: . _=

Mentally Disordered Offenders

Inter-Agency Working

\

Produced by the HomeOffice and the Department of Health- 1995

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Contents Page

Introduction ............................................................................................. 5

1. Centrally funded projects ................................................................. 6

2. Health and Social Services ...............:............................................. 10

3. Police ................................................................................................ 14

4. ProbationService ............................................................................ 19

5. Courts (Magistrates' Courts andCrown Courts) .................................................................... :.......... ......... 21

6. Prison Service .................................................................................. 23

7. Legal Representatives ............................................................... .....25

8. Homelessness and Ethnic

Monitoring ................................................ ............................................. 28

Annex ............................................................................. .:......................29

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Introduction Since the issue of the Circular inSeptember1990, a wide range of

It is the Government's policythatthose initiativeshas been undertaken,bothsuffedngfrom mental disorderwho require centrallyand locally. This booklet,whichspecialist medicaltreatment or social has beenproducedjointlyby the Homesupportshould receive it from the health Officeand Departmentof Health,givesand socialservices. Those who are some informationaboutthesesuspectedof committingcriminaloffences developmentsandreinforcesspecificshouldbe prosecutedwhere this is pointsaboutthe role of thoseinvolvedinnecessaryin the public interest. In cases at a locallevel. We hopethis maydecidingwhethera personshouldbe be helpfulin assistingthoseworkingin the"charged, it is essential that account is cdminaljusticesystemand inthe health

" taken of the circumstancesandgravityof andsocialservicesin reviewingcurrentthe offenceand what is knownof the localarrangementsand in consideringperson'spreviouscontactswiththe what more mightbe doneto promotecriminaljustice systemand the psychiatric effectiveinter-agencyworking.and socialservices.

' Where proceedings are instituted, accessto treatment or care should not be delayedor prevented and the needs of mentallydisordered people should be properly met,for example, by the use of bail with acondition of residence at a hostel or ahospital, by remanding to hospital, bytransfer from pdson to hospital.or by themaking of a hospital or guardianship order..However,mentally disordered peopleshould notbe drawn into the cdminaljustice s.ystemunnecessadly, for examplein the hope of secudng treatment in prison'.Detention in pdson is likely to bedamaging to the mental health of a•mentally disordered person, and thePdson Service is not equipped to providetreatment equivalent to that available inhospital.

" These pdnciples were set out in HomeOffice Circular66/90 aboutthe provisionwithinthe cdminal justicesystem and thehealthandsocial servicesfor mentallydisorderedoffenders. It describedtheexistingpowersavailableand it alsoencouragedthe developmentof inter-agency co-operationas the meansofmakingthe mosteffectiveuse ofresourcesand of developingarrangementsso that the trea|mentandcare needsof mentallydisorderedpeopleare met whetheror notcriminalproceedingsare taken.

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1 Centrally Funded area. Three types Ofinformationwere• sought;the perceptions of relevant

Projects professionalsworking in this field;factualinforrnationaboutthe range andscope of services and resources

Pilot Projects available and statistical data about thenumbers of offenders being dealt with.

The Home Office joined with the Mental This produced a core of findings onHealth Foundation to fund three pilot which recommendations for change

" projects on mentally disordered could be based.offenders to run for three years fromJuly 1990. These were undertaken by The second phase involved agreementthe National Association for the Care on, and implementation of,and Resettlement of Offenders recommendations for change, many of(NACRO) and took place in which have already been put in place.Birmingham, Kirklees and Liverpool. Many of these recommendations

: Their purpose was to encourage concerned either new or improvedeffective co-operationbetween those agreements on policies and proceduresworking in the criminal justice system while others tackled specific problems.and the health and social services to They included:ensure that the health and care needsof mentally disordered offendersare • the development of a rota ofmet. The aims included identifying the trained volunteers to act aschanges needed at a strategic level to 'appropriate adults' (who aremake more effective use of available required to attend duringresources, and improvingthe questioningby the police ofstructures, networks and working mentally disordered person)';practices at service level. It was hopedthat this approach would produce • improved training for the police,examples of good practice for wider clerks to the justices andapplication, magistrates;

A policy development officer was • the" production of laminated cardsappointed for each area and steering setting out procedures and optionscommittees set up in all three under the for the police and courts;chairmanship of a Senior Recorder for

each locality. The other members were • improvedarrangements for passingsenior officials from each of the key information to the Crownagencies in the criminal justice system Prosecution Service; and

i:_. and the health and social services.

.. The initial meeting of each steering • consideration of the development.committeewas held in March 1991 and of cautioningpanels and a system

. interim reports on progress were for 'fast track' processing by courtssubmitted to a national steering of cases involving defendantscommittee comprisingofficials from the sufferingfrom mental disorder.Home Office, the Crown Prosecution

Service, the Deparlment of Health and This booklet describes several of theserepresentatives from the Mental Health proposals in more detail.Foundation.

All three projects have had aProgramme of work considerableimpact on local

• arrangementsand acted as a catalyst• Each local steeringcommittee agreed forother initiatives.There is a clear

a programmeof workin threephases, commitmentto continuinginter:agencyThe firstwas to establisha common arrangementsbeyondthe periodofunderstandingand approachto the NACRO's directinvolvement. Inproblemwhichincludeda additionto respondingto the local

•comprehensivereviewof current recommendations,NACRO produced- arrangementsfordealingwith mentally distancelearning materialsfor the

disorderedoffendersin the project police,magistratesand justices'.clerks

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and good practice guidelines. Policy assess the extent to which the lessonsdevelopment officershave arranged from the pilot projects have generalseminars for middle managers and application. NACRO has identifiedfront line staff in each of the areas to existing inter-agency initiatives intry to ensure effective dissemination, several new targeted areas and helped

to build on these by using a refinedEvaluation version of the comprehensivereview

undertaken in the three original projectThe final phase involvedthe evaluation: areas and by developing improvedand assessment of the three projects in information record!ng and monitoringorder to provide information about the . arrangements. NACRO is beingresource implications of such schemes funded to continue this project work inand ways in which they might be 1994195and developed a computeriseddeveloped in future. A key finding from information system to provide quickthe three projects is the need for information about good practice anddevelopmentto be overseen and : practical advice on developing inter-driven by inter-agencygroupings which agency schemes. Details of thebring together senior representatives services NACRO offers are set out infrom all of the relevant agencies. The the Home Office letter of 26 Augustevidence from the NACRO projects : 1994 which was issued to health andsuggests that where such a body is social services under cover of aestablished, together with a'clear work Department of Health letter of 26programme, it is possible to achieve a September 1994.good deal within the Contextof existingstaffing and resources, forexample, by Psychiatric Assessment Panelsmaking effective and appropriate use ofkey staff time. Such improvements Annex C of Home Office Circular 66190also helped cladfy important gaps in described a multi-agency assessmentexisting provision and led to new scheme in operation in Hertfordshireinitiatives such as the attachment of a which had been established to co-community psychiatric nurse to a polic_ ordinate the contributions of variousstation in Birmingham (see section 3). agencies involved in preparingvarious

• " agencies involved in preparing reportsThe Home Office Research and on an accused person's mental,state.Planning Unit has undertaken an and the availability of hospitalevaluationof the pilot projects. It accommodation or community care. -concluded that participants in local The improved service to the court,steering committees thought the which receives a more detailed

• projects had been useful and that, assessment of the accused andwithoutNACRO's involvement,change informationaboutthe availableoptionswouldhave beenslowerandmore other thana custodialsentenpe,difficultto achieve. "l'hevalueof an enables mentallydisorderedoffendersindependentfacilitatorinhelpingto to obtainaccessto the healthand

•obtaininter-agencyagreementwas socialservicesand offersthealso recognised, opportunityof preventingfurther

offendingand mentalrelapse.An account and evaluationof theNACRO initiative for mentally In view of the provenvalue of thedisordered Offenderswas published in HertfordshireScheme, the Home OfficeApril t994 (as a 1994 London Home decided to fund the HertfordshireCareOfEce- NACRO - Mental Health . Trust for two years from Autumn 1990FoundationOccasional Paper). This to employ a probation officer and acan be obtained from the Home Office community psychiatric nurse toUbrary, Queen Anne's Gate, London, - promote the panel assessment scheme.

SWlH 9AT. and the concept of inter-agencyworking. The aims of these panels are

Current work to encouragecloser inter-agencywork_to providecourtswith more

The Home Office also funded NACRO constructive and coherent reports into undertake an additional project to terms of the assessment of the

6 14835

individual and to propose a co-ordinated package for the management • all agencies involved must makeof the individual's case which may, an initial commitment including awhere appropriate, include a probation willingness to allocate resourcesorder with or without the condition of needed to make the scheme work;psychiatric treatment and may alsoinvolve links with the education and • a steering group is •neededfromhousing services, the outset to give a Sense of joint

" ownership of the project, commonAlthough the constitution of a panel purpose and a vested interest in -may vary according to local seeing the arrangements succeed;requirements, a typical panel mayinclude a consultant psychiatrist, a • membership of the group must be

•clinical psychologist, a community at senior level to be able topsychiatric nurse, a probation officer implement agreed policies;anda social worker. It may alsoinclude a general practitioner, a • arrangements must be Setup tohousing officer, an employer and monitor and evaluate the scheme.

'members of the individual'sfamily.The initial pattern was for panels to More information is contained inconsider cases during the period of Research and Planning Unit Paper 76adjournment for medical and social available from the Information Sectionreports but during the course of the of the Home Office Research andprojecta variety of schemes emerged Planning Unit, Queen Anne's Gate,tomeet local circumstances. London SW1H 9AT.

