Written evidence from Together (Working
for Wellbeing) (PB 32)
1. EXECUTIVE
SUMMARY
1.1 Together (Working for Wellbeing) is a national
mental health charity, which through its Forensic Mental Health
Practitioner Services has over the last 15 years supported the
work of the courts and offender management with offenders and
defendants with mental health needs.
1.2 Genuine collaboration and partnership is
one of the key factors in the successful delivery of probation
services to effectively protect the public and reduce re-offending.
It needs to be the thread that runs through all aspects of criminal
justice service provision—commissioning, service interventions
and the knowledge and understanding of staff.
1.3 Harnessing the resources of all agencies
could more effectively meet the needs of offenders who present
with complex needs and promote creativity in community sentencing
as an alternative to short-term custody.
1.4 Community and voluntary organisations have
a key role to play in the delivery of probation services. This
should be one that supports the probation service to discharge
its legal and statutory responsibilities of offender management
rather than promoting standalone delivery by a variety of providers.
This risks the development of uncoordinated services that are
expensive and unaccountable.
2. INTRODUCTION
2.1 Together (Working for Wellbeing) is a national
mental health charity that has been supporting people with mental
health problems over a number of decades. For the last 15 years,
the organisation has been working in partnership with London Probation
Trust (LPT) through its Forensic Mental Health Practitioner (FMHP)
Service to support the work of the courts and offender management
to more effectively meet the needs of defendants and offenders
with mental health problems. In a year, the service on average
screens over 6,000 defendants at court and offers an assessment,
liaison and offender management support service to over 1,800
service users within London. More recently the service was a key
delivery partner in the National Mental Health Court Pilot at
Stratford Magistrates' Court.
2.2 In 2009, the partnership was cited as a practice
example in the report by Lord Bradley of his review of people
with mental health and learning disability needs in contact with
the criminal justice system. Together is also a member of the
National Advisory Group, which supports the work of the Health
and Criminal Justice National Programme Board and the implementation
of the national delivery plan.
2.3 The Service Manager of the Together FMHP
Service has a background in forensic psychology and extensive
experience of working within the criminal justice mental health
field within the community and voluntary sector. She is currently
on a part-time secondment with the National Mental Health Development
Unit supporting the unit's work around the offender health strategy.
Practitioner staff within the service have relevant professional
and academic qualifications as well experience of working in mental
health in a range of settings.
2.4 Together has worked in close collaboration
with probation staff over a number of years to support the delivery
of offender management services. Since 2006, this work has been
supported formally through a contract with the probation service,
including a recent successful re-tendering of the contract for
a further three years.
2.5 This submission is based on the experiences
of Together, as a community and voluntary organisation (CVO) partnership
agency with the probation service within London.
2.6 Data collated from the Offender Assessment
System (OASys) has indicated that across London, around half of
probation caseloads have mental health problems and traits indicating
personality disorder. The link between mental health and offender
behaviour is now well documented. Associated needs, "criminogenic"
needs, such as homelessness, unemployment, alcohol and substance
misuse are also factors that may lead someone into a offending.
A multi-agency response is required to meet these needs from a
number of specialist service providers with the shared aim of
improving their mental wellbeing and social circumstances and
reducing the risk of further offending.
2.7 The key drivers for the development of the
Together FMHP Service reflected the need to provide interventions
to address the impact of criminogenic needs on offending and probation
staff's limited knowledge of relevant health and social care provision
and referrals pathways with the result that vulnerable offenders
were at risk of not receiving the appropriate care and support.
3. Are probation services currently commissioned
in the most appropriate way?
3.1 There should be greater flexibility in terms
of the decision-making processes around how commissioning should
take place.
3.2 Together's recent experience of re-tendering
with the probation service has been extremely negative. The tender
documents were confusing and the service specification inaccurate.
Clarification sought by Together indicated that the procurement
department was very unclear as to what was being commissioned
and how this should be achieved. Once Together was appointed as
the preferred supplier, negotiations regarding the contract were
protracted and overly-complicated—the procurement department
continued to have difficulties with understanding the aims and
objectives of the service, which was reflected by the continuing
factual inaccuracies relating to the service specification. Any
risk associated with the contract, including potential withdrawal
of funding by other agencies, was initially placed firmly with
Together rather than being shared by both parties and had to be
continually re-negotiated before the final contract could be agreed.
