Written evidence from Rethink (PB 29)
EXECUTIVE SUMMARY
Rethink, the leading national mental health membership
charity, works to help everyone affected by severe mental illness
and other mental health problems to recover a better quality of
life. For four decades we have been representing the voice of
people affected by severe mental illness—as a result we
are supporting and in touch with over 350,000 people affected
every year through our services, support groups and by providing
information on mental health problems. This history and experience
means that we have a unique insight into working with and supporting
people affected by severe mental illness with their recovery.
Rethink has identified the following key priorities
for probation services in relation to offenders with mental health
conditions:
— Probation
staff writing pre-sentence reports need sufficient mental health
training so that appropriate sentence proposals can be made.
— Provision
should be made for those offenders with complex needs, such as
offenders with mental health problems, who are currently not under
the supervision of the National Probation Service due to sentences
of less than 12 months.
— The
voluntary sector could offer probation services advice and support
in their areas of expertise and also be involved in areas of workforce
development to ensure the probation service is able to handle
offenders with specific needs effectively and efficiently.
— Clear
guidance on the Mental Health Treatment Requirement for Community
Orders should be developed so that probation staff and sentencing
courts have more confidence issuing these requirements.
— Agreements
on local provision need to be made between key bodies, such as
the National Probation Service, the NHS and Her Majesty's Court
Service so that Community Orders with MHTRs can be delivered effectively.
— Comprehensive
mental health training for all probation staff would help ensure
that those with specific mental health needs are identified and
either diverted effectively or handled appropriately within the
system.
1. Introduction
1.1 Rethink is experienced in the area of criminal
justice and mental health. In December 2007, Lord Bradley was
asked by the Secretary of State for Justice to carry out an independent
review of how more offenders with severe mental health problems
can be diverted away from prison and into more appropriate facilities.
Lord Bradley and his team commissioned Rethink to set up a Service
User and Carer Review Panel to assist this work. Fifteen mental
health service users and carers from across England, each with
direct experience of the criminal justice system, formed the panel
and met twice with Lord Bradley and his team in the House of Lords.
Rethink also conducted a focus group with prisoners based in HMP
Birmingham. Rethink is currently working with the Health and Criminal
Justice Programme Board on the Delivery Plan of Lord Bradley's
recommendations and continues to facilitate the Service User and
Carer Panels to inform this work.
1.2 Given Rethink's experience and expertise,
this submission focuses on the experience of offenders with mental
health problems and the probation service. It will therefore not
address the question of the probation service handling different
groups of offenders appropriately as a separate question, as this
is not our area of expertise Current training need for probation
staff is also highlighted throughout the submission, rather than
as its own section.
2. How effectively are probation trusts operating
in practice? What is the role of the probation service in delivering
"offender management" and how does it operate in practice?
2.1 Introduction
The probation service has a key role in "offender
management" throughout the offender pathway, being present
in courts, prisons and community settings, with a focus on reducing
re-offending, protecting the public, rehabilitation of offenders
and the proper implementation of community sentences. This section
discusses the roles of the probation service in pre-sentence reports,
approved premises and reducing re-offending for offenders with
mental health problems. The current challenges around community
sentences will be discussed in the following section.
2.2 Pre-sentence reports
For probation staff in court, pre-sentence reports
(PSRs) are the key element of their "offender management"
role with offenders with mental health problems. These reports
provide information about the offender and the offence and the
report writer is also expected to make sentence proposals based
on their assessment of the offender. It is therefore essential
that probation staff need sufficient knowledge of and training
in mental health so that an appropriate sentence proposal can
be put forward, especially as the offender may appear in court
with no information on their mental health background and unknown
to local services. In these cases, as highlighted in The Bradley
Report, if liaison and diversion services are not present,
it can fall to untrained probation staff to identify and then
assess mental health needs. As the probation service also has
a public protection remit, the weight of responsibility of making
an informed assessment of the risk of the offender to themselves
and others as part of the PSR is significant. Without the appropriate
mental health training, this can result in inappropriate sentence
proposals which could have a detrimental effect on the offender's
mental health and stop them accessing much-needed treatment and
support. This in turn could have a knock-on effect on re-offending
if their offending behaviour is linked to their mental health
condition.
Either probation staff need to receive significant
training or they need a lower level of training and support from
professionals with mental health knowledge. Rethink's Community
and Advice Support Service (CASS), which operates in the Community
Justice courts in Plymouth, has supported good practice in the
area of pre-sentence reports. Probation officers often ask CASS
staff to sit in on interviews with offenders as part of the PSR
process. By engaging with CASS at this stage, probation staff
ensure informed decisions about possible care packages and signposting
to local mental health services etc. can be made and ensure the
mental health needs of the offender can be appropriately met in
the PSR recommendations. However, funding for services such as
CASS is insecure and this service has recently been subject to
cutbacks despite the focus at national level on diversion.
