Escolar Documentos
Profissional Documentos
Cultura Documentos
3
Date: 21st July 2014
Author: M. Scott & S. Senker
Status: Draft
Rebalancing Rehabilitation
Making the case for change to ensure a level playing-field for Offenders
with Complex Needs across Essex
CONTENTS
Executive Summary
1. Literature Review
2. Local Data Analysis
3. Qualitative Interviews
4. Recommendations
5. Next Steps
Annex: Data workbook
TONIC: Discussion Paper
LD
= Learning Disability / Difficulties
SM
= Substance Misuse (drugs &/or alcohol)
MH
= Mental Health problems
DD
= Dual Diagnosis (mental health & substance misuse)
DIP
= Drug Intervention Programme (also known as CJIT Criminal Justice
Intervention Team)
CJMHT = Criminal Justice Mental Health Team
CRC
= Community Rehabilitation Company (formerly known as Essex Probation)
L & D = Liaison & Diversion service (for MH & LD)
NDTMS = National Drug Treatment Monitoring System
HMP
= Her Majestys Prison
CJS
= Criminal Justice System
DRR
= Drug Rehabilitation Requirement
ATR
= Alcohol Treatment Requirement
MHTR = Mental Health Treatment Requirement
Older Prisoner = those aged 50+
Vulnerable = Any individual who is, or maybe, in need of community care services by reason of mental, physical or
learning disability, age or illness and who is or may be unable to take care of himself or herself, or unable to protect
himself or herself against significant harm or serious exploitation which maybe occasioned by actions or inactions
of other people. [Law Commission, 1995]
Executive
Summary
TONIC: Discussion Paper
Executive summary
Summary of Recommendations
Quick Wins
1. Clear pathways (inc. agreed
Medium
4. Engender a climate that promotes
Longer-Term
8. System-level change including
agencies:
consultation
Importance of women-specific
services not to be underestimated
LD may not be seen as treatable
in the way SM & MH are, but there
is still a vital place for management
and adaptation to improve
outcomes/reduce re-offending
The Challenge
The Reducing Re-offending Board wanted to explore pathways and systems for
offenders with complex needs (OCN)
The OCN group across Essex, Southend & Thurrock want to improve services for
individuals with:
As a result of the Care Act coming into force from April 2015 and its renewed clarity
over adult safeguarding, there is also a need for local authorities to consider the
needs of
Older offenders
Vulnerable adults
That are in contact with the CJS
TONIC was commissioned to help the group better understand the scale and scope of
OCN needs
TONIC: Discussion Paper
Our Approach
We conducted a number of lines of inquiry, across
the CJS, including:
Reviewing UK literature on OCN including
prevalence & priority needs/issues
Collating & analysing relevant local data from a
range of partners throughout the different
stages of CJS
Conducting qualitative interviews with key
stakeholders
Producing an options paper on potential ways to
address the needs identified in this project
TONIC: Discussion Paper
Chapter 1
Literature Review
TONIC: Discussion Paper
Interlinked Relationships
There is a strong and recognised relationship between Substance Misuse (SM), Mental
Health problems (MH), Learning Disability (LD) and offending in terms of:
An increased likelihood of committing a range of crimes from acquisitive offences (drug
misuse); violent crime (alcohol & MH; sex offences and arson (LD); & re- offending (drug
users are 3-4 times more likely to commit crime than non-users)
Their prevalence in offending populations (an estimated 25% - 65% of offenders have
MH; 50% SM; 30% LD needs)
Their overlapping, co-occurring nature (dual diagnosis is the norm not the exception; &
60% of individuals with LD will also have an SM problem)
These issues, therefore, have a high cost to the CJS (est. 13.9 billion for drug related crime)
OCN are often more vulnerable in CJS being more likely to experience restraint in custody
(LD & MH), violence (alcohol), being frightened and confused (MH/LD) with higher rates of
attempted suicide and self harm (LD). They are also more vulnerable on exit from the
Criminal Justice System, experiencing higher rates of housing difficulty and unemployment
Research and campaigning organisations have made strong and enduring calls for dual
diagnosis services (SM/MH) & MH/LD services to be delivered jointly for offenders
OCN have unequal access to support options available to other offenders, and as a result
are further disadvantaged
NOTE: The full Literature Review is available as a separate document
Older Offenders
Prisoners over 60 are the fastest growing group in the prison estate. The number of women
prisoners aged over 50 has more than trebled (Prison Reform Trust, 2008)
Older prisoners now represent around 12% of the total prison population and have a high
prevalence of physical and mental disability (Ministry of Justice, 2014)
Much research on older offenders in the criminal justice system comes from the prison estate.