The high level of commitment of the Contact pointorganisers meant that the development

project met its aims very effectively. The organisers developed considerableRequests were receivedfrom around expertise in the practical aspects ofthe country for the organisers to give mufti-agency working and clarifying theadvice about multi-agency working and roles of the various agencies. Althoughto participate in local steering groups the project has concluded, one of thewhich had set up and managecl .organisers- Mrs Dorothy Tonak MBEassessment schemes. At the - has kindly agreed to continue toconclusion of the project, some 40 respond to enquiries about theschemes were in existence and bait knowledge and experience Shehasthat numbermore in planning..The gained. She has acted as an adviser "demand createdbythe organisers' to the Universityof Hertfordshirewhicheffortsseems likelyto continuefor " offersprogrammesdesignedtomeet

' , some considerabletimp. " the trainingneedsof the variousdisciplinesinvolvedin multi-agency

Evaluation working. She also assistsa multi-" disciplinaryteam establishedby the

•The HomeOfficehas also undertaken Centrefor Mental Health Servicesresearch intothe effectivenessof panel Developmentat .King'sCollegeassessment schemes and has looked, Lqndon,whichprovidesassistanceforin particular,at the oPerationof three localagenciesin developingjointspecific schemes and the impact at _trategies for improvedlocal servicesnational level of promoting.the idea. for mentallydisordered offenders.The study concluded that where panelassessment schemes have been . Mrs Tonak canbe contacted at: Littleoperating they have made a significant Adstock, Adstock, Bucks, MK18 2HTcontributionto ensuringthat properly (0296 713439) or The Centre forinformeddecisionsare made about Mental Health ServicesDevelopment,mentallydisorderedoffenders. While King's CollegeLondon (0171 333 .there is no singleideal model,because 4194).each scheme is adapted to meet localneeds,a numberof commonfeatureswere identifiedas key elements:

7 14836

Enquiries about the University ofHertfordshire programmes should be The consensusof those involved in themade to: organisation of the conferences and

participants who responded to theLisa Maclean, Division of Mental delegates' questionnaire is that theHealth, School of Health and Human events have been successful and,. inSciences, University of Hertfordshire general, met most of the aims of the(01727 823333 ext 2763). After June project. In particular, the conferences1995, enquiries should be directed to have raised awareness of mentalthe Hatfield Campus (01707 284000). health issues and of the nature and

concerns of the different services andREGIONAL CONFERENCES professions in relation to them and

generated considerable interest inA major joint central initiative in carrying forward issues at the local1992/93 to promote inter-agency co- operational level as well as atoperation and the development of management level. A significanteffective local inter-agency degree of agreement, enthusiasm andarrangements has been the series of commitment among•all practitionersconferences in the (then) 14 health was evident although a wide range ofregions in England and in Wales. The issues and questions were identifiedHome Office, with the support of the about the difficulties in taking forwardDepartment of Health, commissioned inter-agency working.and funded the Mental HealthFoundation to organise the Evaluationconferences, which were aimed atsenior managers and practitioners in The Mental Health Foundationthe health and social services as well published a report-on the conferencesas senior members of the judiciary, in November 1994. It includes themagistrates, the legal profession, the findingsof a survey of over 200police and the prison, court and delegtates,undertaken by the Homeprobation services. Office Research andPlanningUnit,

which indicates that these events areThe purposesof the conferences were regardedas having made a usefuldefined as follows: contributionto the development of local

arrangements. The report has been(i) to stimulate joint working circulatedwidely to those working in

between health and social the criminal justice system and in theservices in both the statutory health and social services. Furtherand non-statutory sectors, copies are available (price £9.50) fromcriminal justice agencies, the Foundation at 37 Mortimer Street,

• "_ " magistrates and the judiciary; London, WlN 7RJ. The twoDepartments,togetherwith the

(ii) "to emphasise_ importanceof Foundation,are considering,how.best•. effectivearrangementsfor the to build on the achievementsof the

assessmentand, where conferences.necessary, accessto healthand socialservices of mentallydisorderedoffenders(whetherdetainableor notundertheMental HealthAct 1983);.

(iii) to considerthe full range ofservicesthat needsto be inplace to complement(ii)as well -as their planning,purchasingand provision;and

(iv) to encouragethe jointdevelopmentof localactionplans.

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2. Health and Social TheGovemmentconsidel:sthatthefindings of the review will set the

Se rvices agenda for the development of servicesfor mentally disordered offenders for

Health care policy many years to come.

The Government supports the policy Advisory committee on mentallythat mentallydisorderedpeoplewho disordered offendersrequire treatment and supportbecauseof their health care needs should be The Secretary of State for Health andcared for or treated: ,the Home Secretary have accepted a

recommendation arising from the

, with regard to the quality of care review of services to appoint anand proper attention to the needs advisory committee on mentally

disordered offenders. Its terms ofof individuals; referenceare to advise the

• as far as PoSsible,in the Government on issues referred to itcommunity rather than in arising from the implementation of theinstitutional settings; recommendations of the Reed

Committee and on other issues relating

• under conditions of no greater to provision for mentally disorderedsecurity than is justified by the offenders referred to it by the twodegree of danger they present to Departments. Its members are drawnthemselves or others; from relevant services in health and

social services, the criminal justice

• in such a way as to maximise system, and the voluntary sector,rehabilitation and their chances of together with representatives of

government departments. Itssustaining an independent life; secretadat is provided jointly by C3

Divisionof the Home Office and tl_e+ as near as possible to their own Health Care Division of the Department

homes or families, if they have of Health.them.

Review of Legal Powers andReview of services for mentally Community Caredisordered offenders

An officialreviewteamwas formedinA joint Department of Health/Home January 1993 to considerurgentlyOffice review of services for mentally whether new legal Powersare neededdisordered offenders(The"Reed" to ensure that mentally ill people in theCommittee) completed its work in 1992.It circulatedfor consultationeleven communityget the care they needand ;adv=_oryrePorts- whichhave now whether the presentlegalPowersin the

Mental HealthAct 1983 are beingused

been publishedin7 volumesbetween1992and 1994:the FinalSummary as effectivelyas they can be. It was_. Report(Cm 2088); service needs cardedoutin the lightof the fact that

(rePortof the community,hospitaland the principleof a locally-basedserviceprisonadvisorygroupsanda Steering for mentally,ill peoplehas provedto beCommitteeOverview);finance,staffing successful:the greatmajorityofand training;the academicand dischargedpatientsare leadingresearch base; specialissuesand .+ peacefulandsafe livesinthedifferingneeds;race,genderand equal community.

opportunities;and peoplewith learning As a resultof the review, the Secretarydisabilities, of State for Health announced on+12

August 1993 a T.enPoint Plan toCopies of all these documents can be reinforce community care for mentallyobtained from HMSO. ill people. The Ten Point Plan is

A copyof the chapter in the review's designed to strengthen the working ofthe Care Programme Approach, infinal rePort discussingthe way forwardis givenin the annex to this booklet, particularforthe mostvulnerable

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patients. It includesa new power of Key requirements for health andsuperviseddischargeto improvethe social servicescare of patientswhohave beendetainedunder the Mental Health Act The Departmentof Healthhas helped1983 whoneed specialsupportafter raise the awareness of mental illnessthey leave hospital. Legislationwillbe andpushforwardactionby the relevantintroducedat the earliestopportunity, services by includingit as oneof the

five key areas inthe GovemmenrsGuidanceon the dischargeof mentally strategyfor health. 'The Healthof thedisorderedpeopleand theircontinuing Nation'White Paper (CM 1986, 1992).care in the communitywas issuedtohealth authoritiesand localauthorities The NHS planningand prioritiesin May 1994 (HSG(94)27/LASSL(94)4). guidancefor 1994195(NHSThis will be supplemented by the Management Executive Letter (93)54publication of a new Guide to and EL(94)55) has:Arrangements for Inter-AgencyWorking for the Care and Protection of • identified services for mentallySeverely Mentally Ill people, which was disordered offenders as a 'firstissued for consultation on 10 October order" Ministerial pdodty; and

. 1994.• made clear that future service

Mental Health Task Force development should follow thedirection set by the DH/HO review.