There were also occasions when the approach and attitude of the
procurement department towards Together lacked any professional
courtesy. The process has taken over one year to complete, from
the completion of the expression of interest documents by Together
to the signing of the contract by both parties. This has included
a five month period when Together has been out of contract.
3.3 From monitoring and performance reviews of
the service provided by Together, the probation service had indicated
its satisfaction of the outputs and outcomes being achieved by
the organisation. Together and the probation service has utilised
a successful collaborative approach in meeting the needs of offenders
with mental health problems and had established a mutually trusting
and professional relationship on a practice and operational level.
Service developments in response to changing legislative context,
for example the Criminal Justice Act (2003), could only have been
achieved with this level of partnership. Whilst every effort was
made by Together to work with the probation service in relation
to the new contract, there were times when the organisation had
to question whether it wanted to enter into a new contract at
all.
3.4 If the provision of probation services is
going to attract the right providers with the right expertise
and experience to deliver high quality, cost-effective services,
the commissioning process will need to be clearer, more expedient
and within a context of partnership.
3.5 Recommendations for action:
— Consider
commissioning approaches that include both open and closed tenders
and preferred provider frameworks.
— Consider
commissioning for partnership—that harnesses resources to
meet the identified needs of service users; that doesn't prohibit
the involvement of smaller CVOs; that generates creativity rather
than targets; that can generate new sources of income (for example,
funding from grantmaking foundation and trusts).
4. 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?
4.1 Together does not consider that it has the
necessary experience to comment on the effectiveness of LPT as
it only relatively recently achieved trust status.
4.2 We do consider that one of the main roles
of the probation service in delivering "'offender management"'
is to discharge its statutory duty and responsibilities in terms
of enforcement of community sentences. Working on a daily basis
with offenders of all level of risk, we see the importance of
there being a single statutory agency that is clearly accountable
for offender management, but one that can be supported through
partnership arrangements in the delivery of probation services.
4.3 When community sentences include requirements
that are generally less used by the courts, as with the Mental
Health Treatment Requirement (MHTR) and/or the offender has multiple
needs requiring a multi-agency response, the probation service's
response can be patchy and limited. An example of this is a community
order with a standalone MHTR—in these cases, probation is
required to undertake order management—this is when
the Offender Manager has limited contact with the offender, as
the requirement is being fulfilled by the treating team of a health
agency but does have a duty to ensure compliance and to take enforcement
action if necessary. There have been many cases that Together
has become aware of when the order was not managed appropriately—for
example, when liaison has not happened between the probation service
and health agency regarding offender compliance with the requirement.
4.4 Recommendations for action:
— Consideration
that the legal responsibilities and accountability for offender
management remains with the probation service as a statutory provider.
5. Are
magistrates and judges able to utilise fully the requirements
that can be attached to community sentences? How effectively are
these requirements being delivered?
5.1 The probation service has developed good
working relationships with the courts, but there is a general
lack of understanding by probation of some of the complex issues
facing offenders, such as mental health. This, in turn, impacts
on the information and recommendations presented to the courts
in probation reports.
5.2 Magistrates and judges are able to effectively
utilise the full range of community sentences when presented with
robust assessment information and recommendations that clearly
account for the drivers of the offending and issues of public
safety. To this end, Together supports pre-sentence report (PSR)
authors by undertaking comprehensive mental health and social
care assessments at pre-sentence report stage to ensure that there
is an understanding of the needs of the offender, the interventions
required to address those needs and the services able to provide
those interventions. The information is incorporated into the
PSR report stage allowing the PSR author to make recommendations
that ensures that any health care plan is an integral part of
sentence planning.
5.3 For offenders with more serious mental health
concerns, the mental health assessment may need to be undertaken
by a psychiatrist—this not only allows for the appropriate
level of assessment, but also the opportunity for an offender
to be considered for a Mental Health Treatment Requirement (MHTR)
as part of a community order if this is deemed appropriate. However,
there are many pitfalls in the attempted use of this requirement
particularly in terms of accessing psychiatric reports for court
as they are not considered to be "core business" by
many psychiatrists. There is also limited understanding both on
the part of criminal justice agencies and psychiatry as to the
function and purpose of the MHTR. The construction of the requirement
could also be considered a barrier for its use as, for example,
it requires an assessment by a Section 12 approved psychiatrist
and consent of the offender. An informal review of some London
boroughs last year by the Together FMHP Service indicated that
many of the orders with a MHTR were not working properly in terms
of liaison between probation and health services or had been imposed
by the court without the required assessment reports and care
plans in place ie they were not legal.
