People at all stages of the criminal justice system (CJS) in England and Wales are not receiving the mental health support they need, according to a major inspection report from all four criminal justice inspectorates, the Care Quality Commission and Healthcare Inspectorate Wales.
The findings from this inspection are being labelled as ‘disappointing’ and inspectors say that little to no progress has been made since their last review, carried out over ten years ago in 2009
The joint thematic inspection involved looking at more than 300 cases from six nationwide regions, interviewing over 500 professionals and hearing from 67 people with mental health issues who had been through various stages of the CJS.
One pertinent issue that ran through the inspection was the lack of ‘a common definition of mental ill health’ throughout the CJS. This lack of a standardised definition means that not only is the collective number of those with mental health issues in the CJS likely inaccurate, but the process of determining whether someone fits the requirement for mental ill health as a person moves from one branch of the CJS to another is ineffective.
Inspectors found a ‘myriad’ of systems and procedures to screen and assess people moving through the CJS from the instance they are arrested, charged, sentenced, and then supervised by probation.
These inconsistencies in establishing whether a person is experiencing mental-ill health or not has meant many individuals have inaccurate records, resulting in receiving the wrong treatment (if any), affecting charging decisions and ultimately delaying court proceedings.
Speaking on behalf of all six inspectorates involved, Chief Inspector of Probation, Justin Russel said:
“The criminal justice system is failing people with a mental illness. At every stage, their needs are being missed and they face unacceptable delays in getting support. Not enough progress has been made since our last joint inspection 12 years ago to put right these critical shortfalls."
“Police forces, prosecutors, prisons and probation services all assess individuals in different ways, which leads to gaps and inconsistencies. Even when mental health needs are identified, the information is not always recorded fully or used to make effective decisions.”
“There are significant problems in the exchange of information in every agency and at every stage of an individual’s journey in the criminal justice system. This part of the system is broken and needs to be fixed urgently.”
Another issue the inspection came across was a widespread misunderstanding of confidentiality and data protection laws, resulting in cross agency miscommunication and in some instances, an agency simply not passing on any relevant information to another.
The inspectors found that police officers who were unclear on whether or not they could share an individual’s mental health status with the Crown Prosecution Service (CPS) simply didn’t pass the information on. In actuality, there is an exemption in the Data Protection Act (2018) that allows for data sharing in justice purposes. These misunderstandings and miscommunications have meant prosecutors, defence lawyers, judges and magistrates have been making decisions in regard to charges without crucial details that might affect those charges.
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Information sharing between different agencies was found to be inadequate, meaning people transferring in and out of prison are not receiving support plans in line with their mental health needs. The inspectors also found that probation officers frequently had their work hindered due to community mental health services not allowing them to access vital information about the mental health history of those they were supervising, which is in direct conflict with the legality of these requests.
This lack of effective information sharing between agencies also lead to disturbing cases of ‘extremely unwell’ prisoners who had been detained prison for long stretches of time while they waited for mental health beds. This is an issue which has seemingly arisen due to a severe lack of medium to high-security beds. In these instances, unsurprisingly, the mental health of those prisoners deteriorated severely as they waited.
A distinct lack of specialist services for Black, Asian, and Minority Ethnic people, who are overrepresented in the CJS and more at risk of mental illness, was also very apparent
In conclusion, inspectors concluded that not enough has been changed or addressed in the 12 years since the last joint inspection, which echoed many of the same recommendations present in this most recent inspection.
The few areas of improvement were of the increase in alternative Mental Health Treatment Requirements given by court, the nationwide roll-out of mental health liaison and diversion services in police stations and courts, and the decrease in the use of police custody to safely detain those experiencing a mental health crisis.
HMI Probation Chief Inspector, Mr Russel concluded: “Criminal justice agencies need to make major improvements to the way they work with people with mental health issues. If someone is charged, they need to understand and be able to participate in the criminal justice process. An individual may need additional support to understand the questions put to them during an investigation or may lack the mental capacity to plead or stand trial.”
“The criminal justice process itself can have a severe and negative impact on someone’s mental health, especially if they are already unwell. Justice agencies should act in ways that do not make matters worse, for example they should help to reduce the risks of suicide and self-harm, which we know to be high in criminal justice populations.”
"The Inspectorates have made 22 recommendations following our joint inspection. We urge police forces, the Crown Prosecution Service, prisons and the Probation Service to work with the government and NHS to improve delivery for people with mental health issues in the criminal justice system.”
Included in the 22 recommendation Mr Russel mentioned above is:
- For the Department of Health and Social Care, NHS England and Improvement and Welsh Government: the assurance that the supply of medium and high secure beds will increase to reduce ‘unacceptable waiting times for transfer of custody’.
- For the Ministry of Justice and Home Office: to work with the Department of Health and Social Care to develop a ‘multi-agency Memorandum of Understanding’ with the aim to improve across agency information sharing and improve outcomes for people in the CJS with mental health problems.
- For local criminal justice services including police, CPS, courts, probation and prisons: training to improve and build upon mental health awareness in staff working in criminal justice services. The inspectorates’ recommendation stated ‘This should include skills to better explain to individuals why they are being asked questions about their mental health so that there can be more meaningful engagement.’
This inspection is evidence of a stark reality that our CJS is not made to work with or support people who experience mental-ill health. A mixture of a lack of resources (namely beds), confused approaches to screening for mental illness, and a structure throughout the CJS that does not easily allow or promote information sharing has resulted in a system that is actively hurting many people.
As Mr Russel said most astutely, “This part of the system is broken and needs to be fixed urgently."