Improving outcomes for people with mental ill-health, learning disability, developmental disorders or neuro-diverse conditions in the criminal justice system

In ten years time

A report by Revolving Doors Agency and , Co-Chairs of the Bradley Report Group In ten years time In ten years time

Contents Acknowledgements

One 8 First and foremost, we would like to thank Revolving Doors Agency’s Lived Experience team members, Sue Introduction Wheatcroft, Liam Folkes, Alyce Ellen Barber, Jason Roderickson, Dean Huntley, Adrian Esdaille, who have Two 10 generously shared their experiences and insights with us. Their work has ensured that the views of people with lived Early identification, experience shaped this report and ensured the themes arrest and prosecution within in are grounded in their experiences and expertise. Our thanks to Lord Bradley for chairing the roundtables that contributed to this report Three 14 and for the sharing of expertise. Courts Thanks too to the Bradley Report Group who shared their expertise with us at two roundtables and made this report Four 16 possible. We offer our sincere thanks to: Lorraine Atkinson, Howard League; Chris Bath, NAAN; Emma Bailey, Centre Sentencing for Mental Health; Mandy Banks, Sentencing Council; Linda Bryant, Together for Mental Wellbeing; Dr Jo Easton, Magistrates Association; Dr Jenny Earle, Prison Five 20 Reform Trust; Mignon French, CSTRs; Jocelyn Gaynor, Prisons and Resettlement The Disabilities Trust; Dr Emily Glorney, Royal Holloway, University of ; Laurie Hunte, Barrow Cadbury Trust; Jan Hutchinson, Centre for Mental Health; Jessica Six 24 Southgate, Agenda; Jonathan Moore, Rethink; Connie Recommendations Muttock, Agenda; and Glyn Thomas, NHS England. Particular thanks to Jenny Talbot, who extensively commented and edited the earlier drafts. Appendix: Definitions 26 Thanks to Vicki Cardwell, Burcu Borysik and Christina Marriott of Revolving Doors Agency and to Andy Bell of References 26 the Centre for Mental Health who authored this report.

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By Rt Hon Lord Bradley

By 2020 no matter where It is now a decade since I published and reminds us all that there is still you live in the country, my independent review of the support much more to do. As it highlights, offered to people with mental ill-health we need to improve resettlement these vital services will and people with learning difficulties support after prison and we need to exist to identify, divert or in the criminal justice system. ensure all the relevant information is available to the courts to support better care for people with I was delighted to be asked to appropriate sentencing. If we can chair this 10 Year On Report and vulnerabilities. I pay tribute improve assessment and information I am grateful for the contribution sharing, fewer people with mental to the skilled staff working of many expert organisations in ill-health or learning disabilities will in these services, to people our roundtable. I would also like end up in prison in the first place. with lived experience, and to thank the Lived Experience Team members who contributed Inequity in access and outcomes to decision makers that their expertise to this report. across the whole system remains a have made this a reality. deep cause for concern and I urge all Reflecting on the last decade, I am who work in the criminal justice system proud that Liaison and Diversion to review their practices so we can services are approaching full national eradicate this over the next decade. roll out. By 2020 no matter where you live in the country, these vital services I am confident that by continuing will exist to identify, divert or better to work together we can affect care for people with vulnerabilities. I further important change as I know pay tribute to the skilled staff working many share the vision for the next in these services, to people with decade to make a real difference. I lived experience, and to decision therefore commend this report to makers that have made this a reality. commissioners, policy makers, and everyone involved in the development Of course this is only one part of the and delivery of Liaison and Diversion picture. This report both celebrates services across the country. what has been achieved so far

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One Two Three Four Five Six Introduction Early identification, Courts Sentencing Prisons & Recommendations arrest & prosecution Resettlement