A special Mental Health Task •Forcestarted work in January 1993 to The guidance requires NHS authoritiespromote and assist the more to work with personal social servicesconcerted, comprehensive and speedy and criminal justice agencies toimplementationof Department of develop strategic and purchasing plansHealth policies formental health for servicesfor mentallydisorderedservices,withparticularregardto the offendersandsimilarpeople,based oncreationof more locallybasedand the jointDepartmentof Health/Homeaccessibleservices. Officereviewof services. These

shouldinclude:Social Services Training Package

• an effectiverangeof non-secureIn mid 1993, NACRO (National and secureservices(includingAssociationfor the Care and those for patientswith specialorResettlementof Offenders)was differingneeds, suchas peoplecommissioned,throughthe Social with learningdisabilitiesor

• Services TrainingSupportProgramme, psychopathicdisorder,ethnic• . to preparea Socialservicestraining minodlies, youngpeopleand

packageaboutworkingwithmentally women);disorderedoffenders. The trainingpack was launched in March 1994. It • arrangementsfor the multi-agent7has been circulatedto all social assessmentof offendersand, asservicesdepartments,probation, necessary, access to healthandservicesand police forces. It is also socialcare services;availableto health authoritieson

requestfrom the Departmentof Health. • meetingthe mentalhealthcareNACRO andthe Social Services needsof transferredor dischargedInspectoratehave beenrunninga prisoners;seriesof seminars (1994195)to

promotethe trainingpackage. • the placement,withinsix months,of specialhospitalpatientswhono

The Departmentof Healthhas also longer requirehighsecurity.commissioned the preparationof ..

guidelines on training forensic social For the time being services for mentallyworkers, which will be ayailable in disordered offendersmust be protected1995. at least at !993/94 levels until 31

March 1995. (Executive Letter (92)6,

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as modified by the NHSME Key FactorsCommunications Summary, April1994). The Department of Health has

identified certain mechanisms asRegional Directors of Public Health essential in providing an effectivehave co-ordinated a comprehensive service for the health and care needsneeds assessment for mentally of mentally disordered offenders.disordered offender services, in which These are:the Special Hospitals Service Authodtyand the Prison Servicewere involved. • a multi-agency focus to ensure that(NHS Management Executive Letter all those with a responsibility for(93)68).i mentally disordered offenders,

whether in the statutory, voluntaryCare Programme Approach or independent sectors, are

working to a common agenda;

From 1 April 1991 all district health • arrangements at the court and pre-authorities were required to initiate the court stages for assessing mentallyCare Programme Approach in disordered offenders and ensudngcollaboration with local social services they obtain access to thedepartments (Health Circular (90)23 appropriate health and careand Local Authority Social Services services;Letter (90)11). This involves drawingup explicit individually tailored care • links between the NHS and pdsonsprogrammes for all in-patients about to for the effectivetransfer of mentallybe discharged from mental illness disordered prisoners who requirehospitals and all new patients accepted in-patient mental health treatmentby the specialist psychiatric services, and to plan continuing care onThe needs of each patient, both for release;continuing health and social care andfor accommodation, should be • application of the Care Programmesystematically assessed and the Approach to ensure that the care ofappropriate arrangements made: A . patients Withmental health carekey worker is identified to keep in close needs who are discharged fromtouch with the patient and to monitor hospital or prison is properly co-that the care package is, in fact, ordinated (involving criminal justicedelivered. If an adequate package of agencies where necessary).care cannot be agreed and provided inthe community, the patient should be The main elements of this service are:•offered alternative in-patient care.

• a rangeof communityservices,The Governmenthas taken several includingsupportedand non-furtherstepsto reinforcecommunity supportedaccommodation,daycare for mentally ill people,including care andprimaryorout-patientthe introductionof the Mental Illness health care. Other services suchSpecificGrant to encourage local as employmentand .education,authoritiestoincrease the levelof may also.beneeded;socialcare availableto peoplewithasevere mental illness,the issuingof • secureand non-securehospitalguidanceon the dischargeof mentally, services,including;.disorderedpeopleand their continuing

care in the community(Health Service • in-patientpsychiatriccare, eitherGuidelines(94)27/LocalAuthority ona generalward orwitha lowSocial ServicesLetter (94)4) and the degreeof security(eg an intensiveintroductionof supervisionregisters.T.helatter are aimedat those patients care orlockedward);who are judgedto be at significantrisk • mediumsecure or similarservicesof Suicide,severe,self-neglectorof (forboth shortor long-termin-committing seriousharm to others, patienttreatment)andassociated

"outreach"services;

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Department of Health wishes to see the• high security provision (currently in mediumsecure programmediversify to

the special hospitals, which are a include longer-term provision and servicescentrally-financed service). There for specific groups.need to be effective links betweenspecial hospitals and the wider Local authority community care plansNHS. Two Regions (SouthWestern and Mersey) have A scrutiny of local authority communityrecently signed service agreements care plans for 1993/94 indicated that aboutwith the Special Hospitals Service half had included services for mentallyAuthority. disorderedoffenders. Health and social

services agencies should involve criminalFor offenders with leaming disabilities, justice agencies in identifying servicethere must be special attention to: planning requirements in community care

plans. It is important that health• people with mild to moderate authorities provide local authorities with

disabilities who are liable to fall information_bout mentally disorderedthrough the net of care; offenders. A training package for social

services staffworking withmentally

people who need some form of disordered offenders, produced bysecure provision. NACRO, was launched in March 1994 and

, is being supplemented by a series ofCentral capital funds of over £45 million seminars.have been allocated in the period between1991-1995to increase the number of NHS Walesplaces nationally from about 700 atpresent to m ore than 1150 in 1996. Policy in Wales in relation to health andDevelopment beyond the current target social care derives from three strategicwill be based on local comprehensive documents; Mental Illness - strategy forassessments of need. Further capital Wales; the protocol for Investment infunds to develop medium secure places Health Gain -Mental Health, and thewill be made available through the main report of the All Wales Advisory Group onNHS capitalprogramme if commissioning Forensic Psychiatry. l'he latter inauthodties and trusts agree that there is a particular addresses the needs of mentallyviable case for doing so. This procedure disordered offenders and appropriateallows authorities to establish their own service responses. It also informed thepriorities and seek funding to develop police decision in Wales for the strategicservices accordingly, development of forensic services.

£4.4millionadditionalrevenuefunding(in The mental illnessstrategy confirmsthei 1994/95) has been allocated nationallyfor need to give highestpdorityto the most

. the purpose of helping to fund medium seriously ill and the most vulnerable. Itsecureplaces. Thisincludes supportfor has establishedan annualreviewprocess,

•placesthat are beingmade avagableon a withcomprehensiveplans foreach countryshortterm basisto relievecurrent compiledon an inter-agencybasis.pressureeither withinthe NHS orin'theprivatesector. The additionalrevenuecan Reference shouldbe made to the Welshalso be used to assistwith start-up costs, Office for clarificationof policyas it affectsincludingstaff trainingas new places the pdncipaiity.come on stream.

Needs assessmentsfor a range of secureand some non-secureserviceswere

• undertakenby RegionalDirectorsof PublicHealthin 1992 and 1993 (NHSManagementExecutiveLettei"(93)68).The SpecialHospitalsService Authodtyand the Prison Servicealso tookpart.Considerationis beinggivento futurearrangementsfor theseservices. The

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3 Police detention and examination of mentally,• disordered people.

The police service willbe the first contact Local Schemesthat mentally disordered people have withthe criminal justice system. This may be The following are three examples of locallybecause intervention is called for under developed schemes which may be ()fthe terms of sections 135 and 136 of the particular assistance to thepolice inMental Health Act 1983 in the interests of responding to cases where mentala mentally disordered person who may be diso,rder is suspected.thought to be in need of care or control. It

may also be because the person is Barnet Crisis Intervention Servicesuspected of committingan offence.Circular 66/90 provided guidance on the This is a 24-hour, seven days a week, on-police response in such circumstances, call service in which a multi-disciplinaryThe following points are intended to team (doctor/social workedcommunity;supplement that Circular. psychiatric nurse) provides support to

those experiencing mental health orDefinition of mental disorder emotional crises. It has been in operation

since 1970.It is important to recognise that the termmental disOrder (which is used in The rationale behind the scheme is thatlegislation) includes mental illness, early intervention,preferably in the homepsychopathic disorder and mental where individuals are likely to be lessimpairment. The term mental impairment confused, will in many cases enablerefers to peoplewith mental,handicap and problems to be dealt with without recourseis also known as learning disability, to hospital admission or heavy medication.Mental handicap/learningdisability can be It is, therefore,concernedwith preventiona mild, moderate or severe disability which and treatment not simply assessment. Itmay affect the ability of individuals to has resulted in a dramatic reduction in thecommunicate and/or to understand. This need for psychiatric beds in the area (tois of particularrelevancein deciding about one-thirdof the national average)

• whether to cell an appropriate adult, and and a reduction in the use of medicationalso in developing train!ng, and in the number of suicides and

Co-ordination attempted suicides in the district.

Some individualsmay have, or might haveIt may be helpful for a senior police officer in the future, come to the attention of theof Assistant Chief Constable rank to take

police and so the service has acted toon responsibilityfor the developmentof preventindividualsfrom becomingforce policyin relationto mentally involvedinthe criminaljusticesystemas• 'disoideredpeopleandto ensurethat well as fromin-patientcare. Referralswilleffectiveco-operationisdevelopedWith usuallybe from GPs butthey couldalsoother servicesand agenciesboth inthe comefromthe policewhenthe teamwillcriminaljusticesystemand health and notonlyassessbut providefollow-upsocialservices. This wouldinclude keatment as well.responsibilityfor theforce's policyondecidingwhento charge, to caution,or to The serviceis pert of the psychiatrictake nofurtheraction, in relationto servicefor the Bamet area and receivesmentallydisorderedpeople; for the nospecialfunding,althoughthe savingsitestablishmentof proceduresin agreement generatesmorethancompensatefor thewith localhealthauthodtiesto ensure that costs. Further infbnna_on about thepeoplewithmentalhealth needswho are service can be obtained from Dr Ratna,

idetained are seen at an eady stage by a Consu/tant Psydhiatfist at the Barnetmentalhealth professionalsuchas a Psychiatric Unit, Barnet General Hospital,psychiatristor a communitypsychiatrist Wellhouse Lane, Bamet, Hertfordshirenurseand, whereappropriate,an

_ approved socialworker;,and, taking into EN5 3DJ. (0181 440 5707).accountadvicefromthe health and socialservicesrepresentatives,for ensudngthatsuitablearrangementsare in place forthe

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Canterbury and Thanet Community Place of SafetyHealthcare Trust

Circular66/90 drewattentiontotheA multi-agency working party was set up in desirability of ensuring that,whereverApril 1991 with representatives from the possible, police stations are not used aspolice, probation service, courts and places of safety for the detention ofhealth and social services, chaired by the mentally disordered people. PoliceDirector of Mental Health Services for the stations will not have the facilitiesTrust, in response to concerns about the necessaryfor the welfare of such peoplenumbers of people with mental health care and detention in them is likely to beproblems who were being remandedto damaging to their health.prison.

