Examination of Witnesses (Questions 340
- 346)
TUESDAY 28 OCTOBER 2008
ANGELA GREATLEY
AND PROFESSOR
JONATHAN SHEPHERD
CBE
Q340 Chairman: Particularly in light
of the National Audit Office evidence that some of these things
are under-used at the moment.
Angela Greatley: I think there
are a number of factors there. Clearly, the quality of services
will differ across different areas, but we could almost set that
aside because it is something we know about. What we do not know
is, if you like, the quality of the interaction between, in our
case, mental health, drug and alcohol services and the criminal
justice agencies. In some places there is evidence that that is
working well; in other places it does not work so well. However,
in terms of the national framework, there is the availability
of services for seriously mentally ill people, whether they are
in prison or whether they are in the community and could be diverted
to assertive outreach teams, and so forth, as I mentioned. One
of the key gaps that we have identified is for people who come
into contact with the criminal justice system; sometimes, as you
said, they are victims and sometimes they are people who are involved
in crime, and they have a rather difficult mix of low-level mental
health problems—depression and anxiety or personality disorder—drug
problems or alcohol problems, none of which will hit a threshold
of seriousness, if you will, for some services but, taken together,
they are quite a toxic mixture in terms of people's difficulties
and the unwillingness of some services to deal with them. In our
view, one of the things we are developing is to think more about
how primary health care can take more seriously some of the issues
that are coming up for people with this mix of difficulties. Clearly,
it is not easy to just say that any primary health care setting
in the community, any local GP practice, is immediately able to
take on people in this way, but we are looking, for instance,
at prisons having particularly enhanced primary health care so
that they can really begin to hit quite hard, using techniques
like motivational interviewing as well, which, as you say, is
used in the mental health and drug addiction services strongly.
However, also, that when people are discharged from any kind of
serious mental illness service, and, indeed, released from prison,
there are primary health care services that are geared up to be
able to give that additional and special support. I could not
say that it is widespread and that there is a common standard—it
is very patchy.
Q341 Mr Heath: Coming back to Professor
Shepherd for a moment, one of the things that I have been trying
to explore in the course of this inquiry is the role of the sentencer
and the way, perhaps, the role of the Justice of the Peace could
be exactly that—to take perhaps a wider management role
rather than simply at the point of sentence. I just wonder, with
the dialogue that you were suggesting as good practice between
the sector inspector or superintendent and the senior registrar
at the trauma unit or whatever, whether there is a role there
for the JP as well in being aware of these issues in their own
patch and, perhaps, their being able to then directly affect both
the application of services but, also, the way in which sentencing
takes place.
Professor Shepherd: In my experience,
chairing the violent crime part of the partnership in Cardiff,
the involvement of practitioners in that way can be very helpful.
I am sure it was right to move responsibility for licensing away
from the magistrates to the local authorities, but we were sorry
to lose the magistrates from the Community Safety Partnership
or from the violent crime committee which I chair, because I think
that perspective is useful. Another example is the role of the
Crown Prosecution Service. When we had a problem with robbery
and the suggestion was made this was not being prosecuted as well
as it might have been, having someone from the CPS to come and
join the Committee and have a dialogue with the police officers
there was very useful.
Q342 Mr Heath: Just one, almost,
observation on what you have said. It sounded to me very aspirational
that the media would take a more analytical approach. I just wondered
whether The Western Mail was now doing this, and
whether it is something we could apply to The Daily Mail
in due course.
Professor Shepherd: I understand
that entirely. Think of what happens in medicine. How often are
the opinions of senior NHS managers headlines in the newspapers
and, in comparison, how often are the results of the latest clinical
trials the headlines in newspapers?
Q343 Mr Heath: Journalists do not
think they know about medicine.
Professor Shepherd: Well, I grant
this is a hard nut to crack.
Mr Heath: I am teasing!
Q344 Mrs James: Ms Greatley mentioned
the support in the community, and you were honest enough to say
that the coverage is very patchy. Several months ago I would have
agreed with every word that you said, but I have been dealing
with some very difficult issues in my constituency where young
men come home from prison within existing communities and they
have no support; they have no drug support apart from voluntary
organisations, etc, and they are not "plugged-in" well
enough. I think there is a great will to do this and I think we
need everybody signed up to that, but what I then have are problems
that just migrate and multiply and there is very, very little
patience within the community for this work. I can take you to
half-a-dozen places in my community where they have said: "Well,
we don't want these young men", (and they are mainly young
men) and because of the raft of drug problems and alcohol abuse
they migrate the problems to somewhere where it has not been before.
There is very, very little patience. As I said, several months
ago (or several years) I would have been totally signed up for
this but now, honestly, I just know they are a disaster waiting
to happen and what we are going to successfully do is just move
them on to the next community. I sense from you that you really
need to have this joined-up thinking, and we need to have those
support systems in the community.
Angela Greatley: If I might respond,
I think it is clearly unacceptable that any community should have
people who come out of prison, for instance, effectively, dumped
in communities. We have been talking particularly from the perspective
of the person with a whole mix of mental health problems, drug
problems and so on. If their experience is a short sentence—so
short that no health care catches up with them while they were
on the short sentence and they are sent up country somewhere else
or they are on a very short local sentence—and they come
out and no one has seen them, and when they come out of the gate
they have the small amount of cash they are given, they might
or might not be picked up by an agency, they certainly probably
do not have some roof over their head, and they immediately, of
course, gravitate back to the kind of company and groups who are
their friends and their companions. Actually, I think it is our
responsibility to them and to those other communities that you
rightly describe to have a system whereby people particularly
on these short sentences, and who are just going to keep going
back through the front door, are picked up and dealt with. There
have been some very successful experiments, for instance, with
things called link workers who deal immediately with that "plugging-in"
process. I think it is that "plugging-in"—if it
does not happen early enough on you can just get a migration back
to, particularly, young men. I would emphasise as well that lots
of women are on these short sentences; they could be much better
dealt with with non-custodial sentences, with earlier investment.
I think that it is this constant revolving that is the real piece
that is probably very damaging to communities as well.
Chairman: Alun Michael assures me he
has a very brief question.
Q345 Alun Michael: You may wish to
answer in writing to save the wrath of the Chairman descending
on me! All this sounds blindingly obvious. You then look at projects
which have followed those sorts of activities—and I give
the example of the Trevi Centre in Plymouth which sought to break
the cycle for young women of prostitution, drugs and back into
prison—and they rarely seem to survive all that long. Why
not? Can you tell us how to crack that one, in terms of justice
reinvestment? You can see why I thought a written answer rather
than an oral one might be appropriate.
Angela Greatley: I think so. If
I could say one sentence, it really is the test of whether those
partnerships are working between agencies, because it is soft
money from one place, others do not pick it up, and then the whole
thing—that has been relatively successful in many cases—just
falls apart. I think that is the test of where partnerships have
got to work much, much better.
Q346 Chairman: Departments love piloting
but they are not too keen on the mainstream.
Angela Greatley: Too many pilots
and not enough mainstream.
Chairman: Thank you very much for bringing
your ideas to us, it has been very stimulating and is much appreciated.
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