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It has been a decade since Lord Alongside these changes, coproduction major reform, including digitalisation Bradley’s landmark report set out a in the criminal justice system has of services. In probation, Transforming vision for better support for people with gathered pace and is increasingly Rehabilitation made major changes mental health problems and learning embedded in commissioning. As to the structures by which people disabilities at all stages of the criminal an exemplar, lived experience is on community sentences and those justice system from early intervention now part of the operating model for released from custody are supervised. and prevention to police custody, Liaison and Diversion services. Transforming Rehabilitation has failed to courts, prisons and resettlement. deliver on the promise of rehabilitation A lot has changed since 2009. Police and has been criticised, in particular, The decade since has seen concerted and Crime Commissioners were for the failures in supporting people effort and progress in achieving this introduced with new powers to reduce with multiple needs, including mental vision. A major achievement has and tackle crime in local areas. Our ill-health. Sadly, prisons have seen been the progress towards universal courts and tribunals are undergoing rising rates of self-harm and violence coverage of Liaison and Diversion and suicides in prison remain a serious services working to a nationally concern despite efforts to reduce risk. mandated operating model in all police stations and courts for people The last ten years have also seen of all ages. This systemic change There is more compassion unprecedentedly large and sustained means that people in contact with and empathy in the spending cuts in public health, youth, the criminal justice system who criminal justice and voluntary sector have mental health needs, learning system now definitely. I services – essential to meeting disabilities or other vulnerabilities are am 50 odd years of age. the needs of vulnerable people. better identified and more able to I used to have psychotic The Bradley Report Group is clear that receive the support that they need. episodes, throw myself despite significant progress, far too Other promising innovation includes many people in the criminal justice the emergence of a variety of ‘street in the police cell, get system with mental ill-health or a triage’ schemes, as well as the piloting offered nothing but learning disability are left without their of new sentencing options that allow paracetamol, and be needs properly identified. Too many still some people to serve their sentence end up in prison when they could have in the community while getting taken to court and then been safely diverted and cared for in the support for their mental health or get remanded. I wanted community; and too many people who addictions, rather than on costly and to harm myself, I was continue through the justice process ineffective short prison sentences. are left without the adequate care and suicidal, you know, and support they need in prison and beyond Again, as recommended in the Bradley now there is a lot more the prison gates. A decade on from the Report, assessment processes and Bradley Report, we are as ambitious treatment options have improved for awareness…a lot more as ever for change. This report sets out people who have personality disorders safeguards in the system. the key progress that has been made in the criminal justice system. and what is now needed to ensure we make another decade of difference.

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You might be there Mental Health Crisis Appropriate Adults with a mental health condition, and that’s The last decade has seen some In 2018, the revised Police and improvements to the police response Criminal Evidence Act 1984 (PACE) hard enough to talk to mental health emergencies. introduced a wider definition of about without someone The Mental Health Crisis Care ‘vulnerability’ to include, for example, talking to someone else Concordat has driven development communication difficulties or being of cross-system responses in many prone to suggestibility, compliance beside you and behind areas whilst the definition of a or confusion, either as a result of a you. It’s intimidating. Place of Safety has been changed mental health condition or temporary to allow police detention only in vulnerabilities, such as bereavement, exceptional circumstances, such as trauma and extreme stress. significant violence, and never for The new code requires police officers children. Information-sharing and to call an Appropriate Adult if there is joint decision-making responses any reason for them to suspect any of such as street triage, home triage these functional factors and there is a and control room initiatives have further requirement to take proactive flourished in many police services. steps to identify and record factors that However, the recent Inspectorate indicate whether a suspect may require report (HMICFRS, 2018) on policing the assistance of an Appropriate Adult. and mental health highlights the extent However, research has consistently to which police services across the identified issues with how the country still feel poorly supported to Appropriate Adult safeguard is carried respond to people in a mental health out (Bradley, 2009; Dehaghani, crisis in the community. The triage and 2017; National Appropriate Adult control room schemes remain subject Network, 2015). This is in part due to the vagaries of local commissioning, to the reluctance of suspects to give and as yet do not work to a nationally personal and sensitive information evaluated model. In addition, concerns in the police custody environment or have been raised that for some people, because they do not wish to wait for police contact is now the most direct long periods of time in police custody way into mental health services, and for an Appropriate Adult to arrive. the use of police powers under the Mental Health Act has continued to Studies also show that vulnerability rise. This concern is heightened by the is seen as difficult to identify by the Acknowledging the overwhelming evidence for early intervention, starting in childhood awareness that for some ethnic groups police and, in practice is subject to and led by health and social care agencies, access to mental health secondary interpretation by officers. For example, the main focus of this progress report is on care remains disproportionally a recent National Appropriate Adult adults who are in or at high risk of contact via criminal justice pathways. Network report (2019) found that with the criminal justice system.

