Last week (13 August 2020), the probation inspectorate published another in its new series of specially commissioned research papers aimed at exploring the evidence base underpinning probation practice.
Authored by Professor Charlie Brooker and Dr Coral Sirdifield, this paper focuses on maximising positive mental health outcomes for people under probation supervision.
The authors acknowledge that there is a limited evidence base on the mental health needs of people under probation supervision. Many of the existing research studies focus on particular sub-sets of the probation population. This, combined with methodological differences between studies, makes it hard to compare findings across the literature. However, it is clear that there is a high prevalence of mental illness in probation populations around the world, with many people under probation supervision experiencing more than one mental illness (co-morbidity) and/or a combination of mental illness and substance misuse (dual diagnosis).
The National Probation Service (NPS) recognises the importance of focusing on health, and has a commitment to ‘improve the health and wellbeing of people under probation supervision, and contribute to reducing health inequalities within the criminal justice system’ (National Probation Service, 2019: 10). It is important to maximise positive mental health outcomes and ensure provision of equivalent mental health services for a number of reasons:
- To improve the health and wellbeing of these individuals.
- As part of a wider agenda to reduce health inequalities across society.
- To improve compliance with probation.
- To reduce reoffending and thereby future criminal justice costs.
- To produce a wider community dividend through benefits such as reduced fear of crime and reduced NHS costs.
Recently, probation staff and those working in other agencies supporting people in the criminal justice system have had to rapidly change their practice as a response to the COVID-19 pandemic. Presently, there is little research to show the impact on the mental health of those under supervision. The social distancing measures in place across England and Wales may have created additional stress for both staff and those being supervised, and made it difficult to maintain supportive relationships. Discussion of sensitive issues such as mental health, and identifying signs of deteriorating mental health, is also likely to have been problematic whilst supervision is ‘locked down’. In some cases, necessary changes to practice may have caused disruption to care, or meant that care has to be accessed digitally or over the phone. In others, it may be that the situation has acted as a catalyst for existing efforts to improve partnership working between health and justice agencies. It is important that the potential for exacerbation of mental health issues is considered in the Probation Business Recovery Programme planning.
Research suggests that people under probation supervision can encounter many barriers to maximising positive mental health outcomes. Despite having a high level of mental health need, many people in this population do not access mental health services until they are at crisis point. This results in use of expensive care such as Accident and Emergency departments, which could potentially have been avoided if services had been accessed earlier. Causes of a lack of engagement with services and poor health are varied, and encompass inter-connected personal level, service level, and societal level factors.
There are a number of steps that individuals under probation supervision, professionals working in the health and justice field, policy makers, and researchers can take to maximise positive mental health outcomes for people under probation supervision including:
- Improving literacy and health literacy
- Improving commissioning processes and provision for complex needs
- Improving access to data and training
- Increasing integration between health, social care, and probation services
- Improving GP access
- Addressing the social determinants of health
- Investing in research and evaluation
Potential models of practice
There are no proven models of effective practice in this areas but some potentially fruitful approaches include:
- Diversion programmes (mental health liaison and diversion teams now operate across England & Wales)
- Psychiatric input in probation
- Specialist caseloads (a common model in the USA).
The authors identify nine key action points to support a co-ordinated move towards maximising the mental wellbeing of people under probation supervision:
- All probation clients should have their mental health assessed and recorded. This will require investment in training and ideally should take place as a part of mandatory probation staff training.
- Aggregate level data on health needs should be shared with service commissioners.
- The number of Joint Strategic Needs Assessments that include the health needs of people under probation supervision needs to increase substantially.
- Gap analyses need to be conducted to assess the extent to which the needs of people under probation supervision are currently being met.
- Investment by CCGs (and in the future Integrated Care Systems) needs to increase to ensure sufficient appropriate service provision is available to meet the complex needs of this population.
- Clear pathways into services need to be created between probation and Mental Health Trusts.
- All Local Authorities need to acknowledge the high level of suicide in probation populations in their suicide prevention strategies.
- Investment needs to be made into research and evaluation to investigate the effectiveness of different models of working to improve mental health outcomes for people under probation supervision.
- Those working in health and justice need to be aware of the potential for exacerbation of mental health issues due to the impact of the COVID-19 pandemic. As part of recovery planning work, systems need to be in place to ensure that both staff and those being supervised can access appropriate support. This could be via dedicated phone lines, support with accessing primary care, and closer partnership working with local Mental Health Trusts and voluntary sector agencies.
Thanks to Artem Beliaikin for kind permission to use the header image previously published on Unsplash.com.