Interagency training between the mental health and criminal justice systems: the need, the now and the next

1. Interagency training between the mental health and criminal justice systems: the need, the now and the next Sarah Hean Bournemouth University, UK

2. Content THE NEED • Context Offender Mental Health • need for collaborative practice and interagency training. THE NOW • Crossing boundary workshop • MHS and CJS professionals’ attitudes towards interagency training • content and constraints. THE NEXT • Exploring future development of pedagogical framework in this field • Development of a EU collaboration to develop a Community of Practice supporting research and education in collaborative working • COST

3. Problem: the need • In Europe, 9 out of 10 prisoners demonstrate signs of at least one mental disorder[1]. • Represents severe health inequality within the Europe. • Neglecting this area leads to: • Non adjustment to life on outside: social exclusion and reoffending/recidivism. • Compromised wellbeing of offenders’ family, fellow prisoners, frontline staff and public safety. • economic strain on the public purse and prison and mental health hospital places [2].

4. Solution • Effective partnership working between MHS and CJS needed for early diagnosis of the offender, treatment, appropriate sentencing or diversion into the MHS [5]. • Collaborative practice at the interface of the MHS and CJS particularly challenging [3]. • lack shared protocols, agreed timeframes, information sharing, clarity on lines of responsibility. • Range of collaborative models: • diversion and liaison schemes, • specialist mental health courts, • care coordination • service level agreements [4].

5. No Interprofessional training • UK Bradley report [4] called for joint training: but what format? • Mental health awareness for CJS front line professionals [10] • Interorganisationaland interprofessional training required. [11]

6. The now: crossing boundaries workshop • A crossing boundary workshop [25] delivered to 52 professionals: • criminal justice system (probation, police and courts) • mental health system (learning disability, substance misuse and mental health services) • Individuals within each activity system brought together in facilitated environment. • Together presented with stimulus mirroring dimensions of their collaborative practice. • A case study “Kevin” with mental health issues, in contact with the CJS. Written by practice partners served as this mirror. • Co-observe case study: • identify challenges and contradictions of working together, • discuss a potential solution to this problem • Develop models whereby cross agency partnerships might be able to address this.

7. Mediating tools Assessment tools Mediating tools Liaison workers, assessment requests Object/Activity Request for info on mental illness of defendant & relationship with crime for disposal and support of defendant Object/Activity: Assessment/report writing; Defendants referred to MHS by CJS; Make requests of CJS for information on patient Subject Psychiatrist Subject Magistrate • Outcome: • Different expectations, priorities, culture. • Delays, • Report content • Low efficacy (Hean et al. 2008) Community Legal advisors, liaison workers, lawyers, probation, judges, magistrates, Reliance (police) Division of labour Probation, Lawyers, liaison Legal advisors, Magistrate Division of labour Psychiatrist, Community psychiatric nurses, liaison workers, probation Rules Cost effectiveness; Disposal time targets Rules Con-fidentiality Community Patient, liaison workers, other health & social care professionals in MHS Theoretical perspective to interagency training MHS CJS Engestrom, 2002

8. Perceptions of participants • The receptiveness of criminal justice system and mental health service professionals to interagency training: • Readiness for Interprofessional Learning Scale (Reid et al., 2005)(Q). (n=51). • Perceptions of the challenges facing interagency working and the expectations of the workshop • interactive exercises (E). • What needed to prepare the workforce to respond effectively to the liaison/diversion agenda and constraints in current climate. • 6 parallel focus (F)

9. Taster of some themes Person centredness • High person centredness (Q) • Interagency training would help offenders with mental health issues (F). • MHS and CJS share similar patient centredness (Q) Positive attitude to interagency training and its benefits • Interagencytraining (F, E) builds relationships to enhance interagency working (E), improve and share good practice (E) and implement liaison agenda (F). • Be included in preregistration and mandatory basic training for professionals from both the CJS and MHS (F).

