Bradley Review Terms of Reference To examine the extent to which offenders with mental health or learning disabilities could, in appropriate cases, be diverted from prison to other services and the barriers to such diversion To make recommendations to the government, in particular on the organisation of effective court liasion and diversion arrangements and the services needed to support them
Bradley-Key Recommendations • 82 recommendations accepted by the government • Early identification and assessment of mental health problems or learning disabilities • Review responsibility for health services in police custody • Section 135/136 Places of Safety • Criminal Justice Mental Health Teams to ensure continuity of care
Key Recommendations • Common Assessment Tools • Improved data collection and sharing of information • Commissioning and planning of services • Improved Training at every stage of the Criminal Justice System • National Joined up approach with the establishment of a National Programme Board and National Advisory Group • Regional and local partnerships • Better use of existing resources • Leadership
Lord Patel of Bradford Independent Group looking at drug treatment in prison • Improve quality • Increase innovation • Achieve efficiencies
Challenges 136 adult prisons – 84,000 prisoners have Complex problems: • 10% of those sentenced have a diagnosed severe and enduring mental illness • 69% of those who enter prison have taken drugs in previous 12 months • 40% report injecting drugs in period preceding imprisonment • Twice as likely to commit suicide than non dependent prisoner
Challenges Dual Diagnosis • 74% of users of drug services and 85% users of alcohol services have experienced mental health problems • 44% of mental health service users reported drug use and were assessed to have used alcohol at hazardous or harmful levels in the past year • In week following release, male offenders are 37 times more likely to die of drug overdose. Women are 69 times more likely
Recommendations • Unified cross government drug treatment and intervention strategy • National Health and criminal justice outcome model with aim of reducing reoffending and improving rehabilitation • Streamlined communications system • National drug treatment and interventions framework (communities and prison) • Establishing effective links with wider criminal justice, health and social care system
Recommendations • Streamlined commissioning system • Collaborate and jointly commission at a local level to ensure the needs of drug users in prison and on release are met • Commissioners and local partners focus on increasing social capital of users and carers through ‘Recovery Champions’ and appropriate community groups
The Local Picture Information from Court Assessment & Diversion 2007
East Sussex-The way forward • Build on learning and areas of good practice from the Brighton Mental Health Court Pilot • Mental Health Nurse available daily at court • Comprehensive pro-active screening and assessment • Creative use of community orders • Court review processes • Involvement of MHCP post sentence • Develop a collaborative approach to the assessment and management of dual diagnosis cases • Develop flexibility to embrace new areas of practice such as learning disability or dual diagnosis with substance misuse as the primary need
Facilitated Discussion Based on the presentation and your experience… • What are your thoughts on the the mental health needs of offenders in East Sussex? (e.g. is this larger/smaller than expected) • Are there areas of East Sussex where you think there is more or less need? • Are there any groups of offenders who are more likely to have an unmet mental health need? (e.g. older offenders, BME groups of offenders) • Do offenders experience any further barriers in communicating their mental health needs and seeking support?
Mental Health Services for Anxiety and Depression • Health in Mind • Primary Care Mental Health Workers • 22 in post • Provide: • Assessment and onward referral • Advice, signposting & support • Brief intervention • Providing advice to Primary Care staff
GP Social Care Direct PCMHW Signposting Day Services Consultant Advice CRHT Urgent 4 hours Recovery 7 Day LTSU Step 2 Step 3
Mental Health Services for Anxiety and Depression • CBT Therapists • 11 qualified, 32 in training • Provide: • 1:1 Therapy for anxiety disorders and depression • Workshops – Mindfulness, Mind over Mood, Self-esteem, Anger management • Criteria: Mild to severe anxiety and depression, low to moderate risk, moderate impact on functioning, able to develop a collaborative alliance & develop a focus for therapy
Facilitated Discussion In your experience… • Is there good awareness of the Health in Mind service and its access routes within your service? • Do offenders have any specific needs that might present a barrier to accessing the Health in Mind service? • What elements of the Health in Mind service are likely to be the most beneficial for offenders in the community? • Are there elements of the Health in Mind service that are less likely to benefit offenders in the community? • Are there other means of supporting offenders with mental health needs such as anxiety or depression? What are the advantages/pitfalls with these?
Coffee Break (15 minutes)
Integrated Offender Management • Discusses people who have the greatest need and are most likely to reoffend at weekly multi-agency meetings • Aims to put a package of support around clients that meets their needs holistically • Ensures intervention is directed where the need/harm is greatest
Facilitated Discussion How can the service you represent link in with the Integrated Offender Management approach to ensure the mental health needs of offenders are met?