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people with the most commonly Healthcare in police custody Liaison and Diversion Liaison and Diversion diagnosed illnesses e.g. anxiety, services are commissioned PTSD and depressive illness were The Bradley Report recommended The Bradley Report made the strong We know that a higher proportion of less likely to get an Appropriate by NHS England and cover I’ve been in and out of that police custody should be as case that diversion services should women in contact with Liaison and Adult than those that are infrequently much a health care environment as 92% of the population, have a national model to ensure police custody, courts, Diversion services have mental health diagnosed (in some cases despite a criminal justice one; custody often with an aim to achieve consistency and high standards, prison all my life. Hand needs than of men (Ministry of Justice, their prevalence) e.g. brain injury, constitutes the first occasion on which and should work with people of 2018) and women are also more likely dementia and schizophrenia. There is national coverage by the on heart, I can tell an individual has the opportunity to all ages throughout the criminal than men to engage with the service. a significant variance in the recorded have their vulnerabilities assessed. end of March 2020. justice pathway. At the time, the you than in the last NHS England has recently been need among police forces (NAAN, availability of liaison and diversion ten years, things have working to develop their pathways for 2019), and there is some evidence Research indicates that detainees was patchy and limited. There was women in the criminal justice system; that those who ‘presented well’ within police custody typically changed. There is a lot no agreed blueprint and no quality and services now screen all women are thought not to need additional experience poorer physical health, standards for what effective liaison more understanding coming into police custody. Of the support (Dehaghani, 2019), as well alongside mental health and learning and diversion should look like. Some of mental health individuals in contact with Liaison as those who appear ‘aggressive’. disabilities, than the general population, areas had no such services at all; and Diversion services in 2016/17, consistent with the levels seen in prison problems, there is a others were available only on certain black offenders were more likely to be and probation. While the number of days or limited times; only a very lot more support out identified as having a mental health people being taken into police custody few worked with people under 18. there. Police is a lot need than offenders from all other has fallen in recent years, the demand ethnic groups (Ministry of Justice, 2018). for healthcare services in custody has Now Liaison and Diversion services more compassionate. not fallen in line with this reduction; operate to a nationally mandated model Liaison and Diversion To fulfil Lord Bradley’s vision of the proportion of detainees being to identify vulnerable people in police services have made diversion away from the criminal examined by a healthcare professional custody and the courts to improve justice system, Liaison and Diversion is increasing (London Assembly, 2018). health and criminal justice outcomes. a huge difference. services need to have strong links with The national model now includes peer local mental health, learning disability In the last decade, there has been support which is supporting effective and other relevant support services, widespread support for the transfer engagement. These vital services including specialist services for of custody healthcare to the NHS, are commissioned by NHS England children, women and for people from as recommended in the Bradley and cover 92% of the population, black and ethnic minority backgrounds. Report and more recently in the I kick off, because I’m scared, with an aim to achieve national communities. They also need to have Mental Health Act Review. I’m frightened, I don’t know coverage by the end of March 2020. links with wider support for example with housing and welfare advice. where I am, I don’t fully The most recent evaluation of Liaison Brain Injury. Offering effective and age- They need to have the confidence of and Diversion (RAND, 2016) found appropriate support to children and understand things. I’m the criminal justice system to inform that increasing numbers of people young people is also a challenge for not trying to bea pain or decision-making and ensure vulnerable with vulnerabilities were now being many Liaison and Diversion services. people are appropriately diverted away anything it’s just the way identified in custody. This is very One emerging challenge is ensuring from custody as early as possible or encouraging, however some challenges that the service is available to all I react to that situation. offered effective support quickly if they remain with effective identification suspects irrespective of whether they stay within the criminal justice system. of certain vulnerabilities, such as are detained or attending voluntarily. learning disabilities and Acquired

