Centre for Mental Health

Turning young lives around: how health and justice services can respond to children with mental health problems and learning disabilities who offend is a briefing paper from the Prison Reform Trust.

It seeks to encourage effective joint working between health and wellbeing boards and youth justice services. It aims to ensure that local strategies reflect the needs of children and young people who offend, especially those with mental health problems and learning disabilities. It outlines a practical action agenda and provides examples of good practice.

This single operating model aims to initiate a move away from regionally and locally isolated commissioning to a clear and consistent national approach. It sets out the national strategy for commissioning and how it will be co-ordinated via the four NHS Commissioning Board regional teams. It also outlines how the NHS Commissioning Board (now called NHS England) will move towards a national contract framework with a national set of service specifications, standards, policies and quality measures.

The Youth Justice System is currently failing children in care and care leavers and there should be more effort to prevent the unnecessary criminalisation of these vulnerable young people, the Justice Committee has concluded. It makes a series of recommendations including:
-A statutory threshold to enshrine in legislation the principle that only the most serious and prolific young offenders should be placed in custody;
-Devolving the custody budget to enable local authorities to invest in effective alternatives to custody; and
-More action to reduce the number of young people who breach the terms of their community sentences and the number of young black men in custody.

Read more here

The Howard League for Penal Reform has published this pamphlet, Intelligent Justice: Balancing the effects of community sentences and custody, which compares the effectiveness of prison terms and community sentences in preventing crime.

The annual figures from the Youth Justice Board have been released in Youth Justice Statistics 2011/12. The report shows that the number of children entering the criminal justice system for the first time is falling but that there has been a 17 per cent rise in the number of times restraint was used against children aged 10 to 17 in custody in England and Wales.

The All-Party Parliamentary Group on women in the penal system conducted an independent inquiry on girls and the penal system, with the aim of reducing the number of girls who entered the criminal justice system.

The inquiry focused on policy and practice regarding girls and investigated the decisions that route girls away from or into the criminal justice system. It looked at how the police and the courts dealt with girls who came into contact with the criminal justice system and the different approaches to working with girls, both nationally and internationally.

It made recommendations for reform across the social and penal systems and published two briefing papers: Keeping girls out of the penal system, outlines the initial findings of the inquiry and From courts to custody looks at provision for and the treatment of girls in the penal system.

The CJA has produced a short briefing paper for Police and Crime Commissioners covering subjects across the criminal justice system including re-offending, resettlement and restorative justice. It discusses mental health in the criminal justice system and calls on the new commissioners to act as champions for liaison and diversion services. Download a copy here.

According to a report of joint inspection of transition arrangements by independent inspectors, work to help 18-year-olds in the criminal justice system move from youth services to adult services needs to improve.

Read more on the Ministry of Justice website here.

Following 39 clients, the results show statistically significant increases in individual wellbeing and provide important information on how the shape and cost of wider service use changes as people engage with coordinated interventions.

In two of the three pilot areas there was a reduction in costs to the criminal justice system. In Cambridgeshire this reduction was large enough to offset the other costs incurred as people got the help they needed, resulting in an overall cost reduction. The total cost of service use in the first year increased in the other two areas.

Download the full evaluation.

This report by the think tank Civitas focuses on the evidence base for what works in drug rehabilitation, with a particular focus on criminal justice issues. It concludes that the evidence does not conclusively support one particular treatment, but suggests that a diverse range of quality treatments are necessary.

The report recognises that it is only in a few cases where drug addiction is the primary motivator for crime and that in most cases successful interventions must address multiple needs, including those relating to mental health, housing or access to employment or training. Read the report here.

The Department of Health has published its final report of an evaluation of the youth justice liaison and diversion pilot scheme. The report notes that there was universal support for making diversion a more systematic or compulsory element within police practice, and makes 11 eleven policy, practice and research recommendations, including integrating diversion scheme with existing services.

The Centre welcomes the government's decision to abandon plans to scrap the Youth Justice Board, minister Lord McNally announced yesterday. The plan, detailed in the Public Bodies Bill, had met with considerable opposition. The Centre had urged for a separate body independent from the adult system to ensure that young people in the youth justice system are seen as children first and offenders second. The House of Commons Justice Committee published the Tenth report of session 2010–12, The Proposed Abolition of the Youth Justice Board yesterday.

