Interagency training to support the liaison and diversion agenda

Background In England and Wales there are an unacceptably large number of people in prison or in contact with the criminal justice system who have mental health issues. Integrated and effective interagency collaboration is required between the criminal justice system and mental health services to ensure early diagnosis, treatment, appropriate sentencing or diversion of these individuals from the criminal justice systems into mental health services. Liaison and diversion schemes are proposed as a means to integrated service provision through positioning mental health professionals within the criminal justice system. These schemes were recommended by the Bradley Report (2009) to be rolled out for all police custody suites and courts by 2014 in a National Diversion Programme. Working within these schemes, at the interface of the criminal justice system and mental health services, has its challenges (Hean et al., 2009) and the workforce from both systems must be prepared to address these. This was recognised by Bradley when he recommended that: “where appropriate, training should be undertaken jointly with other services to encourage shared understanding and partnership working. Development of training should take place in conjunction with local liaison and diversion services (p111; Bradley, 2009). The form this joint training should take is as yet unexplored. We have proposed elsewhere that joint training should equip different agencies and professionals with the skills and knowledge required to collaborate effectively, and not only focus on mental health awareness courses for those in police, prison and courts services (Hean et al. 2011). The criminal justice system and mental health services need to come together to learn about, from, and with each other in interagency training. Aim We present in this report our vision of what this joint interagency training between the criminal justice and mental health services should contain, how it may be delivered and its potential benefits. We explore the receptiveness of professionals from the criminal justice and mental health services to interagency training and explore their perceptions of the challenges to interagency working between the two systems. We focus particularly on one particular dimension: an interagency crossing boundary workshop and its theoretical underpinnings. We explore professionals’ expectations of this type of intervention as well as their perceptions of the knowledge and skills required to deliver the emerging liaison and diversion agenda in general and the content and delivery of interagency training in the future. These findings are synthesized into a series of recommendations and a model of interagency training that will prepare professionals in both agencies to respond to the liaison and diversion agenda more effectively and work collaboratively in the interest of the mentally ill offender. Method A crossing boundary workshop (Engeström, 2001) was delivered in December 2011 to a sample of 52 professionals from a range of non-health professionals associated with criminal justice system (probation, police and courts) and professionals from the mental health system or health domain (learning disability, substance misuse and mental health services). The receptiveness of criminal justice system and mental health service professionals to interagency training was assessed through the Readiness for Interprofessional Learning Scale (Reid et al., 2005) administered to respondents before the workshop. Perceptions of the challenges facing interagency working and the expectations of the workshop were explored through interactive exercises. Professionals from both agencies participated in a series of 6 parallel focus groups to discuss how to prepare the workforce to respond effectively to the liaison/diversion agenda and the constraints they worked under in terms of commissioning, delivering and attending this training. Findings Professionals from both the mental health and criminal justice systems need to build empathic relationships with staff from other agencies. They stressed the importance of actual face-to-face contact between professionals from different agencies to achieve this and saw interagency relationships as being built through increased knowledge of other agencies and the orchestrating of formal facilitated contact between them. They were strongly in favour of interagency training and its contribution to enhanced collaborative competence across the workforce and, in the long term, improved offender mental health. They believed interagency training would develop in the workforce a greater knowledge of other agencies and help them understand other professionals’ roles and responsibilities. They believed interagency training should occur pre-qualification, through into continued professional development and contain a variety of interagency training experiences. Professionals from both systems shared a high level of person centredness in their approach to their practice and stressed the importance of training being grounded and delivered in a real world environment. Participants acknowledged that training opportunities are under threat due to financial and time limitations and that joint commissioning, shared resources and economies of scale must be considered. Recommendations • A training package should be developed to prepare professionals both from the mental health and criminal justice system for the liaison and diversion agenda and integrated service provision. This training must offer a strong interagency component aimed at developing interagency collaboration skills and interagency knowledge. A four-stage training model is proposed in this report. This incorporates pre-registration or undergraduate training for trainee professionals in the mental health services and criminal justice system, general awareness training, interagency training for continuing professional development and the development of interagency reflective practice opportunities. This model may be supplemented by a variety of on-line resources, some of which are described. • These interagency training models should be developed in partnership between universities and local facilitators from within the criminal justice system and mental health services to provide both the theoretical and evidence based rigour associated with developing collaborative practice curricula alongside the real world contextual knowledge required of these programmes. • In the long term, interagency training should be delivered in practice by practitioners to ensure the continued validity and sustainability of these programmes. Training should be sensitive to changes in the workforce due to turnover and the pressures of organisational change. • In times of economic constraint, training should be well targeted at staff and organisations essential to the liaison and diversion agenda. • An interagency commissioning approach will be required to deliver the training package outlined to support the liaison and diversion agenda, and especially if there is to be joint training and sharing of resources

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

Improving collaborative practice to address offender mental health: criminal justice and mental health service professionals’ attitudes towards interagency training, current training needs and constraints,

Background Professionals from the mental health and criminal justice system must collaborative effectively to address offender mental health but interprofessional training is lacking. Pedagogical frameworks are required to support the development of training in this new area. Aim To inform this framework this paper explores the readiness of professionals towards interprofessional training and demographic differences in these. It explores expectations of interprofessional training, perceived obstacles to collaborative working, interprofessional training needs and challenges facing delivery. Method A concurrent mixed methods approach collected data from professionals attending a crossing boundaries interprofessional workshop. Data was collected through a combination of the RIPLS questionnaire (n=52), free text questions (n=52) and focus groups (n=6). Findings and Conclusions Mental health and criminal justice professionals’ attitudes towards interprofessional learning were positive (x=17.81; n=43). They did not see their own service as insular (x =4.02; n=44) and reported strong person centredness (x= 6.07; n=43). This suggests professionals are open to the introduction and implementation of future interprofessional training. There were no significant demographic differences in these attitudes. Professionals raised a range of generic curriculum and educator mechanisms in the development of future interprofessional training suggesting the transfer of pedagogical frameworks from established interprofessional programmes into this new arena is feasible. Context specific factors such offender national policy agendas and the challenges of user involvement using mentally ill offenders must be taken into account. Greater clarity on multi versus interprofessional training is still required with this group of professionals. Key words: mental health, offenders, criminal justice, interprofessional training

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

Mental health and the criminal justice system: The role of interagency training to promote practitioner understanding of the diversion agenda

Historically there has been a significant under-recognition of mental health problems among people in the criminal justice system, and little research exploring the issues encountered by those with mental health problems who come into contact with the criminal justice system. Recent policy has highlighted the importance of early identification of mental health needs in criminal cases, and the role of diversion of offenders into appropriate mental health services. However research suggests that currently the provision of mental health services for offenders is patchy, and it has been suggested that improved interagency communication and training is required to improve the diversion of offenders with mental health problems into more appropriate mental health provision.The aim of this paper is to consider the current position of those with mental health conditions within the criminal justice system in England, and discuss how joint interagency training can improve understanding of the diversion agenda for the range of practitioners that come into contact with offenders with mental health problems. The perspectives of a range of practitioners who attended a joint interagency training day will be discussed, and recommendations for future training will be offered. © 2014 Taylor & Francis

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