Social work, criminal justice and mental health – the business of all social workers

1. Social work, criminaljustice and mentalhealth – the businessof all social workers BASW Seminar Date: 31st May 2013 Facilitator: Linda Holt

2. Values: • HCPC: Standards of Conduct, Performance and Ethics • HCPC: Standards of Proficiency for Social Workers in England (15 standards)

3. Mental Health Social Work (Scie workforce development report 32) • Understanding and ameliorating mental health problems which diminish the state of well being requires “a life course perspective along with a broad social view of mental health problems especially in regard to concerns about discriminatory practice, civil rights and social justice”

4. Why Social Work Business?Needs and social issues frequently identified in the offender population • Homelessness • Poverty • Unemployment • Social Exclusion • Childhood Abuse • Domestic Violence • Learning Difficulty • Mental Illness • Substance Misuse • Alcohol misuse • Vulnerable Adults • Victims • Risk

5. “Socially excluded”; “Complex Needs”; “Chaotic Lifestyle” Revolving Doors Agency Service User Forum preferred the phrase ‘people with multiple problems’. • While every person’s experiences are unique, people often describe some of the following experiences: early adversity, behavioural problems giving rise to low educational attainment, low skill levels, and subsequent unemployment with associated poverty and debt problems. Many of the group experience poor physical and mental health, often in conjunction with drug and/or alcohol misuse. Problems with housing and or homelessness are also common.

6. Stats from “Making the Difference” briefing paper produced by: Adass, CfMH, Prison Reform Trust, Revolving Doors Agency • • 39% of adult offenders under supervision in one probation area had a current mental illness; 49% had a history of mental health problems (Brooker et al, 2011) • • 75% of adult prisoners have a dual diagnosis of mental health problems and substance misuse (Offender Health Research Network, 2009) • • 7% of adult prisoners have an IQ below 70 and a further 25% have an IQ in the range 70-79 (Mottram, 2007); it is generally acknowledged that between 5 and 10% of the offender population has a learning disability • • 15% of newly sentenced prisoners reported being homeless before custody; 37% said they would need help finding somewhere to live when released; 60% said that having a place to live would help them stop reoffending (Ministry of Justice, 2012) • • 40% of young people in custody have previously been homeless (YJB, 2007) • • 43% of children and young people on community orders have emotional and mental health needs (Healthcare Commission, 2009) • • 25% of children and young people who offend have an IQ below 70 (Harrington & Bailey, 2005), and 60% have communication difficulties (Bryan, Freer and Furlong, 2007).

7. What is Stigma? ‘Children acquire attitudes about mental health at an early age’ Wahl, 2002 ‘Stigma is a societal reaction which singles out certain attributes, evaluates them as undesirable and devalues the persons who possess them’ Miles, 1981 ‘ Stigma can increase the complexity of mental health problems and the impact they have on the individual’ Social Inclusion Unit, 2004 ‘Stigma operates at a number of levels within individuals, families, education systems, healthcare, the media and social policy’ Hinshaw, 2005

8. Inequality • Guardian 12.6.12: “Police up to 28 times more likely to stop and search black people” Under 3% of Stop and Search leads to arrest • Rates of admission to and detention in hospital are proportionally higher for Black African, Black Caribbean • There is a higher prevalence of mental health problems in the homeless population, both for common mental disorders and more severe conditions. • The history of mental health services in relation to LGBT people persists with a history of aversion therapies and hormone therapies. This reinforces the impact of shame and stigma on LGBT mental health • Scotland’s See Me anti-discrimination campaign found that more than half (57%) of people who had experienced a mental health problem had concealed the fact when applying for a job.

9. Ethnicity • People from Black and minority ethnic (BME) communities represent about 10% of the UK population (ONS, 2001) but in prison this rises to 26%, a significant proportion of whom are foreign nationals (MoJ, 2008). Of these, 11% are black British, whereas black Britons represent 2.8% of the general population (Prison Reform Trust, 2011). • There is some limited evidence to suggest that black and other BME prisoners are underrepresented in prison mental health team caseloads by comparison with their representation in prison population

10. Women in Prison (June 2011) • total prison population in England and Wales was 85,374, of which 4,185 (5%) were female • foreign national women in the prison population has fallen in the last five years, from 22 % to 16 % (in part can be explained by fall in number in prison for drug offences) • 59 % aged 30 or older (compared with 54 % of men) • 21 % serving a sentence of 12 months or less compared with 10 % of men, and 15 % serving a sentence of six months or less compared with seven % of men.