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The first appearance at a magistrates’ In places where the service has been ability to engage with the court court can be crucial to the operating for some time, practitioners process; their responses, including identification of vulnerabilities that are well known, and court staff and lack of eye contact, might be misread, were not picked up at the police defence practitioners seek their advice. and they may not be able to respond station stage. This hearing is also of to the questions as competently. The use of video link hearings at the critical significance in the vast number Plea and Trial Preparation Hearing There is a range of guidance available of offences which are prosecuted in the Crown Court for vulnerable for legal practitioners as to how to without the defendant having been defendants also raises concerns. deal with vulnerabilities once potential arrested (e.g. non-payment of TV We have heard suggestions from problems are identified. For the licences). In these circumstances, Revolving Doors lived experience judiciary, the Criminal Procedure Rules court may be the only opportunity panel members that requiring people and Practice Directions set out the for vulnerability to be identified. to use video links might inhibit their requirement that reasonable steps The digitalisation of courts risks must be taken to ensure parties can making the identification of participate fairly. The Equal Treatment vulnerabilities more difficult. The Court Bench Book also provides guidance on and Tribunal Reform Programme I was judged on my meeting the needs of different groups proposes that plea and mode of trial of people (Judicial College, 2018). There will be dealt with online, avoiding first mannerisms. I came is further Judicial College guidance on appearance at the magistrates’ court across as cold, but dealing with vulnerable adults which altogether. Additionally, it is expected that’s my Asperger’s. states that judges and magistrates that most summary, non-imprisonable should be alert to vulnerability, even offences will be dealt with online The Judge brushed over it. where previously not flagged. through a plea and sentence website. However, the lived experience This is of particular concern given panel who gave evidence to this that the magistrates’ court presents report often reported difficulties in an important early opportunity to understanding court proceedings identify vulnerabilities before people and legal language, as well as having proceed through the system. difficulties expressing themselves. Liaison and Diversion has made An intermediary can provide a significant improvement to the assistance to defendants at court, as information known about defendants can support workers, but the level in magistrates’ courts. Liaison and of appointment of intermediaries Diversion practitioners typically look is still very low in criminal cases at the court lists to identify those (Communicourt, 2014). already known to the service who may need assistance at the Court. They also take referrals, including from the defendant’s advocate, court staff, court probation officers and the magistrates.

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Mental health needs

There is no recent study looking at the Deaths of people serving In addition to the inadequate screening prevalence of mental health needs to identify people with mental health among people supervised by probation court orders in the conditions2 there is evidence to suggest services. Strengthening probation, community increased by that the information is not effectively building confidence (Ministry of Justice, 40% in the last year. shared along the criminal justice 2018b) cites a study of adult offenders pathway to ensure that the interventions (MoJ, 2018c) starting community orders in 2009 are appropriate to the needs of the and 2010 which showed that 35% individual. A previous study (Brooker et. reported having a formal diagnosis al., 2011) found that in over half of those of a mental health condition. identified as having a current anxiety disorder, this information was not Another frequently cited study recorded in the offender’s case file, and (Brooker, 2012) which was based in half of those with a current psychosis Lincolnshire probation service before were not receiving any support from the introduction of Transforming mental health services. Another study Rehabilitation suggests that 39% of (Butler Trust, 2014) suggests that offenders in contact with probation recognising mental health needs of had a current mental illness, that 25% people under probation supervision had an anxiety disorder (compared was particularly difficult if they had to 12.7% in general population) and learning disabilities and neurological that nearly half had the symptoms impairments, or if they were serving of a personality disorder (compared short sentences of less than 12 months. to 13.7% in general population). Finally, there is a very high degree of Yet mental ill-health in the probation co-morbidity and co-occurring need caseload is, for the most part, in the probation population. 72% of unrecognised and untreated. Recent those surveyed who had a diagnosable figures1 show the huge variance among mental illness also had a substance Community Rehabilitation Companies’ 40% misuse problem (the level of alcohol ability to identify the mental health related needs were even higher). needs among those serving community increase orders. And there is evidence that 1 Obtained from the Ministry of Justice under mainstream NHS mental health services the Freedom of Information legislation by the do not regard people in contact with 1 Revolving Doors Agency probation as ‘their’ business. This failure 2 It is important to note the findings of the NAO is costing lives. Deaths of people serving year report highlighting some of the shortcomings in the way NHS conducts prison health needs court orders in the community increased assessments. Frequently the number of prisoners by 40% in the last year (from 380 in currently in treatment are used as a baseline for 2016/17 to 533 in 2017/18) (MoJ, 2018c) the level of mental health need, but this does not include unmet need.