The leading exectives of eight of the UK’s most prominent companies have urged UK business to offer more jobs to former prisoners and those still in jail. In a recent letter to the Financial Times, the company chiefs call for fellow bosses to take advantage of the skills many ex-offenders can offer; “It makes sense for UK companies to recruit these individuals and to make use of their skills and enthusiasm”. The letter was published on the day that Justice Secretary Ken Clarke announced plans for every prison in England and Wales to start up a profit-making company staffed by inmates.

Acknowledging evidence that re-offending figures are significantly reduced among prison leavers who go into a full-time job upon their release, the business leaders back the government’s efforts to “introduce real work into prison”, so that offenders can learn new skills while behind bars.

The Department of Health has published this replacement good practice procedure guide for transferring and remitting remand, Immigration Act detainees to and from inpatient treatment under the Mental Health Act.

Some prisoners have experienced delays in the process to transfer them to hospital. The aim of this good practice procedure is to facilitate timely access to treatment under the Mental Health Act and reduce the likelihood of these delays.

The Ministry of Justice has published the first report from the joint Prison Offender Management Inspection programme between Prisons and Probation. It reflects its findings from the first 13 establishments inspected.

This best practice handbook from the Department of Health aims to provide information, practical advice, sign-posting and best practice examples for criminal justice professionals working with offenders with learning disabilities and learning difficulties.

A booklet for offenders with a learning disability is also available providing useful information about Positive Practice Positive Outcomes and information about the Criminal Justice System.

The Public Accounts Committee published its report on the Youth Justice System in England and Wales on 15 February 2011. Amongst the findings and recommendations are:

• those young offenders serving custodial sentences or more serious community sentences remain highly likely to reoffend, and the Ministry of Justice should set out a strategy for how it will work to reduce this risk of reoffending;
• the Youth Justice Board has limited evidence of what interventions work, making it difficult to achieve better value for money, and the YJB and MoJ should focus on research that will enable them to assess which interventions are most effective;
• and prevention work has had an impact on reducing the number of first time entrants to the youth justice system but funding is being reduced, so the YJB and the MoJ should encourage investment in prevention where reducing youth crime has been identified as a local priority.

NOMS and the Department of Health have published a practitioners guide to working with offenders with personality disorders. It is designed to provide practical, hands-on advice to other frontline staff working with offenders with highly complex needs. It will be particularly useful for people working with those who present a high risk of serious harm to others.

The NHS Confederation's Mental Health Network has produced this briefing, which summarises the strategy’s six objectives and describes how progress will be measured. It also outlines further work to support implementation, which will be taken forward over the next year and beyond.

A study of prisoners' health needs has found that up to three quarters of male inmates in Scotland have a problem with alcohol.

The Prison Health Needs Assessment for Alcohol Problems study report estimates that more than a third are dependant on drink. Its authors say that measures such as routine alcohol screening for offenders could help tackle the problem.

More than a third of prisoners said if they were offered help for their alcohol problems they would take it. A prisoner survey published last year found that half of all prisoners were drunk at the time they committed the offence that put them behind bars.

Also, see our recent policy paper A Label for Exclusion: Support for alcohol-misusing offenders, which identifies areas and practical examples of how, in a changing and uncertain policy and commissioning landscape, the joint commissioning and delivery of alcohol interventions for offenders in the community might be productively developed.

The UK’s National Preventive Mechanism (NPM) has published its first annual report, giving an overview of the state of detention in prisons, police custody, children’s secure accommodation, immigration, military and mental health detention.

The NPM is made up of 18 independent bodies and co-ordinated by HM Inspectorate of Prisons. It was established in 2009 to meet UN treaty obligations regarding the treatment of anyone held in any form of custody. The NPM has the right to regularly inspect all places of detention for the purpose of monitoring the treatment and conditions of detainees.

In its first year, some common themes have emerged. In particular, members were concerned about:

• the need to divert detainees with mental health problems from the criminal justice system and the ineffective use of diversionary schemes;
• prison overcrowding having an adverse affect on all aspects of a prisoner’s life, with prisons potentially increasingly unable to deal with problems caused by overcrowding because of decreasing resources;
• the negative impact immigration detention can have on children’s emotional wellbeing, mental health and ties with the community; and
• the rights to dignity and privacy of people deprived of their liberty, particularly in social care and health settings.

