Extract from our lecture by Sir Keir Starmer, 2014


16 September 2014

Five years ago, in 2009, the Bradley Report noted that “there are more people with mental health problems in prison than ever before”. With the prison population now standing at over 85,000, we can still say the same today.

The evidence set out in the Bradley Report made the nature and the extent of the problem clear for all to see. His report made 82 recommendations under five headings: for early preventive measures; for all police custody suites to have access to liaison and diversion services to enable diversion to take place; for support in courts to give the same help to vulnerable defendants as is offered to vulnerable victims and witnesses; for adequate community alternatives to prison and better health provision for those in prison; and for greater continuity of care as people enter and leave prison.

The Bradley Report offered an end-to-end review setting out practical recommendations at every stage. None of it was rocket science. But that was five years ago. Where are we five years on? The Bradley Report’s recommendations were reviewed by Centre for Mental Health in June 2014. The headline news is good – there has been significant progress in key aspects of Lord Bradley’s vision.

But there are some areas where not enough progress has been made. There are no governance arrangements in place for providing Appropriate Adults in police stations. Appropriate Adults will always be needed by vulnerable suspects as well as victims and witnesses; they need a statutory framework with funding on a proper footing. Recommendations to help vulnerable offenders to participate in court proceedings through intermediaries have not been taken up.


The Centre’s review called for an Operating Model for prison mental health care, similar to the one developed for liaison and diversion. It also identified a continuing concern about accommodation for people leaving prison and called for a new prevalence survey of mental health problems among offenders.

So there are still difficulties at all stages of the criminal justice system: the number of people in prison with mental health problems is no smaller than in 2009, with high levels of psychosis and personality disorder and a high suicide rate. We need a greater sense of urgency: a gear change in implementation and a shift in thinking to ensure victims, witnesses, defendants and offenders with mental health problems are properly supported throughout the criminal justice system.

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