The police service is asked to agree withThe police station was identified as the local health authorities and social servicesplace of initial intervention. The police departments suitable arrangements for thesurgeon, having been called out by the detention and assessment of mentallyduty officer, calls on the duty psychiatrist disordered people. This may involve theand approved social worker to assess use of social services accommodation orindividuals at the police station who might hospitals, depending on availability and onthen be directed into health or social care whether the person is likely to requireas appropriate. The scheme has resulted hospital treatment.in a considerable reduction in the numberof mentally disordered offenders hav!ngto In cases where the use Of police stationsbe referred to the court. Further cannot be avoided - for example, ininformation can be obtained from lan relation to the investigation of seriousWright, Director of Mental Health Services, offer_ces- it may also be advantageousCanterbury and Thanet Community for each police force to considerHealthcare Trust, LitUeboume Road, developing a policy on the use of specific,Canterbury, Kent CT1 IAZ (01227 identified police stations for the detention459371). of mentally disordered people where

arrangements can be established for their• B0urnevUle Lane Police Station speedy assessment by a mentalhealth

professional.These couldbe designatedA communitypsychiatricnurse (CPN) is stationsestablishedunder the Policeandbasedat this policestationto offeradvice CriminalE_,idenceAct. With this -and guidanceto the policeonhowto approach,it maybe possibleto arrangeatrespondto the needsof mentally al! times,at specifiedstations,fortheretodisorderedOffendersand to obtainaccess be on dutya policeofficer who hasto the psychiatricand social services. This specialisttrainingin dealingwith mentallypilotscheme has been runningsince disorderedpeople. Alternatively, forcesOctober1992 andincludestwo other mayprefer usinga 'call out'systemofpolicestationswithinB Divisionof the trainedofficers.West MidlandsPolice.

When to consider chargingThe main benefitsof the schemeincludebetterand morecomprehensive The policehave a crucialroleto playinassessmentsat the police stationbecause determiningwhethera mentallydisorderedthe CPN workswith the custodysergeant personentersthe criminaljustice process.on a daily basis; improvedaccessto The existenceof mentaldisordershouldpsychiatricservicesandthe•opportunityfor neverbe the onlyfactorconsideredinthe CPN to liaisewithotheragencies reachinga decisionaboutcharging. Thewhere hospitaladmissionis not needto protectthe safety of the publicappropriateand to offerfollow-upcare. mayindicatethat.formalactionis needed.

It is importantto recognisethatFurther information about the service can prosecutiondoesnot prevent the

•be obtained from Stuart Wix, Community individualhavingaccess to the healthand•Psychiatric Nurse at the Reaside Clinic, socialcare services. A rangeof optionsisBristol Road South, Ruben/, Rednal, avagableto courtsto ensu'rethat a personBirmingham 13459BE (0121 453 6161).

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receives treatment and care (see Section the local probation and social services to5). A mentally disordered person can also ensure an appropriate response to thebe transferred from prison to hospital by person's mental health needs.the Home Office (see Section 6).

Information and training for policeDeterminingwhenprosecutionis the officerspropercourse can be a finely balancedjudgement. To help reach a decision,the The useof specifiedstationsfor thepolicewill needto findoutwhetherthe detentionof mentallydisorderedpeopleperson has any historyof mental disorder will help in ensudng the involvementofor has had any previous,contact with the police officers with the necessarycriminal justice system. Good links with knowledge of procedures for respondingthe local psychiatric and social services and for liaising with other services. It willare essential to provide a ready source of be helpful also to make widely available toadvice about the person's current mental all officers who come into regular contactstate and any previous psychiatric history, with members of the public brief guidance

on relevant information and action to take.This information should helpthe police to This might be done, for example, by

• determine whether an incident can be means of a plastic laminated card or,assessed as an isolated event, and to alternatively, where there is a centraldecide an appropriate way forward, taking command and control computerisedaccount of the gravity of the offending and _system this may produce a guidancethe potential dsk to others if the behaviour checklist.recurs. Although an incident may be aminormatter in itself, it is important to Chief Officers willalso wish to considerestablishwhether it representsthe latest in whethercurrentarrangementsadequatelya developingpatternof dangerous meet policetraining•needs,particularlyforbehaviourwhichrequiresinterventionby officerswhosedutiesmean they may bethe criminaljustice system for the called onto assistmentallydisorderedprotectionof the public, people. The followingtwo initiatives may

be of interest:The police will want to consider anyoptions offered by health and social Merseyside Police has produced a training

.services staffwhich may include package which provides officers of allcompulsory admission to hospital using ranks (but particularly beat officers)the powers available to doctors and social information that will be of use in theirworkers under the Mental Health Act. dealings with mentally disordered peopleHowever, if the person's current or in public and private places. The packageprevious behaviour appears to put others / consists of a booklet (The Mentally III inat risk, it will be preferable to charge so " the Community) and an accompanying

., that the court can consider whether a video. The booklet gives details ofdisposal, such as a hospital or medical terminology, summarises andguardianship order, is required for the defines the most common mentallonger term protection of the public as well disorders (signs and symptoms), providesas enabling the person's health and care a range of do's and don'ts in terms of .needs to be met, police approaches, considers the "

. managementof violenceand providesflowNo further action and cautioning chartsof the ways in whicha mentally

disorderedoffendermightbe dealtwith• In cases whereprosecutionis not dependingon particularCircumstances.necessaryin the publicinterest,Chief • The videocovers similaraspectsand isOfficersof Police willwish to ensurethat intendedto accompanythe manual.

• adequatealternativeformsof response Further information is available fromare available. This may involvenofurther Inspector Barry Delaney, Merseysideaction by the police,orthe cautioningof Police, 0151 777 6061.suspectsif they are ableto understandthe

implicationsof their actions and thisis not The MetropolitanPolice,in partnershipa case of repeatedoffending. In such with the BritishTransportPoliceandthecircumstances,it will.be desirableto co- NationalSchizophreniaFellowship,ordinate the responseof the policewith

1514844

launcheda new trainingvideoin October Information for the Crown Prosecution1994. The video(A Meetingof Minds) Serviceformspartof a package,availablefrom theend of 1994, intendedto addresstraining In decidingwhetherto prosecute,thefor officers from constableto inspector. Crown ProsecutionService is guidedbyOfficerswillfirstreceive a distance the Code for CrownProsecutors.If therelearningmoduleon legislation,local is enoughevidenceto prosecute,Crownpracticeand procedures,and recognising Prosecutorswillalso need to considertheand respondingto mentallydisordered publicinterestfactors inreachingapeople. They willthen take part in a decisionaboutprosecution. They mustseminar orworkshopbaseddiscussion, balancethe factors for and againstThis will includethe videowhich aimsto carefullyand fairly. While the existenceofdispelsome of the mythssurrounding . mentaldisorderis a factor againstmental illnessand to showofficershowto prosecution,it mustbe weighed againstmake informedjudgementsabout the best the sedousness of the offenceandthecourseof actionin situationsinvolving possibilitythat it mightbe repeated.mentallydisorderedpeople. Further

, information is available from Inspector It is consequently.importantfor the _oliceChris Auger, Central Planning Unit, Yew and the.Crown Prosecution Service to beTree Lane, Pannal Ash, Harrogate, North aware, from-an early stage, of any relevantYorkshire HG2 9JZ (01423 87120!). information conceming an accused

person's mental disorder so that this canRecording and monitoring be taken fully intoaccount. For example,

where prosecutionis necessary,a remandChief Officers mayconsiderit helpfulto to hospitalcan be made by the courtensurethatuseful recordsare kept about rather than to prisoncustody.mentallydisorderedpeoplewho aredetained bythe policeandwho are There are a numberof stagesat whichsubsequentlydealtwith by other agencies, informationaboutthe defendant'smentalsuchas healthand socialservices, the state may be sought. For example,theprobationserviceorthe Crown policemay identifya potentialproblemandProsecutionService. The policemay find seek medicaladvicepre-charge. After theit helpfulto discusswith otheragencies police have chargedor bailedthewhat can be done about setting up defendant,it will fall to either the court orreck),rdingand monitoringarrangements, the defence to seek a .medicalreport if a -which mayinclude the development of a mental health problem is suspected. It is

.. form so that information can be passed on customary for the prosecution to be shownas other agencies become involved in a report ordered by the court, but there ishandling a case. This arrangement can no requirement or equivalent customaryhelp inform decisions taken by the Crown practice for the defence to disclose theProsecutionService and the courts. It can contentsof any reportwhich it has sougllt.alsohelp the police,andother services, inmonitoringthe numbersof mentally There may wellbe some raredisorderedpeoplecomingto their attention circumstanceswhen the Crownand in assessingthe effectivenessof local " ProsecutionService wishesto have itsarrangementsfor respondingto such _ own reporton the defendant'smentalcases, condition. In such circumstancesit is

opento the Crown ProsecutionServicetoNACRe has helpedintroducetl_euse of approachthe defence to obtainagreementrecordingand monitoringarrangementsin to the defendantbeingseenby anotherSeveralareas. The experienceof these doctorso that a further medicalreportmayprojectsmay be useful in developinglocal be prepared.arrangementselsewhere. Details of theadviceandconsultancyservicesoffered It shouldbe noted that in the case of aby NACRe are set out in the HomeOffice defendantcharged withmurder,a medicalletter of 26 August 1994 (see Section 1). report shouldbe obtainedbeforebailis

granted. In the case of a defendantwho isin custody,the CrownProsecutionServicewill assistthecourt in obtaininga medicalreportby submittingthe committal papers