11. Women in Prison Many women offenders with mental health issues still end up in prison when there may be a case for treatment within the community. Up to 80% of women in prison have diagnosable mental health problems. The comparable figure in the community is less than 20%. Approximately 50% of all self-harm incidents in prison are committed by women, even though they comprise only 5% of the total prison population. Women recently released from custody are 36 times more likely than the general population to commit suicide. • Women’s Diversionary Fund in 2010, jointly provided by the Corston Coalition (charitable funders) to support alternatives to custody for women, particularly the one-stop-shop model.

12. Learning Disability • Average IQ of Population = 100 • Approx 30% prisoners < 80 (50% young offenders) • Mental Health Probs more common in people with LD • Some people with LD also have ASD but they are separate conditions

13. Young Offenders • Of the 87,531 people in prison on 31 March 2012, 9,198 were young people (aged 15-20). • Children who end up in custody are three times more likely to have mental health problems than those who do not. We also know they are very likely to have more than one mental health problem, to have a learning disability, to be dependent on drugs and alcohol and to have experienced a range of other challenges. Many of these needs go unrecognised and unmet.

14. Skills/knowledge • Legislation: Mental Health Act, Mental Capacity Act, Children Act, PACE • Complexity in working with offenders: Working across transitions of age/service/need • What barriers are there and how can they be overcome? – service configuration, separate and distinct services for service user groups, differing priorities between agencies and services; different quality monitoring and targets; professional language; • Impact of offending on people’s lives and impact of life experience on offending • Challenges in information sharing/confidentiality • Report Writing • Risk Assessment and Management

15. Key Legislation • MH Act 1983 (as amended by MH Act 2007) • Domestic Violence, Crime & Victims Act 2004 – fitness to plead • Mental Capacity Act 2005 • Children Act 1989 and 2004 • United Nations Convention on the Rights of the Child • P.A.C.E. - Appropriate Adult provisions • Human Rights Act 1998 • Disability Discrimination Act 1995 & 2005 • Equalities Act 2010 • Health and Social Care Act 2012 • Legal Aid, Sentencing and Punishment of Offenders Act 2012 • Criminal Justice Act 2003 – s207 provides for the MHTR

16. Criminal Justice System • Includes police, courts, prisons, probation, secure hospitals, community sentences • How do we operate with it? • Where are our responsibilities? • What are our challenges and opportunities? • What can we influence? • What’s happening in practice?

17. Part III (1983 MH Act) –Sections for Court / Prisons • S35 – Remand to Hospital for a Report • S36 – Remand to Hospital for Treatment • S48 – Transfer to Hospital of Remand Prisoners, civil prisoners, detainees under Immigration Act • S47 – Transfer to hospital of sentenced prisoner • S38 – Interim Hospital Order • S37 – Hospital Order • S41 – Restriction Order • S45a – Transfer and Limitation Order • S49 – Restriction Direction for transferred, sentenced prisoner

18. Mental Health Treatment Requirements207 Criminal Justice Act 2003 • One of 12 options for courts considering a community sentence or suspended sentence • Treatment from Psychiatry or Psychology • For people not meeting criteria for hospital or guardianship order • Fixed time period • Treatment can be provided in community, hospital, care home • Treatment must be available • Offender must consent • See Centre for Mental Health papers e.g. “A Missed Opportunity”

19. DV Act 2004: Fitness to Plead = understanding • The nature of the charge • The difference between guilty and not guilty and their likely consequences • Properly instruct a legal representative • Able to follow the trial, challenge a jury and understand details of the evidence

