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Race, 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

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Presentation to Cover

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• The role that NHS England has in commissioning services

• Update on key initiatives

• How 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

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Health & Justice Commissioning Context

• £472 million budget• Commissioned by 10 Lead Area Teams• One Health & Justice Clinical Reference Group• Mixed market of providers – NHS Trusts, independent and private sector• Strong mental health links including substance use• Patients are offenders, victims, detainees and families• Support reduction of offending behaviour• Strong partnership governance and reliance• Patient voice essential to monitor quality and integration of patient pathways

Through the Gate

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What 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 Settings

• Key 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

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‘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.

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• Liaison & 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.

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We 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”

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Why are Liaison & Diversion Services needed?

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

Almost 50% of adult prisoners suffer from anxiety and/or depression compared with 15% of 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.

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.

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Liaison & Diversion Core Model

• Early intervention in criminal justice processes

- Identification, assessment and referral

• Integrated model for children, youths and adults

• Targeting a range of vulnerabilities such as

- Mental Health, Learning Disability, Substance Misuse

- Social issues, Housing, Education…

• Provision at Police Custody and Courts

• Hours to suit operational requirements

• Range of referral pathways to suit identified issues

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Liaison and Diversion points of operationIdentificationCriminal 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.

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Benefits 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 remand

• Improved efficiency as vulnerable people are identified earlier, thus reducing the likelihood that they will reach crisis-point leading to possible reductions in repeat arrests

• Improved information on vulnerable people and their conditions to the judiciary and police

• Reductions in the time it takes to process vulnerable individuals though police custody, by the provision of timely information to the charging / disposal process

• Reductions in court time and unnecessary adjournments, by the provision of timely assessment information

• Assurance that vulnerable people have been able to understand, and participate appropriately in the justice system

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Predicted growth in Liaison and Diversion services

Fully specified servicesExisting L&D services

No cover

KEY

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Learning from Wave 1

MH Needs

Alcohol Misuse

Substance Misuse

394

108

272

443

155

887

183

Numbers of adult cases identified with Mental Health, Substance and Alcohol misuse needs,(Quarter 1 data, L&D)

Trial Sites in Quarter 1:

• Returned data for 2,945 adult cases

• 296 cases involving children and young people

• Key needs (adults): mental health, substance misuse, self harm

• Key needs (children and young people): mental health, family conflict, substances

• On average, more than 2 co-morbidities per service user

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Hearing from Liaison & Diversion Service Users

‘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

‘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.

‘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.

‘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

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Benefits 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; and • Re-establish service users engagement with mental health service

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Case Study

• Black Caribbean woman aged 34, mother of 3 children, 48 offences, 8 prison sentences, crack cocaine user, victim of domestic violence

Outcome – Liaison & Diversion service intervention support includes women's centre and BME third sector provider.

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Putting Patient First: Objectives

Ensure equitable access to effective treatments for the health and justice patient cohort across England

Continue to promote continuity of care from custody to community

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Securing 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

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Health and Justice - The Future

• Integration with Street Triage, Liaison & Diversion and Police Custody Healthcare

• Continuity of care - Through the Gate, Custody, Prisons and CommunityStreet Triage Mapping. Ensuring consistency and sustainability of available Street Triage across EnglandOptions for future commissioning

• Core Definition• Service Specification / Operating Model to support quality and patient

pathways• Health & Justice Information Management• Tackling Health Inequalities and assuring an equivalent of care for all

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Questions?

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