A Multiple Method Evaluation of the Mid Essex Memory Assessment and Support Service

On 3rd February 2009, the Department of Health published “Living well with dementia: A National Dementia Strategy”. This proposed a series of changes to the way services for people with dementia are organised and delivered, from raising awareness and understanding through to “living well” with dementia, whether in the community or in long-term care. This report outlines the work undertaken by Bournemouth University in response to the “Specification for evaluation of newly created memory services in Mid Essex.” (July 2009). It details the consultancy and research advisory/ assistance role in order to comprehensively evaluate the pilot memory service- which commenced in January 2009. The approach was essentially a pragmatic service evaluation utilising existing data, supplemented with additional reviews in order to allow comparison between the new service and previous provision. In addition it makes recommendations which can inform future provision and where necessary improvements. The model identified the component elements of the new service (patient pathway) as well as those previously offered through an initial scoping exercise. From these elements it was possible to obtain comparisons utilising quantitative and qualitative outcome measures. The report identifies a range of positive benefits from the MASS provision and makes recommendations for the future

Challenges at the interface of working between mental health services and criminal justice system

Background: Provision of mental health reports for defendants in contact with the criminal justice system is problematic. Aim To explore factors that facilitate the flow of information on a defendant between the courts and the mental health services by: • identifying key challenges to this information transfer from a court worker’s perspective • Exploring potential mismatches in the expectations held by the criminal justice system and the mental health services of the timeframes in which reports should be delivered. • Exploring the perceived usefulness of reports Method: In part 1, questionnaires were distributed to a population of 2107 court workers. In part 2, monitoring forms were completed by court and health professionals on each report request made over a 7 month period. Results: Three key challenges to information transfer were identified: • delays in report production • perceived inadequacies in the report content and • report funding Perceived timelines with which respondents believed reports should be delivered varied and there is mismatch between the expectations of the two services on these timeframes. Perceptions on the usefulness of court reports also varied. Conclusion Poor interagency communications are caused by lack of a clear, shared protocol outlining agreed timelines, report content and lines of responsibility related to resource provision. Clear service level agreements are required between services to achieve clarity. Declaration of interest. non

Exploring the potential for joint training between legal professionals in the Criminal Justice System and health and social care professionals in the Mental-Health Services

Effective screening of mentally-ill defendants in the criminal court system requires cooperation between legal professionals in the criminal justice system (CJS), and health and social care workers in the mental-health service (MHS). This interagency working, though, can be problematic, as recognised in the Bradley Inquiry that recommended joint training for MHS and CJS professionals. The aim of this study was to examine the experiences and attitudes of workers in the CJS and MHS to inform the development of relevant training. The method was a survey of mental health workers and legal professionals in the court. The results showed that showed both agencies were uncertain of their ability to work with the other and there is little training that supports them in this. Both recognized the importance of mentally-ill defendants being dealt with appropriately in court proceedings but acknowledged this is not achieved. There is a shared willingness to sympathise with defendants and a common lack of willingness to give a definite, unqualified response on the relationship between culpability, mental-illness and punishment. Views differ around defendants' threat to security. Findings suggest there is scope to develop interprofessional training programmes between the CJS and MHS to improve interagency working and eventually impact on the quality of defendants’ lives. Recommendations are made on the type of joint training that could be provided

A women’s worker in court: A more appropriate service for women defendants with mental health issues?

Aims Court liaison services aim to reduce mental illness in prison through early treatment and/or diversion into care of defendants negotiating their court proceedings. However, liaison services may inadvertently contribute to gender inequalities in mental health in the prison system. This is because women often do not access liaison services. This is attributed to services failing to recognise that women have different needs from men. To address this, it is essential that the needs of women in contact with the criminal justice system (CJS) are clearly articulated. However, there is a dearth of research that considers women’s needs at this stage of their journey through the CJS. This paper aims to identify these needs before women enter prison. It does so through an analysis of a pilot Women’s Support Service based at a Magistrates’ Court, a response to concerns that women were not accessing the local liaison service. Characteristics of women defendants attending the service are described, specifically their home environments, general and mental health needs. Their support needs when in contact with the CJS and the links the service must forge with local community organisations to provide this, are also presented. This knowledge will develop/ tailor existing services available to women defendants to improve their access to these and optimise the benefits they can derive from them. Methods Proformas were completed by a women specialist worker for 86 women defendants assessed in 4 months. Information was collected on characteristics including education, domestic violence, accommodation, physical and mental health.. This specialist worker recorded the range of needs identified by defendants at assessment and the services to which women were referred. Results Access to the Women’s Support Service is high, with only 11.3% of women refusing to use the service. Women attending have high levels of physical and mental health issues. Their mental health issues have not being addressed prior to accessing the service. Women often come from single households and environments high in domestic abuse. Women have multiple needs related to benefits, finance, housing, domestic abuse, education and career guidance. These are more frequent than those that explicitly link to mental health. The women’s worker providing the service referred women to 68 services from a wide variety of statutory and voluntary organisations. Conclusions The Women’s Support Service is accessed by a higher number of women, many more than access the local liaison service. It is suggested that this is due to their multiple and gender specific needs being adequately addressed by the former service and the organisations to whom they are referred. Mental health needs may also be secondary to other more basic needs, that makes the generic service provided but the Women’s support Service more appropriate than a liaison service that deals with mental health support alone

