How can we better support people with a mental illness who come into contact with the Criminal Justice System?

A few months ago Hafal held a seminar looking at mental health and the Criminal Justice System. The subject is an important one for our clients: many people with a mental illness come into contact with the Criminal Justice System because of their illness. Often failure to identify them early on in the process can lead to them becoming more unwell and more involved in a system which was not set up to deal with their needs.

The ‘Reducing Risk – Achieving Recovery’ seminar was the culmination of a summer-long campaign led by service user Jo Roberts, and supported by charities Hafal, CAIS, Bipolar UK, Diverse Cymru and Hafal Crossroads.

The campaign included a survey which 300 people completed, the majority of whom are directly affected by mental illness.

The results of the survey are revealing. They show that users, carers, and professionals did not believe mental health and criminal justice agencies were supporting users effectively at any stage in the pathway, as the following table sets out:

How well are mental health and criminal justice agencies doing at each stage?

A key purpose of the campaign was to ask people affected by mental illness how things can be improved in the Criminal Justice System.

One of the overwhelming responses is that mental health training is vital – for police, for judges and court staff, and for prison staff.

Put simply, our respondents believe that all staff working within the Criminal Justice System should receive training to recognise and respond to mental health problems. All staff need to know the protocols for dealing with mental health problems; all staff need to be aware of the importance of clear communication and the use of appropriate language.

And respondents feel strongly that the training should be delivered by – or should at least involve – people with lived experience of mental illness, and particularly those who have been in crisis, so that criminal justice staff get to understand the despair, distress and challenges faced by those with a mental illness.

Furthermore, respondents were especially clear that judgemental attitudes need to be addressed in all areas of the Criminal Justice System.

Some of the fundamental, long-term reforms identified by the research can be summarised as follows:-

• A specialised pathway is required for people with a serious mental illness who enter the criminal justice system. This pathway needs (1) to protect them from the damaging environments of detention, courts, and imprisonment and (2) wherever possible to divert them systematically to the most appropriate service at each opportunity along the pathway.
• Nobody with a serious mental illness should be in a police cell or prison: sufficient hospital and other specialised provision should be available – with appropriate levels of security – in all circumstances, whether or not any offence was directly connected to a mental illness. While prison is still used the needs of women and young people need to be addressed, ensuring appropriate provision is available close to home – in Wales.
• Recovery and resettlement should be foremost at all stages of the pathway, providing hope for users and families and a main focus for agencies and professionals. Care and Treatment Plans required under the Mental Health Measure provide a practical model for this focus.
• Inequalities must be addressed in particular the continuing disproportionate representation of people from black and minority ethnic communities in the criminal justice system.
• Carers and families must be supported: often providing the only consistent support for service users along the pathway, carers and families need information, training and support together with easy access to service users and to the professionals who are supporting them.

Jo Roberts, who led the ‘Reducing Risk – Achieving Recovery‘ campaign, has valuable personal experience of mental health services and the Criminal Justice System having been remanded in prison, spent time in the Caswell Clinic and Ashworth Hospital among other institutions, and having been under a Home Office Section 37/41 for many years.

Jo told me: “The ‘Reducing Risk – Achieving Recovery‘ campaign goes right to heart of what I stand for – respectful and kindly care and treatment which keeps everybody safe but also gives real hope and the prospect of recovery.

“There have been some improvements over the years but there are still too many people suffering in prison when they need hospital care or receiving only medical treatment when they need holistic  care and treatment which helps them move on and make a good life for themselves.

“Let’s work together to change the outcomes for this most marginalised and neglected group of people in both the health and the justice systems. I know so many of them well and they deserve better.”

This is what Hafal Members intend to do in the coming years: we have reported back to the Welsh Government and criminal justice agencies about our campaign, and we will make an offer to work with them to improve the lives of a very vulnerable group who deserve much better.

As part of the Action Research Project we identified the need for improved information for users and carers. To this end we have developed an interactive Criminal Justice Survival Guide which cover each stage of the criminal justice process and provides advice on people’s rights and responsibilities along the way.