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3 in 5 people sentenced Short prison sentences and pre-sentence reports to less than six months in prison report a drug The majority of short sentenced “If we can find effective alternatives to R prisoners experience multiple short sentences, it is not a question PS or alcohol problem on vulnerabilities, including mental- of pursuing a soft-justice approach, arrival at prison. ill health, substance misuse and but rather a case of pursuing homelessness. For example, 3 in 5 smart justice that is effective at people sentenced to less than six reducing reoffending and crime.” months in prison report a drug or Court reports, including pre-sentence alcohol problem on arrival at prison. reports (PSRs) are essential to We know that short prison sentences supporting effective sentencing, and are largely ineffective with 68% of can highlight to the court where people serving them being reconvicted people have vulnerabilities. There within a year. At the same time, has been a substantial fall in the last the use of community sentences decade in the number of new PSRs overall has declined substantially produced. Cases with PSRs are over the last ten years. In particular, more than ten times more likely to the use of certain requirements that receive a community sentence, and can address health needs, such falling numbers of PSRs is linked to Community Sentence Treatment Requirements as the Mental Health Treatment the decline in community sentences Requirements, have been extremely (Centre for Justice Innovation, 2018). The Community Sentence Treatment successful partnerships, processes, low and have further declined in use. Requirement Programme (CSTR) was services and pathways that enable Information gathered by Liaison established to reduce offending and accessible treatment for people We welcome the Justice Secretary’s and Diversion services should be reoffending; and to reduce short term with multiple and complex health announcement in February 2019 of consistently fed into PSRs and the custodial sentences by addressing the and social needs, many of whom his plans to review the use of short information clearly identified as root cause of the offending behaviours. do not reach the threshold of prison sentences under six months: being from a qualified mental health The programme has successfully secondary healthcare services. practitioner where this is the case. supported the increased use and A recently published study (Ministry When you plead guilty, effectiveness of the three treatment of Justice, 2018d) found that the pre-sentence requirements: Drug Rehabilitation including a mental health treatment Requirement, Alcohol Treatment report is usually seen as requirement and alcohol treatment Requirement and Mental Health requirement in a community order unnecessary. They say, Treatment Requirement as well as the or suspended sentence order can if you are guilty, then use of combined orders to support have a significant and positive people with co-existing needs. you’re guilty, you have impact on reducing reoffending. It is to serve your time. The programme has been tested highly welcome that the NHS Long in Sefton, Birmingham and Solihull, Term Plan has identified CSTRs as Northamptonshire, Milton Keynes a provision to be increased across and Plymouth. They have developed England over the next five years.

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It is all about the time The majority of people entering prison The Public Accounts you got to the reception. will have pre-existing vulnerabilities including mental health problems Committee Inquiry into If you arrive on Friday at and/or substance misuse; and the Mental Health in Prisons 6pm, you have to wait experience of being in prison can concluded that “existing for the whole weekend cause further damage to mental health, especially for people who have screening procedures are to get your prescription. experienced traumatic events prior to insufficient to adequately But if you land midweek being in custody (Durcan et. al., 2017). identify those who need say about 2pm, then you Indeed, poor mental health is the norm rather than the exception among support and treatment”. can get your medication prisoners and rates of self-harm are in the evening. So there rising year on year. Much of this need is something deeply remains unidentified, undiagnosed and unsupported. The Public Accounts unfair – the quality of Committee Inquiry into Mental Health care depends on what in Prisons concluded that “existing time you arrive at prison. screening procedures are insufficient to adequately identify those who need support and treatment.” prison mental health teams report Effective and timely transfer of that they can be very helpful, for information between health and justice example in helping them to prepare services has been a longstanding for life after prison (Durcan, 2016). challenge but is essential to keep But there remain significant gaps people safe and well. The full roll-out in mental health support in prisons, of the health and justice digital patient including a lack of primary care and record information system across all talking therapy provision (Durcan, adult prisons, including the transfer 2016) which can put inreach teams of patient records before custody, in under very great pressure. custody and on release, is welcome. There is a clear need to change prison For those people who can access environments and regimes to reduce services in prison, there has been the risk of serious harm or loss of life. limited progress in improving mental Self-harm and self-inflicted deaths in health in prisons during the last prison have risen significantly over the ten years. All prisons have had a last decade across the prison estate. mental health ‘inreach’ team since Levels of self-harm differ considerably the responsibility for commissioning by gender, with a rate of 570 incidents prison healthcare was taken up by per 1,000 in male establishments the NHS in 2001. People seen by compared to a rate of 2,675 incidents

