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Criminal justice system still failing people with mental health issues

Joint inspection finds that thousands of people with a mental illness are coming into the criminal justice system each year but their needs are being missed at every stage.

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Not enough progress over last 12 years

A major new joint inspection published today (17 November 2021) has found poor support for people with mental health issues as they progress through the criminal justice system in England and Wales. Inspectors labelled the findings “disappointing” and said too little progress had been made since the last review in 2009. The inspection was conducted by:

  • HM Inspectorate of Constabulary and Fire & Rescue Services
  • HM Crown Prosecution Service Inspectorate
  • HM Inspectorate of Prisons
  • HM Inspectorate of Probation
  • Care Quality Commission
  • Healthcare Inspectorate Wales.

Inspectors looked at more than 300 cases from six regions, interviewed 550 professionals, and heard from 67 people with mental health issues who had been through the criminal justice system. Their headline findings were:

  • Thousands of people with a mental illness are coming into the criminal justice system each year but their needs are being missed at every stage.
  • “Broken” system for sharing information between agencies, with confusion over data protection rules and incomplete/inaccurate records.
  • Shortage of services and long delays to access them – made worse by the pandemic.
  • Unacceptable delays in psychiatric reports for court and in transferring extremely unwell prisoners into secure mental health hospital beds for treatment.

Findings

The main findings of the report are summarised below.

Lack of a common approach

The lack of a common definition of mental ill health means nobody has an accurate picture of the numbers of people with mental health issues in the criminal justice system, or the collective needs or risks posed by these individuals. Inspectors found a myriad of systems are used to screen and assess people as they are arrested, charged, sentenced and supervised. Incomplete or poor records mean individuals might not receive appropriate treatment, charging decisions are affected, and there are delays to court proceedings.

There is widespread confusion over confidentiality and data protection rules – leaving agencies unable to access pertinent information and leading to poorer mental health outcomes.

Inspectors interviewed police officers who said they were unclear when they could share information about an individual’s mental health with the Crown Prosecution Service. This was despite the Data Protection Act (2018) including an exemption for sharing data for justice purposes. This gap means prosecutors, defence lawyers, judges and magistrates can make decisions without crucial details.

Poor information-sharing hampers work in prisons and probation services too. As a result, prisoners transferring in and out of prison do not get seamless support with their mental health needs. Probation practitioners reported their work was often hindered because community mental health services would not allow them to access information about the individuals they supervised – despite the fact these requests are lawful.

Resources

The inspection found delays are common at every stage of the criminal justice system. Courts face long waits for psychiatric reports, which are used to make sentencing decisions. The shortage of good-quality mental health provision leads to “unacceptable delays” for individuals accessing services.

Inspectors found extremely unwell prisoners were often left in prison instead of being transferred urgently to mental health hospitals. Delays were often caused by a lack of medium and high-security beds; the mental health of these prisoners often further deteriorated as they waited.

Inspectors have called for urgent steps to be taken to address the situation, to meet the 28 day targets from first assessment to transfer now laid down in NHS guidelines.

Black, Asian and minority ethnic people are both overrepresented at every stage of the criminal justice system and at comparatively higher risk of mental illness. Inspectors found a lack of specialist services for these individuals.

Some progress

Although inspectors concluded that not enough has changed in the 12 years since the last joint inspection, they did, however, note improvements in some areas.

Inspectors welcomed the roll-out of mental health liaison and diversion services in police stations and courts, and recent initiatives to increase the number of Mental Health Treatment Requirements given by the courts. There has also been a significant fall in the use of police custody as a “place of safety” for people in mental health crisis.

Inspectors found police officers had a good understanding that minor crime – particularly crime caused by mental health issues – could be dealt with using a health care approach.

Lived experience input

To underpin the report, the Inspectorates commissioned Penal Reform Solutions to explore the journey through the criminal justice system and its impact on mental health from a service user perspective. PRS gathered the views of 67 people with lived experience by letter (with people in prison) or telephone (with people on probation) and also asked people to share their experiences via artistic expression – poetry or drawings.

Below are a series of quotes from people with lived experience at different stages of the criminal justice system (all names have been changed):

On arrest:

  • Filip said he was left alone for three days in police custody. He spoke to a mental health nurse briefly about having suicidal thoughts. He said: “(Arrest) was the lowest point in my life. (It was) unbearable, shocking… full of worry and fear… I did not understand what was going on in my mind.”
  • Marcus found the experience of being arrested: “exhausting, confusing and frightening.”
  • Sammy said: “It’s only reflecting back I realised how bad it was… It traumatised me for a long time, how I was handled (in the police station) and treated… I was disassociated, detached and suffering psychosis and anxiety. They (police) didn’t notice… they interviewed me anyway. For months after, I’ve had panic attacks and nightmares.”

 

On courts:

  • George said: “Courts are eerie places, everything feels unnatural and on edge and that doesn’t help with anyone’s mental health, even if you consider yourself to have good mental health.”
  • Luke said: “I was on remand for eight months, and going back and forth from court four or five times a month and always ending up with a new pad-mate (cellmate). It was a real struggle, as I didn’t know who I was going to get. It’s the last thing I need after having my life dragged out through court.”

 

In prison:

  • Wilson described informing his block manager that he has Asperger’s syndrome. Wilson said: “They just gave me anti-depressants to shut me up and fob me off.” He wrote to the mental health team and was told he did not quality for help, despite being on medication for anxiety and depression for eight or nine years. Wilson said: “I asked to see a counsellor, which took five months to process – only to have an appointment where they didn’t show up… I sat in my cell full of anticipation and anxiousness.”
  • Lilly commented that when a prison officer stopped and talked to them, it demonstrated that someone cared. She said: “Just having a trained officer to chat to for five minutes, to ask how you are doing and to talk to, really does make a big difference. It doesn’t have to be someone from the mental health team even.”
  • Steven said: “The constant noise in prison forces tension on you, in an already hostile existence.” He described an incident where he had a mental health crisis: “My cell bell had been going off for over four hours… all I wanted to do was talk to somebody, a listener [this person resides in prison and has been trained by the Samaritans to offer a listening ear]… it was the lowest point of my prison mental health… (I) felt like I have been denied air to breathe.”

 

On probation:

  • Several interviewees reported that they felt the Probation Service was “on their side”. Filip said: “She (probation practitioner) has taken into consideration my view and has given me the feeling that I have a voice… (this) impacted massively on my mental health”.
  • Brian said: “Probation knew my struggles with drink and have played a key part in helping me stay sober and finding a healthier way to deal with my mental health.”
  • However, others felt talking about their background with a probation practitioner could cause trauma. Cooper said: “There is no point bringing up shit from when I was a kid… this causes mental health problems.”
  • Jakob said: “I have been moved from probation officer to probation officer and I sit there wondering if the (criminal justice) system has given up on me. I have no belief in the system or believe there is genuine care there for me and my mental health.”

Recommendations

The report concludes with a series of 21 recommendations aimed at different authorities within the criminal justice system. Many of these are concerned with the need for more resources, better mental health training for staff and improving information sharing across the system.

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