Today, the National Institute for Health and Care Excellence (NICE) has published a revised quality standard for the mental health of adults in contact with the criminal justice system, which can be found here. Revolving Doors Agency has responded to the draft quality standard for consultation in October 2017.
Currently, NHS England is responsible for commissioning healthcare provision including mental healthcare for people in contact with the criminal justice system, with the exceptions of police and court custody. There is also a joint care pilot scheme between the criminal justice system and NHS funded by the Department of Health, with initiatives such as 'street triage' schemes. However, identifying mental health problems in police custody is complicated by the lack of training, education and a standard assessment. There is also a lack of clarity on appropriate signposting and prompt access to a mental healthcare.
This quality standard covers the subjects of recognising, assessing and managing mental health problems in adults (aged 18 and over) who are in contact with the criminal justice system (this includes police contact, court and prison custody, street triage, liaison and diversion services, and probation services). The quality standard provides evidence-based recommendations for commissioners and providers of health and justice services, and all health and social care professionals working with adults in contact with the criminal justice system in community, primary care, secondary care and secure settings. It also sets clear expectations of what adults who have or may have mental health problems should expect when they come in contact with the criminal justice.
The standard is welcome and timely, following the publication of the Public Accounts Committee’s report on mental health in prisons as well as the wake of media reports on the record-high suicide rates in prisons.
While recent studies show that prevalence and severity of mental health problems in prison tend to be higher than probation and community services, as our publication Rebalancing Act showed, the prevalence amongst people in contact with criminal justice more broadly is still significantly higher than the general population. For example:
• Nearly 2 in 5 of people detained in police custody have some form of mental disorder
• Nearly 2 in 5 adults serving community sentences have a mental disorder
• 8% detained in police custody and 11% of adults serving community sentences have been diagnosed with a ‘psychotic disorder’. This compares with 0.5% in the general population.
Similarly, people in contact with the criminal justice system are recognised as a priority group within the current cross-government suicide prevention strategy, and have substantially more risk factors for suicide, including increased prevalence of mental illness, substance misuse and socioeconomic deprivation.
The revised standard highlights some helpful measures.
Statement 1 Adults in contact with the police because of a suspected offence have any features of mental health problems responded to in a way that reduces the risk of anxiety, self-harm or aggression.
Statement 2 Adults in contact with the police because of a suspected offence who have suspected mental health problems are referred for a comprehensive mental health assessment.
Statement 3 Adults with mental health problems who are in contact with the criminal justice system have a care plan that is shared with relevant services.
Statement 4 Adults who have a mental health risk management plan and are transferring within the criminal justice system have their plan reviewed by the receiving service.
These quality statements naturally only reflect a small part of the activity needed to provide effective mental health support for people in contact with the criminal justice system, and should be implemented alongside the guidance on the Care Act 2014 which has relevance particular relevance for people with neurodevelopmental disorders, including learning disability and autistic spectrum disorders.
Revolving Doors Agency continues to see mental health of people in contact with the criminal justice as a policy priority. We are part of the Offender Health Collaborative, supporting the roll out of liaison and diversion services. The national programme is a cross-government initiative delivered by NHS England and aims to provide a consistent and cohesive approach to liaison and diversion across England.