Partnership work

There are many benefits to making sure that we understand the mental health needs of people on probation and address them. Criminal justice and health agencies need to work together to make sure that people get the support that they need with their mental health. However, currently, the services that are provided are not always suitable to meet this population’s needs, and people on probation can face numerous barriers to accessing care.

This evidence review looks at:

• The benefits of focusing on the mental health of people on probation
• What we know about the mental health of people on probation
• The organisation of mental health care, current initiatives, and challenges to providing high-quality care
• What good quality care for people on probation looks like
• Improving the evidence base and provision of care.

Benefits

A number of arguments for the benefits of focusing on the mental health of people on probation have been articulated in the literature. These include:

• Prevalence and opportunity to engage support: As the section below shows, we can expect that around 40% of people on probation are experiencing a mental illness at any given time, but not all of them will be accessing treatment or support. Contact with the Probation Service can provide an opportunity to engage people with support who may not otherwise access it.
• The moral argument and rehabilitation: “people with a mental illness need and deserve treatment” and ensuring that people get appropriate support contributes to the Probation Service’s rehabilitation role.
• Reducing re-offending and cost savings: The relationship between mental illness and offending is complex, but mental health crises and behaviours such as self-medicating with drugs and/or alcohol can bring people into contact with the criminal justice system. As part of the Probation Service’s public protection role, such risks need to be monitored when someone is under probation supervision. Addressing such needs as soon as possible may contribute to improving compliance with community orders and ensuring that people are able to engage well with probation and other agencies. It may also contribute to reducing re-offending, and potentially produce cost savings in terms of avoiding (re)imprisonment or use of crisis services such as Accident and Emergency (A&E).
• Importance within the judicial process: We need to know whether someone understands what they are being accused of and that they have the capacity to plead and stand trial. Staff also need to consider the appropriateness of options such as diversion from the criminal justice system or recommending a Mental Health Treatment Requirement at sentencing.
• Community dividend: Improving the mental health of people on probation can have wider societal benefits, for example through reducing health inequalities and fear of crime.

Best practice

Generic services do not always work well for people on probation. Whilst we may not want to create services that are exclusively for people on probation, it is important that the needs and experiences of this population are fully considered in the commissioning process and for probation-specific elements such as clear access routes that staff can use to support people who may struggle to navigate services on their own to be available.

The probation inspectorate produced an effective practice guide for mental health in 2022. This guide was aimed at a probation audience and emphasises a number of elements that relate to best practice with working with people with mental illness on probation including:

• Accurately identifying (the severity of) mental health need. 
• When a mental health need has been identified, this should be followed by comprehensive plans to address the identified need.
• Taking a personalised and trauma-informed approach.
• Agencies working together to ensure that individuals receive all of the support that they need.
• Effective training and leadership.
• A national strategy to support work in this area.

We know that provision is poor in this area so it is very helpful that the authors conclude the review by identifying the critical success factors of working well with people with mental health problems:

• A compassionate and person-centred approach in probation practice
• Routine screening, assessment and recording of mental health status when on probation using validated screening tools rather than simple self-report.
• Routinely collecting feedback on people on probation’s experience of and satisfaction with care.
• Prevalence, experience, and satisfaction data informing local-level commissioning decisions as an essential step towards ensuring that services are available that meet their needs.
• Multi-agency collaborative working to create straightforward access routes for self and supported-referral. It should be clear what mental health services are available, what their eligibility criteria and access routes are both in terms of self-referral, and in terms of cases where an individual feels that they would benefit from probation staff supporting them to access care.
• Addressing current challenges around multi-agency working and information sharing.
• Processes to support GP registration for people on probation.
• Investment in training for probation staff, and in providing community-based mental health services, and services that support continuity of care on release from prison.
• Investment into the probation service to ensure caseload sizes are appropriate and that the number of times that an individual’s supervisor is changed is minimised.
• Ensuring that initiatives aiming to improve mental health care and access for people on probation are formally evaluated and findings are widely shared.
• Lived experience input – for example into training, mentoring, and providing feedback on care.

Conclusions

The authors conclude by saying that despite very committed staff, there are multiple failures in this arena especially for people with a serious mental illness with only half of this group in touch with services. They recommend that probation staff receive systematic training in mental health issues and point out the need for conversations between probation and local mental health services and the development of referral pathways.