Presentation on theme: "Race, Mental Health and Criminal Justice: Solutions for better practice Kate Davies OBE Head of Public Health, Armed Forces and their Families and health."— Presentation transcript:
1Race, Mental Health and Criminal Justice: Solutions for better practice Kate Davies OBE Head of Public Health, Armed Forces and their Families and health & Justice NHS England 6 November 2014
2Presentation to CoverThe role that NHS England has in commissioning servicesUpdate on key initiativesHow NHS England is trying to address the over-representation of people with mental health needs from black and minority ethnic communities in contact with the criminal justice system
3Health & Justice Commissioning Context £472 million budgetCommissioned by 10 Lead Area TeamsOne Health & Justice Clinical Reference GroupMixed market of providers – NHS Trusts, independent and private sectorStrong mental health links including substance usePatients are offenders, victims, detainees and familiesSupport reduction of offending behaviourStrong partnership governance and reliancePatient voice essential to monitor quality and integration of patient pathways Through the Gate
4What We Commission?NHS England is responsible for planning and commissioning health services including the public health of people in Detained and Secure Settings across a range of justice services’ sites:Prisons;Young Offender Institutes;Secure Children’s Homes;Police Custody Suites;Immigration Removal Centres;Liaison & Diversion Service, Police Custody and Courts;Sexual Assault Referral Services;Public Health in Detained and Secure SettingsKey documents are ‘Securing Excellence in Commissioning for Offender Health’ published in January 2013 and Health & Justice Commissioning Intentions published May 2014 and updated on a yearly basis
5‘During 2013/14, nearly three quarters (72% of 27,697) of detentions were of patients in the ‘white’ ethnic group. Within the black and ethnic minority group categories, there were more longer-term detentions of people in the ‘black or black british’ category than in any other category (these detentions accounted for 10% or 4,012 of all longer term detentions).’ Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment Annual Report 2013/14.
6Liaison & Diversion Services are committed to understanding the cohort of individuals passing through their respective police custody suites and criminal courts and plan to deliver services tailored to meet their needs. This will include the recruitment of a culturally competent workforce and the development of a wide range of referral pathways.An example from our London wave 1 trial site:-Liaison & Diversion practitioners at Thames Magistrates’ Court identified a number of Romanian sex workers who were regularly appearing before the court. They usually pleaded guilty and were fined, often being returned to court for failure to pay their fines. The practitioners forged links with a local third sector organisation with links to the Romanian community, that assists individuals to exit the sex industry. The L&D service makes every effort to engage with this cohort to offer assistance at the court stage and to make onward referrals to the third sector organisation. As a result the number of Romanian sex workers appearing before the court has significantly reduced both the numbers of those re-offending and those who fail to pay their fines.
7We recognise that the ageing prison population is increasing and that BME groups are historically harder to engage in services. In the Health & Justice Strategy we articulate our ambition to deliver patient driven commissioning to address the overarching inequalities for this patient population and ensure we commission for quality of delivery taking into account the particular diverse needs of this population. This includes caring for individuals across the secure and detained estate who have physical disabilities as well as those with learning disabilities. There are a small but growing number of women in secure settings who require gender specific care, not least if they are pregnant during their sentence with a small number requiring post natal care.“Health & Justice Strategy – NHS England”
8Why are Liaison & Diversion Services needed? People in contact with the criminal justice system are also known to be one of the groups of people known to be at higher risk of suicide than the general population.2004/5 found that nearly half (47%) of the offender population had misused alcohol in the past, 32% had violent behaviour related to their alcohol use and 38% were found to have a criminogenic need relating to alcohol misuse, potentially linked to their risk of reconviction.Almost 50% of adult prisoners suffer from anxiety and/or depression compared with 15% of the general population.31% of young people (aged 13-18) who offended (including young people in custody and in the community) were identified as having a mental health need.Based on the study by Harrington & Bailey (2005), Chitsabesan et al. (2006) found that 20% of young offenders had a learning disability
9Liaison & Diversion Core Model Early intervention in criminal justice processes- Identification, assessment and referralIntegrated model for children, youths and adultsTargeting a range of vulnerabilities such as- Mental Health, Learning Disability, Substance Misuse- Social issues, Housing, Education…Provision at Police Custody and CourtsHours to suit operational requirementsRange of referral pathways to suit identified issues
10Liaison and Diversion points of operation IdentificationCriminal justice agencies, such as police and courts, are trained to identify signs that an offender may have a learning disability, mental health issue, drug and substance misuse or other vulnerability.Screening and assessmentSpecialist workforce, such as L&D practitioners with learning disability expertise, carries out an assessment to identify the offenders needs and if they should be referred onwards to treatment or further support. L&D services can also call for a specialist assessment and when a specialist expertise doesn’t exist, there is an opportunity include them into the L&D workforce.ReferralOffenders needing further support and treatment will be referred into appropriate services, such as learning disability services.
