatley: One of the areas of success that has happened in investment in mental health services is the growth of quite a variety of community-based teams. There was a National Service Framework in mental health. It did have targets about criminal justice but they have not been well observed. What there is in the community is quite an array of different kinds of community mental health teams, assertive outreach terms, home treatment teams and crisis teams. The Committee was asking earlier about the partnerships, and if the inter-agency partnerships are flourishing then there should be very clear protocols and guidelines by which the police (who should not be dealing with these matters, you are quite right, it is not their business in that sense) are able to identify and know exactly where they can both signpost but in more serious cases make sure that somebody arrives at the door of services. There are more services there than perhaps there were some many years ago. Psychiatric hospitals of course do exist now but they are in general dealing with people with much more severe problems, particularly crises, and of course they are covered by the Mental Health Act that was brought in not too long ago.

  Q333  Chairman: We rather stopped you.

  Angela Greatley: Those were the first three of our priorities. The fourth speaks very much to the conversation we have just had which is for the Health Service to invest (we are not looking for Justice's money here, I think it is the job of the Health Service) more in assertive teams and particularly we are concerned that if people are sentenced to community orders there is the option of a mental health treatment requirement. It is almost never used, and we think this is partly because courts and sentencers are not confident of what will actually be provided by the mental health services and the mental health services themselves have probably not been alerted properly to the responsibilities and actions they could take. My own organisation is currently doing a great deal of work on the mental health treatment requirement which is not working well now, not as well as for instance the drug treatment requirement which is also available. We would hope for instance that we could write to you as that develops. We have had a great deal of co-operation from probation and from others but clearly that is an option with good assertive working. With primary care that becomes interested in offenders one would be able to divert more people perhaps from short custodial sentences to community orders with some real teeth to the kind of mental health support that they would get. I guess our fifth point from a mental health perspective is that although we are interested in effective treatment and care for mental health problems we also know that the biggest contribution is that someone has somewhere to live and something to do in the day, preferably work, and therefore the whole re-settlement area is one where we think we can effectively spend money better by avoiding that revolving door of people with a complex mix of drug and alcohol and mental health problems, poor housing, just revolving back through the prison system because they are not being treated and supported effectively. Those would be our five priorities.

  Q334  Chairman: Thank you very much indeed. I would invite Professor Shepherd to do something similar and then we will open the field.

  Professor Shepherd: Thank you very much, Chairman. I have four priorities that I would like to draw the Committee's attention to. The first one is to develop offender management schools and institutes in research-intensive universities. I know the Committee has heard evidence with regard to research and I think this is important. These institutes and schools would work to provide and carry out high-quality research and they would also integrate their activities with the training of offender management staff. I was privileged to hear a talk by Jonathan Allen from the Research Directorate in the Home Office about the quality of the evidence which is relevant to "what works" in offender management. It is clear that the studies are limited, the interventions are limited, the research standards are not high and there is little applied research in this area. This proposal would increase the number and the quality of offender interventions. It would result in disinvestment in things that do not work, as has happened in the Health Service in a number of areas. It would increase service reliance on what works and it would provide local research hubs with which practitioners could work. There are models for this in our medical schools, in town planning schools, in our best universities. They are all power houses for innovation and driving up efficiency and effectiveness. Clearly there is a cost issue but to reassure the Committee that in a related field, in police science, we developed in South Wales a university police school which is entirely cost neutral and it is already resulting in local economic benefits and less crime locally as well as contributing internationally with regard to the products of its work. That is the first point. It would require the training of a cadre of practitioner academics. Just as I am a Professor of Surgery who practised in the clinic this morning and runs a research team, in the same way we need to train offender management staff as academics. That is the first point. The second point relates to victims. I think it is very important that we look at how we can increase the quality of victim services. There is one particular proposal I would like to bring to the Committee and that is that we acknowledge that alcohol intoxication increases the chances of victimisation (without of course blaming victims for what has happened to them) and by acknowledging that, which is strongly supported by the research, we deliver motivational interviews (which are known to work across a range of settings) in the violent crime units across the country. The delivery of that kind of intervention to reduce alcohol misuse is known to be cost-effective. Thirdly, we need to use Crime and Disorder Reduction Partnership (Community Safety Partnership in Wales) resources to ensure high-quality data analysis for crime reduction. I would even go as far as saying that we might develop a new crime reduction specialty with analysts who are high-quality and trained in statistics but also have an eye on the research evidence on what works. Targeted police work and local authority work is effective but deployment of their precious resources depends on the identification of targets and crime hot spots. Without that identification continuously we cannot target our resources properly because, for that, policing needs to respond to continuously updated information. My team has been around the country recently and it is clear that even with police data this is not used to target hot spots for violence, for example, in some areas. The model I bring, and which you have had information about prior to the Committee today, relates to the combination of accident and emergency data and police data, but data analysis is crucial to that. Fourthly and lastly, a point that relates to the role of the media, which I know the Committee is interested in. Developing offender management schools and institutes will increase very substantially the amount of research which is published on what works, and so the media would then pick that up and we would be in a position where the media would be diverted perhaps from reporting opinion to reporting the results of high-quality experiments about what works, as happens almost every week when a new medical advance is published in the British Medical Journal or The Lancet. Secondly with regard to the media, we need to contextualise crime risk. With every story about the death of Jimmy Mizen or Damilola Taylor for example,we need always to contextualise that in terms of risk and how much violence we are really dealing with. We need much less focus on police records for violence and disorder. They are a poor measure of minor violence and even of moderately serious violence and disorder. I would suggest—and it is something we have done in our publications—that we need to switch from a focus on police records to harm-based injury public health approaches which really do quantify violent crime, in particular, in a straightforward way and avoid the archaic language of "grievous bodily harm", which may not even involve bodily harm at all, so this approach would bring simplicity to this work. Those are my proposals, Chairman.

