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Forensic Session 1: An Introduction to the Criminal Justice System

Forensic Session 1: An Introduction to the Criminal Justice System. Local Education Programme Session 14. Outline of the day. 1 – 2 Case Presentation 2 – 3 Journal Club Presentation 3 – 3.15 Break 3.15 – 3.30 555 3.30 – 4.30 ‘An introduction to the CJS’ 4.30 – 5 MCQs & reflection.

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Forensic Session 1: An Introduction to the Criminal Justice System

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  1. Forensic Session 1: An Introduction to the Criminal Justice System Local Education Programme Session 14

  2. Outline of the day 1 – 2 Case Presentation 2 – 3 Journal Club Presentation 3 – 3.15 Break 3.15 – 3.30 555 3.30 – 4.30 ‘An introduction to the CJS’ 4.30 – 5 MCQs & reflection

  3. Curriculum Links

  4. Learning Objectives

  5. An Introduction to the Criminal Justice System

  6. Development of forensic psychiatric services • 1800 – James Hadfield  review of Bethlem Hospital and care of prisoners in asylums • 1816 – criminal wing at Bethlem Hospital • 1850 – 1989 – development of criminal asylums / special hospitals • 1960s – forensic psychiatry conceptualised

  7. Development of forensic psychiatric services • 1975 – Butler report • Lack of secure beds • Overcrowding • Recommended development of RSUs • 1980 – First RSU opened • Services expanded since then • Psychiatric input to prisons • Court diversion • General management advice • Community follow-up

  8. High secure hospital provision • Three high secure hospitals • Ashworth Hospital • Rampton Hospital (incl HSS for women, LD and deaf) • Broadmoor Hospital • ‘Grave and immediate danger’ • Grave offence • Immediacy of risk if at large • Capacity to escape / subvert security

  9. Medium secure services • 3500 national beds • Often mainstay of forensic psychiatric inpatient care • Regional centres • Prison in-reach • Court diversion and liaison • Forensic outreach / community • Specialised services for women, forensic CAMHs, older adults, LD

  10. Low secure services • Services delivering “intensive.. multidisciplinary treatment…for patients who demonstrate disturbed behaviour…and who require the provision of security.” • Active rehabilitation and long-term facilities • Step-down from medium security • Community rehabilitation • Longer-term care

  11. Forensic Community Services • No uniform service • No forensic community follow up • Parallel model • Integrated model • Consultation and liaison model

  12. Entry into secure care • Referrals may come from • CJS (court, prison, police stations) • Movement between levels of security • Up / down / sideways • Gate-keeping for specialist services outside of NHS • Second opinion on diagnosis / risk / management

  13. Clark T & Rooprai DS. Practical forensic psychiatry (2011) Table 2.1

  14. Criminal justice system

  15. Criminal Justice System • Police • Crown Prosecution Service (CPS) • National Offender Management Service (NOMS) • National probation service • HM Prison service • Youth Justice Board and Youth Offending Teams (YOT)

  16. Police detention

  17. PACE • Police and Criminal Evidence Act 1984 • Custody Officer – statutory duties • Deciding to detain • Welfare of detained persons • Calling an appropriate adult • Risk assessment • Rights • Liaise with health-care professionals

  18. Appropriate Adult • Introduced to provide protection for vulnerable people at police station – witness / suspect • Required for anyone who is • Mentally disordered • Mentally vulnerable • Under the age of 17 • Role is • To advise the person being questioned • To observe that the interview is conducted properly and fairly • To assist in communication (may explain words or procedures)

  19. Psychiatrist in Police Station • Issues that may be encountered: • Fitness for detention • Fitness for interview • Risk assessment • Observation • Need for appropriate adult • Medication • Further psychiatric treatment / placement

  20. CPS • Advises police on possible prosecutions • Determines whether or not to charge • Prepares and presents cases to Court

  21. Courts in England and Wales

  22. Prisons and prisoners

  23. Prisoners • Prison population 110% • > 50% Young (20 – 34 yrs) • 95% Male • 84% sentenced • BME overrepresented • Low IQ common • Socio-economic deprivation • Poor physical health

  24. Mental Health of prisoners • Higher rates of mental disorder* *JCP related to mental disorder in prisoners • Higher rates of psychosis, mood disorder and PD than general population • High prevalence of substance and alcohol abuse

  25. Mental Health Care in prisons • NHS responsible – facilities vary between prisons • Mental Health In-Reach Teams • Analogous to CMHTs • Psychiatric Assessment • Same as for all other settings • Reception screen • Physical / Mental disorders • Substance Use • Risk of suicide and / or self-harm

  26. Mental Health Treatment in prisons • No different to community / hospital • Prison health-care centres are NOT hospitals • No compulsory treatment • May use MCA but consider transfer to hospital • Prescribing in prisons – need to consider • Medication times • Medication in possession • Drugs of abuse • CPA applies

  27. Difficult behaviours in prisoners • Food refusal • Most common protest behaviour • Management depends on aetiology • Dirty protests • Psychiatric assessment often required • Self-harm • 17% male sentence prisoners have lifetime history • Alcohol dependence • May be extreme and persistent

  28. Suicide in prison Liebling 1995

  29. Managing suicide risk in prison • Assessment, Care in Custody and Teamwork (ACCT) • Monitors and protects prisoners at risk of serious self-harm or suicide • Collaborative working • Peer support – Listeners Scheme • Personal officer • Chaplaincy • Mental Health In-Reach Teams

  30. leaving prison

  31. Parole Board • Main focus is protecting the public and managing risk • Parole Hearings • May require psychiatric risk assessment • Satisfied that it is no longer necessary for the protection of public that the prisoner should be confined • Risk = dangerousness and must be substantial

  32. MAPPA • Key functions • Identification of MAPPA offenders • Risk assessment & Risk management • Sharing information • Categories of MAPPA offender • Category 1 – registered sex offender • Category 2 – violent or other sex offender • Category 3 – other offenders • Possible 4th category – potentially dangerous offenders

  33. Diversion from CJS

  34. Diversion from CJS • Removal of mentally-disordered offender (MDO) from CJS to hospital for treatment • An MDO may be diverted from • Police custody • Magistrates’ Court • Prison

  35. Diversion from CJS

  36. Court diversion • Magistrates’ Court – filter cases • Effects • Reduced re-offending and improved outcomes • Reduced delay in receiving treatment • Increased admissions  pressure on beds • Better liaison between services • Most patients do not require a secure bed

  37. Prison transfer • Improved psychiatric care in prison, but prisoners with SMI may require admission • Increase in prison transfers • Increasing prison population • Better identification of MDOs • Limited bed availability

  38. Questions? • Additional Resources / Reading in module handbook

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