11Benefits of Liaison and Diversion Improved access to treatment and support services for service users, decreasing health inequalities, improving health outcomes.Improved use of police time and possible reduction in costly adjournments and periods on remandImproved efficiency as vulnerable people are identified earlier, thus reducing the likelihood that they will reach crisis-point leading to possible reductions in repeat arrestsImproved information on vulnerable people and their conditions to the judiciary and policeReductions in the time it takes to process vulnerable individuals though police custody, by the provision of timely information to the charging / disposal processReductions in court time and unnecessary adjournments, by the provision of timely assessment informationAssurance that vulnerable people have been able to understand, and participate appropriately in the justice system
12Predicted growth in Liaison and Diversion services KEYFully specified servicesExisting L&D servicesNo cover
13Learning from Wave 1 Trial Sites in Quarter 1: MH NeedsAlcohol MisuseSubstance Misuse887394443272Numbers of adult cases identified with Mental Health, Substance and Alcohol misuse needs,(Quarter 1 data, L&D)108155183Trial Sites in Quarter 1:Returned data for 2,945 adult cases296 cases involving children and young peopleKey needs (adults): mental health, substance misuse, self harmKey needs (children and young people): mental health, family conflict, substancesOn average, more than 2 co-morbidities per service user
14Hearing from Liaison & Diversion Service Users ‘It was three years ago that my life was a living hell, it really was and looking back now it’s just, you know, every day is a blessing...[Liaison and Diversion] helped me immensely. I don’t think I would be alive today if I didn’t have that intervention’. L&D service user.‘A [Liaison and Diversion] professional who is able to assess someone from a difference and more informed perspective makes a massive difference improving treatment and outcome for those in custody’ Partnership Inspector, Newcastle Area Command‘Liaison and Diversion would support people, signpost them. Without them you are just going to have more people falling through the cracks’. Pat, L&D service user‘Liaison and Diversion has given me a chance to stop reoffending for good and I am now optimistic about my future for the first time that I can remember’. Jeff, L&D service user.
15Benefits of integrated Liaison & Diversion and Street Triage Demonstrates clear financial benefits to Police Forces;A reduction in Section 136 usage;A reduction in A&E admissions;A reduction in 999 ambulance usage;Earlier identification of mental health problems to ensure timely intervention, including reducing relapses; andRe-establish service users engagement with mental health service
16Case StudyBlack Caribbean woman aged 34, mother of 3 children, 48 offences, 8 prison sentences, crack cocaine user, victim of domestic violenceOutcome – Liaison & Diversion service intervention support includes women's centre and BME third sector provider.
17Putting Patient First: Objectives Ensure equitable access to effective treatments for the health and justice patient cohort across EnglandContinue to promote continuity of care from custody to community
18Securing Excellence in IT Services for Health & Justice Develop Health & Justice Information Systems to support data sharing across health and criminal justice pathways and to improve access, identify gaps in provision and improve quality of care.NHS England is now leading the development of a major programme to develop and improve Health & Justice Information Programme.- Phase 1, improvement of patient and information within secure settings- Phase 2, to develop Health & Justice Information Systems across all pathways of care including Police Custody, Liaison & Diversion and Childrens Secure- Phase 3, to develop a stronger focus on social care and a Full Business Case for the second generation Health & Justice Information System
19Health and Justice - The Future Integration with Street Triage, Liaison & Diversion and Police Custody HealthcareContinuity of care - Through the Gate, Custody, Prisons and Community Street Triage Mapping. Ensuring consistency and sustainability of available Street Triage across England Options for future commissioningCore DefinitionService Specification / Operating Model to support quality and patient pathwaysHealth & Justice Information ManagementTackling Health Inequalities and assuring an equivalent of care for all