Challenges Facing Interprofessional Working at the Interface between the Court and Mental Health Services in the United Kingdom

In the Criminal Justice system in England and Wales, Magistrates’ and Crown Courts wanting psychiatric opinion on a defendant, currently have to pay for that opinion from a psychiatrist working independently. If the psychiatric advice is not forthcoming or delayed defendants can wait unnecessarily long periods on remand in custody, failing to access mental health support and/or appropriate sentencing. This system can lead to tensions between the court and the mental health service providers. To address this, a local partnership between Mental Health services and the Criminal Justice system in the SW of England has developed a Service System Development Project. Part of this is the collection of baseline data to identify current challenges to the system from the perspectives of both the Court and Mental Health service personnel. This paper explores the latter, namely the Court’s perspective. As part of the baseline of a longitudinal survey design, questionnaires were sent to all legal advisors, lawyers, magistrates/judges and probation officers linked to courts participating in the project. Findings of the study revolved around their perceptions of the adequacy of current mental health advice provision and highlighted what they see as the strengths and limitations of the system. The paper concludes with a discussion of potential resolutions to the above tensions, exploring where these perceptions may be in conflict with those held by the mental health system and how these relate to the needs of the defendant themselves. As an audience, participants will learn of the: o Challenges facing interprofessional working at the interface between the UK Court and mental health services. o Potential conflict between two working cultures o Ways in which these may be resolved. As presenters, we will learn: o How these challenges can be compared and contrasted with the experiences of international colleagues

Women defendants going through Bristol Magistrates’ Court: the findings of a four month pilot of a women’s advocacy worker.

This pilot came out of the SW courts mental health assessment and advice pilot who, working with the Court Assessment and Referral Service (CARS) provided by Avon and Wiltshire Partnership Trust (AWP) identified that, of the women defendants who had previous contact with a mental health provider, 30% refused to see the mental health professionals at the court. A partnership was formed between AWP and Missing Link (a women’s organisation established in 1982 to provide a range of housing and support to women who have either acute or long term mental health needs), funded by Offender Health South West. Missing Link seconded a worker for four months to approach women defendants in Bristol Magistrates’ court with a view to establishing what practical needs they had and what, if anything, could be done to help them with those needs. The worker was supported by the CARS team and the pilot evaluated by Bournemouth University. In this workshop we will offer information about: • The information that led to the rational for the pilot. • The quantitative and qualitative data about the women seen, their needs and outcomes. • The importance of partnerships with the third sector when working with women offenders. • Some research outcomes of an evaluation of this project. After, these brief introductions, the workshop leaders will work together with participants to identify commonalities and similarities with their own models of and views of working with women and share good practice. We anticipate this work shop will be of interest to those professionals working with offenders with mental health needs wishing to learn lessons to improve current liaison services or implement new liaison services in their region

Interagency working between courts and mental health services: the Implications for interprofessional education and training

Background/Rationale The prevalence of mental health issues in prison populations is exacerbated by ineffective screening for mental illness during earlier contact with the criminal justice system (CJS). Effective screening is reliant on cooperation between the CJS and mental health services. Interagency working has proved difficult in the past as might be expected of working between public services so distinct in expectations, priorities and working culture. Poor interprofessional working leads to court proceedings and public safety being compromised. Further, mentally disordered defendants face inappropriate imprisonment and fail to access community support/treatment. The aim of work is to explore the nature of interprofessional working at the interface of working between the CJS and the mental health services. Methods Data was collected through a cross sectional survey of court (n=479) and mental health workers (n=146). Results Attitudes towards defendants and willingness to work across agencies were comparable across agencies. Procedural expectations varied as did awareness, feelings of efficacy and levels of training that supports better interagency working. Conclusions We discuss the implication of findings for future interprofessional training needs of both court and mental health services. We compare and contrast these with current interprofessional education whose focus is almost exclusively on relationships between health and social care professionals