In ten years time - Revolving Doors Agency
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Improving outcomes for people with mental ill-health,
learning disability, developmental disorders or
neuro-diverse conditions in the criminal justice system
In ten years time
A report by Revolving Doors Agency
and Centre for Mental Health,
Co-Chairs of the Bradley Report GroupIn ten years time In ten years time
Contents Acknowledgements
One 8 First and foremost, we would like to thank Revolving
Doors Agency’s Lived Experience team members, Sue
Introduction Wheatcroft, Liam Folkes, Alyce Ellen Barber, Jason
Roderickson, Dean Huntley, Adrian Esdaille, who have
generously shared their experiences and insights with us.
Two 10
Their work has ensured that the views of people with lived
Early identification, experience shaped this report and ensured the themes
arrest and prosecution within in are grounded in their experiences and expertise.
Our thanks to Lord Bradley for chairing the
roundtables that contributed to this report
Three 14 and for the sharing of expertise.
Courts Thanks too to the Bradley Report Group who shared their
expertise with us at two roundtables and made this report
Four 16 possible. We offer our sincere thanks to: Lorraine Atkinson,
Howard League; Chris Bath, NAAN; Emma Bailey, Centre
Sentencing for Mental Health; Mandy Banks, Sentencing Council;
Linda Bryant, Together for Mental Wellbeing; Dr Jo
Easton, Magistrates Association; Dr Jenny Earle, Prison
Five 20 Reform Trust; Mignon French, CSTRs; Jocelyn Gaynor,
Prisons and Resettlement The Disabilities Trust; Dr Emily Glorney, Royal Holloway,
University of London; Laurie Hunte, Barrow Cadbury
Trust; Jan Hutchinson, Centre for Mental Health; Jessica
Six 24 Southgate, Agenda; Jonathan Moore, Rethink; Connie
Recommendations Muttock, Agenda; and Glyn Thomas, NHS England.
Particular thanks to Jenny Talbot, Prison Reform Trust who
extensively commented and edited the earlier drafts.
Appendix: Definitions 26 Thanks to Vicki Cardwell, Burcu Borysik and Christina
Marriott of Revolving Doors Agency and to Andy Bell of
References 26 the Centre for Mental Health who authored this report.
Layout design & illustration by Avenue Design Ltd, avenuelondon.co.uk
2 3In ten years time In ten years time
By Rt Hon Lord Bradley
By 2020 no matter where It is now a decade since I published and reminds us all that there is still
my independent review of the support much more to do. As it highlights,
you live in the country, offered to people with mental ill-health we need to improve resettlement
these vital services will and people with learning difficulties support after prison and we need to
exist to identify, divert or in the criminal justice system. ensure all the relevant information
is available to the courts to support
better care for people with I was delighted to be asked to
appropriate sentencing. If we can
vulnerabilities. I pay tribute chair this 10 Year On Report and
improve assessment and information
I am grateful for the contribution
to the skilled staff working of many expert organisations in
sharing, fewer people with mental
ill-health or learning disabilities will
in these services, to people our roundtable. I would also like
end up in prison in the first place.
with lived experience, and to thank the Lived Experience
Team members who contributed Inequity in access and outcomes
to decision makers that their expertise to this report. across the whole system remains a
have made this a reality. Reflecting on the last decade, I am
deep cause for concern and I urge all
who work in the criminal justice system
proud that Liaison and Diversion
to review their practices so we can
services are approaching full national
eradicate this over the next decade.
roll out. By 2020 no matter where you
live in the country, these vital services I am confident that by continuing
will exist to identify, divert or better to work together we can affect
care for people with vulnerabilities. I further important change as I know
pay tribute to the skilled staff working many share the vision for the next
in these services, to people with decade to make a real difference. I
lived experience, and to decision therefore commend this report to
makers that have made this a reality. commissioners, policy makers, and
everyone involved in the development
Of course this is only one part of the
and delivery of Liaison and Diversion
picture. This report both celebrates
services across the country.
