Challenges Facing Interprofessional Working at the Interface between the Court and Mental Health Services in the United Kingdom School of Health and Social Care, Bournemouth University, United Kingdom Sarah Hean Jerry Warr (PhD) Health and Social Care in Criminal Justice (SW England), Department of Health Sue Staddon

Rationale In the United Kingdom, problems with getting information about defendants’ mental health problems Increase concern about the number of people in prison with mental health difficulties Improvement in the interface between criminal justice and health.

Project Jointly funded by Her Majesty’s Court Services and Department of Health in the United Kingdom New way of funding information – courts become ‘commissioners’ Service level agreements clear about Responsibilities Timescales Funding

Reflections on interagency and interprofessional working Project crosses interagency and professional boundaries Health and Criminal Justice services separated by the same language Health and Criminal Justice services interested in different outcomes

Location

Baseline Baseline data to identify current challenges in interagency working between Mental Health (MH) and Criminal Justice agencies Focus on provision of advice on MH of defendants in contact with Criminal Justice System (CJS) Provided by assessments/reports from MH services

Advice received by courts on mental health of defendants: Questions Adequacy of advice? What is good about current provision? What are the limitations about current provision? How could provision be improved in the future?

Sample ProfessionNumber of questionnaires returned% of total sample- (479) Judges153.1 Legal Advisors245.0 Lawyers Magistrates Probation204.2 TOTAL

Problem Recognize high levels of mental illness amongst defendants. Insufficient mental health assessment of the defendants when in contact with the CJS. Implications for defendant Mental health issues remain unidentified Do not access treatment. Reoffending alone, isolated, without support, homeless, access mental health (MH) services unaided Families unsupported

Implications for court personnel Sentencers struggle with appropriateness of sentence to MH defendants In their deliberations, they consider: public safety impact of sentence on defendant, a prison sentence in particular. moral issue of punishment versus treatment relationship between mental illness and the offending behavior Inadequacy of their knowledge of the above issues The need for advice on sentencing, a wider range of sentencing options, especially in less severe cases in particular. They look to reports to provide this information.

Inter-agency themes Delays in report preparation Cost Report content

Theme 1: Delays Unacceptably long periods to produce reports. Psychiatric reports problematic Some defendants need more rapid assessment than others (e.g., young defendants, those with severe mental illness). Delays caused by: Assessment not easily accessible lack of MH services and staff available to perform assessment Reliance on intermediary to make contact with MH service. Mismatch between expected timescales MH professionals not meeting required deadlines Defendant not being known to service Defendants not attending assessment

Impact of delays Court Lengthy and multiple adjournments Delays in court proceedings Court personnel discouraged from requesting reports Cases continue and sentencing occurs without information on defendants’ MH Risk to the public and of reoffending if defendant on bail Defendant No assessment that compromises their need for treatment In remand inappropriately when should be receiving treatment Defendants in remand longer than sentence commensurate with their offence Unnecessary stress when waiting outcome

Theme 2: Cost Funds available to court to purchase reports too low Implications: court personnel loathe to request reports defendants slip through criminal justice system without assessment. prison seen as cheaper than report money dictates whether liaison officer employed. Psychiatrists loathe to provide reports for low fee. Psychiatrists charge more than guidelines suggest Unclear which service should pay for report. Court refuse responsibility for finding psychiatrist. abbreviated reports cheaper but less effective.

Theme 3: Content of report Essential when probation, magistrates and judges consider appropriate sentence required. Variation in perceived quality/usefulness of report Reports improve: understanding of case and defendant in general an up to date account of the defendant’s history, previous and current treatment the relationship between the defendant’s criminal behaviour and mental illness-culpability the public risk posed by the defendant the treatment required for the defendant and the effect treatment would have on future offending The content of reports does not always contain sufficient information for the above to be achieved.

Further pros and cons Clear, well written in lay language psychiatric reports thorough. expert, professional and impartial assessment useful in identifying a MH exists; helpful in differentiating mental illness from related issues such as drug and alcohol misuse. difficult to understand-medical terminology. Vague, inconclusive, no concrete or practical advice relevant or useful as how best to proceed with defendant. Other reports, especially shorter and GP reports, superficial, little more than MH issue. No added value psychiatric reports longwinded, confusing and call for briefer, clearer reports instead. Sometimes reports and professionals appear conflicting.

Recommendations Training for magistrates/probation to identify, dispose of defendants appropriately, to understand content of reports Advice from experts. Untrained officials sufficient. earlier screening of defendant, before reaching court (e.g. at point of arrest, in police station). Extra funds to pay for reports, so requested if and when necessary. More attractive fee offered for report writing

Recommendations: delay fast track system: reports on the day or the week. short/brief reports or verbal reports timescales used similar to those imposed on probation service reports Professionals other than the psychiatrist providing reports Providing workers on site

Recommendations: Report writing Clear and concrete recommendations in report, particularly related to sentencing Reports that more closely address requirements of the court Consent protocol to facilitate release of information by MH services. Clear protocol for reporting (e.g. nature and time frames)

Recommendations: accessibility Improve accessibility of MH service wider range of MH services more information on the services available and how to access these. named contacts in MH services Clear record keeping from the moment of arrest to disposal Access to the report writer or having the report writer on site allowing court to clarify the report content if necessary.

Mental health/liaison worker dedicated to court Some courts have a MH worker in court. Dedicated MH worker, means court personnel obtain: expertise otherwise unavailable Up to date information on defendant Useful, thorough information Information that contributes to bail and sentencing decisions immediate information on MH health of defendant reduced delays, fewer adjournments Discomfort of defendant is minimized The dedicated health work is able to: Fill the gap left when no psychiatric report is available assess both known and unknown defendants offer defendants support

More recommendations These outcomes are achievable because: there are good personal relationships between the mental health worker and court personnel the worker accompanies the defendant into court the worker is frequently present and ready availability staff characteristics, e.g., dedication, being highly motivated Information can be delivered reports orally Court personnel are able to interact and interrogate worker personally on their assessments. This is preferable to dealing with a report.

Improvements Many courts do not have a dedicated MH worker at all. Liaison service may be present, but court personnel not in habit of accessing this advice do not know of service’s existence do not understand their exact role. Services intermittent dependent on funding, Low human resources. Worker not always available to the court on a daily basis or on the exact day case comes to court. Gap in service when the worker on annual leave. Defendants may fall beyond the remit of liaison worker: geographically nature of the illness

Recommendations extended to all courts More MH workers in court MH services mirror those provided by probation services always and immediately available like probation service; report availability like persistence report provided by probation duty mental health worker, like a duty solicitor; increased availability of MH workers to cover daily and bank holidays, etc.. increased awareness of the service in court personnel. MH workers need greater powers to support and work with a greater range of defendant MH worker to provide briefings to magistrates and provide appropriate advice on disposal MH worker as a filter to conduct an initial evaluation, to determine whether report is required and/or act as a link between the court and other MH services

Problems unaddressed Reports and mental health disposal useless if recommended treatments, community support and/or residential places unavailable after sentencing. The impact of no treatment/placements: custody/prison only viable alternative at disposal/during court process. court doesn’t bother getting assessment as no treatment/bed is available regardless of recommendation defendant receives support, so re-offending is more likely. release into the community without treatment Respondents request more supported accommodation; more secure residential housing, more placements in community and more treatment opportunities for defendants in contact with the CJS and for offenders after disposal.