Mental Health and Crime Dr Jayanth Srinivas, Consultant Forensic Psychiatrist and Clinical Director, Forensic Mental Health Service Sue Havers, Consultant Forensic Clinical Psychologist Mark Smith, Senior Nurse, Forensic Directorate Lisa Agell, Head of Mental Health Services

What link is there between mental health and crime? What services are available locally for people with mental health difficulties who may come into contact with the police, courts or prison? What are the key issues in keeping the mental health service user and the public safe?

Mental Health in the General Population 1 in 4 people will experience a mental health problem in any year At any time 1 in 10 people will be experiencing depression and / or anxiety

Prevalence of mental disorders in general adult population Phobias2.6 % Eating disorders1 – 3 % Obsessive Compulsive1.3 % Personality disorders2 – 13 % Bipolar 1 % lifetime Schizophrenia0.2 % (1 % lifetime)

Prevalence of mental disorders in prison population 72 % male prisoners 70 % female prisoners have 2+ diagnosed mental disorders Compared to 2 % and 5% of general population

Prevalence of mental disorders in prison population 7 % male prisoners 14 % female prisoners have psychosis Compared to 0.4 % of general population

Although rates of mental illness in the prison population are high MENTAL ILLNESS DOES NOT CAUSE OFFENDING BEHAVIOUR

Prevalence of substance misuse in prison population 50% remand prisoners 40 % sentenced prisoners have substance misuse problem

Prevalence of mental disorders in prison population Risk of suicide is 10X higher for prisoners

People with mental health problems are at higher risk of self harm and more likely to be victims of crime

Risk of being killed by someone with mental illness 700 homicides annually 8 % by mentally disordered offender 5 – 6 % people in contact with mental health services 92% homicides by people with no mental disorder

Risk of being killed by someone you know 60 % victims killed by person they know 24% killed by a stranger Homicides by strangers more likely to be linked to substance misuse

To summarise: 1 in 4 people have mental disorder at any time Incidence of mental disorder and substance misuse are much higher in the prison population 92 % of homicides are by people with no mental disorder 60 % of victims are killed by someone they know ‘Stranger’ homicides are more likely to be linked to substance misuse than mental illness

The way forward ? Address stigma about mental health problems so that people can ask for and receive the help they need at an early stage in their illness

The way forward ? Address societal issues regarding drug and alcohol abuse People with substance misuse alone cannot be detained or treated under the Mental Health Act

Mental Health Act 2007 The Mental Health Act 1983 (which was substantially amended in 2007) is the law in England and Wales that allows people with a ‘mental disorder’ to be admitted to hospital, detained and treated without their consent – either for their own health and safety, or for the protection of other people. The decision to detain someone in hospital or to put someone on supervised community treatment is taken by specially trained doctors and other mental health professionals who are approved to carry out certain duties under the Act and follow specific procedures. Covers areas such as Civil admissions to hospital, Criminal Justice system diversion, Public orders, Consent to treatment and supervised treatment in the community Diversion from the Criminal Justice system- DAPA, Pre-trial, Trial, Remand and sentence Insanity Defence, Diminished responsibility

Mental Health Services for prisoners Prison In Reach services to 8 local prisons Healthcare organisation in prison- equity of care Role of prison in-reach- managing patients, diversion and aftercare Interagency and Multiagency working- MAPPA

Secure services For prisoners requiring treatment For people sent by the Courts For people who cannot be safely managed by local services

Forensic Mental Health Service Serves Staffordshire & Shropshire and part of Wolverhampton in West Midlands 47 bed medium secure service in Stafford – The Hatherton Centre 32 bed low secure service in Shrewsbury – Clee unit (12 acute + 20 rehab. beds) Prison In Reach to 8 local prisons

Forensic Mental Health Service Range of Community Services: –Court Diversion –Criminal Justice Mental Health Liaison Scheme –Forensic Liaison Schemes in Wolverhampton and Shropshire –Psychology & Psychiatry Outpatients for Staffordshire –Community Personality Disorder services with Probation

Examples of service users The tragedy of someone with undiagnosed schizophrenia who kills parent due to voices Prisoner transferred to hospital for treatment of severe depression or psychosis Person who commits offence in context of psychosis and maladaptive coping strategies

How we manage risk Focus on risk assessment and management Dual responsibility to patient and public safety Work with MAPPA Probation service local services Careful rehabilitation programmes

Mental health Services for local people Community Services: Primary Care Mental Health Services (PCMH) Early Intervention in psychosis (EIP) Community Mental Health Teams (CMHT) Crisis Resolution & Home Treatment Services (CRHT) Assertive Outreach services (AOT) Dementia Services Community Substance Misuse Teams (CSMT)

Mental health Services for local people In-patient Services - Stafford: 12 bedded Dementia Unit 14 bedded older peoples assessment unit 12 bedded PICU 35 Acute beds 6 MOD beds Section 136 Assessment Unit