1614845

to the Prison Health Care Service or to a In September 1994, the Home Officenominated doctor once committal has began a review of the role and functions oftaken place, the appropriate adult and related matters,

such as their availability and the need forAny information the police have about an training and improved guidance.accused person's psychiatric conditionshould be recorded in the police file which Mental health assessment schemes atis passed to the prosecutor. Where the magistrates' courtspolicehave arrangedfora detainedpersonto be examinedby a medical The Governmentwelcomesthepractitionerinaccordancewiththe developmentof arrangementsatrequirementsof the Code of Practicefor magistrates'courtswhichfacilitatethethe Detention,Treatment,and Questioning assessmentof accused personsandaof Personsby PoliceOfficers issuedunder responseto theirmentalhealth needs.section 66 of the Police and Criminal This ensuresthat courts have expertEvidence Act 1984, or by a community advice which may assist them in thepsychiatric nurse Where arrangements for exercise of their powers, andit helpsthis have been setup in conjunction with a facilitate access to the health and carelocal health authority, a note of the agencies and to avoid Unnecessarymedical practitioner's or nurse's remands to prison custody. Further detailsassessment and advice should be are given in section5.included in the file .that is sent to theCrown Prosecution Service. The co-operationof the police will play an

important role in ensuring the success ofAppropriate adults such schemes at courts, in particular in

establishing arrangements for access byThe presence of an "appropriate adult" mental health professionals to peopleduring the questioning of mentally detained in cells at courts, and in assistingdisordered persons susPected of in the transporting of mentally disorderedCommittingan offenceis required in people to hospitalwhere a police presencecircumstancesset out in the PACE Code is desirablefor the protectionof the public.of PracticeCode C (inparticularAnnex E Chief Officersare asked to co-operatewithof Co(_eC). To ensurethatthe police courts,probation,and hea!thand socialhave readyaccessto peoplewho are servicesin ensuringthe successof suchsuitableto act as appropriateadults,Chief arrangements.Officersare askedto discussWithDirectorsof SocialServices, Chief

Probation Officersand representativesofvoluntaryorganisationsarrangementsforaccessto suchpeoplewho may, forexample,includepeople fromvoluntarybodiesspecialisinginprovidingcare andsupportfor mentallydisorderedpeople. Itis importantthat anyone actingin thiscapacityhas receivedtraininginordertocarry outthe role effectively.

There is a potentialconflictwhich mayarisewherean approvedsocialworker iscalled in by the policeto make an.assessmentfor the purposesof the MentalHealthAct and is subsequentlyrequestedto performthe roleof "appropriateadult"duringan investigativeinterview. One

,personshouldnotbe asked to fulfilbothfunctions. Similarly,it wouldbeundesirablefor the person'sownprobationofficerto be asked to undertakethe role.

t714846

4. Probation Service Information for the courts

At courtswherearrangementshave beenThe probationservicehas an important established for accesstQmentalhealthrole to play inrelationto mentally professionalsto assess defendants anddisorderedoffendersin fosteringthe adviseOnappropriateintervention,thedevelopmentof close co-operationata probationserviceshouldbe satisfiedthatlocal level between the criminal .justice effective arrangements are inplace tosystem and health and social services, identify defendants who might benefitfromWhere prosecution is necessary in the such an assessmentand to ensure they.public interest, the probation service will are able to receive it.. In other cases, thewish to ensure that the Crown Prosecution probation servicewill wish to Consider inService and the courts have relevant consultation with justices clerks and localinformation available to them to enable the health and social services whether furthercourt to decide whether the defendant can steps are desirable to ensure that courts

•be safely bailed or remanded to hospital receive appropriate information about theinstead of prison before conviction and mental health of defendants, for example

• sentence-,and to decide on the suitability through ithe commissioning of psychiatricof non-custodial disposals after conviction, reports for courts.The probationservice will also wish toensure, that arrangements exist locally so Bailthat, where a prosecution is not necessaryin the public interest,mentally disordered Bail Information Officers need to usepeople are not drawn unnecessarily into specialist resources to help assess andthe criminal justice system (for example,•in meet the needs of mentally disorderedthe belief that only this course will ensure offenders, so that they can safely putaccess to treatment), forward information to.help the court

decide whether a non-custodial remand isCo-ordination with health and social appropriate.The probationservicewillservices wishto considerhowaccess to these

resourcescan best be obtained.Chief ProbationOfficersmay find it helpful

to allocateto a seniormemberof their The probationservice has an importantservice responsil_ilityfor developing roleto playinensuringthe availabilityofservicepolicyin relationto mentally accommodation.Responsibilityfordisorderedoffenders_for liaising at a providingaccommodationmay restwithSeniorlevelwith membersof related, other services. For example, in the caseservices,and inparticularfor developing Of peoplereleasedon police bail, it may beco-operationwith directorsof social appropriateto lookto local housingServices. This will includeregularreviews authorities,socialservices orvoluntaryjointlywith localsocialservices organisationsfor as.sistancein providing

" managementof _e arrangementsfor accommodation. If a court,grantsbailwithresponding to the needs of mentally a residence requirement,an approved bail

. disorderedoffendersandthe development hostelmightbe appropriate.Thejointlyof plansto improvethat response probationservicewillwish to considerwhere necessary, whetherthe rangeof accommodationand

its accessibilityis sufficientto ensure thatA guidefor probationservicemanagerson mentallydisorderedpeople are notworkingwith the healthand socialservices remandedto prisonsolelybecauseof theirin the managementof mentallydisordered homelessnessorfor lack of suitableoffendershas beenpreparedby the facilitiesin the community. ConsequentlyAssociationof ChiefOfficers of Probation. adequatesupportmust be availableinbail

- copies are availablefrom the A._sociation hostelsboth for the baileeand for the staff• of Chief-Officersof Probation; 20/30 of the hostelto enablethem to respond

•Wakefield Lane, Wakefield,West effectivelyto the needsof baileeswhoareYorkshireWF2 85P (01924 361156). mentallydisordered.

1814847

Psychiatric assessment panels There may be othercircumstancesinwhichmedicaltreatmentis notappropriate

These were describedin Section1. The for mentallydisorderedpeople,whowillProbationServicewillwish to be involved nonethelessbe eligibleforothernon-in monitoringthe progressof these custodialdisposals,such as probationschemesto ensure theireffectiveness, orders,or communityserviceorders. The

suitabilityof suchdisposalsshouldbeNon-custodial disposals assessedin each case in the lightof the

needsof the individualconcerned,andChief ProbationOfficersare askedto defendantsshouldnotbe excludedfromreview, in conjunctionwithlocalhealthand considerationsolelyon accountof theirsocialservices,the effectivenessof non- mentaldisorder.custodialdisposalswithwhichthey areinvolved. It is importantthat mentallydisorderedoffenderswho requiremedicalsupervisionor treatmentare able to ireceive it in the communitywhere it is intheir mental health interests and this does "not put members of the public at risk. Theprobation order with a conditionOfpsychiatric treatment offers a usefulmeans of enabling the court to achievethis. •

The number of probation orders withconditions of treatment has been steadilydecreasing over the last 10 years. HMInspectorate of Probation has undertakenan examination of theuse of such ordersin five probation areas to try to identifyhow their effectivenesscan be assessedand improved. Just under 140 individualcases were examined, many of whichwere extremely complex, but theInspectorate concluded that some 60% of

•these had been effective disposals. Thereport identified a range of factors whichcan influence the effectivenessof suchorders andmade a number of

•recommendations, in particular,• . concerningthe needto increase inter-

.agencycontact andto improvethe policyand proceduresfor makingordersand •their subsequentsupervision.

The Home Office is consideringjointlywiththe AssociationofChief OfficersofProbation,the bestway forwardinrespondingto these recommendations.The reportwaspublishedinNovember1993 and copieswere circulatedto theProbationService. Add#ional copies areavailable from HM InspectorateofProbation, Room 355, Home Office,Queen Anne's Gate, London SWIH 9AT.

i914848

5. Courts jurisdiction allows, wish to considermaking arrangements for such cases to beheard at a convenient larger court where

Magistrates' Courts an assessment scheme operates.

Justices' Clerks will wish to review the There is no one preferred model for anarrangements at their courts for obtaining assessment scheme which should beprofessional advice to ensure the designed to retied the local needs ofidentification of defendants suffering from magistrates courts and the availability ofmental disorder and to avoid remanding local health and social services. It isthem to prison. Circular 66/90 drew important,however, that in developing aattention to the options available to the scheme, a range of practical factors arecourts both before and after conviction, considered and that any areas of potential

uncertainty about the operation of theGuidance has also been issued by the scheme and the respective roles ofLord Chancellor's Department in the participating services and .agencies arebooklet entitled "Best Practice Guide on resolved. The issues which need to beMentally Disordered Offenders"available addressed include:from the Courts Business Branch,Magistrates' Courts Division, Lord • assessment of the likely local need;Chancellor's Department, 30 Great PeterStreet, London SWlP 2BY.