The national minimum standards for the care of older people in the community or in care
homes do not apply in prison (HMIP, 2008)
The Prison Reform Trust (Doing Time; The needs and experiences of Older Prisoners, 2008) has
indicated poor regimes and lack of engagement with older people are leading to isolation in
prison and a lack of planning for resettlement means that older people do not get the services
they need on return to their community and experience anxiety about the future
Thematic work from the Inspectorate of Prisons (No Problems, Old and Quiet, 2004) found that
none of their sampled prisons had a separate regime for older prisoners. Retired prisoners had
not been asked about what they wanted to do during the working day. Where activities are not
accessible, alternatives should be provided to avoid discriminatory practice
Older offenders needs are not restricted to their time in custody but also require specific
resettlement plans, especially where they have served life sentences. The Inspectorate found
that over a quarter (28%) of the prisoners sampled would be at least 70 years old on release.
They would be unlikely to be seeking employment. Many will require health and social services
support in addition to having to adjust to the outside world.
Of course, not all older offenders are ill or infirm but there is a strong encouragement to view
age as a potential vulnerability
TONIC: Discussion Paper
Vulnerable Offenders
Vulnerability in the prison estate and specifically the term
vulnerable prisoner is unique to this environment and is not
the same as in the community this presents various
difficulties in communication between settings and presents
challenges in identification
The Inspectorate of Prisons states: Prisoners, particularly
adults at risk, should be provided with a safe and secure
environment which protects them from harm and neglect.
They should receive safe and effective care and support.
The Care Act 2015 seeks to improve and clarify local
authority safeguarding procedures for vulnerable adults
including those in prison and across the criminal justice
system being able to identify such adults is clearly crucial
in order to ensure their safety
TONIC: Discussion Paper
Identification Is Vital
Identification of these needs for offenders should be at the earliest
possible point in the CJS, and also repeated on entry to prison & probation
This is crucial when rehabilitating people / reducing re-offending, not least
with regard to making appropriate referrals and recommendations for
adapting sentences or facilitating access to suitable treatment
There is chronic underreporting of these issues for offenders, influenced by:
There is great variation in the criteria and terminology used to identify
these needs across agencies and across the country
The data not regularly or uniformally captured (e.g. sometimes only a
primary factor can be recorded)
Individuals fear being stigmatised and do not divulge information,
meaning that identification must be sensitively handled
There is a lack of consistent, validated tools many tools in circulation
require specialist skills or training &/or significant time to complete
Practitioners do not feel skilled or empowered to identify these needs
TONIC: Discussion Paper
10
11
12
Recommendations To Consider
The literature points to a number of recommendations that have
been regularly made to deal with these issues more effectively:
Introduce an integrated service throughout the CJS process and
unified across MH, LD, SM agencies
Terminology and criteria used to identify these needs should be
specific and consistently applied
Tools used to aid identification should be validated,
comprehensive and used at the earliest opportunity and
throughout the CJS
Practitioners should feel skilled, confident and competent at
identification of these needs and ensuing adaptation & referral
Agencies and policy makers should consult CJS service users in