what has been achieved so far
4 5In ten years time In ten years time
One Two Three Four Five Six
Introduction Early identification, Courts Sentencing Prisons & Recommendations
arrest & prosecution Resettlement
6 7In ten years time In ten years time
It has been a decade since Lord Alongside these changes, coproduction major reform, including digitalisation
Bradley’s landmark report set out a in the criminal justice system has of services. In probation, Transforming
vision for better support for people with gathered pace and is increasingly Rehabilitation made major changes
mental health problems and learning embedded in commissioning. As to the structures by which people
disabilities at all stages of the criminal an exemplar, lived experience is on community sentences and those
justice system from early intervention now part of the operating model for released from custody are supervised.
and prevention to police custody, Liaison and Diversion services. Transforming Rehabilitation has failed to
courts, prisons and resettlement. deliver on the promise of rehabilitation
A lot has changed since 2009. Police
and has been criticised, in particular,
The decade since has seen concerted and Crime Commissioners were
for the failures in supporting people
effort and progress in achieving this introduced with new powers to reduce
with multiple needs, including mental
vision. A major achievement has and tackle crime in local areas. Our
ill-health. Sadly, prisons have seen
been the progress towards universal courts and tribunals are undergoing
rising rates of self-harm and violence
coverage of Liaison and Diversion
and suicides in prison remain a serious
services working to a nationally
concern despite efforts to reduce risk.
mandated operating model in all
police stations and courts for people The last ten years have also seen
of all ages. This systemic change There is more compassion unprecedentedly large and sustained
means that people in contact with and empathy in the spending cuts in public health, youth,
the criminal justice system who criminal justice and voluntary sector
have mental health needs, learning system now definitely. I services – essential to meeting
disabilities or other vulnerabilities are am 50 odd years of age. the needs of vulnerable people.
better identified and more able to I used to have psychotic The Bradley Report Group is clear that
receive the support that they need.
episodes, throw myself despite significant progress, far too
Other promising innovation includes many people in the criminal justice
the emergence of a variety of ‘street
in the police cell, get system with mental ill-health or a
triage’ schemes, as well as the piloting offered nothing but learning disability are left without their
of new sentencing options that allow paracetamol, and be needs properly identified. Too many still
some people to serve their sentence end up in prison when they could have
in the community while getting
taken to court and then been safely diverted and cared for in the
support for their mental health or get remanded. I wanted community; and too many people who
addictions, rather than on costly and to harm myself, I was continue through the justice process
ineffective short prison sentences. are left without the adequate care and
suicidal, you know, and support they need in prison and beyond
Again, as recommended in the Bradley now there is a lot more the prison gates. A decade on from the
Report, assessment processes and
awareness…a lot more Bradley Report, we are as ambitious
treatment options have improved for
as ever for change. This report sets out
people who have personality disorders safeguards in the system. the key progress that has been made
in the criminal justice system.
and what is now needed to ensure we
make another decade of difference.
8 9In ten years time In ten years time
You might be there Mental Health Crisis Appropriate Adults
with a mental health
condition, and that’s The last decade has seen some In 2018, the revised Police and
improvements to the police response Criminal Evidence Act 1984 (PACE)
hard enough to talk to mental health emergencies. introduced a wider definition of
about without someone The Mental Health Crisis Care ‘vulnerability’ to include, for example,
talking to someone else Concordat has driven development communication difficulties or being
of cross-system responses in many prone to suggestibility, compliance
beside you and behind areas whilst the definition of a or confusion, either as a result of a
you. It’s intimidating. Place of Safety has been changed mental health condition or temporary
to allow police detention only in vulnerabilities, such as bereavement,
exceptional circumstances, such as trauma and extreme stress.
significant violence, and never for
The new code requires police officers
children. Information-sharing and
to call an Appropriate Adult if there is
joint decision-making responses
any reason for them to suspect any of
such as street triage, home triage
these functional factors and there is a
and control room initiatives have
further requirement to take proactive
flourished in many police services.