• local agreement between thoseworking in the criminal justice system

The Government attaches importance to and the health and social servicesensuring that those suffering from mentaldisorder are not imprisoned unnecessarily, about the nature of the scheme with a

clear understanding from the outset ofIf-medical reports are required before the contribution from each and wheresentence, arrangements can be made for

the lead responsibility lies;this either on bail, from an assessmentscheme or through a remand to hospital. ° whether there are other interestedIf treatment is thought desirable after parties such as defence solicitors,conviction this can be provided in thecommunity, for example by means of a housing officers or voluntary agencies

which couldusefullybe involved;guardianshiporderor, if the offenceisseriousenoughandthere is a medical

• dependingon the type of scheme,recommendation,a probationorderwithaconditionof psychiatrictreatment, accessto a psychiatristor aTreatment in hospitalas an in-patientis communitypsychiatricnurse and anavailablebothas part of a probationorder approvedsocialworkeron a regularwith a conditionof psychiatrictreatment basisor on call;and underthe provisionsof hospitalorders. In the Caseof defendantswhose • clarificationand resolutionas far asmentaldisorderis notamenable to, or practicableof diff]cultiesarisingfromdoes notrequire,medical treatment, the the lackof commonb_Jndadesandcourtswillwishto considertheir suitability catchmentareas;for othernon-custodialdisposals.

• dearlydefinedarrangementsforMental health assessment schemes at activatingthe scheme; accesstomagistrates' courts interviewingfacilitiesand office

supportand accessto court recordsArrangements forprovidingthe subjectto suitable safeguards;magistrates'court withadviceandassistancefrom mental health • clearresponsibilityfor the provisionofprofessionalshave nowbee.n established suitabletransportforthose admittedtoat manycourts. The HomeOffice has healthor socialservicesprovisionand

: made funding availableto assistabout50 for their returnto court if need be;such schemes by meetingthe costs ofpsychiatristsor communitypsychiatric ° clearrelationshipwith Bail Informationnurseswho attend court. Ruralcourts schemesandlocal arrangementsforwhich onlyoccasionallyhave to dealwith providinginformationfor the Crownmentallydisorderedoffendersmay, where ProsecutionService.

2O

_ 14849

Training

An example of a local training initiative isthe multi-agency programme devised inTynedale at the instigation of the CourtUsers Group and in conjunction with thelocal psychiatric services. A series ofseminars, under the heading "Dealing withMentally Disordered Offenders", wasdeveloped to cover a rangeof mentalhealth clinical and legal aspects andfurther training sessions are inpreparation. Further details are availablefrom Miss P Axon, Clerk to the Justices,Tanner House, 20 Gilesgate, HexhamNE46 3QD.

Crown Courts

Guidancewas providedin paragraphs10c16of Circular 66/90 on the powersavailable to Crown Courts in relation tomentally disordered people. The law inrelation to people found unit to plead ornot guilty by reason of insanity, which was ._described in paragraphs 13 and 16 of thatCircular, was amended by the CriminalProcedure (Insanity and Unfitness toPlead) Act 1991. Guidance on itsprovisions was given in Home OfficeCircular 93/9,1.

2114850

6. Prison Service security needs, for an assessment to bemade with a view to making a hospitalplace available. In any case of difficulty,

Health Care Service for Prisoners C3 Division of the Home Office should beinformed at an early stage so'that they

It is the responsibility of the National may assist in resolving problems whichHealthService to provide treatment for may arise. Guidanceon thesementally disordered offenderswho require arrangements have been provided to alltreatment in hospital for their mental prison medical officers by the Director ofdisorder. The Prison Service is Health Care and by C3 Division.responsiblefor the provisionof primaryhealthcare compatiblein rangeand Remand prisonersqualityto that providedinthe communityby generalpractitionersand out-patient Remand pdsonershave the same dghttoservices. It is its policyto providesuch hospitaltreatmentas all other citizens.care througha combinationof directly Medical officersshouldbear in mindtheprovidedservicesand throughcontracting- possibilityof arrangingtheirtransfertoin fromoutside healthservice providers hospitalwhenexaminingthemandsuchasthe National Health Service. -forming]a view ontheirtreatmentneeds.However,mentallydisorderedoffenders In any casewhere a medicalofficerneedingpsychiatricin-patienttreatment reachesthe viewth'ata remand pdsonershouldbe transferred to hospital for that would, if still in the community and seentreatment. They cannot receive equivalent on an out-patient basis, be assessed astreatment in pdson, as the Pdson Service requiring impatient treatment for mentalis not equipped to provide it, and detention disorder, the_rnedicalofficer should seek

• in pdson is likely to be damaging to the to arrange transfer to.hospital in themental health of a mentally disordered normal way. In case of difficulty, C3person. Division should be informed.

For prisoners who are regarded as Where a remand pdsoner is tranferred torequidng treatment in hospital for mental hospital under the provisions of section48disorder, arrangements will be made to . of the Mental Health Act 1983fortransfer them to hospital under the trea.tment, the receiying hospital will wishprovisions of sections 47 and 48 of the to consider whether it would beMental Health Act 1983. Close co- appropriate to recommend to the courtoperation with the National Health Service • detention in hospital after convictionhas resulted in a substantial increase in through the making of a hospital order

' the numbers of such patients in recent under.theprovisionsof section37 of theyears. Howe_/er,it remainsa causeof " 1983 Act,or the suitabilityof some otherconcemthat seriouslymentallydisordered form of treatment Odenteddisposalsuchpeopleare inappropriatelycommittedto ._ as a probationorderwitha conditionofpdsonand the PrisonServicewilllend full psychiatrictreatment Ora guardianshipsupportto arrangementsdesignedto order. Considerationof these coursesofreducethe I_elihood of this happening, actionwillhelpto remove_e needfor thesuchas the developmentof arrangements patient to returnto prison.

" for psychiatriststo assesspeople detainedin police stations,and the establishmentof Close linkswith the health servicesandinter-agencypanelsand assessment C3 Divisionare essentialfor transfers toschemes at courts, be arrangedeffectively.

Prison medicalofficerswere asked in "t'heBracton Clinic/Circular66190to ensure they had inplace HM Prison Belmarsh Schemeeffectivearrangementsforexaminingall

newardvals in their prisonto ensurethe A goodexampleof linkswiththe National- speedyidentificationof mentaldisorder. HealthService workingeffectivelymaybe

In allcases wherea prisoneris identified foundin the scheme run by the Bractonas requiringtreatmentin hospitala request Clinicat BexleyHospitaland HM PrisonShouldbe made to his/herlocal hospital Belmarsh. The BractonClinicprovidesapsychiatrist,or to his regionalforensic court liaisonserviceat four magistrates'psychiatrist,or to a special hospital, courts in its catchmentarea. In addition,accordingto the patient'streatmentand

22 z4esz

since June 1991, two psychiatdsts inhigher training have been seconded to theprison. They are responsible for preparingpsychiatric reports, providing psychiatriccare within the prison health care centre,assessing references from prison medicalofficers, arranging assessments bycatchment area services and expediting

v

transfers to hospital. The scheme issupervised by the Consultant ForensicPsychiatrist at the Bracton Clinic. Furtherdetails are available from Dr J Parrott atthe Bracton Clinic (telephone 0322 526282).

Durham cluster/Newcastle MentalHealth NHS Trust

A contracthas been made withNewcastleMental Health NHS Trustfor the supplyofa complete psychiatricservice to HMPrisonsDurham, Franklandand HMRemandCentreLowNewton. Teams ofexperiencedpsychiatrists,nursesandpsychologistsvisit the pdsonsregularly toassess both remandand sentencedprisonersandto provideappropriatetreatment. High priorityis giventoproviding in-patient NHS beds at theearliest opportunity for prisoners whosecondition requires treatment in hospital.Further details areavailable from Dr R GMitchell, Head of Health care at HMPDurham (0191 3862621 x2340).

Asimilar but more limited scheme is inoperation at HM Pdsons Bdstol,Gloucester, Leyhill and HM RemandCentre Pucklechurch. Details.ofthisscheme are available from

.'.. Dr M Rowlands, Head of Health Care at' •HMP Bristol (01272 426661),

23 14852

7. Le.qal Representatives so,ctorsactingfor-mentallydisordered• defendants will need to have a workingknowledge of the following:

As a Home Office Circular, 66/90 could not

offer guidance on the role of legal • Parts I, II and I1!1of the Mental Healthrepresentatives, but it is recognised that Act 1983 and the accompanying Codesolicitors, particularly those acting in the of Practice concerning the definitionsdefence of mentally disordered suspects, of mental disorder, and provisions forhave an important role to play in the both informal and compulsoryimplementation of effective inter-agency admission to hospitaLworking and in helPingensure that

mentally disordered people gain access to • the provision of the Cedes of Practicetreatment and care services. In preparing under the Police and Criminalthis booklet, the opportunity has been Evidence Act 1984 (PACE), relating totaken to include advice relating to the role mentally disordered suspects, inof the legal representative. This section particular PACE Code C, Annex E.has been written in conjunction with the

Law Society's Mental Health and Disability • Criminal Procedure (Insanity) Act 1964Sub-Committee. as amended by the Criminal

Procedure (Insanity and Unf_ness toIt should be noted that solicitors acting for Plead) Act 1991mentally disordered clients retain the dutyto listen carefully to the client and where • Home Office Circulars 59190,66/90,possible to take the client's instructions 93191and 12/95.and to act on them.