improving the response to these needs
TONIC: Discussion Paper
13
Qualitative Interviews
Map which relevant services are available locally
Where the service provision gaps lie
The identification process - tools, training,
requirements, recording data
Response & Referral processes when needs are
identified barriers, strengths, adapted
programmes, addressing stigma
Joint working arrangements & practices information sharing
Views on how to better meet needs & an integrated
OCN service inc. best practice examples
TONIC: Discussion Paper
14
Chapter 2
Local Data Analysis
TONIC: Discussion Paper
15
Alcohol
Substance Misuse
POLICE
CUSTODY
PRISON
PROBATION
12%
10%
24%
5%
42%
29%
COMMUNITY
19%
Drug treatment
clients are CJS
4%
Alcohol
treatment
clients are CJS
13%
12 - 17%
42 - 71%
39 58%
25%
10 - 11%
9 12%
awaiting
8%
(proxy)
2 30%
16 - 23%
2.4%+
7%
8%
6%
15%
awaiting
4%
3 4%
n/a
awaiting
23%
11 15%
awaiting
3%
2 3%
Essex Probation
data on those with
prison sentences
(SM)
Mental Health
(MH)
Learning Disability
(LD)
Dual Diagnosis:
Mental Health &
Substance Misuse
TOXIC TRIO:
Substance Misuse,
Mental Health &
Learning Disability
Data Source
HMP Chelmsford
Needs Assessment
Essex Probation
data
Treatment
clients are CJS
n/a
n/a
NDTMS data
POLICE
CUSTODY
Drugs
4,800
Alcohol
2,000
PRISON
PROBATION
COMMUNITY
1,339
554 in DIP
1,628
111
587
220 Inside
Out
97 IDTS
59
57 Treatment
814
1,534
Substance Misuse
4,800
(SM)
10,000
Mental Health
85 Appropriate
Adult call outs
(March 2014)
247
59
2,207
Estimate of
those with SM
treatment
need in CJS
155 on CPA
8 Transferred to
MH hospital
492
644
13 Appropriate
Adult call outs
(March 2014)
176
887
37
2,800
47
334
1,092
awaiting
23
163
n/a
awaiting
135
620
n/a
awaiting
18
124
n/a
(MH)
3,200
Learning Disability
(LD)
Dual Diagnosis:
Mental Health &
Substance Misuse
TOXIC TRIO:
Substance Misuse,
Mental Health &
Learning Disability
Data Source
Key: Actual Estimate
TONIC Consultants Ltd
PREVALANCE ESTIMATES
From literature review
Offenders with
Complex Needs
POLICE
CUSTODY
PROBATION
COMMUNITY
27%
25 40%
64%
Drugs
Alcohol
PRISON
(MoJ, 2013)
66%
(Sloshed &
Sentenced)
Substance Misuse
32 73%
(MoJ, 2013
Scottish Prisoners
Needs
Assessment)
32%
(Singleton,
2003)
(SM)
Mental Health
33% Male,
depression
(MH)
(Brooker, 2012)
2013)
Learning Disability
(LD)
Dual Diagnosis:
Mental Health &
Substance Misuse
Learning Disability &
Mental Health
Substance Misuse &
Learning Disability
TOXIC TRIO:
Substance Misuse,
Mental Health &
Learning Disability
20-30%
(Louckes, 2007)
7%
25% Borderline LD
40%
women (No
one Knows, 2007)
75%
(Prison Reform
Trust, 2011)
60%
reading age
of 5 or
under
2%
(DH, 1998)
74 85% of SM
clients have MH
44% of MH
clients have SM
36%
60%
of LD service
users have SM
SERVICE AVAILABILITY
Balanced Scorecard
Offenders with
Complex Needs
POLICE
CUSTODY
PRISON
PROBATION
COMMUNITY
Inside Out
Atrium
DIP
Treatment
System
DIP
Treatment
System
Emerging
growth in
alcohol
treatment
DIP
Treatment
System
Drugs
Arrest
Referral,
DIP, FME
Alcohol
FME &
Treatment
system
Atrium
Low referral
rates into
treatment
IDTS
Inside Out
Atrium
DIP
Substance Misuse
(SM)
Barriers to 3rd
sector support
Appropriate
Adult service,
FME, Liaison
& Diversion
pilot, CJMHT
Prison
Inreach
Atrium
Appropriate
Adult service,
Liaison &
Diversion pilot
Nowhere
to refer to
Nowhere
to refer to
Siloed
approach
Good
prison DD
provision
Siloed
approach
No
identification
No
identification
1 lead in
CJMHT,
but not
specialist
Data gaps
Service gaps
No
identification
No
identification
High
prevalence
in frequent
offenders
No
dedicated
services
No
identification
Highest
prevalence
in frequent
& severe
offenders
No
dedicated
services
Mental Health
(MH)
Learning Disability
(LD)
TOXIC TRIO:
Substance Misuse,
Mental Health &
Learning Disability
No
identification
CJMHT, but no
NHS Trust
engagement
Training &
service gaps
Choice &
Control
Thurrock
NO#SPECIFIC#RESPONSE#FOR#COMPLEX#OFFENDERS#
Dual Diagnosis:
Mental Health &
Substance Misuse
[to add ?]