20. Sir Keith Pearson said in February 2011 “The Government is committed to reducing the prison population and improving the support offered to offenders with mental health problems. It is also planning a major reform in the justice system alongside big changes in the NHS and social care. Achieving these simultaneously will be a big challenge for all involved and community services - probation, adult mental health, CAMHS and drug and alcohol services - will need to provide better support to people they have not always supported well. Every day, vulnerable people, many with undiagnosed mental health and learning difficulties, are picked up by the police, to appear before the courts and many will ultimately go to prison. Without effective diversion and robust community services, the prison population will simply carry on drifting upwards. “

21. “Diversion” NLDDN are currently consulting on this working definition of ‘liaison and diversion' : ‘Liaison and Diversion’ is a process whereby people of all ages passing through the criminal justice system are assessed and those with mental health, learning disability, substance misuse and other vulnerabilities are identified as soon as possible in the offender pathway. Identified offenders are provided with access to appropriate services including, but not limited to, mental and physical health care, social care, substance misuse treatment and safeguarding. Information gained from assessments is shared with relevant criminal justice agencies to enable key decision makers to make more informed decisions on diversion, charging, case management and sentencing. Diversion should be interpreted in its wider sense, referring to both diversion ’out of’ and ‘within’ the criminal justice system.

22. Practice issues and Diversion • What might be appropriate alternatives to custody? • Sentence planning for short term prisoners? • Do commissioners consult with practitioners? • Separation anxiety – particularly women and young offenders • Employment and education support • Tenancy support • Managing risks • Out of hours help

23. Children visiting policies • National Guidance for High and Medium secure which outlines process and responsibilities of patients, hospital managers, Local Authorities, those with PR and the clinical team • Local Psychiatric hospitals should refer to this framework

24. Elements of Risk Assessment • What is the risk? – e.g. Self Harm; self neglect; suicide; vulnerability to harm from others; harm to others; violence; crime • Where is the evidence of risk? – self disclosure; information from records and people; observation • How reliable is the evidence and are there any conflicting reports? Opinion or facts? Discrimination? Hearsay? MYTHS? • Circumstances of the risk – Who? When? Where? How? Any triggers? “unpick the risk” • Is the risk Past, Current or Future?

25. Risk Management – reducing, eliminating or promoting • Team approach NB Clarity of roles of care team and service user and carers • CPA, Safeguarding Procedures, MAPPA, Case conferences • Care planning including contingency planning • Victims considerations? • Sharing information • Recording with care

26. Sharing Information WRITTEN: • Information for Magistrates Court • Information for the receiving prison • Care Programme Approach • Ward rounds • Ministry of Justice – download up to date formats for Social Supervisor report and Mental Health Tribunals • Information to Victims • Safeguarding VERBAL: • MAPPA • MARAC • Information to Victims • Safeguarding • Information for Magistrates Court • Information for the receiving prison • Ward rounds

27. Deciding how and what information to share • What information would you be prepared to share? • What information would you want to know? • Justify your actions! • Duty to Co-operate?

28. Consider • Duty of confidentiality • Duty of public safety • Duty to cooperate • Seek consent of individual (if possible) • Record reasoning and circumstances • Case-by-case • Proportionate • Relevant

29. Sharing information with Victims • Probation has a statutory requirement to inform victims of release arrangements • Responsible Authority has duty of care towards victims • Remember that Victims contribute to assessment and management of risk • Victims have right to be kept informed of certain information relating to those sentenced to S37 or S37/41 (see DV Act 2004 amended by 2007 MH Act))

30. No Health Without Mental Health: Implementation Framework. July 2012 • The National Diversion Programme is to roll out liaison and diversion services for mentally ill offenders by 2014 • Intensive treatment based alternatives to custody are being tested as part of the National Diversion Programme, • A new reception screen and health assessment tool, the Comprehensive Health Assessment Tool (CHAT), will better assess and identify the health needs of children and young people in the secure estate and in the community. • Work is underway to provide and evaluate alternatives to custody for young offenders • A programme to improve the management and psychological health of offenders who present a high risk of serious harm to others with severe personality disorders.