steps to identify and record factors that
However, the recent Inspectorate indicate whether a suspect may require
report (HMICFRS, 2018) on policing the assistance of an Appropriate Adult.
and mental health highlights the extent
However, research has consistently
to which police services across the
identified issues with how the
country still feel poorly supported to
Appropriate Adult safeguard is carried
respond to people in a mental health
out (Bradley, 2009; Dehaghani,
crisis in the community. The triage and
2017; National Appropriate Adult
control room schemes remain subject
Network, 2015). This is in part due
to the vagaries of local commissioning,
to the reluctance of suspects to give
and as yet do not work to a nationally
personal and sensitive information
evaluated model. In addition, concerns
in the police custody environment or
have been raised that for some people,
because they do not wish to wait for
police contact is now the most direct
long periods of time in police custody
way into mental health services, and
for an Appropriate Adult to arrive.
the use of police powers under the
Mental Health Act has continued to Studies also show that vulnerability
rise. This concern is heightened by the is seen as difficult to identify by the
Acknowledging the overwhelming evidence
for early intervention, starting in childhood awareness that for some ethnic groups police and, in practice is subject to
and led by health and social care agencies, access to mental health secondary interpretation by officers. For example,
the main focus of this progress report is on care remains disproportionally a recent National Appropriate Adult
adults who are in or at high risk of contact
with the criminal justice system.
via criminal justice pathways. Network report (2019) found that
10 11In ten years time In ten years time
people with the most commonly Healthcare in police custody Liaison and Diversion Liaison and Diversion
diagnosed illnesses e.g. anxiety, services are commissioned
PTSD and depressive illness were
less likely to get an Appropriate
The Bradley Report recommended by NHS England and cover The Bradley Report made the strong I’ve been in and out of We know that a higher proportion of
that police custody should be as case that diversion services should women in contact with Liaison and
Adult than those that are infrequently
much a health care environment as
92% of the population, have a national model to ensure
police custody, courts, Diversion services have mental health
diagnosed (in some cases despite with an aim to achieve prison all my life. Hand
a criminal justice one; custody often consistency and high standards, needs than of men (Ministry of Justice,
their prevalence) e.g. brain injury,
dementia and schizophrenia. There is
constitutes the first occasion on which national coverage by the and should work with people of on heart, I can tell 2018) and women are also more likely
an individual has the opportunity to all ages throughout the criminal than men to engage with the service.
a significant variance in the recorded
have their vulnerabilities assessed.
end of March 2020. justice pathway. At the time, the
you than in the last NHS England has recently been
need among police forces (NAAN, ten years, things have
availability of liaison and diversion working to develop their pathways for
2019), and there is some evidence Research indicates that detainees
was patchy and limited. There was changed. There is a lot women in the criminal justice system;
that those who ‘presented well’ within police custody typically
no agreed blueprint and no quality and services now screen all women
are thought not to need additional experience poorer physical health,
standards for what effective liaison
more understanding coming into police custody. Of the
support (Dehaghani, 2019), as well alongside mental health and learning of mental health
and diversion should look like. Some individuals in contact with Liaison
as those who appear ‘aggressive’. disabilities, than the general population,
areas had no such services at all; problems, there is a and Diversion services in 2016/17,
consistent with the levels seen in prison
others were available only on certain black offenders were more likely to be
and probation. While the number of
days or limited times; only a very
lot more support out identified as having a mental health
people being taken into police custody there. Police is a lot
few worked with people under 18. need than offenders from all other
has fallen in recent years, the demand
more compassionate. ethnic groups (Ministry of Justice, 2018).
