3 December 2024
Some mental disorders put people at higher than average risk of criminal offending. A few people in this position may be sent to hospital. Most are not and it is hard to find optimal services to promote the health and future safety of those not eligible for in-patient treatment. Many get sent to prison, so people with mental disorders are over represented there and suicide and self-harm rates rising. For a substantial number there are safe and effective community alternatives but these are rarely used for people who need specialist psychiatric treatment.
Laws in England and Wales and in Scotland allows for people convicted of an offence that could result in a prison sentence not only to have that sentence suspended or to be placed under a community sentence, but also to have those sentences tailored to meet their special needs and risks. Courts may add requirements or conditions to a community sentence – for example placing a restriction on where the person may travel or imposing a curfew. There are three possible treatment requirements – for mental health, for drug rehabilitation or for alcohol treatment. Before any of these three requirements may be added, however, the person concerned must agree to them as must a consultant psychiatrist or psychologist and a probation officer. If all do, then a court may order, in effect, a contract between these parties for a specified period of up to three years.
Such arrangements for formal partnerships between probation, health and an offender-patient have been available for several decades, but take up remains low. We will explore model delivery and experience of being under such an arrangement and evidence to date of effectiveness in terms of both criminal justice and clinical outcomes. We will look at a national programme in England that has substantially improved uptake of the arrangement for people who need primary health care in such circumstances. This has improved access at this level but further highlighted the difficulty in giving people who are seriously ill this opportunity for change. We will explore one developing model to support increased uptake of the arrangement for women who need specialist mental health services (secondary health care) across Greater London. Finally we will provide an early view of new research into meeting the needs of the wider range people of people needing secondary mental health services while enhancing community safety and, ultimately reducing health and justice system costs.