31. Current Policy and service developments • “I can confirm that there will be a dedicated Minister in any future Ministry of Justice of which I am Secretary of State specifically tasked with the job of guardian of mental health issues across our courts, prisons and probation service.” Sadiq Khan Labour MP July 2012 • Francis report 290 recommendations – Govt response “Patients first and foremost” • National Liaison and Diversion Programme • “Swift and Sure Justice” • Health Needs Assessments – CCGs • SARCS – sexual assault referral centres • Commissioning – Joint commissioning panel for mental health (JCP-MH) has launched guidance for commissioners in 3 areas (perinatal MH, rehab services, public MH) and more will follow by this June

32. Policy/developments continued • Section 15 of the Health and Social Care Act 2012 - NHS CB to commission “services or facilities for persons who are detained in a prison or in other accommodation of a prescribed description.” “Other” includes - a) Secure children‟s homes; (b) Secure training centres; (c) Immigration removal centres; (d) Police custody suites; and (e) Courts • NICE guidelines for Offender Health topics (in development): Guidance for those working in health, youth and criminal justice, education and social care sectors on the cost effectiveness of interventions for the prevention and early treatment of the mental health problems of offenders, taking account of the whole offender pathway • Change to forensic commissioning arrangements – financial responsibility for individuals is where they actually are and not where they are from • Appointment of Chief Inspector of Hospitals and Chief Inspector of Social Care

33. Policy/developments continued • 14.3.13 – Report from MPs on Youth Justice • Evaluation of youth justice liaison and diversion pilot schemes 9/3/12 at www.gov.uk • Report from RCPsych “Whole person care: from rhetoric to reality” Norman Lamb, Minister for Care and Support, said: I will consider these findings and recommendations carefully to think through what more the Government can do. Promotes notion of “parity of esteem” between mental and physical health. The report makes a series of key recommendations for government, policy-makers and health professionals, as well as the new NHS structures coming into force on 1 April including the NHS Commissioning Board, Clinical Commissioning Groups and Public Health England.

34. Policy/developments continued • Alternatives to Custody for Women and Young Offenders • Proposal from several quarters to increase age of criminal responsibility to 14yrs • National Health and Criminal Justice Board which has cross government representation from Department of Health (DH), Ministry of Justice, Home Office (HO), National Offender Management Service (NOMS) and Association of Chief Police Officers (ACPO). The Board currently manages two deliverables that affect the way that the NHS interacts with policing, namely: • The transfer of commissioning and budgetary responsibility for police detainee healthcare, forensic provision and Sexual Assault Referral Centres (SARC) to the NHS and • The development of mental health Criminal Justice (CJ) diversion schemes Staffordshire is one of the Early Adopter areas for the two developments emanating from the Bradley Review – see North Staffs Combined HC and Staffs Police liaison and diversion project at Stoke central custody suite

35. Policy/developments continued • Consultation on Standards for Community Forensic Mental Health services – RCPsych Quality Network – has been raised in the Knowledge Hub and social workers need to ensure they are getting involved. • “Improving Mental Health Services in the Criminal Justice System Conference” This conference chaired by Graham Beech, Offender Health Collaborative Programme Lead, on 29 April, aimed to provide an opportunity to prepare for the new health commissioning landscape and meet the deadline of implementing effective liaison and diversion services at all police custody suites and criminal courts by 2014

36. Convergence • Of mental health and criminal justice policy • Of legislation • Of systems • Of Practice See “Blurring the Boundaries” Centre for Mental Health 2010

37. Convergence: Good • improvement to mental health treatment and care in the criminal justice system • Information-sharing is improving between health and criminal justice agencies • We have a cross-government, multi-department National Delivery Plan • Increased multi-agency provision of services • Improved commissioning between criminal justice and health agencies • A national network of criminal justice liaison and diversion services • Engaging the police with health services

38. ...and Bad? • Black and Minority Ethnic (BME) groups are overrepresented in both the criminal justice system and the secure forensic mental health services • fundamental differences between the objectives of health and criminal justice agencies can be challenging • The lines between prisons and hospitals may become overly blurred • danger that convergence could increase stigma for offenders with mental health problems, who may receive a dual labelling of ‘criminal’ and ‘mentally ill’. • It is important that health and criminal justice staff retain their individual identities, and in particular that clinical and ethical principles are not eroded.