5.4 Other requirements could be utilised more
effectively as alternatives to the MHTR. For example, Together
Forensic Mental Health Practitioners often provide mental health
interventions to offenders under offender management of the probation
service as part of the Specified Activity Requirement or Supervision
Requirement ie the practitioner is named on the order. This is
generally applied to cases where it has been assessed that the
mental health needs are mild to moderate, are the primary drivers
to the offending behaviour and that a level of compliance may
be required to facilitate the offenders' engagement with interventions
to address the needs. For offenders with more serious mental disorder,
the Specified Activity Requirement could be used as a replacement
for the MHTR, with similar mechanisms applying in terms of naming
the provider on the order. This would enable a wider range of
mental health professionals to undertake the assessment (as opposed
to being limited to a section 12 doctor), make the necessary recommendations
and provide the most appropriate interventions as well addressing
the issue of consent where it could be considered in the best
interests of the offender to impose such an order.
5.5 Recommendations for actions:-
— Assessment
and review of the effectiveness of the MHTR and consideration
of stopping its use in its current form.
— Review
of alternative requirements and how they can be used more creatively
to address the social care and health needs of offenders.
6. What
role should the private and voluntary sectors play in the delivery
of probation services?
6.1 Community and voluntary sector organisations
should have a role in providing criminal justice services through
supporting the delivery of offender management in partnership
with the probation service. We would not advocate that CVOs, or
indeed the private sector, provide standalone offender management
services with statutory responsibilities of enforcement. We would
consider this as potentially creating expensive and uncoordinated
service provision, which runs the risk of no, one agency being
accountable for the statutory duties relating to offender management.
6.2 We do consider that the voluntary sector
has a strong role to play in the engagement of offenders to improve
outcomes for them around their health and criminal justice needs.
6.3 The approach taken by Together in supporting
the delivery of offender management has been one of partnership
and collaboration with the probation service. The longevity and
recognition of the partnership, the development of a responsive
and flexible service model to support effective community orders,
and outcomes that indicate improved mental wellbeing and enhanced
social participation and integration provides some evidence that
CVOs have a key role to play in the support of offender and order
management. Whilst Together can take a formal role in supporting
offender management, which includes providing probation with information
to support breach and recall decisions, as well as inputting information
directly onto probation systems, the strength of the service model
is supported by the fact that actions relating to enforcement
remain firmly and explicitly with the National Probation Service.
This allows Together, as a CVO, to do what it does best—engage
hard-to-reach groups who respond to negotiating and complying
with state systems with confusion at best and with hostility at
worst.
6.4 CVOs can provide a range of services that
directly support the delivery of probation services:
— Specialist
assessment, including enhanced risk assessment, and reporting
to inform community sentencing decisions.
— Tailored
interventions as part of offender management aimed at improving
health and wellbeing and reducing re-offending.
— Liaison
with/referrals to health and social care provision.
— Integrated
record keeping and information sharing.
— Co-ordination
of other CVOs to provide services as part of sentence planning.
— Advice,
guidance, consultation and training to probation staff.
These services also provide the mechanisms not only
to divert offenders away from custody when appropriate to do so
but also provide the support in the community to address criminogenic
need, another key role for the CVO—to support offenders'
engagement with community sentences as an alternative to custody
when public safety issues allow.
6.5 Recommendations for action:
— Greater
engagement of CVOs to support the probation service in the delivery
of offender management including capacity building to understand
the criminal justice system and how to work within its structures
and legislation.
— Investment
in collaborative working practices that recognises the need for
genuine partnership and best practice along the whole offender
care pathway rather than creating standalone criminal justice
services.
7. Does
the probation service have the capacity to cope with a move away
from short custodial sentences?
7.1 Probation staff have high caseloads of offenders
with wide ranging needs and risk concerns. As already described,
the probation service struggles to manage the large number of
offenders with low level offending but who have multiple needs.
Any significant increase in the numbers of offenders subject to
community sentences with resources at their current levels would
have an impact on probation's capacity to effectively meet those
needs and to discharge their statutory responsibilities.
