Centre for Mental Health

Community sentences and the Mental Health Treatment Requirement

The Mental Health Treatment Requirement (MHTR) is one of 12 possible requirements for all people given a community sentence in England and Wales. It is rarely used in practice, even though more than two-fifths of people on community sentences have mental health problems.

We carried out some research to understand how the MHTR works in practice and the factors that facilitate/prevent the issue of the requirement. The study explored how the offender is managed post-sentence, what treatments are available and the effectiveness of the MHTR in improving offender's mental health and reducing re-offending.

The study was conducted in London in four phases, at the court level, probation, healthcare services and finally with offenders currently on a MHTR.

The results were published in A Missed Opportunity? which finds that the purpose of the MHTR and the group of people to whom it can be given are not clear to sentencers, probation staff or health professionals. It calls on the Government to issue clear guidance on the use of the MHTR.

Following up on the Mental Health Treatment Requirement

We are now conducting a further study into the Mental Health Treatment Requirement, looking at where it has been used.

This new project aims to assess the mental health treatment provided to the offenders and thereby the benefits of the requirement and any areas of difficulty. We will look at the met and unmet needs in areas including mental health, physical health, accommodation, social support and agency support for these offenders as well as what outcomes are sought and achieved as part of the requirement.

We will carry out interviews with offenders serving an MHTR and with probation and mental health professionals in Hertfordshire and South Wales.

This short, quick study will be carried out over the next few months and the results will be published later this year.

For more information about the project, contact Claire Warrington.

Serving indeterminate sentences

"We welcome In the Dark, the Sainsbury Centre report on imprisonment, public protection sentences and mental ill health... The report raises some important points about the information available to prisoners and about access to treatment and care that we will certainly incorporate into our offender health strategy to be published early next year."

Lord Darzi of Denham, House of Lords, November 2008

The sentence of Imprisonment for Public Protection (IPP) has been used far more than was originally expected and has significant mental health implications.

IPPs are sentences for prisoners who are deemed to be a 'dangerous' offender. They are placed on sentences with a minimum term, but of potentially indeterminate length. Release is determined by the Parole Board, who assess risk reduction following course completion and risk management planning.

On 5 July 2010, there were 6,130 people serving IPP sentences in prisons in England and Wales. This far exceeds the Government's original estimate. Only 60 IPP prisoners have been released to date and 14 of those have already been recalled to prison. This is in part due to the shortage of treatment and behaviour programmes available to IPP prisoners, which need to be completed to demonstrate suitability for release.

Those serving IPP sentences probably have a higher prevalence of mental illness than those on other sentence types. This is perhaps because IPPs are sometimes used instead of mental health options such as hospital orders.

The indeterminate nature of IPPs, as well as the uncertainly felt by prisoners about their sentence has, in particular, impacted negatively on their emotional and mental strain.

The Bradley Review and IPP

Lord Bradley recommended that: "A study should be commissioned to consider the relationship between imprisonment for public protection sentences and mental health or learning disability issues" (page 100).

Bradley also noted in his report (page 99-100) that:

"There have been several reports critical of the impact that IPP sentences have on prisoners, particularly on their mental health, and on those with existing mental health problems or learning disabilities. The studies show that the mental health needs of IPP prisoners are high... There are several distinct issues in relation to IPP sentences:

• the impact of an indeterminate sentence on the mental health and well-being of an individual, as a result of the emotional distress brought about by having no set release date;
• the difficulty of access to offender behaviour programmes for prisoners with mental health problems or learning disabilities: prisoners whom staff consider to be unsuitable to participate because of mental illness or emotional instability are often excluded entirely. However, offender behaviour programmes are often necessary to reduce an individual's risk, and thereby help them towards release; and
• the high levels of pre-existing need identified in the IPP and detention for public protection (DPP - used for children and young people) populations and the high impact this has on demand for mental health services in prisons, in particular on the services of the prison mental health in-reach teams."