The Community Order and the Mental Health Treatment Requirement

Just a few months into 2008, a convergence of unfortunate circumstances has brought the plight of offenders with mental health problems into sharp focus. Figures released by the Ministry of Justice showed there were 92 apparently self-inflicted deaths among prisoners in England and Wales in 2007, compared with 67 in 2006. This 37% increase in suicides in prison has been associated with the overcrowding that has continued inexorably.This article discusses the application of mental health services to offenders in the prison and the community contexts

Differences between homeless and non-homeless people in a matched sample referred for mental health reasons in police custody

Introduction: Homelessness has risen across high-income countries in the last decade, and in the United Kingdom, there has been a drastic increase in people living on the streets. Due to these increases, policy responses from public services are required to address the needs of this group. The risk factors for homelessness and conditions that this group live in mean they are at elevated risk of both mental health problems and contact with the criminal justice system. Despite this, there is little previous research on the homeless in police custody. Methods: Our study used a matched sample of homeless (n = 77) and non-homeless (n = 77) individuals to examine whether there were different needs across this group and whether the responses of a criminal justice mental health service differ for this group. This study is a secondary data analysis of a more extensive study. Results: Homeless and non-homeless detainees referred to the mental health service were broadly similar. However, differences in some variables show that homeless detainees had higher rates and frequency of substance misuse as well as some suggestion of more acute immediate need. Onward referrals were lower for homeless people, and it is not clear why this is the case. In addition, for those referred contact with services over time was reduced compared to the non-homeless group. Discussion: Our findings indicate that mental health services in police custody may need adaptations to ensure homeless individuals’ higher level of need is addressed and that they receive appropriate care both during and after detention. Further quantitative and qualitative research is needed to confirm why responses differ and to assess what can be done to address this issue

Pathways through the criminal justice system for prisoners with acute and serious mental illness

Purpose: To evaluate pathways through the criminal justice system for 63 prisoners under the care of prison mental health services. Results: Only a small number (3%) were acutely mentally ill on reception to prison, and this may reflect the successful operation of liaison and diversion services at earlier stages in the pathway. However, a third (33%) went onto display acute symptoms at later stages. Cases displaying suicide risk at arrest, with a history of in-patient care, were at increased risk of acute deterioration in the first weeks of imprisonment, with a general lack of health assessments for these cases prior to their imprisonment. Inconsistencies in the transfer of mental health information to health files may result in at-risk cases being overlooked, and a lack of standardisation at the court stage resulted in difficulties determining onward service provision and outcomes. Foreign national prisoners were under-represented in the sample. Conclusions: Greater consistency in access to pre-prison health services in the criminal justice system is needed, especially for those with pre-existing vulnerabilities, and it may have a role in preventing subsequent deterioration. A single system for health information flow across the whole pathway would be beneficial. Summary points: 1. Only 3% of cases were acutely mentally ill at prison reception. 2. Cases identified at arrest as presenting a high risk of suicide, with a history of in-patient care, may be at increased risk of acute deterioration in the first weeks of imprisonment; but they were over-looked for assessment prior to prison. 3. Inconsistencies in the transfer of mental health information into prison health files may result in overlooked at-risk cases

Italian mental health care in the 1978 post reform era : the impact on relatives

A radical movement in psychiatry effectively changed the face of Italian mental health care when in 1978 law 180 was passed. For the first time this introduced systematic deinstitutionalisation of the mentally ill on a scale that generated international interest. Italy however, was ill prepared to receive the mentally ill into the community at the rapidity with which mental hospital numbers were being reduced. Little thought had been given to what this might imply. Some feared the repercussions would be devastating, others were encouraged by the successes of previous community care initiatives and the impetus to spread them nationally. Families of the mentally ill were to form one of the major cornerstones for the new reform to function. The reliance on relatives to provide care was not foreseen by policy makers. The recognition of informal carers in Britain by feminist academics pointed to he heavy burden placed by community care policies on women. Understanding the extent of impact on relatives caring for someone diagnosed mentally ill was a parallel theme for academics in clinical psychology and psychiatry. The present study sought to address some of these issues: community mental health care after the 1978 reform, the impact of care on relatives and what this signified for women. South Verona was the location chosen for the study. The success there in implementing community mental health services was well in tune with what the originators of the reform sought to achieve. Amongst the relatives interviewed remarkably little material or objective impact was found. Favourable economic and cultural factors accounted for the comparatively minimal impact materially. There was however, a notable degree of psychological or subjective impact on relatives. Most relatives were satisfied with community psychiatric services received by patients, but some were unhappy with the way staff perceived them. Some policy implications and service recommendations are considered in the final sections