The government has opened its consultation on ways to reform ways in which anti-social behaviour is tackled. The proposals include:

• repealing the ASBO and other court orders and replacing them with two new tools that bring together restrictions on future behaviour and support to address underlying problems
• ensuring there are powerful incentives on perpetrators to stop behaving anti-socially
• bringing together many of the existing tools for dealing with place-specific anti-social behaviour
• bringing together existing police dispersal powers for anti-social behaviour into a single police power
• making the informal and out-of-court tools for dealing with anti-social behaviour more rehabilitative and restorative
• introducing a Community Trigger that gives victims and communities the right to require agencies to deal with persistent anti-social behaviour.

The consultation is open until 3 May. For more information and to respond, see the Home Office website.

The Government today published a Mental Health Strategy, No Health Without Mental Health, setting out its six key objectives to improve mental health in England and the lives of people with mental health problems.

It also published a Call to Action in support of the strategy. Centre for Mental Health is among the signatories to the Call to Action and supports the six objectives in the strategy.

Read our response and the Future Vision Coalition's response.

The Ministry of Justice has published Youth Justice Statistics for 2009-10. Key findings include:

• there were 198,449 proven offences committed by young people aged 10-17 which resulted in a disposal in 2009-10, a decrease of 19% from 2008-09 and 33% from 2006-07;
• during 2009-10 there was an average of 2,418 young people in custody at any one time, a decrease of 463 from the 2008-09 average of 2,881 young people in custody;
• and the number of first time entrants (young people receiving their first reprimand, warning or conviction) to the youth justice system in England and Wales fell by 23% from 79,851 in 2008-09 to 61,422 in 2009-10.

The All Party Parliamentary Group on Women in the Penal System (APPG), chaired by Baroness Corston, has produced a second report on women with particular vulnerabilities in the criminal justice system, which reveals bipartisan support for closure of women's prisons and calls funding cuts a 'challenge'. (Read the Howard League press release.)

The report reveals that while many of Baroness Corston's original recommendations have been implemented, there are a number of outstanding concerns. The first Corston report's most significant recommendation to shut down women's prisons and replace them with a limited number of small, multi-functional custodial centres, is yet to be resolved. The APPG is also concerned that there are still too many women in prison for non-violent offences, and too many women being remanded into custody.

This is a collection of information from seminars organised by the All Party Parliamentary Group for Children in 2009/10. It looks at prevention and entry into the youth justice system, courts, custody, vulnerable children, the age of criminal responsibility and resettlement.

The Ministry of Justice has published its Green Paper on sentencing and rehabilitation. It aims to break the cycle of crime and reoffending.

The proposals include:

• making offenders work hard through the discipline of regular working hours in prison, more demanding tasks in the community, and greater use of tough curfew requirements
• rehabilitating offenders by getting them off drugs and benefits and into honest work
• simplifying the sentencing framework to make it more comprehensible to the public, enhancing judicial discretion and reforming the indeterminate sentence of Imprisonment for Public Protection (IPP)
• improving youth justice to prevent and tackle offending by young people and stop them becoming the career criminals of tomorrow
• working with communities to reduce crime, with local people playing a more central role in criminal justice – moving the focus from the centre to local areas; creating more opportunities for other providers to deliver services and increasing transparency so that local communities are better able to hold services to account.

The consultation on this paper is open until 4 March 2011. You can read our response to the proposals in the paper here.

Children with learning disabilities and other impairments are more likely to go to prison than other young people because the youth justice system is failing to recognise their needs, according to this survey of youth offending team staff by the Prison Reform Trust.

The report identified a lack of routine screening and assessment to identify children’s support needs. Although staff spoke highly of specialist services and support, many reported gaps in provision.

Nick Hardwick, the Chief Inspector of Prisons, has published a thematic report, Children and Young People in Custody 2009-10: an analysis of the experiences of 15-18-year-olds in prison. It finds some welcome progress has been made for young people in custody, though in some areas, treatment and conditions have deteriorated.

The report, published jointly with the Youth Justice Board, sets out how young people aged 15 to 18 describe their own experience of imprisonment in 2009-10. The number of children and young people in custody, held in young offender institutions, fell during 2009-10 from 2,126 to 1,724. This may mean the treatment directed to the young people can be more effectively targeted, but also that imprisonment is now increasingly focused on the most troubled, and troublesome, young people. The survey results should be interpreted accordingly.

