Written evidence from Centre for Mental
Health (PB 28)
EXECUTIVE SUMMARY
— Probation
services have a key role in ensuring that offenders with mental
health problems are diverted successfully from short prison sentences
and are rehabilitated following a prison sentence.
— The
Mental Health Treatment Requirement has the potential to divert
more offenders from prison yet is rarely used in practice. For
the MHTR to be delivered successfully, we need to foster better
communication and joint working between probation and health services.
— Use
of the Alcohol Treatment Requirement and Alcohol Specified Activity
Requirement varies widely. Successful use of these requirements
depends upon health and probation working together to commission
support for the wide range of offenders who misuse alcohol.
— The
voluntary sector can offer support to probation services, both
in supporting commissioning of alcohol and mental health treatment
and in offering peer support to clients.
— There
are widespread concerns about the capacity of probation services
to deliver more community sentences. But there are also concerns
about the capability and willingness of a range of services to
work together to provide support to offenders with multiple needs.
These need to be addressed to fulfil the potential of community
sentences as an alternative to short-term imprisonment.
— Support
into employment should be a central part of any support package
offered by probation services. This should include offenders with
mental health problems, who are too often excluded from such support.
INTRODUCTION
1.1 Centre for Mental Health is an independent
national charity which works to improve the life chances of people
with mental health problems. The Centre aims to find practical
and effective ways of overcoming those barriers so people with
mental health problems can make their lives better, with good
quality support from the services they need to achieve their aspirations.
A major focus of our work is the mental health of people within
the criminal justice system.
1.2 We are pleased to have the opportunity to
provide evidence to the Committee based on our research and development
work. We have found that the role of Probation services is vital
both to create robust alternatives to imprisonment for offenders
with mental health problems and to facilitate the effective resettlement
of released prisoners. Nine out of 10 prisoners have a mental
health condition, personality disorder or drug or alcohol dependency.
Two-thirds have more than one such difficulty, while an estimated
50% of probation service clients have mental health problems.
Imprisonment damages a person's mental health, can exacerbate
existing mental health conditions and uproots people from sources
of support in their communities to get their lives back on track.
Investing in alternatives to prison for people with mental health
problems is thus a major justice reinvestment opportunity.
Are magistrates and judges able to utilise fully
the requirements that can be attached to community sentences?
How effectively are these requirements being delivered?
2.1 Of the 12 requirements that can be attached
to a community order, the mental health treatment requirement
(MHTR) is among the least widely used. Our research has shown
that this is because:
— use
of the MHTR depends upon probation officers, solicitors and psychiatrists
all being familiar and confident in using it: but this is far
from being the case;
— court
and probation workers vary widely in their knowledge of mental
health issues and confidence in dealing with them;
— mental
health professionals are rarely aware of the MHTR and the role
of mental health services in supporting the requirement; and
— court
psychiatric reports are subject to long delays. These are vital
for an MHTR to be created and need to include an offer of treatment
from local services, which is often not the case.
2.2 Offenders with a "dual diagnosis"
of mental health problems and drug or alcohol dependency are much
more likely to be given a Drug Rehabilitation Requirement than
an MHTR. The courts and probation services are more familiar with
the DRR, it has a dedicated staff team and the process for managing
it is clearer.
2.3 The MHTR has the potential to offer many
offenders a robust and cost-effective alternative to a short prison
sentence. To fulfil this potential the Government should support
improved communication between health and justice agencies, including:
— providing
practical guidance for justice and health professionals on how
to construct and manage MHTRs;
— supporting
the development of protocols between the courts, probation and
health services, for example to facilitate timely and adequate
psychiatric reports; and
— implementing
the Bradley Report's recommendation of a diversion service to
serve all courts and police stations to identify people who may
benefit from an MHTR and ensure they can be used.
2.4 The availability and take-up of the Alcohol
Treatment Requirement (ATR), and the lower level Alcohol Specified
Activity Requirement (ASAR), appears also to be highly variable
and dependent upon the quality of particular strategic and joint
commissioning relationships between probation and primary care
trusts, the commitment of front line staff, and the interests
of sentencers. Training for court staff (for example clerks, jailors
and magistrates) about alcohol has been identified as essential
to enable treatment requirements to be utilised. The Alcohol Specified
Activity Requirement represents a highly effective means of addressing
the alcohol support needs of a wider group of alcohol misusing
offenders (compared with the ATR).
What role should the private and voluntary sectors
play in the delivery of probation services?
3.1 Voluntary sector organisations appear to
fulfil three functions in relation to alcohol and probation services:
— Providing
a developmental function for commissioners. In Devon, Addaction
employs an alcohol development worker who has been jointly commissioned
by the PCT/DAT and Probation to develop alcohol services for offenders.
The recruited individual has developed a strategic and operational
framework for the delivery of ATR services and is now moving on
to do the same for ASARs.
— Delivering
"peer support" services for alcohol misusers. Wiltshire
PCT commissions an addiction peer support and advocacy group which
engages with a large number of offenders. While probation does
not directly commission this service, the coordinator sits on
the county's joint commissioning group.
— Several
probation managers have spoken of how third sector organisations
are valued as being able to provide more flexible "wrap around"
services for offenders with multiple needs with a more "client
centred" approach to that required from directly employed
probation staff. In this sense contracted third sector organisations
frequently appear to fulfil the original role of probation to
"advise, assist and befriend" offenders.
Does the probation service have the capacity to
cope with a move away from short custodial sentences?
4.1 Diverting offenders with mental health difficulties
from short prison sentences to community-based alternatives like
MHTR is vital if the Government is to achieve its stated aim of
reducing the prison population and bringing about a "rehabilitation
revolution" in the justice system. The current rate of imprisonment
of people with mental health difficulties is unsustainable given
the cost pressures facing the justice system. It is therefore
vital to investigate alternative ways of providing probation supervision
for any increase in community orders to be manageable and for
risk and need to be adequately managed.
4.2 The needs of some young adults are poorly
met due to under developed capacity and need particular attention.
Probation and mental health services for young adults do not as
a rule have the necessary skills to meet the needs of young people
in transition to adulthood.
4.3 As well as investigating the capacity in
the probation to support and divert people from short prison sentences,
the capability of all agencies to come together and jointly commission
services meeting multiple priorities also needs to be considered.
We have found, for example, that probation managers sometimes
find difficulty in "holding their own" with PCT colleagues
on joint commissioning panels. This is partly systemic as probation
and health operate separate commissioning frameworks - but also
possibly indicative of a need for greater training and support
for those in probation seeking to negotiate joint funding for
treatment programmes.
4.4 The remit of probation to deliver targeted,
timely interventions for identified offenders also frequently
appears to sit poorly with PCT colleagues who are reluctant to
consider enhanced levels of treatment for offenders to that of
the general population. Some PCTs have been reluctant to co-commission
services to deliver the Alcohol Treatment Requirement, leaving
probation services to do this alone.
4.5 People with mental health problems, and particularly
those who come into contact with the criminal justice system,
rarely just have mental health problems and indeed often have
multiple health and social problems. Probation have a crucial
role in coordinating the elements of support required to address
these as well as any sanction for offending that applies.
4.6 Employment needs to take a central place
this package of support. Being in paid work has an important role
in improving mental health, addressing social need and reducing
reoffending. Recent research by Centre for Mental Health reveals
that placement in real employment with ongoing support (Individual
Placement and Support) has real potential to achieve the above.
The Centre is working with a number of employers who provide such
opportunities for former offenders. Currently, people with mental
health problems are often likely to be excluded from employment
schemes as a default. Probation needs to consider routes into
employment as a part of all sentence planning.
September 2010
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