10. Increasing knowledge of other agency • Knowledge of other agencies (E): • Roles and responsibilities of professionals in other agencies (F,E) • How systems fit together (F). Building empathic relationships • Legaland political environment others practice within (F). • Different priorities and values (F) and alternative perspectives (E), targets and priorities (E, F) • Interagency empathy reduces prejudice, builds communication channels and information sharing (E, F) and clarity on lines of accountability (E) • Important horizontally between senior managers across agency boundaries (F).

11. Working together in an imperfect world: sharing resources, economies of scale • Budget cuts: Sharing training resources across agencies, piggy backing interagency training onto existing training programmes and joint commissioning of services including training (F). • Economies of scale and learning from good practice: bring together a wider range of regions versus localisedevents for local interagency partnerships to develop (F). • Targeting staff involved in cross agency working only (F).

12. A valid interagency learning experience • Interagency placements, shadowing opportunities or formal visits between agencies, case conferences, service development projects(F) • Use of real life issues (F)(Kevin the case study). • Well established adult learning approaches including practice based, situated and experiential learning principles. • Interagency training champion within practice and train the trainer.

13. Role of the university • Role of university: • Evidence base • Conceptual or pedagogical framework. • University evaluating this work. • The interagency champion monitors the roll-out of the training/train the trainer.

14. The next: pedagogical framework • A valid interagency learning experience. • Explore new methods of linking interprofessional education (IPE) and interprofessional collaborative practice (IPP). • Substantive content, based in practice reality and with obvious value for practitioners.

15. The pedagogical framework IPE IPP partnership • UK/Norway/ Sweden (Bournemouth University, University of Stavanger, University College Molde, Nordic School of Public Health) • national drivers and context (Norway) • assessment tools and measures of service integration and collaborative practice. • Prototype for piloting in the MHS and CJS in the EU • Transferability to other national contexts and clinical contexts

16. Some of the substantive content being explored Interorganisational integration • Quality of joint effort put in by two or more organizations and their constituent professionals to collaborate with one another • On a continuum: full segregation to no contact between service providers • Optimum level of integration depends on context and service user need. • The Scale of Organisational Integration (SOI) measures both actual and then optimal levels of interorganisationalintegration required for optimal collaboration [5]. • Utility: service development, evaluation

17. Collaborative Practice • individual behaviour of different professions and organisations working together • Perception of Interprofessional Collaboration Model (PINCOM). Quantifies collaborative practice at individual, group and organisational levels[6]. • Utility: Link to service integration, staff appraisal Collaborative leadership and other interprofessional competencies • Lancet Commission on Education of Health Professionals [7]: • generation of core competencies drawn from global knowledge but adapted to local contexts. • include interprofessional team working competencies of interprofessional communication, role clarification, conflict resolution, 2nd order reflection and collaborative leadership.

18. Collaboration for social innovation • Social innovation: using new knowledge or combining existing knowledge in new ways or applying it to new contexts. • Being collaborative enables professionals be innovative to adapt to the ever complex and changing needs of service users within an interorganisational environment. Innovation is required to fill the grey spaces that lie between services[9] Cost effectiveness of Collaboration • Further in the current economic climate, and cuts to public sector resources, different organisations must collaborate more effectively to achieve financial savings. • Professionals must collaborate to find innovative ways of working to be cost effective and deploy resources differently. Remaining Challenge: despite focus groups remains top down approach.

19. Seeking COST partners • Transferability to other clinical contexts • Propose a COST Action that enriches international research cooperation between EU and international partners with the long-term improving innovative collaborative practice for health and welfare in Europe.