A Howard League for Penal Reform inquiry has revealed that veterans in both the US and England and Wales are less likely to go prison than their respective civilian populations, but when they do veterans are more likely to be serving sentences for violent and sexual offences.

The briefing Leave no veteran behind follows a visit to the USA and is part of Howard League's inquiry into former armed service personnel in prison, chaired by Sir John Nutting QC, which aims to uncover why veterans enter the penal system and will make recommendations to the government about how to prevent offending.

The Ministry of Justice's Business Plan for the next spending review period is now available.

This plan sets out a programme of reform that takes into account the spending cuts required of most areas of government. The reform priorities are

1. Introducing a rehabilitation 'revolution'
2. Reforming sentencing and penalties
3. Reforming courts, tribunals, legal aid and work with others in the delivery of criminal justice
4. Assuring better law
5. Reforming how we deliver our services

The Law Commission is proposing that defendants with mental health problems who would currently be jailed for their crimes will be given hospital or supervision orders.

It plans to change the focus from whether a defendant is able to understand the evidence and proceedings of a criminal trial to whether he or she is capable of making decisions about his or her defence.

The Commission's analysis found that 350 people who currently stand trial will lack the ability to make decisions under the plans to reform how courts assess whether a defendant is fit to enter a plea and will be subject to an alternative type of hearing.

An evaluation of the Mental Health Court (MHC) pilot has found that MHCs enable creative and flexible ways of working. The pilot provides a promising model that could improve mental health provision for people who come into contact with the criminal justice system.

The MHC pilot operated at Brighton and Stratford magistrates’ courts between January 2009 and January 2010. During this period, over 4,000 defendants were proactively screened and from those, 547 identified as requiring a formal mental health assessment.

A key and positive finding in the evaluation is that the MHC at both sites resulted in extensive multi-agency collaboration between criminal justice, health and third sector agencies. This collaboration encouraged more innovative ways of working and addressed needs which would likely have gone unmet. This review process is a crucial part of providing a more tailored approach to address an offender’s complex needs.

One service user interviewed as part of the evaluation said: “Great, especially Court Reviews. Before I wasn’t even going to court when I was summonsed but doing this I have been staying out of trouble and attending.” Other service users interviewed made similar positive comments, particularly about the support they received by the MHC team post-sentencing. The involvement post-sentence of a mental health professional – the Mental Health Court Practitioner (MHCP) – provides continued contact and support for an offender.

The evaluation concluded that the core requirements for any new MHC would be:

• a MHCP available daily at court;
• multi-agency agreements put in place prior to the MHC for information exchange and to identify and address the priorities of collaborating agencies;
• comprehensive screening and assessment of defendants for mental health issues (through the MHCP and information sharing protocols);
• tailored use of community orders for offenders;
• court involvement in the processes to review whether Community Orders are being implemented effectively;
• involvement of the MHCP post-sentence;
• training and awareness events for practitioners and stakeholders;
• identification of, and engagement with, local resources for signposting and referral of defendants to appropriate support services.

Although the findings of the evaluation are promising, its scope was limited to a process evaluation of how the MHC pilot was implemented and to identifying areas of best practice. The wider aims of MHCs are to improve mental health and reduce reoffending and therefore we would welcome and support further research which looks specifically at outcomes.

The PRT has published a new briefing highlighting disappointing progress in reducing the size of the female prison population since the Corston review, published more than three years ago. According to the briefing, in the last decade the women's prison population in England and Wales has gone up by 33%.

The Chief Inspector of Prisons has published a short thematic report, Women in prison, based on recent inspections of all 14 women’s prisons.

It finds that though there have been some improvements in women’s prisons, there remain concerns about the overall strategic approach and the inappropriateness of closed prisons for many women. The Corston report had strongly advocated the development of alternatives and alternative forms of custody, but there were still about 4,300 women in prison.

The Howard League for Penal Reform's report Life inside 2010: A unique insight into the day to day experiences of 15-17 year old males in prison has found that despite a 22 per cent reduction in the total number of children in custody over the last three years, the reduction has not been used as an opportunity to lower the proportion housed in young offender institutions, the most basic form of custody for children. The charity said that the fact that three quarters of children reoffend on release from prison shows that poor treatment exacerbates crime.