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per 1,000 in female establishments reducing and, in many areas, secure I ended up in a hostel Fresh start (MoJ, 2018c). The rates of self-harm hospitals are now commissioned after leaving prison. I among prisoners from a mixed ethnic differently in order to speed up One of the major changes since suicides of people leaving prison are 100% background have doubled in the past transfers and discharges. But the can’t get the mental the Bradley Report has been the also known to occur within the first five years. Furthermore, there were recent Mental Health Act Review once health need treatment, increase introduction, as part of Transforming 28 days after release (Sattar, 2001). disproportionate increases in self- again called for a maximum 14-day substance misuse Rehabilitation reforms, of supervision inflicted deaths for women, for black wait for hospital transfer and for further While the government recently and support for people on release men, and for people serving both the reforms to ensure people can be treatment. When you announced significant changes to from prison following a sentence of shortest and longest sentences. discharged when they no longer need come out of prison, you the model of probation, including 5 less than 12 months. This is highly to be in a secure bed (Wessely, 2018). returning accountability for supervision Currently, ‘first night in custody’ have problems with significant given that 250,000 people years of all offenders in the community schemes and additional support There remains a pressing need for churn through prison annually of probation, housing issues, to the National Probation Service, are widely offered to prisoners who a clear blueprint for the full range whom 57% serve sentences of 12 benefit issues, health issues remain with high levels of are assessed as being vulnerable of mental health and wellbeing months or less. Despite the reforms, breach and recalls to prison. to suicide. But many prisoners assessment and support in prisons, for problems. It’s like getting very high numbers of people continue describe not being believed when changes to prison regimes to become into deep water, and you to leave prison without the support The original vision of the Bradley they disclose feelings of distress to more psychologically informed, don’t know how to swim. that they need; the responsibility Report was for Liaison and Diversion prison officers or healthcare staff and for a better system to transfer for care is not being effectively services to exist across the entire (Durcan et al 2017). And relying on risk people to hospital when they need passed on to relevant services. HMI criminal justice pathway, from early assessment tools to identify prisoners urgent help. The development of the Probation has been critical of the contact through to resettlement. It is at risk of suicide is ineffective. Personality Disorder Pathway is a quality of ‘through the gate’ services highly welcome that the NHS Long positive approach to coordinating provided by Community Rehabilitation Term Plan commits to a new care after For people who are in a mental health support from prisons to probation. Companies and, in particular, the custody service, RECONNECT. This crisis and need urgent treatment, lack of planning and arrangements service will start to work with people transfers to hospital under Part 3 of the However, ten years on from the for suitable accommodation (HMIP, before they leave prison and help them Mental Health Act are required. Long Bradley Report, serious self-harm 2019). This is disappointing given to make the transition to community- waits for hospital transfers were cited and tragic loss of life continues the evidence of risk at this point based services that will provide the in the Bradley Report as a concern in our prisons and the need for of transition. For example, 1 in 5 of health and care support that they need. and this continues to be an issue concerted action to bring about in many areas. Nationally, average significant system change remains. waiting times for hospital transfers are

The rates of self-harm among prisoners from a mixed ethnic background have doubled in the past five years.