Section 2.1
PROBATION DATA
16
Drugs#
SM#
20%#
MH#
LD#
15%#
10%#
5%#
0%#
17*25#
26*34#
35*44#
45*54#
55+#
17
12%#
Axis Title
10%#
DD##
8%#
LD#&#MH#
SM#&#LD#
6%#
TRIO#(all#3)#
4%#
2%#
0%#
17*25#
26*34#
35*44#
45*54#
55+#
18
40%#
35%#
30%#
25%#
Male#
20%#
Female#
15%#
10%#
5%#
0%#
Alcohol#
Drugs#
SM#
MH#
LD#
19
12%#
10%#
8%#
Male#
6%#
Female#
4%#
2%#
0%#
DD##
LD#&#MH#
SM#&#LD#
TRIO#(all#3)#
20
60%#
50%#
Prevalence
Alcohol#
40%#
Drugs#
SM#
30%#
MH#
LD#
20%#
10%#
0%#
1#only#
2#to#10#
11#to#20#
21+#
21
30%#
25%#
Prevalence
20%#
DD##
LD#&#MH#
15%#
SM#&#LD#
TRIO#(all#3)#
10%#
5%#
0%#
1#only#
2#to#10#
11#to#20#
21+#
22
60%#
50%#
40%#
Oenders#with#no#vulnerabiliPes#
Oenders#with#only#1#vulnerability#
30%#
Oenders#with#2+#vulnerabiliPes#
20%#
10%#
0%#
ALL#
1#oence#
2*5#oences#
6+#oences#
23
60%#
50%#
40%#
ProbaPon#
Prison#
30%#
20%#
10%#
0%#
SM#
MH#
LD#
LD#&#MH#
LD#&#SM#
DD#
Trio#
24
25
Commentary: Older offenders are categorised by the Prison Service as those aged
50+. When comparing this group with those aged under 50 in the Essex Probation
cohort, we found older offenders were less likely to experience many vulnerabilities,
with the exception of alcohol misuse and mental health problems
11% of Essex Probation clients are aged 50+
1% of the total are aged 65+, 2% aged 60+
Vulnerability,Factors,for,under,50s,&,those,aged,50+,
<50#
50+#
60%#
43%#
34%#
22%#
23%#
20%#
15%#
17%#
21%#
16%#
8%#
9%#
12%#
4%#
ProbaPon#Events#2+#
Prison#sentence#
Drugs#
Alcohol#
LD#
MH#
Perpetrator#of#DV#
26
Section 2.2
SUBSTANCE MISUSE
TREATMENT DATA
TONIC: Discussion Paper
27
20%#
15%#
10%#
5%#
0%#
Essex#
Southend#
Thurrock#
ALL#
28
20%#
18%#
16%#
14%#
12%#
10%#
8%#
6%#
4%#
2%#
0%#
Essex#
Southend#
Thurrock#
ALL#
29
25%#
ComplePons#(DIP)#
20%#
15%#
10%#
5%#
0%#
Essex#
Thurrock#
Southend#
TOTAL#
30
Differences in DD recorded rate across areas Variation in CJS involvement for clients in treatment
OCU around 20%
Low for alcohol
Higher for non-OCU
Estimate there are over 1,000 people with dual diagnosis (excl. out of treatment alcohol & non-OCU)
644 (59%) are currently in treatment
DD rates average 14% (drugs) and 24% (alcohol) across the area
however there is great variation in recorded DD levels from 4% to 29%
OFFENDERS IN TREATMENT
Estimate there are (conservatively) 1,534 offenders in CJS with drug or alcohol misuse problems
925 (60%) of whom are in treatment
554 (60%) of these are DIP clients
CJS clients make up only 4% of those in alcohol treatment, compared to 19% of drug treatment population
REFERRAL SOURCE
Relatively few (5%) referrals to alcohol treatment come from CJS agencies
31
Section 2.3
32
Commentary: of those arrested have MH issues identified and nearly 1/5 have
self harm issues. However, there is relatively low levels of drug/alcohol use
identified (12%)
Gender differences Women are more likely to be identified with MH, self-harm
and drug issues , whilst men were more likely to be identified as needing help
with reading or writing
Note: Need help reading or writing is used as a proxy for LD
35%#
30%#
25%#
Female#
20%#
Male#
TOTAL#
15%#
10%#
5%#
0%#
Alcohol#
Other#drugs#
Drugs#
Mental#Health#
Need#help#with# Self#harm#(indicaPons)#Self#harm#(self#report)#
reading#&#wriPng#
33
Section 2.4
CJMHT DATA
34
Police#
39%#
Court#
56%#
35
Police#
ProbaPon#
36
Section 2.5
HMP CHELMSFORD
PRISON DATA
TONIC: Discussion Paper
37
38
71% have
personality
disorder
8% have
functional
psychoses
22% have
anxiety/
depression
49% have a
neurotic
disorder
39
40
41
Access to specialist drug services from prison is reasonably good, but under
half started treatment within 3 weeks of release. Waiting for access to DIP
after prison release can increase the risk of overdose or re-offending
Note: This data should be checked against NDTMS data at local authority level
42
43
44
Section 2.6
HMP HOLLOWAY
45
46
Section 2.7
LEARNING DISABILITY
SERVICES
