keeping the care not custody promise

centre for mental health, prt, nhs confederation, rethink and wi logos

In order to maintain the momentum to ensure that the government's proposed liaison and diversion schemes go ahead, Centre for Mental Health, Prison Reform Trust, NHS Confederation, Rethink and the WI have produced a briefing and are appearing at party conference round-tables.

You can download the briefing here

Andrew Lansley, health minister, at the Care not Custody event 28/3/11

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Ken Clarke, justice minister, at the care not custody event 28/3/11

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the care not custody coalition


The National Federation of Women’s Institutes (NFWI) has called consistently for the diversion of people with mental health needs from custody into treatment and care. It’s Care not Custody initiative was inspired by the tragic death by suicide of a schizophrenic young man in Manchester prison, the son of a WI member. Since then the Prison Reform Trust (PRT) has worked in partnership with the NFWI to effect change.

In March 2011, at a reception hosted by the NFWI and PRT, the Secretaries of State for Health and for Justice jointly announced their commitment to developing national liaison and diversion services in police custody suites and criminal courts, for vulnerable suspects and defendants, by 2014. Parliamentary reports have shown a welcome investment of £50 million towards the development, commissioning and evaluation of such schemes.

The Care not Custody Coalition, convened following the reception hosted by the NFWI and PRT, comprises a wide range of allied professional groups and charities. The Coalition represents over one million people across the health, social care and justice sectors and wider civic society. Together our organisations show the breadth of support that there is for the development of effective liaison and diversion arrangements across the country for people with mental health needs and learning disabilities caught up in the criminal justice system.

The organisations and professional bodies in membership have agreed to work together to support the government in keeping its ‘care not custody’ promise and to hold government to account for effective delivery. The coalition is well placed to monitor the implementation of liaison and diversion arrangements, offering support for positive steps and raising concerns where they arise.

 Action for Prisoners’ Families
 NHS Confederation, Mental Health Network
 The Advocacy Training Council National Appropriate Adult Network
 Association of Directors of Adult Social Services
 National Federation of Women’s Institutes
 Association of Members of Independent Monitoring Boards Police Federation of England and Wales
 Bar Council Police Foundation
 British Association for Counselling & Psychotherapy POPS (Partners of Prisoners and Families Support Group)
 Centre for Mental Health Prison Governors Association
 Office of the Children’s Commissioner Prison Officers Association
 Clinks Prison Reform Trust
 Criminal Bar Association Rethink Mental Illness
 Criminal Justice Alliance Revolving Doors Agency
 The Howard League for Penal Reform Royal College of Nursing
 KeyRing Living Support Networks Royal College of Psychiatrists
 The Law Society Together: For Mental Wellbeing
 Magistrates’ Association Victim Support
 Mencap Women’s Breakout
 Mind Women in Prison



Care not Custody - the film


In June 2008, the WI AGM passed, by an overwhelming majority, the following mandate:

In view of the adverse effect on families of the imprisonment of people with severe mental health problems, this resolution urges HM Government to provide treatment and therapy in a more appropriate and secure residential environment.
More than two-thirds of all men, women and children in prison have two or more mental health problems such as depression and anxiety. Many have a history of attempted suicide and self-harm, while significant numbers have severe and ongoing illnesses such as schizophrenia and personality disorders.

Prison mental health care is too often a catch-all for people who would be better cared for outside the criminal justice system altogether. Those not getting the care they need can end up harming themselves or even committing suicide. They can also find it difficult to adjust to life when they leave prison – putting a huge strain on families and leading many to reoffend.

Lord Bradley's April 2009 review of mental health and learning disabilities within the criminal justice system said that “there are now more people with mental health problems in prison than ever before. While public protection remains the priority…custody can exacerbate mental ill health, heighten vulnerability and increase the risk of self-harm and suicide’.

In January 2009, a joint report from the Prison Reform Trust and the National Council of the Independent Monitoring Boards in England and Wales, concluded that a failure to identify people in need of mental health care is leading to avoidable or damaging incarceration. It suggested that too often the courts were using prisons as "a default option" for people who should have been diverted into the mental health system, placing
"intolerable strains" on prisons.

There is financial as well as health benefit to favouring diversion over imprisonment. According to the House of Commons Justice Committee report in January 2010, there is strong evidence that swift action in this area, in particular to broaden access to diversion and liaison schemes and, if necessary to secure health treatment, could yield short, medium and long-term reductions in the prison population and result in cost savings to
the public purse.

Prison has a particularly harsh impact on women with mental health problems. There are 4,300 women in 14 prisons in England. Four out of five women prisoners have mental health problems, most commonly depression and anxiety.

Following the death by suicide of six women at HMP Styal, the Government asked Baroness Corston to review and report on vulnerable women in the justice system. The report found that short spells in prison, often on remand, damage women’s mental health and family life yet do little or nothing to stop them offending again. The damage is made much worse when women are imprisoned long distances from home and their families and receive inadequate health care during and after their time in prison.

The Corston report called for women’s prisons to be scrapped and replaced with small units to house the minority of serious and violent female offenders who pose a threat to the public. For non-violent offenders – most women in prison – community sentences should be the norm. The report calls for an extension of the therapeutic work done by women’s centres run by the voluntary and statutory sectors and suggests that more offenders should be referred there.

This mandate highlighted an enormously important and often hidden issue – how we treat people with mental health problems when they come into contact with the criminal justice system and what impact this treatment has on their families and therefore society as a whole.

The subsequent campaign highlighted how, despite Government rhetoric, too many people are getting inadequate mental health care in prisons when they could have been diverted to hospitals or community based alternatives. Women, children and young people are particularly hard hit by prison being the default option, with the after effects of inappropriate detention often leading to pressure on relatives and even family breakdown.

There is a much greater need for higher levels of cooperation between the NHS and the criminal justice sector. People with mental health disorders should be cared for in the most appropriate location – not the most convenient one.

As a way forward, the NFWI outlined ways in which people with mental health problems can get the right care for their condition via better diversion facilities and effective treatment for those already in the criminal justice system.

By raising a difficult issue without being a specialist prison or mental health group, we were able to shine the spotlight on a concern traditionally seen as taboo. Politicians and the press were surprised that this was being raised by the WI and therefore were more likely to listen and act.

The campaign called for

EFFECTIVE DIVERSION SCHEMES AROUND THE COUNTRY. This would be a statutory duty for the NHS to develop a national network of diversion schemes at police stations and courts.

ACCESS TO EARLY ASSESSMENT AND INTERVENTION. This could take the form of mental health clinical advisers in courts and police stations to ensure problems are spotted and assessed quickly

COMMUNITY MENTAL HEALTH SERVICES AVAILABLE OFFERING SAFE ALTERNATIVES TO IMPRISONMENT. Diversion will only work if there are adequate services across England and Wales to which people can be diverted, wherever possible out of custody.

FULL IMPLEMENTATION OF BARONESS CORSTON’S PROPOSALS FOR WOMEN IN THE CRIMINAL JUSTICE SYSTEM: including investment in local community-based provision based on women's centre models, which carry out therapeutic work and are close to families
and networked into local services.

HELP WITH RESETTLEMENT. Support should begin as soon as people are diverted to prepare for life outside. Alongside mental health treatment, they need help to build up work skills and get jobs, to have a home to go to and to maintain contact with family where they are supportive.