for healthcare services in custody has Now Liaison and Diversion services
not fallen in line with this reduction; operate to a nationally mandated model Liaison and Diversion To fulfil Lord Bradley’s vision of
the proportion of detainees being to identify vulnerable people in police services have made diversion away from the criminal
examined by a healthcare professional custody and the courts to improve justice system, Liaison and Diversion
is increasing (London Assembly, 2018). health and criminal justice outcomes. a huge difference. services need to have strong links with
The national model now includes peer local mental health, learning disability
In the last decade, there has been
support which is supporting effective and other relevant support services,
widespread support for the transfer
engagement. These vital services including specialist services for
of custody healthcare to the NHS,
are commissioned by NHS England children, women and for people from
as recommended in the Bradley
and cover 92% of the population, black and ethnic minority backgrounds.
I kick off, because I’m scared, Report and more recently in the
with an aim to achieve national communities. They also need to have
I’m frightened, I don’t know Mental Health Act Review.
coverage by the end of March 2020. links with wider support for example
where I am, I don’t fully with housing and welfare advice.
The most recent evaluation of Liaison Brain Injury. Offering effective and age-
They need to have the confidence of
understand things. I’m and Diversion (RAND, 2016) found appropriate support to children and
the criminal justice system to inform
not trying to bea pain or that increasing numbers of people young people is also a challenge for
decision-making and ensure vulnerable
with vulnerabilities were now being many Liaison and Diversion services.
anything it’s just the way people are appropriately diverted away
identified in custody. This is very One emerging challenge is ensuring
from custody as early as possible or
I react to that situation. encouraging, however some challenges that the service is available to all
offered effective support quickly if they
remain with effective identification suspects irrespective of whether they
stay within the criminal justice system.
of certain vulnerabilities, such as are detained or attending voluntarily.
learning disabilities and Acquired
12 13In ten years time In ten years time
The first appearance at a magistrates’ In places where the service has been ability to engage with the court
court can be crucial to the operating for some time, practitioners process; their responses, including
identification of vulnerabilities that are well known, and court staff and lack of eye contact, might be misread,
were not picked up at the police defence practitioners seek their advice. and they may not be able to respond
station stage. This hearing is also of to the questions as competently.
The use of video link hearings at the
critical significance in the vast number
Plea and Trial Preparation Hearing There is a range of guidance available
of offences which are prosecuted
in the Crown Court for vulnerable for legal practitioners as to how to
without the defendant having been
defendants also raises concerns. deal with vulnerabilities once potential
arrested (e.g. non-payment of TV
We have heard suggestions from problems are identified. For the
licences). In these circumstances,
Revolving Doors lived experience judiciary, the Criminal Procedure Rules
court may be the only opportunity
panel members that requiring people and Practice Directions set out the
for vulnerability to be identified.
to use video links might inhibit their requirement that reasonable steps
The digitalisation of courts risks must be taken to ensure parties can
making the identification of participate fairly. The Equal Treatment
vulnerabilities more difficult. The Court Bench Book also provides guidance on
and Tribunal Reform Programme I was judged on my meeting the needs of different groups
proposes that plea and mode of trial of people (Judicial College, 2018). There
will be dealt with online, avoiding first mannerisms. I came is further Judicial College guidance on
appearance at the magistrates’ court across as cold, but dealing with vulnerable adults which
altogether. Additionally, it is expected that’s my Asperger’s. states that judges and magistrates
that most summary, non-imprisonable should be alert to vulnerability, even
offences will be dealt with online The Judge brushed over it. where previously not flagged.
through a plea and sentence website.
However, the lived experience
This is of particular concern given
panel who gave evidence to this
that the magistrates’ court presents
report often reported difficulties in
an important early opportunity to
understanding court proceedings
identify vulnerabilities before people
and legal language, as well as having
proceed through the system.
difficulties expressing themselves.
Liaison and Diversion has made
An intermediary can provide
a significant improvement to the
assistance to defendants at court, as
information known about defendants
can support workers, but the level
in magistrates’ courts. Liaison and
of appointment of intermediaries
Diversion practitioners typically look
is still very low in criminal cases
at the court lists to identify those
(Communicourt, 2014).
already known to the service who may
need assistance at the Court. They
also take referrals, including from the
defendant’s advocate, court staff, court
probation officers and the magistrates.