It is recommended that all criminal law • criminal Justice Act 1991, section 4.solicitors, particularly duty solicitors;should find out about local facilities and • Cede for Crown Prosecutors 1986 (as "

services fol"mentallydisordered people, amended).The arrangementsof services will varyfrom area to area, but local information • Local policies made under the Mentalcan be obtained from the local social Health Act 1983 Cede of Practice,services department, probation service particuladyfor the use of section 136and district health authority and the (police powers to remove a mentallyregional health authority can provide disordered personto a place ofdetailsof any local receptioncentres and safety)..regionalfacilities(includingmediumsecure facilities)as well as accessto At the Police Station

nationalfacilities,suchas the Special The responsibilityfor the identificationof: hospitals. mentallyvulnerablesuspectslieswiththe

In particular,it is essentialfor defence, custodyofficer,where necessary.advisedsolicitorsto be aware of, and if possibleto by the policesurgeon(forensicmedical"

. be involvedin the operationof any local examiner). However,solicitorswillneed tointer-agencyassessmentschemes for be diligentto makesure that "bordedine"mentally dis'orderedoffenders. Again, mentallyvulnerablepeople,whoarearrangementsforsuchschemeswill.vary includedwithinthe widedefinitionofaccording.tolocalneedsand resources, mentaldisorderundersectionI oftheThe localjustices'clerk is likelyto be Mental Health Act; are identifiedso that

• aware of any schemesin the area, and to " propersafeguardsunderPACECede Chave detailsof the contactperson, can be implemented. The courtsare

increasinglyexcludingevidence nottakenFor out-of-hoursemergencies,the regional ir_accordancewithCode C and areand/ordistricthealth authoritieswill have criticisingsolicitorsfornotgivingactiveidentifiednamedpsychiatristswhocan be advice.contacted for urgentassessmentoradmissionsto hospital,and the local social Where an appropriateadult is calledin,servicesdepartmentwill have an the solicitorshouldsee the client alone atemergencydutyteam whichwill includean first,in orderto explain,in simple terms,approvedsocialworker(ASW). the roleof the appropriateadult, and how

24 14853

that differs from the role of the legal can lead to swift deterioration, and shouldrepresentative, in particular, the solicitor press for the client to be cared for, in theshould explain that while he/she is bound least stressful environment. It may beby legal privilegethe appropriate adult has helpful to involve an approved socialno such duty of confidentiality and, in worker. The solicitor should also press forcertain circumstances; may be asked to an early court date, to avoid long delayspass information to the police in the after charging before appearance in court.interest of public safety (see guidancefromthe Law Society's Criminal Law Appearance in CourtCommittee,[1993] Gazette 19 May, 4!).

Beforean appearancein court, theBeforea mentallyvulnerableClientis solicitorshouldtry to determinewhetherainterviewedby the police,the solicitor psychiatricor othermedicalreportwill beshouldspendtime with him/herto make required. This shouldbe identifiedat thean assessmentof the client'sability to firsthearing,and the solicitorshouldalso

•understandthe cautionand the questions considermakingan applicationto theputto him/her. It may also be helpfulto court to ordera pre-convictionreport(eg indiscussthiswith the apprepdateadult. It cases of unfitnessto plead,orshouldbe notedthat verbalperformanceis recommendingparticularformsofoften betterthan intellectualability, and disposal)inorderto avoiddelayat a laterthat mentallyvulnerablepeople, stage. Unlessthe clientgives instructionsparticularlythose withlearning disabilities, to the contrary,the court shouldalsobeare ofteneasily suggestibleand eager to alertedto any previousinvolvementof thesay what is expectedof them. clientwiththe psychiatricservices, so that

the requestfor a report can be directedtoDudngthe interview,the solicitorshould a psychiatrist knownto the client. ..ensure that the questionsare put in simplelanguage, using terms which are Where a medical report is requested byunderstandable to the client (eg even the court, the cost of that report will be metwords like =caution" may mean little to a by the court. If the solicitor decides tolearning disabledclient). The solicitor obtain a medical report, he/she shouldshould be alert to the use of words or ensure in legally aided cases that pdorphrases whichcan be misunderstood, and authodty is obtained from the Legal Aidshould intervene to ask for questions to be Board for the funding of that report.explained, or to remind the client thathe/sheis not obliged to answer questions It is essential to try to avoid remands intoif that is the solicitor's advice, prison while wafting for the report. All

.other options Should be considered,The solicitor should watch for signs that including:the client may be getting distressed oranxious, and ask for regular breaks to • bail home with or without conditionsrelieve the stress or to be able to consult

•privately in orderto check the client's °. bail to hospitalwithconditionsofunderstanding.If the solicitoris not residence/attendanceat out-patientsatisfiedwith the client'sunderstanding, clinicetche/she shouldensurethat these concernsare fully recordedon the custodyrecord • remandto hospitalundersection35 ofand/or on the tape. the MentalHealth Act 1983

The solicitor should be aware of all If it proves impossibleto find an alternative 'possible alternatives to charges being to remand into custody, the solicitor shouldmade (as set out in Circular 66/90) in as a minimumdraw the Court's attentionorder to assess whether access to the to para 1.305 of Stone's Justices' Manual.health or care services at this stage might If the client is sufferingfrom mental illnessbe the appropdate option, or whether the or severe mental impairment and is inmatter can be dealt with through a police urgent need of medical attention, thecaution or other quick disposal. If charges solicitor should discusswith the prisonare made, the solicitorshould try to avoid medical officerthe possibility of transfer tothe client being kept in police cells, as hospital under section 48 of the Mentalconfinement of mentally vulnerable people Health Act 1983. Where difficulties

25 14854

develop, the solicitor may find it helpful to alternative to a restrictionorder undercontact C3 Division of the Home Office section 41 or a custodial sentence).(see also Section 6).

• an interim hospital order under sectionOn receiving the medical report, the 38 of the MentalHealth Act (where thesolicitor should consider sending a copy to court is undecided whether a hospitalthe Crown Prosecution Service (CPS) to order is appropriate).enable the CPS to consider whether todiscontinue the proceedings. However, • a guardianship order under section 37attention must be given to ensure that of the Mental Health Act.mentally disordered people receive thesame rights and opportunities as any other • bindover.suspects to clear their names againstwrongful allegations and also, in • a community service order.appropriate cases, to take responsibilityfor their actions. There should be no • conditional or absolute discharge.assumption that mentally 'disorderedpeople are necessarily in need of in- After ConvictionlSentencepatient treatment which may involve anindeterminate period of detention in The solicitor should discuss with the clienthospital. A criminal justice disposal may whether to lodge an appeal againstbe more appropriate if treatment or care conviction and/or sentence. If a hospitalneeds can also be met. It should also be order has been made, with or without aremembered that where a prosecution restriction order, the solicitor shouldtakes place, it is still possible for the client explain to the client his/her right to apply toto gain.access to the health or social care the Mental Health Review TribUnal.services.

If the client is sentenced to imprisonmentThe solicitor should discuss with the and his/her condition deteriorates, thepsychiatricservices where a plea of 'Not solicitor should discuss with the prison•guilty by reason of insanity' may be medical officer the possibility of a transferappropriate, if the client fulfilled the criteria to hospital under section 47 of the Mentalset out in the M'Naughten Rules at the Health Act 1983. In cases of difficulty, C3time of the offence. In cases where the Division of the Home Office may beclient is considered unfit to plead at the contacted (see also Section 6).time of the tdat, a committal to the CrownCourt should be considered. In both thesetypes of cases, the range of disposalsunder the Criminal Procedure (Insanity/

and Unfitness to Plead) Act 1991 will.. become available to the court.

Disposals

The solicitorshouldmake representationsto the court to consider the disposalmostsuitable to meetthe client'sneed. Thefollowingmay be considered:

• an order forpsychiatrictreatmentwithoutconvictionundersection37(3)of the Mental Health Act 1983.

• a probationorderwitha conditionof ..

-residenceorpsychiatrictreatment(asan alternativeto a hospitalorderunderthe Mental Health Act).

o. a hospitalorder undersection 37 ofthe Mental HealthAct (as an

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8. Homeless and Criminal Justice Act 1991 requires theHome Secretary to publish information

Ethnic Monitorin.q enabling people engaged in theadministration of the cdminal justice

Homelessness system to avoid discriminating against anyperson on grounds of race. The first of

Homelessness is a serious problem these documents, "Race and the Cdminalamong mentally disordered offenders, as Justice System" was published inthe presence of mental disorder may September 1992.undermine a person's ability to cope andmay lead to the loss of his or her home,and the stress of homelessness mayexacerbate mental disorder. Circular66/90 set out the Government's view thatmentally disorderedpeople have the same

•right to bail as other accused people andthat they should not be denied bail eitherby the police or by the courts simply onaccount of their homelessness. The finalsummary report of the Reed reviewincludes (at Annex F to that report) apaper on the needs of homeless mentallydisordered offenders.

Ethnic Monitoring

Servicesforpeoplefrom blackand ethnicminoritygroups were consideredby the.Reed Committee which identified a rangeof concerns and, in particular, took notethat studies have indicated that peoplefrom the ethnic minorities are more likelythan white people to be brought within thescope of the Mental Health Act or detainedin a Special hospital (Volume 6 of theReview reports concerning Race, Genderand Equal Opportunities, available fromHMSO). The Committee recommendedthat all agencies involved with mentallydisordered offenders should establishstrong proactive equal opportunitiespolicies relating to race and culture which

•should be reflected in staff training and• allow.for consultation with representatives

of ethnic minoritygroups in the planning,development and monitoring ofservices.