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1 4 7

Across the criminal justice Liaison and Diversion Invest in effective community pathway, a common, services should be sentences that command the comprehensive definition of resourced to enable confidence of sentencers, vulnerabilities is adopted that effective screening of including roll-out CSTRs includes mental ill-health, 100% of those who come across England. learning disabilities, autism and into police custody or autism spectrum disorders, attend voluntarily. substance misuse, personality disorders, acquired brain injury and traumatic brain injury. 8

The Ministry of Justice 5 should press forward with plans to restrict the use of 2 short prison sentences. The Courts should not be able to send people to Comprehensive protocol immediate custody or to to screening, assessment, a community sentence information sharing and care in the absence of a across the whole system 9 relevant court report. – including street triage, police, courts, probation Reforms propsed in the and prison – should be Independent Mental Health Act developed and implemented. Review regarding prison transfers and other Part 3 recommendations should be rapidly implemented. 6 3 The roll-out of Transforming Justice digitalisation 10 As recommended in programme should be the Bradley Report, reviewed to ensure robust commissioning of police evidence is available on the RECONNECT should be custody healthcare impact on people with mental invested in to ensure the should be transferred ill-health, learning disabilities, service covers short sentenced to the NHS. or other vulnerabilities. ‘revolving doors’ group.

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Appendix: Definitions References