The Prison Reform Trust has published its latest Bromley Briefing. It features statistics on the prison population, the demographics of prisoners and trends.

The All-Party Parliamentary Penal Affairs Group aims to increase its members' knowledge of penal affairs and to work through parliamentary channels for reform of the penal system. The group meets regularly and hears presentations from a wide range of people and organisations.

Transcripts of presentations from 2008-2010 form the basis of the group's report Too Many Prisoners.

This report from the Care Quality Commission outlines how PCTs and local councils commission health and social care for offenders. The paper provides an overview of findings from questionnaire surveys and includes recommendations for PCTs, as well as highlighting arrangements for continuity of care when prisoners are released or transferred.

The guidance Responding to people with mental ill health or learning disabilities has been developed for ACPO by the NPIA, drawing upon the expertise of health professionals, charities, third sector organisations and social care workers.

The press release, quoting Sean Duggan, our joint chief executive, should be available on the ACPO website, but it might be being archived in light of the recent election.

The prison population for England and Wales today surpassed 85,000 for the first time, with 85,076 men, women and children in custody.

Last year on the corresponding Friday, there were 82,773 people in prison. In the last twelve months the prison population has increased by almost 3 per cent.

A new National Audit Office report says that more could be done to rehabilitate prisoners serving short sentences and reduce their risk of re-offending.

More than 60,000 prisoners serve sentences of under 12 months each year at a cost to NOMS of around £300 million. NOMS is successfully keeping the vast majority of short-sentenced prisoners safe and well - a notable achievement in a time of prison overcrowding - but is currently struggling to manage this group effectively, in part because most spend six weeks or less in prison.

The Law Commission has published a consultation paper on adult social care, which contains its detailed proposals for law reform. Amongst other things, it asks whether there should be a duty to provide social care in prisons.

Find out more from the press release and respond to the consultation here. The consultation closes on 1 July 2010.

The wide scope of sentences of Imprisonment for Public Protection (IPP) has resulted in a huge number of prisoners that neither the probation service nor the prison system can handle effectively, according to this new report by the Inspectors of Probation and Prisons.

Their first report, published in September 2008, commented on how the influx of prisoners subject to the new sentences was flooding the prison system. Today’s report focuses on probation’s role in managing these offenders, both in custody and after release, and expresses doubts about probation’s capacity to work effectively with each case when the number of cases still coming through the system is so great.

Locking up children and young people for non-violent offences is costing the taxpayer millions, while doing little to reduce the amount of crime, says a new report from independent think-tank nef.

The report, Punishing Costs, calls into question the plans of both Labour and Conservative politicians to invest in new prisons. At a time when almost all public services are facing drastic cuts, it is more vital than ever to scrutinise spending on prisons. The report shows how the number of young people and children in prison could be drastically reduced, and how a change in the pattern of public investment can increase the safety of our streets.

The Chief Inspector of Prisons has published a short thematic report, Alcohol services in prison: an unmet need, which shows there is a worrying gap between the needs of prisoners with alcohol problems and the services that exist to support them.

The report revealed that in 2008-09, 19% of prisoners reported having an alcohol problem when they entered the prison, rising to 30% for young adults and 29% for women. This is likely to be an underestimate, as many will not recognise they have a problem.

HMI Probation, HM Crown Prosecution Service Inspectorate, HMI Court Administration and HMI Constabulary have published a joint inspection report on work with offenders with mental disorders.

The joint inspection team found that although concerns about individual’s mental health, once identified, were followed up in almost all cases seen, communication between the criminal justice organisations could be made more systematic and effective.

Read their press release.

HM Inspectorate of Prisons and the Youth Justice Board have published the fifth report of the experiences of children and young people in prison custody. It draws together findings from surveys of every juvenile prison establishment in England and Wales during 2008-9.

The main findings include

• A quarter of young men and nearly half of young women had been in care; almost nine out of ten young men and women had been excluded from school
• Black and minority ethnic young people were over-represented (36%) – though fewer had been in care, or been excluded, than white young people and more planned to continue education on release. They were more likely to report having been restrained in custody and their expectations of prison were lower.

This cross-government action plan sets out the Government's response to the recommendations of Lord Bradley's review of people with mental health and learning disabilities in the criminal justice system.