14 15In ten years time In ten years time
Mental health needs
There is no recent study looking at the Deaths of people serving In addition to the inadequate screening
prevalence of mental health needs to identify people with mental health
among people supervised by probation
court orders in the conditions2 there is evidence to suggest
services. Strengthening probation, community increased by that the information is not effectively
building confidence (Ministry of Justice, 40% in the last year. shared along the criminal justice
2018b) cites a study of adult offenders pathway to ensure that the interventions
(MoJ, 2018c)
starting community orders in 2009 are appropriate to the needs of the
and 2010 which showed that 35% individual. A previous study (Brooker et.
reported having a formal diagnosis al., 2011) found that in over half of those
of a mental health condition. identified as having a current anxiety
disorder, this information was not
Another frequently cited study
recorded in the offender’s case file, and
(Brooker, 2012) which was based in
half of those with a current psychosis
Lincolnshire probation service before
were not receiving any support from
the introduction of Transforming
mental health services. Another study
Rehabilitation suggests that 39% of
(Butler Trust, 2014) suggests that
offenders in contact with probation
recognising mental health needs of
had a current mental illness, that 25%
people under probation supervision
had an anxiety disorder (compared
was particularly difficult if they had
to 12.7% in general population) and
learning disabilities and neurological
that nearly half had the symptoms
impairments, or if they were serving
of a personality disorder (compared
short sentences of less than 12 months.
to 13.7% in general population).
Finally, there is a very high degree of
Yet mental ill-health in the probation
co-morbidity and co-occurring need
caseload is, for the most part,
in the probation population. 72% of
unrecognised and untreated. Recent
those surveyed who had a diagnosable
figures1 show the huge variance among
Community Rehabilitation Companies’ 40% mental illness also had a substance
misuse problem (the level of alcohol
ability to identify the mental health
needs among those serving community
increase related needs were even higher).
orders. And there is evidence that
1 Obtained from the Ministry of Justice under
mainstream NHS mental health services the Freedom of Information legislation by the
do not regard people in contact with 1 Revolving Doors Agency
probation as ‘their’ business. This failure
is costing lives. Deaths of people serving year 2 It is important to note the findings of the NAO
report highlighting some of the shortcomings
in the way NHS conducts prison health needs
court orders in the community increased assessments. Frequently the number of prisoners
by 40% in the last year (from 380 in currently in treatment are used as a baseline for
2016/17 to 533 in 2017/18) (MoJ, 2018c) the level of mental health need, but this does not
include unmet need.
16 17In ten years time In ten years time
3 in 5 people sentenced Short prison sentences and pre-sentence reports
to less than six months
in prison report a drug The majority of short sentenced “If we can find effective alternatives to
R
PS
prisoners experience multiple short sentences, it is not a question
or alcohol problem on vulnerabilities, including mental- of pursuing a soft-justice approach,
arrival at prison. ill health, substance misuse and but rather a case of pursuing
homelessness. For example, 3 in 5 smart justice that is effective at
people sentenced to less than six reducing reoffending and crime.”
months in prison report a drug or
Court reports, including pre-sentence
alcohol problem on arrival at prison.
