Paula Reid was awarded a Fellowship from the Winston Churchill Memorial Trust to travel to the USA and Canada to look at responses to mental illness in the criminal justice system. Her Fellowship report, including case studies from the USA, Canada and the UK, was published in July.
The response of the criminal justice system to people affected by mental illness has had a welcome focus in recent years. This group is disproportionately represented at all stages of the system, from the volume of mental health calls to police, to the statistics showing extremely high rates of mental illness in prisons.
Lord Bradley’s seminal report on this issue in 2009 made a number of recommendations and there has been some significant progress.
Most recently there has been a Government commitment of extra funding to develop the national liaison and diversion programme and the publication of the Mental Health Crisis Care Concordat, to ensure a timely and appropriate response to people experiencing a mental health crisis rather than an over-reliance on the police to fulfil this role. However we still have a way to go.
It was against this background that I was awarded a Churchill Travelling Fellowship last year to look at how programmes in the USA and Canada were better supporting people affected by mental illness in contact with the criminal justice system. I visited a range of projects across policing, prison, courts and community mental health services to see what could be learned and applied to a UK context.
Although the schemes varied significantly, the one key factor they all shared was a collaborative approach, pulling on a number of different local services and agencies. This allows communities to make the best use of limited resources and ensure that the right expertise and support are available at the appropriate time.
Mental health courts have been operating in the USA and Canada since the late 1990s. Although they vary in scope, their principal aim is to divert people from prison sentences into community-based services and support.
The mental health court involves a number of different agencies within the criminal justice and mental health systems, including the judiciary, defence lawyers, the prosecution, probation staff, mental health service providers and more. All these agencies employ a problem-solving approach and work together with the mental health court participant to support them to engage with an individualised, holistic treatment plan.
These treatment plans are different from the Mental Health Treatment Requirement (MHTR) available as a component of community sentences in the UK. People enrol in mental health courts voluntarily and have to agree with the treatment plan, rather than it being mandated as part of a sentence. Many mental health courts work with people pre-prosecution, so there is no admission of guilt in enrolling in the programme. If people successfully complete the treatment programme set out by the mental health court, their charges can be dismissed completely or reduced to lesser charges, and a prison sentence is avoided.
One of the key strengths of the mental health court is its collaborative approach to supporting people going through the programme. Mental health court participants attend regular review meetings with the judge, prosecution and defence lawyers and their case managers. These are usually fairly informal and are an opportunity for any concerns or challenges around the treatment plan to be raised and resolved, with input from all the different agencies. The case manager will also work with other agencies outside the court, such as housing services or drug and alcohol services, to ensure a holistic support package is available.
The problem-solving nature of the mental health court model means that there is a focus on trying to work out what extra support people might need in order for them to fulfil the court’s requirements, rather than sanctions as a first response. Sanctions are used in mental health courts, but there is often flexibility and other options are explored before this step is taken. The various mental health court agencies also work together with the person to ensure that plans are in place for when the person completes, or ‘graduates’ from, the mental health court programme.
The mental health court model does have its critics, who feel that it can be paternalistic and that it keeps people in contact with the justice system longer than traditional processes. People might be in mental health court anywhere from a few months to two years, depending on the local set-up.
However current research also shows some really positive results from the programme. Mental health participants view the process as fair and impartial and value the opportunity that they are given to raise concerns and be involved in the process. In terms of criminal justice outcomes, reoffending is reduced and participants have fewer prison days. These positive outcomes are still evident two years after successfully completing the programme.
Part of this success is due to the more collaborative approach of agencies around the court. By working together in a responsive and flexible way, they can not only offer a more comprehensive package of support for the person, but also ensure they are drawing on resources as and when they are needed.
Even without adopting a full mental health court model in the UK, there is a lot that can be taken from its problem-solving approach. In 2009, the Ministry of Justice ran a pilot mental health court scheme, the main aim of which was to deliver community sentences more effectively, rather than as a pre-sentencing diversion programme. The pilot found that the scheme led to really innovative multi-agency working and saw this as one of the key strengths of the approach.
We must ensure that existing barriers to collaborative working, particularly around information systems and data-sharing, are addressed so the collective skills, experience and passion of professionals across sectors can be best utilised. In a time of budget pressures and uncertainty, it is easy for organisations to turn their focus inwards. However this is one issue on which we cannot afford to isolate ourselves – the cost for people with mental illness is too great.
Paula is a Senior Policy Officer at national mental health charity Rethink Mental Illness and a Fellow at the RSA. You can download a copy of her report and find out more about her project at http://atlanticdiversions.wordpress.com/report/.