1. Exploring Effective Practice in MDO Schemes: Towards a 21 st Century Provision Dr. Francis Pakes Ms. Jane Winstone

2. Pakes and Winstone 2007 2 Making Changes for the 21 st Century? “most court diversion services are currently inadequately planned, organized or resourced, and are therefore of limited effect….A central strategy is required, and properly designed and adequately supported court services should be incorporated into….mainstream local psychiatric provision. Without such action, the future of court diversion lies in doubt.” (James, 1999; pg. 507)

3. Pakes and Winstone 2007 3 Our Research (OCJS/MoJ/DoH) To identify provision of support for individuals in the criminal justice system with mental health difficulties To improve that provision by supporting schemes

4. Pakes and Winstone 2007 4 Aims of the Mental Health Effective Practice Audit Checklist (MHEP-ACE) To use areas and elements identified through literature review and test sensitivity of tool to: – Identify effective practice – Identify sustainability – Identify ways to measure value for money – Identify a range of operational strategies

5. Pakes and Winstone 2007 5 MHEP-ACE 6 Areas of Effective Practice – Screening, Assessment, Facilitating Access; Other Liaison; Multi-Agency Arrangements; Information Sharing; Data Collection and Analysis Each Area tested against 6 Elements of Effective Practice – Statement of Purpose; Policy; Management; Resourcing; Practice; Continuous Professional Development

6. Pakes and Winstone 2007 6 Pilot Study 9 schemes Selected for diversity of delivery and geographical spread Newly established and long running schemes Based in Magistrates’ Courts, Hospitals, Local Government Offices

7. Pakes and Winstone 2007 7 A Brief Word on Provisional Findings A single bastion of best practice does not exist All schemes were driven by committed, hard working individuals often providing a first-class service in the face of numerous hurdles Variety and ingenuity

8. Pakes and Winstone 2007 8 Assessment and Screening Not all schemes undertake both activities (pro-active screening is rare) but all schemes seek to be a low threshold, easily accessible service “even if they call me and there turns out to be no mental health issues that is still good. Manager; I want him (CPN) down there (Custody Suite) so that people know who he is and what he does” Practices are, however, developing non-strategically which can lead to feelings of being asked to “be all things to all people” and to unrealistic expectations and perceptions of failure to deliver Recommendation: Having an identification strategy and development plan is important

9. Pakes and Winstone 2007 9 Facilitating Access to Mental Health Support A core task undertaken by many, but not all, schemes The differences in practice ranged between: “ once referred on then there is no control over what happens or whether the referral agency will provide what is needed for the client – aggravated by massive cultural differences” versus “we do not just refer – we physically take them to their first appointment” Recommendation: To achieve a ‘seamless’ multi-agency delivery there is merit in overlapping boundaries in service provision and admission criteria that are not exclusive

10. Pakes and Winstone 2007 10 Liaison Included constructive contact with statutory, community and voluntary providers Main issues are availability of and access to scarce resources “a grief ridden process” “nothing is easy” The importance skills of “persuasion and manipulation” to achieve “Being able to offer something – not just going through the motions” Recommendation: Protocols and Service Level Agreements would validate fragile personality/networking based arrangements

11. Pakes and Winstone 2007 11 Multi-Agency Arrangements Overall agreed as an essential part of delivery, however: – Role Boundaries “The real problem is that nurses become police officers and police officers become nurses” – Leadership and Management “You work via negotiation; who should take the lead in someone’s care planning?” Therefore clearer agreements for multi-agency work along MAPPA lines is likely to enhance multi-agency arrangements in mental health delivery for those who do not qualify for MAPPA

12. Pakes and Winstone 2007 12 Information Sharing Information sharing often reliant upon personal contacts and networking skills “when I pick up the phone they will recognise my name and voice and tell me everything I need to know – but if it was you (researcher) they might not tell you anything” Recommendation: Sustainability of information sharing arrangements is achieved through protocols “ Policy formalises informal arrangements and gives them some validity”

13. Pakes and Winstone 2007 13 Data Collection and Analysis All schemes collected some form of data All schemes acknowledged the importance of data collection and analysis Schemes used a variety of systems for data collection; most schemes felt that the resources available were insufficient, failed to capture the full range of activities and failed to measure ‘success’ Data analysis was, for most part, very limited Evaluation which might lead to bidding for resources was not strongly evidenced Recommendation: Provision of compatible IT packages measuring data over comparable values would significantly enhance the establishment of value for money practices

14. Pakes and Winstone 2007 14 Establishing Value for Money Value for money at a lowest threshold demonstrates service costs versus service outputs – a budget “We don’t have a budget!” “Whenever we need stationary or such, I have to beg, steal or borrow” “We don’t know the cost of our service. No one has ever asked” Recommendation: To establish operational budgets linked to aims that identify core and ancillary activity to create a baseline measure

15. Pakes and Winstone 2007 15 Working Towards a Unified Costing Framework Need for a comparable framework for activity costing across Schemes (including IT packages and Data Collection variables) Need to specify operating costs - fixed costs (staff, office space, etc) - variable costs (stationary, travel, training etc)

16. Pakes and Winstone 2007 16 Measuring Value For Money Outcomes: Possible Indicators Addressing The Revolving Door Syndrome Criminal Justice Outcomes Reduced involvement in CJ (reduction in frequency of offending) Reduction of use of custody Reduction in delays (for Psychiatric Reports etc) Enhanced public safety (reduction in seriousness of offence) Health Outcomes Reduced use of future services (effective assessment etc) Reduction in individual risk of harm factors (self-harm etc) Other Outcomes Increased social inclusion Reduce social exclusion through welfare provision Promote health and well being

17. Pakes and Winstone 2007 17 Summary Several best practices identified Not a case of ‘one size fits all’ Successful and sustainable models can be identified Disseminating best practice is the next challenge

18. Pakes and Winstone 2007 18 Conclusion The Fall (and Rise?) of Diversion? Lord Bradley Review: "To examine the extent to which offenders with mental health problems or learning disabilities could, in appropriate cases: – be diverted from prison to other services – the barriers to such diversion; and – to make recommendations to government, in particular on the organisation of effective court liaison and diversion arrangements and the services needed to support them."