reports (PSRs) are essential to
We know that short prison sentences supporting effective sentencing, and
are largely ineffective with 68% of can highlight to the court where
people serving them being reconvicted people have vulnerabilities. There
within a year. At the same time, has been a substantial fall in the last
the use of community sentences decade in the number of new PSRs
overall has declined substantially produced. Cases with PSRs are
over the last ten years. In particular, more than ten times more likely to
the use of certain requirements that receive a community sentence, and
can address health needs, such falling numbers of PSRs is linked to
Community Sentence Treatment Requirements
as the Mental Health Treatment the decline in community sentences
Requirements, have been extremely (Centre for Justice Innovation, 2018). The Community Sentence Treatment successful partnerships, processes,
low and have further declined in use. Requirement Programme (CSTR) was services and pathways that enable
Information gathered by Liaison
established to reduce offending and accessible treatment for people
We welcome the Justice Secretary’s and Diversion services should be
reoffending; and to reduce short term with multiple and complex health
announcement in February 2019 of consistently fed into PSRs and the
custodial sentences by addressing the and social needs, many of whom
his plans to review the use of short information clearly identified as
root cause of the offending behaviours. do not reach the threshold of
prison sentences under six months: being from a qualified mental health
The programme has successfully secondary healthcare services.
practitioner where this is the case.
supported the increased use and
When you plead guilty, effectiveness of the three treatment
A recently published study (Ministry
the pre-sentence of Justice, 2018d) found that
requirements: Drug Rehabilitation
including a mental health treatment
report is usually seen as Requirement, Alcohol Treatment
requirement and alcohol treatment
Requirement and Mental Health
unnecessary. They say, Treatment Requirement as well as the
requirement in a community order
if you are guilty, then or suspended sentence order can
use of combined orders to support
have a significant and positive
you’re guilty, you have people with co-existing needs.
impact on reducing reoffending. It is
to serve your time. The programme has been tested highly welcome that the NHS Long
in Sefton, Birmingham and Solihull, Term Plan has identified CSTRs as
Northamptonshire, Milton Keynes a provision to be increased across
and Plymouth. They have developed England over the next five years.
18 19In ten years time In ten years time
It is all about the time The majority of people entering prison The Public Accounts
will have pre-existing vulnerabilities
you got to the reception. including mental health problems
Committee Inquiry into
If you arrive on Friday at and/or substance misuse; and the Mental Health in Prisons
6pm, you have to wait experience of being in prison can concluded that “existing
cause further damage to mental
for the whole weekend health, especially for people who have
screening procedures are
to get your prescription. experienced traumatic events prior to insufficient to adequately
But if you land midweek being in custody (Durcan et. al., 2017). identify those who need
Indeed, poor mental health is the
say about 2pm, then you norm rather than the exception among
support and treatment”.
can get your medication prisoners and rates of self-harm are
in the evening. So there rising year on year. Much of this need
remains unidentified, undiagnosed
is something deeply and unsupported. The Public Accounts
unfair – the quality of Committee Inquiry into Mental Health
care depends on what in Prisons concluded that “existing
screening procedures are insufficient
time you arrive at prison. to adequately identify those who
need support and treatment.”
prison mental health teams report
Effective and timely transfer of that they can be very helpful, for
information between health and justice example in helping them to prepare
services has been a longstanding for life after prison (Durcan, 2016).
challenge but is essential to keep But there remain significant gaps
people safe and well. The full roll-out in mental health support in prisons,
of the health and justice digital patient including a lack of primary care and
record information system across all talking therapy provision (Durcan,
adult prisons, including the transfer 2016) which can put inreach teams
of patient records before custody, in under very great pressure.
custody and on release, is welcome.
There is a clear need to change prison
For those people who can access environments and regimes to reduce
services in prison, there has been the risk of serious harm or loss of life.
limited progress in improving mental Self-harm and self-inflicted deaths in
health in prisons during the last prison have risen significantly over the
ten years. All prisons have had a last decade across the prison estate.
mental health ‘inreach’ team since Levels of self-harm differ considerably
the responsibility for commissioning by gender, with a rate of 570 incidents
prison healthcare was taken up by per 1,000 in male establishments
the NHS in 2001. People seen by compared to a rate of 2,675 incidents
20 21In ten years time In ten years time
per 1,000 in female establishments reducing and, in many areas, secure I ended up in a hostel Fresh start
(MoJ, 2018c). The rates of self-harm hospitals are now commissioned after leaving prison. I
among prisoners from a mixed ethnic differently in order to speed up
100% background have doubled in the past transfers and discharges. But the can’t get the mental One of the major changes since
the Bradley Report has been the
suicides of people leaving prison are
also known to occur within the first
increase five years. Furthermore, there were
disproportionate increases in self-
recent Mental Health Act Review once
again called for a maximum 14-day
health need treatment, introduction, as part of Transforming 28 days after release (Sattar, 2001).
