Moving Forward is the title of a new briefing on race, mental health and criminal justice from four key agencies: Nacro, Clinks, the Association of Mental Health Providers and the Race Equality Foundation.
People from Black, Asian and minority ethnic (BAME) groups are disproportionately represented at all stages of the criminal justice system. At the same time, research studies and data monitoring have consistently shown that those from Black communities in particular are also over-represented across mental health services. This anomaly is compounded by the fact that both systems seriously disadvantage Black people (see my summary of the Lammy Review).
The NHS’s Five Year Forward View for Mental Health report noted that:
For many, especially Black, Asian, and minority ethnic people, their first experience of mental health care comes when they are detained under the Mental Health Act, often with police involvement, followed by a long stay in hospital.
The briefing highlights the fact that even though a significant number of service users from BAME communities access mental health services via the CJS, there is no consistently collected national data that specifically triangulates the combination of ethnicity, experiencing mental health problems and contact with the justice system. The challenge for many service users is how to effectively navigate a system that is at best confusing and impersonal and, at worst, hostile and discriminatory.
The briefing explores how pathways for people from BAME communities can be more effectively integrated to provide the most appropriate and timely support for those with mental health needs who are in contact with, or end up in, the CJS.
It looks at what strategies should be in place to:
- address key challenges highlighted by BAME communities who have experience of both the justice and mental health systems
- address disproportionality and ensure that people’s needs are effectively and appropriately addressed
The briefing highlights seven key themes:
- The interface between justice and health is multi-faceted and complex, making change challenging and complicated. This is exacerbated by the complexity of health and justice commissioning.
- Services are not adopting a person-centred approach which has a focus on supporting wellbeing and developing effective and appropriate interventions. To address this, services need to reflect intersectionality, recognising that BAME people should not be seen as a homogenous group.
- Faith is generally seen as having an integral role to play for many in BAME communities. As such, working practice when engaging with people in contact with the CJS must include considerations of faith. This includes social networking to build support and resilience as well as faith as a protective factor. Despite this, some faith groups feel that their religion is seen as a risk and a barrier to rehabilitation.
- Co-production with commissioners is vital to ensure services are reflective of the needs of those with lived experience, including lived experience of criminal justice, mental health and race/ethnicity.
- Peer support and advocacy are required to help navigate a system that is impersonal and often hostile. This should be available at all points of the justice pathway. Peers should have lived experience of both criminal justice and mental health services.
- Early intervention and prevention is reliant on people and services having knowledge of services which are rooted in communities and whose staff reflect the diversity of their service users. Those inside the criminal justice system also need to understand what services they can refer into.
- Social stigma attached to mental health may result in people not seeking help or engaging with services and is likely to make recovery harder. Stigma also includes agencies stereotyping and seeing Black people in contact with CJS as ‘more dangerous’ and communities not discussing mental health issues.
The briefing highlights the importance of listening to BAME people with lived experience of the criminal justice and mental health systems in designing better services before setting out seven recommendations:
- Commissioners and providers should ensure that a wide range of tailored services are available to meet the needs of different BAME groups. These should include both peer support and independent advocacy services at all points on the justice pathway. Peer support should be provided by people with experience of both the criminal justice system and mental health or other vulnerability e.g. learning disability or substance misuse.
- Assessments completed at all stages of the justice pathway including those by liaison and diversion teams, prison mental health teams and police custody healthcare should appropriately assess the impact of trauma and consider the spiritual and faith needs of individuals and integrate this understanding into each individual’s care plan.
- Service providers should ensure that all printed materials use diverse images, have an easy read copy available, and are available in different languages for those for whom English is not their first language and for those with learning difficulties.
- Commissioners, service providers and criminal justice agencies should engage with anti-stigma initiatives.
- The prison environment needs to become psychologically informed to support and promote the mental wellbeing of people in prison, including those from BAME communities with mental health difficulties. It should also endeavour to improve behavioural outcomes of prisoners and those working within the prison setting.
- The Ministry of Justice should develop its systems to report anonymised single case data for analysis. The Ministry of Justice, NHS England and other partners should work together to develop data analysis systems that can report triangulated data for race, mental health and criminal justice, and intersectionality to include protected characteristics, mental health and criminal justice.
- Organisations providing services to people in the criminal justice system should collect case studies that demonstrate the effectiveness of interventions to address disproportionality.
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