Integrated Health and Justice Strategy 2020-2024 2 3
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INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024 2 3 CONTENTS Health and justice in Greater Manchester 6 Executive summary 8 Our priorities 10 1. Why focus on health and justice? 12 Our opportunity in Greater Manchester 12 Defining the case for change 13 Risk factors associated with contact with the criminal justice system 17 National and international policy and evidence 19 Greater Manchester evidence and insight 24 Benefits of violence reduction in human and system costs 26 2. Whole-system leadership for health and justice 27 A whole-system approach to Family Justice 28 3. Overview of specialist health and justice provision in Greater Manchester 30 4. Rationale for strategic focus on particular groups 33 5. Health and justice strategic framework and priorities 36 Existing health and justice work programmes 36 New strategic priorities 37 6. Delivery and resource planning 38 Delivery 38 Resource planning 38 4 5 In Greater Manchester, justice devolution has provided us with a unique opportunity to address The development of this integrated health and justice strategy is a first for Greater Manchester the typically very poor physical and mental health of people, both victims and offenders, and potentially also the first placed-based strategy in England developed specifically to who come through our criminal justice system. This includes a focus on earlier identification address the health and social inequalities experienced by vulnerable children, young people of health and support needs, more responsive interventions, and providing health and care and adults seen across our criminal justice systems. Like justice devolution, health and social services, which are equal to those available to people living in the wider community. care devolution in Greater Manchester creates new opportunities to address the ongoing social This strategy describes in detail the broad range of risk The values and priorities represented in this strategy challenge of health inequalities. This strategy is a significant part of that effort, focusing on factors and the complexity of individual, family and closely reflect our public service reform principles perhaps the most vulnerable members of our communities. social circumstances that contribute to victimhood for the city-region and our model of public service The health inequalities experienced by children and One of these risk factors is mental health. The strong and offending behaviour. These complexities only delivery – preventative, proactive and person-centred. adults seen in the criminal justice system are broad association of poor mental wellbeing, low to moderate serve to emphasise the value of closer integration We believe that this approach will support the most and deep, and in some cases, contact with the criminal mental health issues and clinical mental health and collaboration between our public services. From vulnerable members of our community, including justice system will be the first time that they have had conditions, with health and justice has been widely services providing health and social care, education victims and offenders, to recover from their experiences, their health needs assessed or have had any consistent referenced by colleagues, partners and the public and accommodation to the police, Crown Prosecution build their physical and emotional resilience, and contact with a health or social care professional. This during the development of and consultation for the Service, courts, prisons and probation services – each eventually enable them to succeed and thrive. is why the strategy places high value on the early strategy. For the purposes of this health and justice has collective responsibility to address the issues Whilst individuals and families benefit most directly identification of health care and support needs, to strategy, a broad definition of ‘mental health’ has been outlined in this strategy. Justice devolution will help from this approach, there is also a ‘community ensure that they are recognised on first contact with adopted, which crucially recognises the psychological to consolidate and strengthen the way services work dividend’ for society as a whole, including safer the criminal justice system and that effective action is and emotional impact of adverse childhood together around the needs of people seen in the communities, less children in care, fewer people at risk taken to prevent issues from getting worse. experiences on lifetime mental health and wellbeing. criminal justice system in Greater Manchester. This is why the strategy recommends a trauma-based of homelessness, lower rates of violent crime, more The strategy also adds to our appreciation that being model of intervention and support, which is also more vulnerable children and young people participating in either a victim of serious violent crime, or an offender, likely to prevent youth offending and effectively support "We believe this approach will education, and better health for all. is often an indicator of past or current vulnerability. The victims of sexual violence and abuse. This signifies an priority groups that are a focus for our early strategic important change in the way public services will work support the most vulnerable work reflect this understanding – children and young with victims and offenders in Greater Manchester. people to recover from their people; vulnerable and marginalised women; people experiences, build their physical with learning disabilities, autism or communication disorders; and people who are rough-sleeping. However, Beverley Hughes and emotional resilience, and the choice of these priority groups has been made Deputy Mayor for Policing, Crime, Criminal Justice with an awareness that the risk factors that lead to eventually enable to them thrive." and Fire victimhood and offending are broad, complex and Lord Peter Smith overlap with each other and this is highlighted in Chair Greater Manchester Health and Social Care the strategy. Partnership Board 6 7 Health and justice in Greater Manchester These Greater Manchester specific research and insight exercises tell us that: Physical Health 55% Mental Health 48% 23–51% 76–83% Self-harm or suicide risk 41% 28–25% 25% More than one in four victims of crime will develop symptoms of post-traumatic stress 0% 10% 20% 30% 40% 50% 60% disorder as a result. People who have experienced One third of young people in the Greater Between 76-83% of women who have been crime can often be surprised by how much Screening of individuals in police custody shows Manchester youth justice system have assessed by a Greater Manchester Women’s distress they experience. Experiencing crime can that members of the public who are arrested substance misuse issues. 28-35% of young Centre have mental health issues, often linked lead to the development of long-term problems on suspicion of committing a crime are far people on the youth justice caseload have to their experiences of domestic abuse. 25% of such as depression or anxiety, which in turn can more likely to have a health problem. 55% of special educational needs, whilst 23-51% women who have accessed Greater Manchester manifest as physical problems. Many victims of individuals in police custody had a physical have recognised speech, language and Women’s Alliance Partnership services have a crime experienced harm – often severe – as a health issue, while 48% had an underlying communication needs. physical health issue. 55% of women who use direct result of the crime that was committed. mental health issue. 41% of these individuals these centres have a child under the age of 18. The experience of each victim will vary. were at risk of suicide or deliberate self-harm. 33% Cardiovascular Disease 34% 16% Muskuloskeletal Problems 24% MEN Asthma/respiratory conditions 20% 16% Epilepsy 5% 50% 44% Diabetes 5% 34% WOMEN 0% 10% 20% 30% 40% In HM Prison Manchester, 16% of prisoners Mental and physical health needs are highly were reported as being homeless during the Mental and physical health problems are often common in prisons. High levels of severe and year before imprisonment. A review of the enduring and can be a cause of re-offending. enduring mental health problems are matched Over 50% of the women who go to the Greater Cheshire and Greater Manchester Community 16% of men and 24% of women who are on by very high instances of physical illness, Manchester Sexual Assault and Referral Centre Rehabilitation Company (CRC) caseload in 2018 probation self-identify as having a mental health including 34% with cardiovascular disease (like (SARC) have a history of domestic abuse. Repeat found that 33.1% of people had an issue with problem. Suicide is the most common cause of angina), 24% with musculoskeletal problems attenders at the SARC are typically female and accommodation. This proportion was higher for death among offenders. It is the cause of 44% (like arthritis), and 20% with respiratory problems have a background mental health problem, a those who had an identified mental health or of deaths for those open to the National (like asthma). Many of these conditions go learning disability, or are a child. suicide/self-harm need. Probation Service. unidentified and untreated. 8 Integrated Health and Justice Strategy 9 However, there is broad acknowledgement that Executive summary the application of trauma-led practice is especially The purpose of this first Integrated Health and Justice Strategy for Greater Manchester important in supporting this population of children, is to inform and enhance