Anti-social behaviour and people with mental health problems

1. Anti-social behaviour and people with mental health problems ESRC SEMINAR: DIVERSITY AND ANTI-SOCIAL BEHAVIOUR Thursday 5 June 2008 European Research Institute, University of Birmingham

2. 1) Guy Wishart • Assistant Director of Community Mental Health Programmes, IASS, University of Birmingham • Mental Health Programmes/Training • Social Work • Mental Health & Deafness • Safeguarding Adults

3. 2) Focus • Antisocial behaviour and people with mental health problems • Existing research and literature • Debates and concerns identified • How are people with mental health problems represented within the antisocial behaviour agenda? • Issues re: • Models and understandings of mental health (problems) • Recovery • Vulnerability • Safeguarding adults

4. 3a) Research and Literature • Not much available • What does exist raises numerous concerns about the use of ASBOs in relation to people with mental health problems – causing, and/or adding to, problems rather than solving them?

5. 3b) Research and Literature Sainsbury Centre for Mental Health (SMHC) Report • Anti-Social Behaviour Orders (ASBOs) and Mental Health: The Evidence To Date (November 2007) • Report produced as a contribution to the Sentencing Guidelines Council consultation on the breach of ASBOs • SMHC active in regard to research that looks at how people with MH probs can be diverted away from the CJS and towards appropriate treatment • Also concerned with policy that has the opposite effect … where people with MH probs are drawn into the CJS and their MH needs go unidentified and/or unmet …. This includes ASBOs

6. 3c) Research and Literature Use of ASBOs:- • When introduced the Government expected 5000 ASBOs to be issued each year • By the end of 2002 only 1017 had been issued so further legislation was passed to broaden usage in a wider set of circumstances • By the end of 2005 9853 ASBOs had been issued …. 50% of which had been breached • Less than 1% of applications for the issue of an ASBO refused in this period • 1/3 of ASBOs given to people with MH probs, despite guidance that MH probs are meant to be a mitigating factor against issuing and sentencing for breach of ASBOs

7. 3d) Research and Literature ASBOs and Mental Health • SCMH is particularly concerned about the use of ASBOs for people with MH probs, the rate at which they are being breached, and the combination on the lives of people with MH probs • Guidelines for sentencers and practitioners have repeatedly stated that more careful consideration should be given for ASB situations involving people with MH probs, eg: • The Sentencing Guidelines Council • The Justice Clerks Society • The Home Office Guide to ASBOs

8. 3e) Research and Literature • Despite the above guidelines,a Home Office (2002) review of ASBOs found that for 60% of those issued an ASBO there was a mitigating factor such as mental distress, addiction, or learning disabilities • In 2007 the British Institute for Brain Injured Children (BIBIC) reported that 30% of young people who receive an ASBO have a diagnosed MH disorder or learning disability • The BIBIC report also states that ASBOs are frequently issued without any assessment for MH problems or learning disabilities + is wide variation, on a case by case basis, in regard to the weight attached to MH issues as a mitigating factor • A National Association of Probation Officers (NAPO) also reported similar findings raising concerns about a disparity in justice + people being jailed where the original offence was non-imprisonable. Called for a review of ASBOs

9. 3f) Research and Literature SCMH Recommends:- • Screening for MH problems and learning disabilities before any application for an ASBO proceeds + better MH training for Court staff and sentencers • Alternatives should be attempted before proceedings begin for issuing an ASBO such as diversion schemes to MH services, or use less criminalising behaviour control methods such as Acceptable Behaviour Contracts (ABCs) • Breach of an ASBO must be viewed in the individuals context (MH, LD’ies, etc.) and should rarely be punished in equal proportion for breach as someone who is otherwise able to be fully compliant.

10. 3g) Research and Literature • ASBOwatch and case examples involving people with MH probs • Kim Sutton aged 23 – “You are not to dip one toe, not one finger, in a river or a canal.” ASBO issued after several suicide attempts – banned from places where she could commit suicide. Was warned that a breach could mean imprisonment (presumably if suicide attempt was unsuccessful!!!!!!) • Appeal made but Judge refused claiming that Kim was an attention seeker.

11. 3h) Research and Literature • John – diagnosed with paranoid schizophrenia ASBO issued after neighbours complained about his behaviour. Sent to prison when breached his ASBO. “Instead of treating my illness, the authorities have treated me like a criminal” “Prison aggravated my mental illness and I am still not receiving the help I need. I’m in a no win situation.”