  Q335  Alun Michael: When I suggested we heard from you, Jon, because we have known each other for long time, it was really with a sense not so much of the specifics as understanding the methodology. The work that you did in Cardiff resulted in the city moving from being high in terms of violent crime to being comparatively safe. What you did was to bring your medical analysis to bear, I think I am right in saying, comparing for instance the methodology that resulted in a drop in the actual injuries that you were seeing in terms of car accidents to that of an inner city. Could you say a little bit about the methodology and how that might be applied to other areas of crime reduction?

  Professor Shepherd: The basis of that approach was the finding from my research team and the finding also of the British Crime Survey which is that there is a lot of violence that is not reported and recorded for a number of well-known reasons. So the conclusion was that, to understand violence in a city, whether Cardiff or Birmingham or Northampton, it means that we need to access accident and emergency information particularly about the locations and the weapons and the times and the dates when the violence occurs and then share that anonymised information (it is not personal data of course; it is all anonymised data) with a crime analyst, hence the centrality of the crime analyst, who then combines those data with police intelligence and then summarises the hot spots on a weekly or monthly basis so they are continuously updated. It is a simple concept but it requires a data delivery chain if you will forgive the jargon. It needs the capacity to collect the data electronically in A&E. It needs the capacity to anonymise that, share it with the crime analyst, for the crime analyst to put the information together, for there to be a violent crime task group in the partnership which combines that information and most importantly acts on it and holds the practitioners to account, especially those in the police and local government, who can make the biggest difference. I would say in terms of methodology it is the unique data that the Health Service can provide in a cost-neutral way. This has happened without any further funding. The first thing is the use of those unique data and the second thing that is emerging from the evaluations is the dynamic between police officer and accident and emergency consultant. "We have seen 17 admissions from that night club in the past quarter; what are we going to do about it?" There is something about that dynamic that is very powerful because it is senior practitioners holding each other to account.

  Q336  Alun Michael: That requires a relationship and communication that is a two-way process.

  Professor Shepherd: Yes, and that is very important. I think that we need to move away from the situation where police officers usually go to A&E seeking evidence about a particular case, but in the context of the CDRP/CSP, for the police officers at the appropriate level to make friends with their A&E colleagues.

  Q337  Julie Morgan: I have questions for both of you. First of all for Professor Shepherd—and I must declare an interest here as a constituent of mine, and I am also well aware of his work—I was very interested in what you were saying about victims and how if you abuse alcohol you are more likely to be a victim. I think that is something that is not thought about widely, because we usually think about those using alcohol being the offenders. I wondered if you could say a bit more about these interviews that you are referring to, because I think that sounds a very fascinating way of reducing the risk of being a victim.

  Professor Shepherd: The research team found that alcohol intoxication increases the chances of victimisation because it makes people less physically competent to get away—to put it simply—and it erodes decision-making ability. Heavy drinking means that people are going home alone at night through risky environments, and being intoxicated means that the victim is far less able to identify the person who hit them. So there are four reasons, really, why intoxication increases the risk of victimisation. Motivational interviews have a very good record and they are very effective, and they take 15 to 20 minutes. They have been used very widely in a range of health care settings but not yet in victim services—

  Q338  Chairman: You are talking about victims who might become victims again. Is that how you have identified who to have these interviews with?

  Professor Shepherd: Yes, exactly; a victim coming into an Accident & Emergency department or identified by Victim Support, in order to reduce their risk of re-victimisation—which, of course, we must consider alongside re-offending—so that the risk of further victimisation can be reduced by that process.

  Q339  Julie Morgan: That sounds a very positive step and I am also very much in support of your proposal for the offender management school. I think that is very interesting. If I could ask you, the comments you are making, are they made in an England and Wales setting, or is your knowledge based on the English health service?

  Angela Greatley: They are based on England and Wales. Indeed, some of the comments about diversion are based on the evidence we have been able to gather from a number of countries internationally. However, we do work with Wales as well as England.

  Julie Morgan: I wanted to know how available you felt that help in the community was, generally. Obviously, with what you are proposing, it is key that those facilities are there to help.


 
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