substance misuse Rehabilitation reforms, of supervision
inflicted deaths for women, for black wait for hospital transfer and for further While the government recently
men, and for people serving both the reforms to ensure people can be treatment. When you and support for people on release
announced significant changes to
from prison following a sentence of
5 shortest and longest sentences. discharged when they no longer need come out of prison, you less than 12 months. This is highly
the model of probation, including
years Currently, ‘first night in custody’
to be in a secure bed (Wessely, 2018). have problems with significant given that 250,000 people
returning accountability for supervision
of all offenders in the community
schemes and additional support There remains a pressing need for probation, housing issues, churn through prison annually of
to the National Probation Service,
are widely offered to prisoners who a clear blueprint for the full range whom 57% serve sentences of 12
are assessed as being vulnerable of mental health and wellbeing
benefit issues, health months or less. Despite the reforms,
issues remain with high levels of
problems. It’s like getting breach and recalls to prison.
to suicide. But many prisoners assessment and support in prisons, for very high numbers of people continue
describe not being believed when changes to prison regimes to become into deep water, and you to leave prison without the support The original vision of the Bradley
they disclose feelings of distress to more psychologically informed, that they need; the responsibility Report was for Liaison and Diversion
prison officers or healthcare staff and for a better system to transfer
don’t know how to swim. for care is not being effectively services to exist across the entire
(Durcan et al 2017). And relying on risk people to hospital when they need passed on to relevant services. HMI criminal justice pathway, from early
assessment tools to identify prisoners urgent help. The development of the Probation has been critical of the contact through to resettlement. It is
at risk of suicide is ineffective. Personality Disorder Pathway is a quality of ‘through the gate’ services highly welcome that the NHS Long
positive approach to coordinating provided by Community Rehabilitation Term Plan commits to a new care after
For people who are in a mental health
support from prisons to probation. Companies and, in particular, the custody service, RECONNECT. This
crisis and need urgent treatment,
lack of planning and arrangements service will start to work with people
transfers to hospital under Part 3 of the However, ten years on from the
for suitable accommodation (HMIP, before they leave prison and help them
Mental Health Act are required. Long Bradley Report, serious self-harm
2019). This is disappointing given to make the transition to community-
waits for hospital transfers were cited and tragic loss of life continues
the evidence of risk at this point based services that will provide the
in the Bradley Report as a concern in our prisons and the need for
of transition. For example, 1 in 5 of health and care support that they need.
and this continues to be an issue concerted action to bring about
in many areas. Nationally, average significant system change remains.
waiting times for hospital transfers are
The rates of self-harm
among prisoners from a
mixed ethnic background
have doubled in the past
five years.
22 23In ten years time In ten years time
1 4 7
Across the criminal justice Liaison and Diversion Invest in effective community
pathway, a common, services should be sentences that command the
comprehensive definition of resourced to enable confidence of sentencers,
vulnerabilities is adopted that effective screening of including roll-out CSTRs
includes mental ill-health, 100% of those who come across England.
learning disabilities, autism and into police custody or
autism spectrum disorders, attend voluntarily.
substance misuse, personality
disorders, acquired brain injury
and traumatic brain injury. 8
The Ministry of Justice
should press forward with
5 plans to restrict the use of
2 short prison sentences.
The Courts should not
be able to send people to
Comprehensive protocol
immediate custody or to
to screening, assessment,
a community sentence
information sharing and care
across the whole system
in the absence of a 9
relevant court report.