2.3 Approved Premises
Approved premises are provided by the probation service
as a means of enhancing supervision for individuals on probation,
on bail awaiting trial, or subject to licence. The Bradley
Report highlighted that there had been strong feedback from
stakeholders that there should be an increased use of bail for
offenders with mental health problems, ensuring they are only
remanded in custody when absolutely necessary. We support this
aim, however, there does not currently appear to be appropriate
mental health service provision to support individuals who might
be housed in approved premises, placing an unnecessary strain
on probation officers, who may be untrained in mental health awareness.
Out of the total of 101 approved premises across England and Wales
there are only three that specifically deal with mentally disordered
offenders and provide enhanced mental health services.[6]
No formal evaluation of these three premises has yet taken place
to measure the effectiveness of services. However, a report has
been carried out into the mental health training needs of probation
staff working in approved premises, and results show that staff
do not feel adequately skilled in the area of mental health. Of
the sample asked, only 15% of staff said they had a lot of confidence
working with residents with mental health problems, and only 3.8%
felt they had a lot of knowledge of mental health.[7]
For staff at approved premises to fully engage with residents
and aid rehabilitation, it is important that they are upskilled
in mental health.
2.4 Reducing Reoffending
Currently, the Probation Service does not have a
responsibility to supervise adult offenders who serve a sentence
of less than 12 months. Services are able to offer voluntary after-care
to this group but take-up of this is currently low. In 2000, the
Home Office funded a study into the voluntary after-care of short-term
prisoners, which found that the provision of this voluntary after-care
was declining and that it was increasingly seen as less of a priority
by probation services.[8]
The report concluded that short term prisoners are often repeat
offenders facing major social and personal difficulties, and it
is argued that there are good reasons for making some provision
for this group. A similar recommendation is made in The Bradley
Report, which also comments that current provision is often
through voluntary sector services and commissioning of these is
inconsistent.
Provision of this kind of support could be crucial
to rehabilitation and reducing reoffending, especially for offenders
with mental health problems. Rethink supports the work that is
currently being done on diverting offenders with severe mental
illness away from the criminal justice system, and will continue
to work closely with the Department of Health and the Ministry
of Justice on the implementation of Lord Bradley's recommendations
in this area. According to figures from the Revolving Door Agency,
over 60,000 people every year start sentences of less than a year.
The majority of these spend less than three months in prison and
are then released with no support, which is not conducive to rehabilitation.[9]
3. Are magistrates and judges able to utilise
fully the requirements that can be attached to community sentences?
How effectively are these requirements being delivered?
3.1 Provision
The Mental Health Treatment Requirement (MHTR) was
introduced alongside the alcohol treatment requirement as a new
provision for Community Orders in the 2003 Criminal Justice Act,
providing access to treatment where the mental health problem
does not require a Hospital or Guardianship Order. If an offender
agrees to comply with the MHTR, they receive mental health treatment
for an amount of time determined in the Community Order, under
supervision of probation. However, there is a growing body of
evidence that suggest that MHTRs are not being used as widely
as they could be. Research from The Centre for Justice Studies
at King's College London suggests that 42% of offenders serving
community sentences have mental health problems according to Ministry
of Justice statistics, but MHTRs made up less than 1% of total
use of requirements in 2006-07.[10]
As one of the newer provisions for the Community Order, the delivery
of MHTR is still being established in some areas of the country
and that might account for a lower take-up than other requirements,
however the figures above suggest that there is much larger discrepancy
between potential need and usage than might be expected. By failing
to address the needs of offenders adequately as part of their
community sentences, the underlying factors of offending behaviour
are not being treated, rehabilitation is not possible and community
sentences are ineffective. Rethink supports the Bradley Report
recommendation that a service level agreement needs to be drawn
up between Her Majesty's Court Service, the Probation Service
and NHS to ensure that the necessary mental health provisions
are in place so that Court Orders can be delivered effectively.
Mental health services may not currently be adequately resourced
to provide the extra capacity that an increased use of MHTRs would
require. There may be some ways to deliver efficiency savings
to ensure resources are available to free up capacity, however
the scope for efficiency savings in the mental health sector is
likely to be less than in other parts of the NHS as this area
of provision has previously been subject to more cutbacks than
other more "popular" services.[11]
3.2 Guidance
Another major barrier to effective delivery of the
MHTR is lack of guidance for staff and subsequent confusion among
probation and healthcare professionals about the purpose and implementation
of MHTRs. This was highlighted by a member of Rethink's Service
User and Carer Panel for the Bradley Report, who told of their
experience of community orders.
Once the order with the MHTR was issued, nobody in
court knew who was responsible for setting up the treatment. The
defending solicitor and probation officer both challenged the
judge when asked to set it up and in the end the judge adjourned
the case, allowing the panel member to ask their new GP to refer
them to a psychiatrist. Once referred, the panel member was told
the hospital psychiatrist was not prepared to say he would take
him on for the full amount of time the Community Order specified,
which led to further complications.
