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Keeping mental health out of prisons

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Breaking the outdated treatment of offenders as ‘m Breaking the outdated treatment of offenders as ‘mad or bad’, liaison and diversion services will operate in police stations and courts across the country by 2020

An arrest can be made for near limitless reasons, ranging from acts of headlining making severity to misdemeanors requiring no more than a slap on the wrist. However, when the courts come to decide on the sentence, they often ignore a crucial factor in the crime.

Many offenders would be far better treated in mental health settings, rather than having to deal with the additional stresses brought on by the criminal justice system.
In recognition of this, the Department of Health is rolling out a new national programme. Liaison and diversion services have been present in some areas for as long as 25 years, but until recently there has been no comprehensive national model.

In an announcement in July, as part of the measures outlined in NHS England’s Implementing the Five Year Forward View for Mental Health, £12 million will be invested into expanding liaison and diversion services across the country by 2020.1

These services assess 50,000 people a year, of whom 70% require support. The new funding will extend NHS England liaison and diversion services from 50% population coverage to 75% by 2018.

‘We have made monumental strides in the way we think about and treat mental illness in this country in the past few decades – but people with a mental illness, learning disabilities or autism still need support when they come into contact with the criminal justice system,’ said former mental health minister, Alistair Burt, announcing the policy. ‘Expanding the successful liaison and diversion scheme will help make sure these factors are taken into account so more vulnerable people have their needs considered.’

The teams are staffed by mental health nurses, who visit police stations, and magistrates courts to assess the mental state of someone who has been arrested. They work to bridge the gap between criminal justice agencies, such the police and courts, and mental health and other support services. Their interventions help to better identify vulnerable individuals, who require additional support, and in some cases, diversion out of the criminal justice system.

The establishment of a national model for the services was first recommended by Lord Bradley in his 2009 report2 into the treatment of offenders with learning disabilities and mental health conditions in custodial settings. His review suggested that the most effective way to help these patients was to have them diverted out of the criminal justice system and into treatment at the first available opportunity, where appropriate.

‘I hope this will ensure that over time offenders with mental health problems or learning disabilities are properly identified and assessed, appropriately sentenced and helped with their rehabilitation and resettlement, thus reducing the number in prison and impacting on their offending,’ he said in the foreword to the review.

‘The evaluation of the first wave of liaison and diversion services shows an increase in the number of people with mental illness, learning disabilities and needs around substance abuse being identified when they come in contact with the criminal justice system,’ says Paula Reid, policy manager at Rethink Mental Illness. ‘Having this information ensures that informed decisions can be made about how that person should proceed, either out of or through the criminal justice system.’

Currently, there are 16 teams around the country, comprised of mental health nurses, and psychiatrists. During the assessments, the nurse in attendance will look into the offender’s mental health state; cognitive functioning; key vulnerabilities; family and social circumstances; drug and alcohol needs; cultural, religious or spiritual needs; safeguarding; and gender needs. If possible, a parent, relative or carer will be included in the assessment.

‘For people to continue through the system without their needs being taken into account could mean they don’t have access to the support they need, and as a result their health could become more unwell. The evaluation has shown that the input from and expertise of the nurses is also welcome by criminal justice professionals, and many feel more confident in the decisions they make as a result,’ adds Ms Reid.

What the teams do

Gemma McSweeney, a nurse and service manager of liaison and diversion at Kent and Medway NHS and Social Care Partnership Trust, says that her team have a daily presence in all custody suites and certain magistrate courts across Kent. ‘We are proactive in that we will look at all the people who have come through custody that day. We will identify people on a priority-led assessment. What that means is that we will look at people that have been referred through by the custody sergeant because they are at immediate risk due to their mental health or they ae experiencing very high levels of distress. Those are our priority cases.’

After the initial assessment, the clinician can recommend whether the patient will proceed further into the criminal justice system or into healthcare. ‘We can only recommend, ultimately it is going to be a police decision. If somebody comes in and it is a minor crime and feel that it is due to the current mental health presentation, we will recommend that the person is diverted into an inpatient unit for mental health concerns,’ adds Ms McSweeney.

The police generally drop charges and agree for that person to be diverted through to a mental health ward in this case, says Ms McSweeney. ‘If the person had committed a very serious crime, and they were very seriously unwell, then they would continue to be remanded but we would request a full forensic assessment, and they would be diverted into a more secure mental health inpatient unit while still being governed by the criminal justice services.’


To be a nurse working in liaison and diversion services, one requires a diverse set of skills. While most clinicians working in the services will be mental health nurses, they will also require training from a range of specialist sources. This is generally left up to the team, allowing them to tailor training relevant to their area.

‘We are always seeking out specialist training,’ says Ms McSweeney. ‘We have CAMHS training, youth offending teams will come along and provide us with training to assist young people in the criminal justice system.’

Because the services cover all vulnerabilities, teams actively seek out training for issues such as alcohol and substance abuse; those with communication and language problems; and learning disabilities. ‘We recently had a training session from a police officer that links in with the travelling community who educated us on the cultural ways of the community to aid us in our assessments,’ adds Ms McSweeney.

An evaluation of the programme commissioned by the Department of Health3 found that ‘the implementation of liaison and diversion services in the pilot sites had a positive outcomes for both patients and professionals.’ These include an increase in the total number of people being identified with vulnerabilities and an increase in relevant and timely information available to police, courts and partner agencies.

‘It opens out more avenues because working alongside the mental health nurses we become more aware of certain terms, certain medications,’ was the verdict of a custody sergeant who had worked with liaison and diversion services. ‘That maybe gives us limited, layman’s knowledge of what certain indications are that we might need to deal with an individual in a certain way.’

‘They have been amazingly successful for the people they have supported,’ said Jenny Talbot, director of the Care, Not Custody campaign, a collaboration between the Prison Reform Trust and the Women’s Institute to strenghten the need for mental health assessments for offenders. ‘The difference that they make to the lives of the individuals they support is significant.

‘Vulnerable people suffering mental crises are not best served in jail; those suffering mental illness or learning difficulties should not be kept at police stations for want of somewhere else to go. We are making progress, but
I recognise there is still some way to go,’ said the former home secretary Theresa May in 2014. Two years later and in a greater position of power, there can only be hope that the prime minister will continue to see the importance of such a service.


1. NHS England. Implementing the Five Year Forward View for Mental Health.

2. Bradley review. 2009.

3. RAND. Evaluation of the Offender Liaison and Diversion Trial Schemes.

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I think anyone who commits a bad Crime should go to a HMP Prison unless they have really bad mental health the crimeal justice is there to seve justice not hospital
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