TONIC: Discussion Paper
47
There are 32,724 adults (estimate) living with LD in Essex this is expected to
increase by 7.75% over the next 6 years.
6,007 (18%) people with LD are aged 45-54, the largest age group cohort
Estimated cases of adults with learning disabilities
4,000#
3,500#
3,000#
2,500#
2,000#
1,500#
1,000#
500#
0#
48
Moderate & Severe LD peaks in the 35-54 age ranges with 42% of all
cases being found in this age range
LD population estimates (Essex)
7,000#
6,000#
5,000#
Low#
4,000#
Moderate#
Severe#
3,000#
Total#
2,000#
1,000#
0#
18*24#
25*34#
35*44#
45*54#
55*64#
65+#
49
Severe
5%
Moderate#
32%#
Low#
63%#
50
Chapter 3
Qualitative Interviews
TONIC: Discussion Paper
51
Total: 20 interviews
Overview
1#general#oender#manager#
1#Housing#Ocer#
1#EducaPon,#training#and#
employment#ocer#
2#Custody#Sergeants#
Forensic#Medical#Examiner#
Safer#Custody#&#Violence#
ReducPon#Manager##HM#P#
Chelmsford#
Deputy#Custody#Commander,
##Essex#Police#
CRC#
Custody:#
Police#&#
Prison#
MH#
SM#
Informal Interviews:
AMP Practice Lead
Nurse Consultant
Director of Secure
Services
G4S Regional Manager
1#Appropriate#Adult#
2#CJMHT#(pracPPoner#and#
service#manager)#
1#Criminal#jusPce#lead;#third#
sector#organisaPon#
######1#DRR#pracPPoner#
1#service#manager;#3rd##sector#
organisaPon#
2#Access#&#Engagement#sta;##
3rd#sector#organisaPon#
52
Key Findings
! Lack of validated or uniform tools across the system; identification is mainly
through clinical judgement and therefore the skills/expertise of the
practitioner
! Use of reading and writing/statemented school as an indication of LD, or no
specific questions asked
! There are problems with self-report but raw scores generated by validated
tools may not be easily communicable to other agencies/professionals
! Services are largely left to their own devices to ascertain and identify further
needs (e.g. substance misuse workers need to identify LD or MH themselves
rather than the information following the client) there are no systems for
information sharing allowing need to be passported through the CJS journey
! Referrals from one agency to another are not felt to be heard or taken
seriously Inc. into social care
Substance misuse workers are seen as the poor profession by mental health workers and prescribing
clinicians even though they have much contact with offenders their concerns & information get ignored
53
54
! Probation stated some services (esp. 3rd sector & GPs) may
exclude offenders with complex offence histories
! There are no specific programme/service adaptations for
individuals with complex needs; this comes down to the
skills of the practitioner and the resources of the
organisation
! E.g. Custody Sergeants have access to simplified rights and entitlements
! There are concerns over the impact of CRCs and a deskilled workforce there will also need to be links with
National Probation Service
TONIC: Discussion Paper
55
56
HMP Chelmsford is piloting a new induction pack on their reception wing in order to identify
prisoners who are vulnerable as per the law commission definition. The current prison
definition in the male estate of vulnerability is based on offence type. HMP Holloway (the
main womens prison for Essex residents) does not use the traditional definition, using the
premise that all female prisoners are vulnerable
Prison is the only CJS environment that uses any older age threshold, as it defines an
offender as older when they are 50 or over. HMP Chelmsford has a separate, but not
exclusive, wing for older offenders
In Police Custody age is considered a vulnerability automatically if the offender is a juvenile
(e.g. with specific pathways and protocols around their care, and checking/observation
mandated to be occur at a minimum of every 30 minutes)
This is not replicated at the other end of the age spectrum. If an offender is older no
specific pathways exist.