In addition, the Committee recommendedthat a co-ordinated system of ethnicity.data collection should be established by allrelevant agencies. The Department ofHealth has already taken steps towardsthis end by announcing in December 1991that it wouldbe seekingto includein thepatientdata collected by health authoritiesinformationon the ethnic originof patientsto enable effectivemonitodngof services.Pilot projectshavebeen undertakeninBdstoland Manchesterpriorto countrywide implementation.Section 95 of the

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Annex:Extract fromfinal report ofReed Committee

(chapter 10)

THE WAY FORWARD

"It eluded us then, but that's nomatter-; tomorrow we will run faster,

stretch out our arms farther ..."F SCOTT FITZGERALD,

The Great Gatsby, Ch 9

_e fmadamenrM issueS

10.1 Each Of the recommendations in Chapter 11 is a piece of a very large jigsaw, whose essential

purpose is to help ensure that mentally disordered offenders are cared for and treated by the health andsocial services and not drawn unnecessarily into the criminal justice system.

10.2 The planning and development of services must reflect the guiding principles of the review,which, as set out at paragraph 3.3, are that patients should be cared for:

• with regard to the quality of care and proper attention to the needs of individuals,

• a far as possible, in the community, rather than in institutional settings;

• under conditions of no greater security than is justified by the degree of danger they present to. . themselves or to others;

• in such a way as to maximise rehabilitation and their chances of sustaining an independent life;

• as near as possible to their own homes or families if they have them.

: We see the fundamental issues as being:

• a positive approach tO individual needs

a positive approach to the needs of individual patients, many of whom, including women and peoplefrom ethnic m/notifies, may have special or differing needs;

.. • joint worlking

a flexible multi-agency and multi-professional approach whose aim is to identify and meet mosteffectively the needs of mentally disordered offenders; .

• the complementary role ofmalnstream and specialised services

the role of general mental health and learning disability services, with access to more specialisedServices, in providing care and treatment for most mentally disordered offenders;

• the police

closer working between thepolice, health and social serv/ces to avoid unnecessary prosecution ofmentally disordered suspects;

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* the probation service

the development of the probation service to:facilitateeffective co -operation at local level between criminal justice agencies and health andsocial services;

ensure that prosecutions are not initiated where they could be avoided; andto help divert from custodial disposals mentally disordered people who have to be prosecuted;

• community care

an improved range of community care services, including accommodation and day services that aresuitable as alternatives to prosecution and Willmeet the needs of homeless mentally disorderedoffenders;

• secure and assoclatcd .s_t_ces

the expansion of medium secure and associated "outreach" services, including in particular those to

cater for people with learning disabilities and longer-term medium security needs;

• health care for prisoners

the improvement of mental health services for prisoners, to be contracted in mainly from the NHS;

• the academic and research base

,- a stronger academic and research base to underpin service improvements and the general andspecialised forensic training of staff to work with mentally disordeied offenders.

Evidence of progress

10.3 There is widespread evidence of a more positive approach by a number of agencies to servicesin this area. This indudes specific follow-upto Circular 66/90 (as shown, for example, by the growthin diversion schemes) and other joint initiatives (such as policy agreements and practice guidelinesestablished at both strategic and working levds, as wall as locally organised multi-agency conferences tostimulate awareness and co -ordinated action).

10.4 There.is also a growing range of innovative service devdopments and, to judge by visits andresponses to our earlier reports, much enthusiasm and interest This.progress is greatly welcomed, butit represents only a start- taken nationally, a. fairiy modest start- which needs to be nurtured andsupported from the top. In this respect, the responses to the recent needs assessment exercise havebeen valuable in pointing to those parts of the country where agencies are acting positively and in

: conc_'t those where they are doing so more haphazardly or, comtmred to others, less effectively.

10:5 We welcome the sponsorship by _e Home Office of a forthcoming series of high-levdconferences for health and social services in every Region (including Wales). These events, which arebeing organised by the Mental Health Foundation, should help to raise further the profile of mentallydisordered offenders and seek to stimulate, as an adjunct to formal action that may stem from thisreview, the multi-agency approach.

Joint work/of nationally and locally

10.6 At the national level, the review itself h as contributed to adosez working relationship betweenthe Department of Health and the Home Office: We welcome Ministers" commitment t0 continue this

-. beyond the review (House of Commons written answers, 13 Nov 1992 and 2June 1992), but webelieve strongly that it requires a continuing formal framework to ensure that awareness of the needs ofmentally disordered offenders is sustained and translated into action (OV 32)!.

10.7 "Haenew Crf,,m','ra/.J;vs.O'ceCam-'a//a/h,bCa,v#d/and the area committees established in the light ofthe Woolfrepott will in future provide multi-agency loci for the criminal justice system_ These bodiesare not designed .to provide the focus for health and social services for mentally disordered offenders,

although they have an important role to play in some areas (such as health care for prisoners).

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10.8 Comparable arrangements are needed for mentally disordered offenders. This requires the

active participation of all the local agencies concerned, guided and monitored at Regional and national

levels. We have already suggested the appointment of consultant advisers in forensic psychiatry as one

possible contribution to ensuring that regional Health Authorities have access to dearly idefitifiedsources of advice.

The Health of the Nation White Paper

10.9 We welcome the priority accorded to mentally disordered offenders in the Health 0fthe

Nation (1992, op c_it);

The essential task here is to ensure that mentally disordered offenders who need spec_ist health

and social care are diverted from the criminal justice system as soon as possible, this requires

dose co-operation between all the local agencies concerned. Authorities' strategic and

purchasing plans should include the neeessa_ry range of health and social services (both

secure and non-secure) to enable them to respond to people's special needs.

10.10 This is the essential complement tO the diversion and discontinuance arrangements

promoted in circular 66/90 and could be matched on the social sei_vices side by implementation ofour recommendation that services for mentally disordered offenders should form part of lo_al

authorities' c0mmunity care plans for 1993-1994.

Effective follow-up of the review

10.11 We think that effective follow-up of this review will require an action plan which sets outdearly the key tasks to be performed and the times by which they are to be achieved: This will need

the active involvement of the NHS Management Executive and the Social Services Inspectorate

which have formal monitoring responsibilities for health and social services authorities, as well as

that of Regional I-Iealth Authorities, which have their own monitoring and strategic functioh/ With

regard to the criminal justice system, the Home Office would need to spearhead work with the

probation, police and prison services and the courts. Other Departments, induding the Lord

Chancellor's Department, the Department of the Environment and the Department o f Education,

may also need to be involved.

10.12 The implementation programme must need to be co-ordinated with the work of the recently

formed mental illness task force (see paragraph 5.18), beating in mind particularly that we expect most

mentally disordered offenders to be cared for and treated within mainstream services.

i0.i3 It is vital that the medium secure programme is firmly managed and monitored. In this

respect we recognise that the monitoring arrangements tlmt the Department of Health now has in place.. are far more sophisticated than existed in" the mid-1970_ The increased capital for medium secure

places above the current targtt of 1,000 and a requirement for more local secure places in lower .

_._-_.

Contin .rang work J

10.14 In many areas, the development of effective diversion arrangements and complementary

seryices for mentally disordered offenders will be starting from a narrow base (CR 4.26). We envisagethe developmental process having the following fundamental stages:

I: /l_e adrt¢_rctt/aft,/ara/_a_tlvarA_r/tl/tr_dttl _ _o_¢ra/Ibtt. Unless this is in place, services arehq_dy to develop bapbaz.ardly, if at all, and will almost certainly/fail a number Of users;

ii. a loc_1 assessment o£necd. Tiffs process has begun, but must be broadened to include all

health and sixial services with need, identified on a multi-agency basis;

iii. a. the inclusion o£multi-agency plans /or menta//y disordered offenders hi

. purchasing, serricc deredopment and other strategies;

b. early actcm taken centm//y, and by local agencies, to determine training

requ/rements and to ensure the deve/opmenr oL'am adequate academic and

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resea_.h base. This is a prerequisite for achieving the necessary service changes and

ensuring that they lead to real health and social service gains for patients;

h, a. 1_e de_e/ojbr_e_l af a more effaIit,e range anLi /et,e/of _ea]l_ aMisocia]$vt_es, a

process which includes the contracting in of mental health care to prisons andmust move on a broad front in tandem with;

#. f_¢ dtt,e]ajgme#l af effe_h,e arra#gemen/s far:

/_e igenhflcan'an of menta_ _'JordemdjOea_le _ t_epvh'ct and t_eir v_taini# d agtfce fram t_e _callb

ang soda] stm6ce_ as/v a'_ita_k cart anJ lmatme#_" a_h,et_g men.'a_.y a_'sar_emi a_nd_r$ Iv/_¢altband

sa_ia]s_ic_ can al/_t_m-caat_s/agg we favour the earliest possible development of

assessment and diversion schemes to achieve nationwide coverage;

t_e idtn__ffea_'a# _ _e_rfm, sem&e a/men/aft), a'isardemtprf_aners w_a mqHit_ _ea]lb or soda/

senv'ces cam a#d_dr Irans_r Iv sJd]abkjbIa¢¢ments.

And finally...

10.17 What happens from now on is subject to the decisions and efforts of 0thers. In 1990 we were

offered what the then Parliamentary Secretary for Health described as "an excellent opportunity". As

we said in our earlier Overview, it was one we have welcomed and which we have endeavoured to seize

effectively. It has been a great encouragement to us that those who have commented on our reportshave very largely endorsed the broad direction we have proposed and our vision of a much more

diverse and sensitive range of services, predominantly non-institutional and non,custodial, which

effectively and promptly meets individual needs. Fortunately there seems to be widespread agreementabout what needs to be done - in itself a helpful base from which to move forward.

10.18 Mentally disordered offenders and others requiring similar services are a vulnerable and, as we

have said, too often neglected group of people. Justice for them, as well as our wider interests as a

society, demand a more effe.ctive response than in the past. We hope that our Work has hdped to build

the foundation on which that response can be given.

r

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