Acquired brain injury (ABI) is an injury ID (70-80) can live independently Bradley, K. (2009) Lord Bradley’s Review Dehaghani, R. and Newman, D. (2017) ‘We’re Ministry of Justice (2017) Statistics on race National Appropriate Adult Network (2015) caused to the brain since birth. There but are particularly vulnerable if they of People with Mental Health Problems or Vulnerable Too’: An (Alternative) Analysis of and the criminal justice system. London: MoJ, There to Help: Ensuring provision of appropriate are many possible causes, including enter the criminal justice system. Learning Disabilities in the Criminal Justice Vulnerability within English Criminal Legal p. 40. Available at: https://assets.publishing. adults for mentally vulnerable adults detained a fall, a road accident, tumour and System. London: House of Lords. Aid and Police Custody’, Oñati Socio-Legal service.gov.uk/government/uploads/system/ or interviewed by police. London: Institute of Mental ill-health: Mental health Series, 7(6). Available at: https://ssrn.com/ uploads/attachment_data/file/669094/ Criminal Justice Policy. Available at: https:// stroke. Traumatic brain injury (TBI) disorders cover a broad spectrum Brooker, C. et al. (2011) An Investigation into abstract=3056198 (Accessed: 23 May 2019). statistics_on_race_and_the_criminal_justice_ www.appropriateadult.org.uk/index.php/ is an injury to the brain caused by a of conditions such as depression, the Prevalence of Mental Health Disorder and system_2016_v2.pdf (Accessed: 23 May 2019). policy/policy-publications/there-to-help trauma to the head (head injury). There Durcan, G., Allan, J. and Hamilton, I. (2017) From anxiety, post-traumatic stress disorder, Patterns of Health Service Access in a Probation (Accessed: 23 May 2019). are many possible causes, including prison to work: A new frontier for Individual Ministry of Justice (2018a) Managing obsessive compulsive disorder, eating Population. Lincoln: University of Lincoln. road traffic accidents, assaults, falls Available at: http://www.research-lincs.org. Placement and Support. London: Centre for Vulnerability: Women. Available at: https:// National Appropriate Adult Network (2019) disorder, bipolar disorder (which used and accidents at home or at work. uk/UI/Documents/RfPB%20Executive%20 Mental Health. Available at: https://www. assets.publishing.service.gov.uk/government/ There to help 2. to be known as manic depression) Summary.pdf (Accessed: 23 May 2019). centreformentalhealth.org.uk/sites/default/ uploads/system/uploads/attachment_data/ Autism and autistic spectrum and schizophrenia. People diagnosed files/2018-09/CentreforMentalHealth_From_ file/721190/police-guidance-on-working-with- Sattar, G. (2001) Rates and Causes of Death disorder, (the latter sometimes as having mental health problems Brooker, C. et al. (2012) ‘Probation and mental prison_to_work_web_version.pdf (Accessed: vulnerable-women-web.pdf (Accessed: 23 May Among Prisoners and Offenders Under known as Asperger’s syndrome), are may have feelings or behave in ways illness’, Journal of Forensic Psychiatry and 23 May 2019). 2019). Community Supervision. research pervasive developmental disorders which are distressing to themselves or Psychology, 23(4), pp. 522–537. study 231. London : Home Office. HMI Probation (2019) Post-release supervision Ministry of Justice (2018b) Strengthening in which intelligence may or may others. They may have hallucinations, Butler Trust (2014) Supporting and supervising for short term prisoners. Available at: probation, building confidence. b. London: RAND Europe (2016) Evaluation of the Offender not be impaired, but may affect delusions and thought disorders. offenders with mental health issues in https://www.justiceinspectorates.gov.uk/ MoJ. Available at: https://consult.justice. Liaison and Diversion Services. Evaluation. emotional and relationship capacities, Personality disorders: Longstanding community. London: The Butler Trust. hmiprobation/inspections/prs (Accessed: 23 gov.uk/hm-prisons-and-probation/ Cambridge: RAND Europe. Available at: often with aspects of speech and May 2019). strengthening-probation-building- and significant impairments in Available at: https://www.butlertrust.org.uk/ https://www.rand.org/content/dam/rand/ communication being present. supporting-and-supervising-offenders-with- confidence/supporting_documents/ pubs/research_reports/RR1200/RR1283/ personality (self and interpersonal) HMICFRS (2018) Policing and mental health: mental-health-issues-in-the-community strengtheningprobationbuildingconfidence.pdf. RAND_RR1283.pdf (Accessed: 23 May 2019). Picking up the pieces. London: HMICFRS. Learning disabilities; The World functioning and the presence of (Accessed: 23 May 2019). Health Organisation defines learning pathological personality traits, which are Ministry of Justice (2018c) Safety in custody: Wessely, S. (2018) Modernising the Mental Home Office (1984) Police and Criminal Centre for Justice Innovation (2018) The Deaths of Offenders in the Community, Health Act: increasing choice, reducing disability as “a state of arrested or not solely due to the direct physiological Evidence Act, C. incomplete development of ”, effects of a substance (e.g. a drug of changing use of pre-sentence reports. London: England and Wales 2017/18. London: compulsion. London: Department of entailing a significant impairment of abuse, medication) or a general medical Centre for Justice Innovation. Available at: Judicial College (2018) ‘Equal Treatment MoJ. Available at: https://consult.justice. Health and Social Care, p. 122. Available gov.uk/hm-prisons-and-probation/ at: https://assets.publishing.service. intellectual functioning or adaptive/ condition (e.g. severe head trauma). https://justiceinnovation.org/sites/default/ Benchbook’. files/media/documents/2019-04/cji-changing- strengthening-probation-building- gov.uk/government/uploads/system/ social functioning. A tested ‘intelligence Along with substantial social difficulties, use-psr-briefing_wip-1.pdf. London Assembly (2018) Detained, not confidence/supporting_documents/ uploads/attachment_data/file/778897/ quotient’ (IQ) is often used to individuals with personality disorder forgotten: Healthcare in police custody. strengtheningprobationbuildingconfidence.pdf Modernising_the_Mental_Health_Act_-_ indicate severity – mild, moderate, also experience poor general health, Communicourt (2014) Number crunching. Available at: https://www.london. (Accessed: 23 May 2019). increasing_choice__reducing_compulsion.pdf. severe. Average intelligence is taken have high co-occurrence of mood 1. Available at: https://www.communicourt. gov.uk/about-us/london-assembly/ Ministry of Justice (2018d) Do offender as 80-120. A person with severe and anxiety disorders and experience co.uk/wp-content/uploads/2014/08/number- london-assembly-publications/detained-not- crunching-0814.pdf (Accessed: 23 May 2019). characteristics affect the impact of short generalised intellectual disability reduced life expectancy. Antisocial forgotten-healthcare-police-custody. custodial sentences and court orders on will have a tested IQ under 35, and personality disorder and borderline Dehaghani, R. and Bath, C. (2019) ‘Vulnerability reoffending?London: MoJ. Available at: https:// cannot live independently. 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