20. Interprofessional and Interagency training UK Norway Canada USA INNOVATIVE COLLABORTIVE PRACTICE FOR HEALTH AND WELFARE IN EUROPE Sweden ? Inter-professional collaborative practice Inter-organisationalpractice ? ? Australia

21. COST Objectives For each Work package: • Development of early career researchers. • Development of approaches to interdisciplinary knowledge exchange. • Identification of research priorities in line with changing practice needs. • Development of pedagogical frameworks that keep pace with changing practice needs • Identification of strategies for achieving and evaluating impact • Seeking COST partners 27th Sept Phase 1 • At least 5 practice partners • To lead in work packages in the different clinical, objective and national contexts

22. TAKE HOME MESSSAGES • Need for valid learning experience that has obvious utility for practitioners. • Interorganisational integration and collaborative practice • Interprofessional competencies including collaborative leadership • Collaboration for social innovation including cost effectiveness. • Pedagogical framework with transferability to other clinical contexts and national contexts. • Seeking COST partners to develop a Community of Practice supporting research and education in collaborative working and education

23. Sarah Heanshean@bournemouth.ac.ukBournemouth University, United Kingdomhttps://www.facebook.com/groups/IN2THEORY/) THANK YOU QUESTIONS

24. References 1. MarleEB, Van HJC. Mental Health in Prisons. In: Health in Prisons: A WHO Guide to essentials in prison health. Copenhagen: World Health Organization : Copenhagen 2007. 2.. World Health Organisation. Mental health and prisons: information Sheet. Geneva: WHO 2005 3. Hean S, J. Warr, Staddon S. Challenges at the interface of working between mental health services and criminal justice system. Medicine, Science and the Law 2009;49: 170–8. 4. Bradley, Lord. The Bradley Report. London : Department of Health 2009. 5 ÅhgrenB, Axelsson R. Evaluating integrated health care: a model for measurement. International journal of integratedCare 2005;5:e01-9 6. ØdegardA. Exploring perceptions of interprofessional collaboration in child mental health care. Journal of Integrated Care 2006;6. 7. FrenkJ, Chen L, Bhutta Z a, et al. Health professionals for a new century: transforming education to strengthen healthsystems in an interdependent world. Lancet 2010;376:1923–58. 8 Willumsen E, Åhgren B, Odegård A. A conceptual framework for assessing interorganisational integration andinterprofessional collaboration. Journal of interprofessional care 2012;26:198–204. 9 HelseogDepartement .Morgendagensomsorg: Norwegian Governement White Paper no. 29. Norway: : HelseogOmsorgDepartement 10 Ministry of Justice., Department of Health. Working with personality-disordered offenders A practitioners’ guide.2011.London: Ministry of Justice. 11 Hean S, Heaslip V, Warr J, et al. Exploring the potential for joint training between legal professionals in the criminaljustice system and health and social care professionals in the mental-health services. Journal of interprofessional care2011;25:196–202.

25. 12 Patsios D, Carpenter J. The organisation of interagency training to safeguard children in England: a case study usingrealism. Journal of Integrated care 2010. 13 Department of Health. Working together – learning together: A framework for lifelong learning for the NHS. London :Department of Health 2001. 14 Hean S, Staddon S, Clapper A, et al. Interagency training to support the liaison and diversion agenda. Bournemouth:SW Offender Health: 2012. 15 Oppenheim A. Questionnaire Design, Interviewing and Attitude Measurement. London: Pinter 1992. 16 Coles C, Grant GJ. Curriculum evaluation in medical and health-care education. Medical Education 1985;19:405– 22. 17 Bernstein B. Class, codes and control. London: Routledge 1971. 18 Wenger E. Cultivating communities of practice: a quick start-up guide London: Routledge 2002. 19 Department of Health. Equity and Excellence: Liberating the NHS. London: Department of Health 2010. 20 World Health Organisation. Framework for Action on Interprofessional Education & Collaborative Practice. Geneva:WHO 2010. 21. Leadership Academy. Clinical Leadership Competency Framework. London: Department of Health 2011. 22. Willumsen, E. Leadership in interporfesssional collaboration-the case of childcare in Norway. Journal of Interprofessional Care, 2006, 20(4), 403–413. 23 Chesbrough, HW Open Innovation: The new imperative for creating and profiting from technology. Boston: Harvard Business School Press, 2003 • Von Hippel, E. Perspective: User toolkits for innovation. Journal of Product Innovation Management, 18(4), 2001, 247-257. • Engestrom Y., 2001. Expansive learning at work: towards an activity theoretical reconceptualisation. Journal of Education and Work, 14, pp.133–156.