Centre for Mental Health

Mental health and criminal justice should come together with caution, says new report

16 March 2010

Health and justice services are working more closely together than ever, but with mixed results for the people who find themselves subject to both of them, according to a report published today by Sainsbury Centre for Mental Health.

Blurring the Boundaries, by Max Rutherford, shows that more and more people are in touch with both mental health and criminal justice services and that the laws governing each have brought them closer together during the past 20 years.

Measures that have blurred the boundaries between health and justice include the rise of 'forensic' mental health services, the creation of a mental health treatment requirement for people on community sentences and the increasing use of indeterminate prison sentences.

The report finds that in many cases convergence between health and justice benefits people with mental health problems. The arrival of in-reach teams in all English prisons, for example, has for the first time brought high standards of mental health care to people who would otherwise have been neglected entirely.

But there are also serious concerns about convergence. Imprisonment for Public Protection, for example, has brought a disproportionate number of people with mental health problems into prison on indeterminate sentences without proper support. The Dangerous and Severe Personality Disorder (DSPD) programme, meanwhile, costs some £60 million a year to detain just 350 people at a time despite a lack of clear evidence about its effectiveness in either improving health or reducing risk.

Report author Max Rutherford said: "Convergence between health and justice can raise the standard of mental health care for some of the most excluded people in our society. The Government's pledge to extend diversion and liaison to all police stations and courts in England, for example, would make a huge difference to the lives of thousands of people, their families and their communities.

"But convergence must be handled with care. A prison is no substitute for a hospital for a person in a crisis, and hospitals should not become just like prisons. Health and justice workers have quite different roles and these should not be lost in a drive to come together."

Sainsbury Centre joint chief executive Sean Duggan said: "The Bradley Report last year showed how important it is for health and justice services to work together to ensure people with mental health problems who offend get the support and care they need to get their lives back on track.

"Blurring the Boundaries shows that there is already a lot of convergence between the two, but it is not always working well. The DSPD programme and the burgeoning cost of medium secure hospitals show that in times of public spending constraints we need to ensure that every pound is spent wisely on services that help offenders with mental health problems to recover and rehabilitate."