– including street triage,
police, courts, probation Reforms propsed in the
and prison – should be Independent Mental Health Act
developed and implemented. Review regarding prison transfers
and other Part 3 recommendations
should be rapidly implemented.
6
3 The roll-out of Transforming
Justice digitalisation
As recommended in programme should be
10
the Bradley Report, reviewed to ensure robust
commissioning of police evidence is available on the RECONNECT should be
custody healthcare impact on people with mental invested in to ensure the
should be transferred ill-health, learning disabilities, service covers short sentenced
to the NHS. or other vulnerabilities. ‘revolving doors’ group.
24 25In ten years time In ten years time
Appendix: Definitions References
Acquired brain injury (ABI) is an injury ID (70-80) can live independently Bradley, K. (2009) Lord Bradley’s Review Dehaghani, R. and Newman, D. (2017) ‘We’re Ministry of Justice (2017) Statistics on race National Appropriate Adult Network (2015)
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a fall, a road accident, tumour and System. London: House of Lords. Aid and Police Custody’, Oñati Socio-Legal service.gov.uk/government/uploads/system/ or interviewed by police. London: Institute of
Mental ill-health: Mental health Series, 7(6). Available at: https://ssrn.com/ uploads/attachment_data/file/669094/ Criminal Justice Policy. Available at: https://
stroke. Traumatic brain injury (TBI)
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of conditions such as depression,
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road traffic accidents, assaults, falls Available at: http://www.research-lincs.org. National Appropriate Adult Network (2019)
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Butler Trust (2014) Supporting and supervising RAND Europe (2016) Evaluation of the Offender
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and significant impairments in
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personality (self and interpersonal) HMICFRS (2018) Policing and mental health: strengtheningprobationbuildingconfidence.pdf.
mental-health-issues-in-the-community RAND_RR1283.pdf (Accessed: 23 May 2019).
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(Accessed: 23 May 2019).
Health Organisation defines learning pathological personality traits, which are Ministry of Justice (2018c) Safety in custody: Wessely, S. (2018) Modernising the Mental
Home Office (1984) Police and Criminal
disability as “a state of arrested or not solely due to the direct physiological Centre for Justice Innovation (2018) The Deaths of Offenders in the Community, Health Act: increasing choice, reducing
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incomplete development of mind”, effects of a substance (e.g. a drug of changing use of pre-sentence reports. London: England and Wales 2017/18. London: compulsion. London: Department of
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intellectual functioning or adaptive/ condition (e.g. severe head trauma).
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indicate severity – mild, moderate, also experience poor general health, Communicourt (2014) Number crunching. Available at: https://www.london. (Accessed: 23 May 2019). increasing_choice__reducing_compulsion.pdf.
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co.uk/wp-content/uploads/2014/08/number- Ministry of Justice (2018d) Do offender
as 80-120. A person with severe and anxiety disorders and experience london-assembly-publications/detained-not- characteristics affect the impact of short
generalised intellectual disability reduced life expectancy. Antisocial crunching-0814.pdf (Accessed: 23 May 2019). forgotten-healthcare-police-custody. custodial sentences and court orders on
will have a tested IQ under 35, and personality disorder and borderline reoffending? London: MoJ. Available at: https://
Dehaghani, R. and Bath, C. (2019) ‘Vulnerability
cannot live independently. In varying personality disorder are two types and the appropriate adult safeguard: examining www.gov.uk/government/publications/
degrees, those with moderate (IQ of personality disorders commonly the definitional and threshold changes within do-offender-characteristics-affect-the-impact-
35-49), mild (IQ 50-69) or borderline seen in the criminal justice system. PACE Code C’, Criminal Law Review. Available of-short-custodial-sentences-and-court-
at: http://orca.cf.ac.uk/118431/. orders-on-reoffending (Accessed: 23 May
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26 27Revolving Doors Agency South Bank Technopark T 020 7407 0747 90 London Road E admin@revolving-doors.org.uk London SE1 6LN @RevDoors
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