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Download Thesis This electronic thesis or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Evaluating the criminal justice mental health pathway Forrester, Andrew Awarding institution: King's College London The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENCE AGREEMENT Unless another licence is stated on the immediately following page this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. https://creativecommons.org/licenses/by-nc-nd/4.0/ You are free to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 29. Sep. 2021 Evaluating the criminal justice mental health pathway Dr Andrew Forrester Thesis submitted for the degree of MD (Res) September 2016 Institute of Psychiatry, Psychology and Neuroscience King’s College London 1 Abstract Background High levels of mental health and substance misuse disorders within the criminal justice system (including prisons, courts and police stations) have been reported across the world. In responding to this challenge, some countries have developed liaison and diversion services. These services began in England and Wales in the 1980s, but their coverage and quality have been patchy and they have been less developed in police custody than in the courts. Studies reported in this thesis aim to evaluate one such service operating in police custody. Methods A multiagency group including the Local Authority, Metropolitan Police and local Mental Health Trust obtained grant funds to introduce a mental health service innovation into two police stations in South London. The service became operational in 2012, and from the outset routine service and follow-up information was collected on consecutive referrals. Data covering an 18-month period were analysed using a statistical software package. Meanwhile, the effect of an open referral system on local prison mental health in-reach team referrals was evaluated using a before-after design. Results The referred group (n = 1092) presented with very high levels of mental health and substance misuse morbidity, vulnerability, and suicide risk. Most had established mental health problems (66.8%) and histories of drug or alcohol use (60%) and an important number (144/888: 16.2%) presented with suicide ideation. Many (370/516: 71.7%) required onward referral to a range of 2 services, and although existing service linkage was protective, male gender and current drug or alcohol use predicted non-engagement. Conclusions It is possible for a mental health service to operate effectively in police custody, but such services require enough resources to deal with the high levels of presenting need and clinical risk. Service links appear protective and should be prioritised, but some referred groups require enhanced support to facilitate service engagement. 3 Table of Contents Abstract ............................................................................................................... 2 List of tables and Figures .................................................................................... 7 Acknowledgements ............................................................................................. 8 Chapter 1. Introduction ...................................................................................... 10 1.1. Background ...................................................................................... 10 1.2. Developing liaison and diversion services in Lambeth ..................... 12 1.3. Morbidity across the criminal justice pathway .................................. 13 1.4. Suicide and suicide ideation across the criminal justice pathway .... 15 1.5. The wider impact of liaison and diversion services .......................... 17 1.6. The aims of this project .................................................................... 19 1.7. Continuity across themes ................................................................. 20 1.8. References: ...................................................................................... 21 Chapter 2. Overview of methods ....................................................................... 31 2.1. Settings and service operations ....................................................... 31 2.2. Procedures ....................................................................................... 33 2.3. Analysis of data ................................................................................ 35 2.4. Ethical and governance considerations ............................................ 36 2.5. References ....................................................................................... 38 Chapter 3. Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals ......................................................................... 39 3.1. Citation ............................................................................................. 39 3.2. Author details .................................................................................... 39 3.3. Acknowledgements .......................................................................... 39 3.4. Abstract ............................................................................................ 40 3.5. Introduction ....................................................................................... 40 3.6. Method .............................................................................................. 44 3.7. Results .............................................................................................. 48 3.8. Discussion ........................................................................................ 57 3.9. References ....................................................................................... 62 Chapter 4. Suicide ideation amongst people referred for mental health assessment in police custody ........................................................................... 69 4.1. Citation ............................................................................................. 69 4.2. Author details .................................................................................... 69 4.3. Acknowledgements .......................................................................... 69 4.4. Abstract ............................................................................................ 70 4.5. Introduction ....................................................................................... 71 4.6. Method .............................................................................................. 77 4 4.7. Results .............................................................................................. 80 4.8. Discussion ........................................................................................ 85 4.9. References ....................................................................................... 90 Chapter 5. Healthcare services in police custody in England and Wales ......... 98 5.1. Citation ............................................................................................. 98 5.2. Author details .................................................................................... 98 5.3. Article content ................................................................................... 98 5.4. Declaration of competing interests ............................................... 101 5.5. References ..................................................................................... 101 Chapter 6. Prison Mental Health In-reach: The Effect of Open Referral Pathways ......................................................................................................... 104 6.1. Citation ........................................................................................... 104 6.2. Author details .................................................................................. 104 6.3. Abstract .......................................................................................... 104 6.4. Introduction ..................................................................................... 105 6.5. Method ............................................................................................ 107 6.6. Results ............................................................................................ 109 6.7. Discussion ...................................................................................... 117 6.8. Acknowledgments .......................................................................... 119 6.9. Disclosure Statement ..................................................................... 119 6.10
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