It aims to ensure there are liaison and diversion services in all courts over the next five years; train staff across the criminal justice system to identify where health issues may need to be addressed; ensure that offenders have access to the same levels of healthcare as everyone else; and improve continuity of care.

The GMC has published some guidance on confidentiality. It sets out the principles of confidentiality and respect for patients' privacy that doctors are expected to understand and follow. It covers such issues as disclosing information in the public interest, sometimes without a patient's consent.

A new report published by the Prison Reform Trust identifies a number of successful international approaches to reducing child and youth imprisonment and cutting crime. Reducing child imprisonment in England and Wales – lessons from abroad examines policies and programmes in countries with effective youth justice systems.

DH has published guidance for commissioners in the NHS, criminal justice system, local authorities and others, which provides information and suggestions on best practice when considering services and systems for people with personality disorders.

IPPR has published a report into youth justice. It argues that the current youth justice system does not reduce offending and proposes ways in which it could. It includes proposals for early intervention for preventative purposes, as well as for the extension of the system to some people over 18.

A new report marking the launch of Make Justice Work reveals the massive cost and chronic inefficiency of short-term prison sentencing in Britain today. It finds that:

• Diverting one offender from custody to residential drug treatment would save society approximately £200,000 over the lifetime of the offender.
• Diverting one offender from custody to intensive supervision with drug treatment would save society approximately £60,000 over the lifetime of the offender.
• In 2007 alone – the most recent year where comprehensive data is available – the new research shows that had short-term prisoners who were drug-users been diverted to community based sentences society could have saved almost a billion pounds over the lifetime of the respective 7,873 prisoners (9.2% of all offenders given custodial sentences in that year).
• Overall, the research reveals that the majority of community sentences provide similar or better value for money and effectiveness than short-term prison sentences.

The Ministry of Justice has published a report summarising international research evidence on the experiences of adults with mental health problems in the justice system.

• Although the review found evidence of the high prevalence of offending amongst adults with mental health problems, there was conflicting evidence about the severity of offences associated with this group.
• Adults with severe mental health problems, such as schizophrenia, are more likely to be victims of crime than the general population by as much as 23%.
• There is evidence that prejudicial attitudes towards people with mental health problems may result in unfair criminal justice outcomes for victims.
• In order to tackle the effects of stigma and discrimination on justice, lessons may be learnt from national strategies, for example to tackle racism and homophobia and from the joint working that was undertaken by police, Crown Prosecution Service and others to reduce domestic violence.

Lord Bradley has published his review. It makes 82 recommendations including better assessment at the earliest possible opportunity and improved continuity of care for people with mental health problems or learning disabilities in the criminal justice system.

The government has also published its response.

The WHO has launched its 'Kiev Declaration on Women's Health in Prison'.

The project has reviewed all issues affecting women's health in the criminal justice system and has especially considered the gross inequities in women's health in prisons. The project has adopted the declaration as evidence that justifies the recommendations and call for action in its conclusion.

The Justice Secretary has announced new plans on prison capacity and the management of both prisons and probation. Plans to build three 2,500-place 'Titan' prisons have been scrapped in favour of five 1,500-place prisons. The new prisons will bring total capacity to 96,000 by 2014.

The Prisons Inspectorate and the YJB have published a report on young people’s experiences of custody, drawn from Inspectorate surveys over the last two years.

Children and young people in custody 2006-2008 shows that, as in previous years, many young people were marginalised and excluded before they came to prison: one in three had been in care and the great majority had been excluded from school.

The Ministry of Justice has published guidance and forms for those working with mentally disordered offenders (restricted patients). The guidance covers work with restricted patients detained in hospital and those discharged into the community.

Prisons vary in the way in which the functions of mental health and substance misuse interventions are divided between the various services involved. These guidelines are intended to be used as a framework that can be adapted by individual establishments to provide co-ordinated services to this client group.

The Forum's 2007/08 report summarises its work over the past year and suggests a number of issues it considers warrant further work.

The report records a slight increase in the number of deaths across all custodial sectors in England and Wales, from 550 during 2006/07 to 577 during 2007/08. The number of deaths remains lower than in 2004/05 and 2005/06, which were 590 and 586 respectively.

Justice Minister Shahid Malik MP will chair the new Ministerial Council on Deaths in Custody.