8. Could
probation trusts make more use of restorative justice?
Together does not have any experience of working
with probation trusts around restorative justice and is not able
to comment.
9. Does
the probation service handle different groups of offenders appropriately,
eg women, young adults, black and minority ethnic people, and
high and medium risk offenders?
9.1 As previously described, the probation service
often demonstrates a lack of understanding of offenders with multiple
needs or who have particular needs and vulnerabilities.
9.2 The Together Service was developed in response
to the probation service struggling to manage offenders with mental
health needs effectively both in terms of the accurate assessment
of needs and ongoing offender management. Whilst the introduction
of the Offender Assessment System (OASys) has potentially provided
the mechanisms for more comprehensive assessment, it is dependent
on probation staff asking the right questions of offenders to
get an accurate picture of the offender's overall situation, including
risk concerns. It also requires probation staff to analyse that
information and apply a level of knowledge and understanding in
terms of its relationship to offending behaviours—however
when probation staff are faced with assessing and understanding
complex needs, they often fail to input the right information
into the assessment, and thus fail to get the necessary information
out. With only a partial or inaccurate assessment, recommendations
made by probation to court will fail to address health and social
care needs as well as the offending behaviour.
9.3 Without timely recourse to specialist services
for advice and support, probation staff often resort to making
blanket referrals to a range of services that may not be appropriate
to the needs or level of need of the offender. For example, referring
an offender to community mental health services when the level
of mental health need could be managed by the person's GP. This
inappropriate use of services by probation often jeopardises effective
inter-agency working, a particular concern in the management of
higher risk offenders.
9.4 In terms of women and black and minority
ethnic people, accessing a diverse ranges of services is likely
to be required to meet their specific needs—for example,
local women-only and culturally specific services. Probation's
knowledge of the range of services in the community is often limited,
often requiring community services to take a proactive approach
in profiling their provision to local probation offices. As an
organisation co-located in probation offices, Together has certainly
seen first-hand the benefits of having community agencies working
"'out of"' probation offices in terms of raising the
awareness amongst probation of the distinct needs of different
offender groups and ensuring effective access to the most appropriate
services.
9.5 Recommendations for action:
— The
probation service to undertake regular equality impact assessments
of all aspects of its provision of criminal justice services.
10. Is the provision of training adequate?
10.1 The training provided to probation staff
around health issues, including mental health and personality
disorder, and its impact on offending is limited. Staff are not
trained to deal with related factors that contribute to offending
and we also understand that probation staff do not receive any
formal training around working with vulnerable adults. Probation
practice also appears to be very much focused on identifying criminogenic
needs, but perhaps is not so strong at understanding and delivering
the interventions that would best meet those needs. This lack
of understanding of the interaction between needs and offending
results in probation staff not gaining a picture of the "'whole"'
person and missing vital information that would contribute to
more effective offender management.
10.2 As part of Together's contract with the
probation service, the organisation provides training in many
aspects of mental health to probation staff. This is generally
based on a training needs analysis. As a result of that analysis,
the experience of Together is that there are recurring themes
identified for training by probation staff—for example,
understanding and knowledge of mental health legislation, such
as the Mental Health Act (83), and frameworks such as the Care
Programme Approach (CPA); understanding of care pathways; knowledge
of mental disorders, including personality disorder; crisis management;
use of requirements related to mental health, such as the Mental
Health Treatment Requirement.
10.3 Recommendations for action:
— In-depth
training of the needs of vulnerable adults, including the social
aspects of health and disease and the impact on offending.
— Greater
use of CVOs in the training of probation staff—such organisations
generally have greater knowledge of the issues faced by people
with multiple needs as well as knowledge of and extensive links
to community service provision.
BACKGROUND TO
INQUIRY
Following the creation of the National Offender Management
Service (NOMS) which brought together prisons and probation in
2004, the previous Government carried out a programme of reform,
converting probation boards into probation trusts, which are contracted
to deliver local probation services. This was to be followed by
the introduction of competition for some aspects of delivery.
In addition, the concept of "offender management" has
evolved considerably since the Offender Management Act 2007 was
passed. The coalition Government has announced that it wishes
to introduce a 'rehabilitation revolution' that will pay independent
providers to reduce reoffending, paid for by the savings this
new approach could generate within the criminal justice system.
September 2010
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