The reluctance of health professionals to guarantee
treatment for the duration of an order may be related to the level
of resourcing of mental health services as well as to lack of
guidance. If the Ministry of Justice budget is to realise planned
savings, it is crucial that a greater proportion of NHS spending
is released for mental health services. The recent White Paper
and the proposal to introduce GP commissioning needs to ensure
that mental health provision is equally accessible and of equal
quality to physical health services. Currently, GPs report that
they feel less confident about taking on mental health commissioning
than physical health commissioning. Additional support will be
required for GPs to take on mental health commissioning.[12]
4. What role should the private and voluntary
sectors play in the delivery of probation services?
4.1 Support and Advice
Rethink runs a number of criminal justice services
that work with both prison and probation staff and there is a
great potential for voluntary sector organisations to work in
partnership or as external agencies to support the delivery of
probation services. Voluntary sector organisations can often offer
expertise and advice to both the offender and the probation staff,
as shown by the example of Rethink's Community and Advice Support
Service's (CASS) input into the pre-sentence report interview
in section 2.2 above. CASS has been integral to the successful
operation of Community Justice courts in Plymouth and works in
partnership with designated police and probation officers, aiding
resettlement and reintegration with the aim of reducing reoffending
by increasing access to the community services which are most
appropriate to each offender. Voluntary sector agencies can develop
more trusting relationships with clients as they are separate
from the state.
As mentioned above, The Bradley Report recommends
that the National Offender Management Service, in partnership
with the Department of Health and the NHS, should develop a national
strategy for rehabilitation services for those leaving prison
with mental health problems or learning disabilities who are not
subject to supervision from the Probation Service. If there were
to be a move towards such a strategy, voluntary sector organisations
could have a role to play in developing and delivering resettlement
packages and after-care that there would not otherwise be scope
for given the National Probation Service's resources. For many
groups, there is a stigma attached to receiving support from statutory
mental health services. Voluntary sectors organisations can appear
less stigmatizing and take a less medical approach to mental health,
which is more acceptable to many groups. For example, Rethink
has developed programmes for young people, who sometimes struggle
to accept or identify mental health needs, by using non-medical
labels and terms.
Voluntary sector organisations also have a role to
play alongside probation services. Rethink's Gateshead Mentally
Disordered Offenders floating support service is specifically
targeted at people currently under the supervision of the National
Probation Service who have a diagnosed mental health condition
or history of chronic mental health issues. This may include people
who are difficult to house due to their complex lifestyles or
challenging behaviour or who are high risk or difficult to manage
due to their presenting problems. They are likely to have a history
of difficulties in maintaining or securing their own tenancies
and require access to floating support, health services and probation
in order to improve their chances of successfully managing a tenancy
in the community. This floating support service helps offenders
to achieve a measure of financial support and to have increased
choice and control over their lives in a safe environment, free
from discrimination and harassment. It provides timely support,
sensitive to individual needs, which enables service users to
live in their own homes and to be supported into employment. Again,
this could reduce reoffending, as people are supported to reintegrate
and this security could have a positive effect on offending behaviour.
4.2 Workforce Development
The need for mental health training for probation
staff in various roles eg writing pre-sentence reports and in
approved premises, has been discussed in more detail above and
there is a role for the voluntary sector to deliver this training.
One of the key recommendations from Rethink's Service User and
Carer Panels is comprehensive mental health awareness training
for all criminal justice staff. This should preferably be designed
by people with lived experience of the system and mental health
problems to be as constructive as possible. The Bradley
Report also prioritised training of staff across the criminal
justice system in its recommendations. Comprehensive training
would ensure that probation staff are more confident identifying
offenders' mental health needs and diverting them or handling
appropriately within the criminal justice system. Rethink has
developed and delivered a range of mental health awareness programmes
suited for criminal justice staff. Our training programmes are
developed and delivered by people with a lived experience of mental
health problems. This depth of experience is critical to the success
of the training and is an element of workforce development that
the voluntary sector is particularly well-suited to deliver and
which could enhance the delivery of probation services. External
evaluation of these programmes has found that social contact with
people with experience with mental illness has far more impact
on attendees than straightforward information.[13]
September 2010
1 6 4Lord Bradley
(2009) The Bradley Report. Back
7
Hatfield et al. (2005) Mental
health training needs amongst staff of Probation Approved Premises:
A comparison with mental health hostel staff in the voluntary
sector Probation Journal Vol 52, Number 2, pp 137-152. Back
8
Maguire, Mike, Raynor, Peter, Vanstone, Maurice, Kynch, Jocelyn
(2000) Voluntary After-Care and the Probation Service:
A Case of Diminishing Responsibility Howard Journal of Criminal
Justice, Vol 39, Number 3, pp 234-248(15). Back
9
Revolving Doors Agency (2010) Case for Change. Back
10
Enver Solomon and Arianna Silvestri (2008) Community Sentences
Digest Centre for Crime and Justice Studies, King's College
London. Back
11
Rethink (2006) A Cut Too Far report. Back
12
Rethink (2010) Fair Treatment Now report. Back
13
Rethink/Institute of Psychiatry (2009) How can we make mental
health education work? Back
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