Q&A: The Bradley Report

What is the Bradley review?
Why is mental health such a big issue in criminal justice?
What are learning disabilities?
What problems do people with learning disabilities face?
What does the Bradley review say?
Does the Prison Reform Trust support the review’s findings?

What is the Bradley review?

In December 2007, Lord Bradley was asked by the government to look into diverting people with mental health problems and learning disabilities away from the criminal justice system.  

The Bradley review considered evidence from criminal justice and health practitioners, as well as vulnerable people who had been through the criminal justice system. 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 an independent advisory group member. 

The Bradley Review published its report on 30 April 2009. Ministers promised to publish an action plan six months later. 

Why is mental health such a big issue in criminal justice?

Many people with mental health problems are caught in the revolving door of the criminal justice system, leading to crime, poor health, increased workloads for the police and the courts and greater pressure on prison places.
 
The Prison Reform Trust’s 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 20 boards specifically stated that they frequently saw prisoners who were too ill to be in prison.
 
The Prison Reform Trust’s Bromley Briefings Factfile contains many facts and figure setting out the extent of the problem, including:
 
·     many prisoners have mental health problems. 72% of male and 70% of female sentenced prisoners suffer from two or more mental health disorders
·     according to Michael Spurr, the operational head of the National Offender Management Service, at any one time 10% of the prison population has ‘serious mental health problems’
·     research found that 96% of mentally disordered prisoners were returned to the community without supported housing, including 80% of those who had committed the most serious offences; more than three quarters had been given no appointment with outside carers.

The Women's Institute has launched a national 'from custody to care' campaign to call a halt to the inappropriate imprisonment of people who are severely mentally ill.

What are learning disabilities?

People with learning disabilities are not a homogenous group, neither are those with learning difficulties or those on the autistic spectrum. They are all individuals with a wide range of different life experiences, strengths, weaknesses, and support needs.
 
However many will share common characteristics, which might make them especially vulnerable as they enter and travel through the criminal justice system. They include people who:

·      experience difficulties in communicating and expressing themselves and understanding ordinary social cues
·      have unseen or hidden disabilities such as dyslexia
·      experience difficulties with learning and/or have had disrupted learning experiences that have led them to function at a significantly lower level than the majority of their peers
·      are on the autistic spectrum, including people with Asperger syndrome.

What problems do people with learning disabilities face?

The Prison Reform Trust’s three year No One Knows applied research programme found that a failure of leadership and direction across the criminal justice system has resulted in vulnerable people facing ‘personal, systemic and routine’ discrimination from the point of arrest through to release from prison. 

At worst, the absence of police safeguards increases the likelihood of vulnerable people experiencing miscarriages of justice, that once in court their lack of understanding grows as their lives are taken over by opaque court procedures and legalistic terminology and in prison many are left to fend for themselves in a shadowy world of not quite knowing what is going on around them or what is expected of them.  Based on research and interviews with prisoners, prison officers and other criminal justice staff and experts, No One Knows found:

·     less than a third of vulnerable people received support from an appropriate adult during police interviews
·     over a fifth interviewed didn’t understand what was going on; some didn’t know why they were in court or what they had done wrong
·     they were 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.

What does the Bradley review say?

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 of 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 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 health support and delays in producing psychiatric 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). 

Does the Prison Reform Trust support the review’s findings?

Yes. The Prison Reform Trust welcomed Lord Bradley’s findings but believes success or failure of the review depends on whether its recommendations are  implemented and adequately resourced. PRT has just accepted independent membership of the National Advisory Group to the Health and Criminal Justice Programme Board convened to focus on delivery.
 
In response to the publication of the review’s findings, 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.