Police use PACE to consider the appropriateness of arrest on an individual basis [https://
www.gov.uk/government/uploads/system/uploads/attachment_data/file/117583/pacecode-g-2012.pdf]
All offenders in police custody are assessed on a range of vulnerabilities rather than age
alone using visual assessment, previous risk assessment, information from PNC and the
g4s medical provision - this determines the level of care provided for the individual
Those in Police Custody have a pre-release risk assessment. Police look to social services
and 3rd sector for help placing and supporting a vulnerable person on release if needs are
identified
TONIC: Discussion Paper
57
58
59
! A system that represents shared care to avoid to-ing and fro-ing and
duplicating information
60
Chapter 4
Recommendations
TONIC: Discussion Paper
61
Produce clear pathways, Concordat, beginners guide & directory resources. This will clarify
Terminology and criteria used to identify complex needs, which should be specific and
consistently applied. Consider adopting a non-stigmatising term, such as offenders with
additional needs. Review current use of specialist court orders (DRR, ATR & MHTR)
2.
3.
Encourage the consideration of vulnerability beyond the prison definition currently based
on offence type to include a broad range of needs (MH, LD, physical health, and age)
4.
Networking events, Joint training & co-location that bring together a range of services
across sectors and disciplines; breaking down barriers. Explore how expert services can
offer case consultation. This will capacity build the ability to identify and respond to these
needs
Regular open days are always a useful
way forward to improve joined up working
3.
Clear information sharing protocols to reflect fast movement through custody chain:
portable risk and need file that mimics or extends the personal escort record form (PERF)
TONIC: Discussion Paper
62
63
64
Chapter 5
Next Steps
TONIC: Discussion Paper
65
Next Steps
This is a complex policy area, and one that in spite of wide recognition of the issues, little significant
reform of service commissioning, design and delivery has taken place. With this in mind, we recommend
consideration of the following points when determining a set of next steps to take forward the learning
from this report:
1.
2.
3.
4.
5.
Disseminate this discussion paper to a wider set of stakeholders across the criminal justice system in
Essex, Thurrock and Southend, and to those support services focusing on the needs of those with
MH, SM or LD issues
Present the key findings to the Reducing Reoffending Board overseeing this piece of work
Conduct a strategic investment mapping exercise to capture the current and planned investment into
support services, interventions and pilots that address the issues raised in this report from across
local authority, public health, CCG, NHS England, CRC, NOMS, Police, 3rd sector, courts & other
partners
Review the findings of the investment map against the issues raised in this report to identify key
service gaps, examine opportunities for pooling the investment to maximise impact
Bring service users, commissioners, service providers and partners together to consider this
landscape and work collaboratively in a co-design environment to assist in identifying innovation to
maximise impact
66
High
Joint work
ing with
other age
ncies
Train othe
rs
Programm
e design
Consultati
on & Advic
Medium
Full case
managem
ent
Therapeu
tic
Interventi
on
e service
Identifica
tion
Signpost
& Refer
Adapt CJS
Programm
es
Info shari
ng
Tailor CJS
response
Staff Train
ing
Low
Tiered Response
Delivery Options
MH
LD
Team Lead
MH
SM
Trainer
Admin
New Co-located
specialist team or
One Stop Shop
LD
Prison
DIP
SM
CRC
Police
DD
L&D
FME
Prison
CJMHT
Annexes
Annex A: Literature Review
Annex B: Data Workbook
67