Health and Social Care Bill

Memorandum submitted by Wish (HS 111)

Wish

1. Wish is the only national charity that works with women with mental health needs across both the mental health and criminal justice systems. It has been a voice for women’s mental health since 1987. We are a user-led organisation, providing long-term support to women throughout their journey between psychiatric hospital, prison and the community. Our members typically have compound issues, and need a combination of treatment and support to address childcare and custody of children, self-harm, experience of abuse, poverty, lack of educational qualifications or training, homelessness and substance misuse. Wish’s unique gender-specific and needs-based approach is effective in turning around the lives of women with multiple support needs, and providing continuity of support as they move between different statutory providers.

Evidence for the committee

2. Our experience of working with women as they receive, or apply to receive, services from local authorities, the NHS and the criminal justice systems, has allowed us to identify issues and evidence relevant to the work of the Health and Social Care Bill Committee. As the Bill aims to devolve decision-making for health and social care commissioning, and bring in a wider range of health and social care providers, we wish to raise the issue of continuity of care and services for one of society’s most vulnerable groups of people.

3. Twenty years of working with thousands of women has shown us that they continue to receive inconsistent and inadequate provision for their mental health, resettlement and other service needs. Rather than following a needs-based model that is holistically designed to build continuity and relational security, women with mental health needs currently face unacceptable variation in the quality of services, the approach used and fractured treatment. This is exacerbated by the failure to effectively divert women with mental health needs, who commit petty and non-violent crimes, away from the criminal justice system and custodial sentences. Community mental health services are severely lacking and, as a consequence, many women only receive treatment when their condition reaches crisis point, or results in offending behaviour. At this point they are forced back into secure settings, which are often inimical to recovery and regaining control over their lives. The geographical dispersion of secure provision for women usually means that they are moved all over the country, disrupting family relationships, removing them from support networks and jeopardising their opportunity to have a say in the direction of their treatment and care.

4. The ‘revolving door’ model of service-use, in which women switch between hospital, prison and the community, is further complicated by the fact that local boards and government departments address the needs of this group of women differently, using different standards of care and differently prioritised outcomes. Wish believes that there should be a co-ordinated approach. The reorganisation of the commissioning and provisioning structure provides the opportunity to implement oversight. Outcomes should be co-ordinated, and the importance of gender-specific approaches in this area reaffirmed, in line with government and independent policy recommendations outlined in papers including the Corston Report, ‘Into The Mainstream’, and Lord Bradley’s Review.

5. If a measure of co-ordination was brought about, with the premise of shifting the focus onto early intervention, continuity of support and community-based treatment, Wish believes that positive benefits would result, in line with the government commitment to the parity of mental health and physical health, early intervention and restrained and effective uses of public funds. For example, the 2008 New Economics Foundation report and cost/benefit analysis, Unlocking Value: How we all benefit from investing in alternatives to prison for women offenders shows the potential savings from a community-based approach. The report found that for every pound invested in support–focused alternatives to prison, £14 worth of social value is generated to women and their children, victims, and society generally, over ten years. Holistic, woman-centred community services, such as those offered by Wish, are also cheaper and more cost-effective than the cost of keeping a woman in a medium secure hospital (£165,000 a year) or in prison (£39,000 a year, excluding mental health care costs).

6. Evidence clearly illustrates that women in prisons and women in secure hospitals present a commonality of issues, needs, characteristics and experiences. Frequent movement between those institutions means that co-ordinating services and treatment across the two systems is vital for realising this value and improving the lives of some of the most vulnerable, and under-supported, groups in our society. Wish is promoting a co-ordinated, consistent and complete intervention approach through our new campaign, urging all stakeholders to harness joined-up thinking and ensure the best outcomes for women, service-providers, tax-payers, and wider society.

March 2011