12. 3i) Research and Literature • Richard Garside, Director of the Crime and Society Foundation stated to the Home Office review of ASBOs that they were being issued in a heavy handed manner without MH issues being addressed. • SANE has stated that MH services are passing the buck of care into the CJS. The CEO of SANE has argued that ASBOs are seen as the cheaper option for LA’s. • Problems of multi-agency working in the ASBO context: • Lack of consulting MH specialists • Social services reluctant to commit to the ASBO agenda as see them as too punitive • Lack of information sharing and issues of confidentiality creates barriers to effective multi-agency working • As the Government increases pressures on Councils to increase the number of ASBOs there are increasing numbers of people with MH probs being drawn into the CJS arena

13. 4a) Understanding Mental Health Problems and ASB How are People with Mental Health Problems Represented in the ASB Arena? • If we look in the Home Office Crime Reduction Toolkit (ASB) we find: • ASB can be a symptom of mental illness (perpetrators) • MH problems makes people vulnerable to ASB (victims) Mental illness explains why people with MH probs are perpetrators and/or victims of ASB

14. 4b) Understanding Mental Health Problems and ASB • The use of MI to explain ASB in relation to MH problems reflects a medical model understanding of MH problems • biology, genetics, brain chemistry • What is wrong with the person • Life difficulties due to the illness • Cure the person • Them, not us • Dangerous • Can’t control themselves, don’t know what they are doing

15. 4c) Understanding Mental Health Problems and ASB • Crime – mad Vs bad debate • Pill to deal with madness + ASBO to deal with badness??????? Social Model: Explores the ways in which MH problems might be understood, in part, as a response to problematic life experiences

16. 4d) Understanding Mental Health Problems and ASB • There are 2 complementary ways in which MH probs may be viewed: • The internalisation or acting out of stressful social experiences that cd not be resolved in other ways. The particular ‘content’ of a person’s distress may be seen as an expression (usually indirect) of unresolved issues in relation to what has happened, or is currently happening, to them. Stressful experiences may include loss, discrimination, injustice, abuse or subjection to oppressive expectations made by powerful others. Typically, what may make these hard to resolve is a person’s powerlessness and lack of personal and social support. • A coping or survival strategy that a person may be using in order to deal with particular painful or stressful experiences. The specific form taken by someone’s distress, such as voice hearing or self harming, may therefore be understood as their best available strategy for coping with life circumstances – both past and present – that may seem threatening and unlivable in some way. In this sense, manifestations of md may be seen not as some unfortunate impairment, but as a reflection of people’s resourcefulness and ingenuity.

17. 4e) Understanding Mental Health Problems and ASB • RECOVERY • Medical model – about fixing the person and removal of symptoms • New approach – about working with people to generate recovery from a holistic perspective (reclaiming and building your life) – described as complex, individual, self-defined, concerned with regaining hope and independence, perservering in spite of reverses and ongoing problems … does not necessarily mean being free of all symptoms

18. 4f) Understanding Mental Health Problems and ASB • ASB and Mental Health Problems and Recovery • What impact does ASB have on recovery? • Does an ASBO help or hinder recovery? • Does going to prison help or hinder recovery? • Can there be a response to ASB situations, involving people with MH probs, that attempts to help the recovery process?

19. 4g) Understanding Mental Health Problems and ASB • ASB and mental health problems and vulnerability • What causes vulnerability? The mental illness? The social response to mental health problems? Both? • A Social Model of Vulnerability • ASB and mental health problems and safeguarding adults - See the Mind report: Equal Access to Justice for Victims of Crime with Mental Health Problems eg majority reported that they had been victimised in the community during the past 2 years.

20. 5) Conclusion Add to the SCMH Recommendations: • Need more training input about MH, including a Social Model approach and Recovery • Is there scope to develop a Recovery approach for ASB and people with MH problems? • Training input about ‘vulnerability’, including the social model of vulnerability (see Wishart, 2003 in Journal of Adult Protection) • Need more training input about Safeguarding Adults? • Need stronger links between the ASBO agenda and services and Safeguarding Adults agenda and services • Need research that documents MH service users lived experiences of ASB and ASBOs and the impact on recovery. Need their ideas about possible solutions.