The size of the prison population has doubled in the last 20 years and many people in the criminal justice system have complex mental health needs which are poorly recognised and inadequately managed. Large numbers end up in prison: a high-cost intervention which is inappropriate as a setting for mental health care and ineffective in reducing subsequent offending.
One prisoner in ten has a severe mental illness such as schizophrenia. Nearly half have depression or anxiety. A similar proportion are dependent upon alcohol or illegal drugs, while two-thirds meet the criteria for a diagnosis of personality disorder. Overall, 90% of prisoners have some kind of diagnosable mental health problem and 70% have two or more such problems.
In many cases the use of prison can be avoided if people are diverted at an early stage of their contact with the justice system (although people can be diverted at ANY stage). Liaison and diversion services identify people who have mental health problems and learning disabilities when they come into contact with the police and courts. They assess the person’s needs, advise on their case management and ensure that those in need receive the treatment and support they require.
NHS England have introduced a model to make diversion support available in all courts and police stations in the country, with the aim of complete coverage by 2021. This will ensure provision for young people in custody, as well as adults. NHSE have issued an operating model for all services to ensure consistency – download it here.
Key components of successful diversion
From our research into liaison and diversion services across the country, we know that these are the key components of successful services:
- having a comprehensive knowledge of local social and health economies and good relationships with agencies across it.
- making engagement a key activity as many of those it will want to target will have had previous poor experience of services.
- assessing for a broad range of psycho-social needs.
- having immediate access (within team) to housing and benefits advice.
- keeping the service user’s view of their needs at the core of their assessment.
- focusing on meeting basic needs first.
- being sufficiently resourced to connect people to a range of services (this might include accompanying people to appointments).
- being pro-active and assertive (services that are active and not just reactive to a clients needs and where possible offer not just a formal appointment based service).
- providing some indefinite support with a focus on crises and educating service users on averting these.
- providing a drop-in service after the initial intervention.
- being interested in outcomes and following up on referrals and sign-posting.
- understanding the needs of police, probation and sentencers.
- improving mental health awareness among criminal justice agencies and staff.