Bradley review calls for new approach to offenders with mental illness and learning disabilities

A new approach to dealing with mentally ill offenders and those with learning disabilities could prevent this vulnerable group being caught in the revolving door of the criminal justice system. It could cut crime, improve health, reduce police and court workloads and free up prison places for serious and violent offenders, according to Lord Bradley’s independent review published today and welcomed by the Prison Reform Trust.

The Bradley review(pdf) emphasises the importance of mental health and social care services being involved at every stage of criminal justice; from before arrest, through prosecution and the courts, to continued treatment and support after release from prison. The review makes recommendations for each stage. The review also sets out how these reforms should be taken forward and implemented.

Membership of the review’s working group included the Department of Health, the Ministry of Justice and the Home Office. The Prison Reform Trust was a member of the advisory group. The review, which focused on people with mental health problems or learning disabilities in the criminal justice system, was first announced in December 2007 and considered evidence from criminal justice and health practitioners, as well as vulnerable people who had been through the criminal justice system.

Lord Bradley calls for the establishment of a National Programme Board to provide leadership across government to ensure mental health and learning disability services are available for people in need of such treatment and support  who get into trouble. New, locally-based criminal justice mental health teams would deliver the service.

Lord Bradley quotes the government’s five-year strategy for protecting the public and reducing reoffending:

The majority of offenders with lower-level [mental health] disorders are not dangerous and could be better treated outside the prison system without any risk to the public.

The report’s main findings include:

PREVENTION & EARLY INTERVENTION 
·        The review calls for interventions to help vulnerable children and adults as early as possible within the criminal justice system but also for ways preventing them from being involved in crime in the first place. It recommends a separate government review looking at prevention and intervention options for children and young people who have offended or are at risk of offending (pg 33)

THE POLICE
·        The review refers to Home Office evidence that 60% of those issued with an ASBO had a mitigating factor such as mental distress, addiction or learning difficulties. It calls for appropriate checks to be made before ASBOs and Penalty Offices are issued, to avoid ‘accelerating vulnerable people into the criminal justice system, rather than to appropriate services, if they are not complied with’. (pg 37)
·        The review calls for all police custody suites to have access to liaison and diversion services, including: screening for vulnerable people and assessing their needs; providing information to police to enable diversion; and signposting to local health and social care services. (pg 53)

THE COURTS
·        The review calls for immediate consideration to be given to extending to vulnerable defendants the provisions currently available to vulnerable witnesses. This is to enable them to understand proceedings and complex questions. (pg 61)

·        The review calls for a maximum wait of 14 days for court reports on mental health. It had heard evidence that vulnerable people are being unnecessarily remanded in prison for a number of reasons. The lack of approved accommodation with mental support and delays in producing mental health reports for the courts both were leading to unnecessary custody. (pg 67 and pg 73).

PRISON
·        The review calls for adequate community alternatives to prison for vulnerable offenders where appropriate. It heard evidence that 2,000 prison places per year could be saved if a proportion of eligible, short-term prisoners who committed offences while suffering mental health problems were given community sentences. (pg 96)

·        The review calls for better mental health screening on arrival at prison and urgent consideration to be given to including learning disabilities in the screening process. (pg 102)

·        The review calls for the Department of Health to introduce a new 14 day maximum wait to transfer prisoners with acute, severe mental illnesses to an appropriate health setting. A 2005 Department of Health audit had found that at any one time in the prison estate there are on average 282 prisoners waiting initial psychiatric assessment. The review finds the absence of timely assessments and the lack of specialist beds accounts for two-thirds of the delays. (pg 106)

RESETTLEMENT
·        The review calls for greater continuity of care as people enter prison and as they leave prison to re-enter the community. (pg 110)

·        The review calls for help to be given to petty offenders with mental health problems or learning disabilities to ensure they are helped to stay out of trouble. The review calls for a new national strategy for rehabilitation services to be developed for this group. (pg 113)

The review extensively references recent Prison Reform Trust reports on mental health and learning disabilities.

Too Little, Too Late: An Independent Review of Unmet Mental Health Need in Prison, published in February 2009,  reveals that many people who should have been diverted into mental health or social care from police stations or courts are entering prisons, which are ill equipped to meet their needs, and then being discharged back into the community without any support. Out of 57 Independent Monitoring Boards surveyed, over twenty boards specifically stated that they frequently saw prisoners who were too ill to be in prison.

Prisoners’ Voices, published in November 2008, was the overview report of the Prison Reform Trust’s No One Knows programme revealing the experiences of people with learning disabilities or difficulties in contact with the criminal justice system.  Previous reports, welcomed by ministers, have estimated that 20-30% of offenders have learning disabilities or difficulties that interfere with their ability to cope within the criminal justice system. 
 
It found that people with learning disabilities are five times as likely as other prisoners to have been subjected to control and restraint techniques and three times more likely to have spent time in segregation
 
Juliet Lyon, director of the Prison Reform Trust, said:

For too long we have locked up our most vulnerable people in our most bleak institutions. Why waste time and public money building new prisons when it is clear that our jails are full of people in urgent need of proper mental health and social care?

If properly implemented, this review charts the way for many vulnerable people out of the criminal justice maze into health and social care. If we can end the buck-passing between the NHS and the justice system then the pay-off is that we can cut crime, reduce police and court workloads and free up prison places for people who really should be there.

This is a serious, thorough and comprehensive effort at system reform. The real test will be what progress is made in six months time. The clear and present danger to these reforms is that they will be knocked off course by departmental turf wars or the money won’t be found because it’s being sunk into building more prisons.