Criminal justice liaison and diversion schemes - Offender Health ...

Criminal justice liaison and diversion schemes: A focus on women offendersPolicy contextDiverting offenders with mental health needsaway from the criminal justice system into thecare of health and social services has been apolicy aim for some time. 1-3 As far back as 1992,the Reed Review of Health and Social Services forMentally Disordered Offenders (the Reed report)recommended that there should be nationwideprovision of properly resourced court assessmentand diversion schemes to achieve this goal.Prison exacerbates mental ill health, heightensvulnerability and increases the risk of self-harmand suicide. In addition, mental health serviceswithin prison are unsuitable and inadequate fordealing with prisoners with chronic and severemental health conditions. 4-7 Recent developmentsin this area include a government review ofservices for offenders with mental health needsconducted by Lord Keith Bradley, and theforthcoming publication in 2009 of the firstoffender healthcare strategy. 8 There are alsoefforts afoot to improve and standardise theprovision of court assessment, liaison anddiversion services through the introduction ofservice level agreements (SLA) betweenmagistrates’ courts and mental health services.Pilot projects using SLAs are currently beingundertaken in the south-west of England andnorth-west London.*Baroness Corston conducted a review of vulnerablewomen in the criminal justice system. 9 Thishighlighted the failure of the NHS to properlyresource schemes to divert women with mentalhealth needs away from prison and intocommunity-based healthcare. The Women’sOffending Reduction Programme (WORP) sought todevelop more appropriate communityinterventions for women to encourage theirdiversion at pre-court and pre-sentence stages ofthe criminal process and the greater use ofcommunity disposals. 10 In addition, the GenderEquality Duty (April 2007) placed a legal obligationon public bodies to show that they werepromoting equality of opportunity between menand women through the Equality Act 2006. Theimplications for criminal justice agencies includedrecognising and catering for the potentiallydifferent needs of male and female offenders. 11,12What we know about the femaleoffending populationMost female prisoners are serving short sentencesfor non-violent crimes and over a third have noprevious convictions. 13 The majority (66%) are* For more details contact Offender Health at the Department of Health.mothers, 14 yet the small size of the female prisonestate means that many are held far from homemaking it difficult to maintain regular family ties,which can have damaging consequences for theirchildren and for the women’s mental health.Ensuring that community-based disposals areavailable wherever possible for women withmental health issues could help to reduce thenumber serving these short prison sentences. 9Mental ill health is high among women offenders.Female prisoners are twice as likely as males tohave had contact with mental health servicesprior to their imprisonment. They are also morelikely than male prisoners to suffer fromfunctional psychosis and neurotic disorders suchas depression, anxiety and phobias. Two-thirds ofwomen prisoners have been assessed as having aneurotic disorder. 15 Approximately 50% of womenprisoners were receiving prescribed medicationsuch as anti-depressants and anti-psychoticmedicine. 15 A more recent study has reported thatwomen in custody were five times more likely tohave a mental health problem than women in thegeneral population. 9Nearly a third of women prisoners self-harmed in2003 compared to only 6% of men, and whilewomen comprise a minority (6%) in the prisonpopulation, they accounted for 46% of all selfharmincidents. 16 Furthermore, nearly half offemale remand prisoners had attempted suicidein their lifetime compared to a quarter of maleremand prisoners. 17 There were 54 self-inflicteddeaths of women prisoners between 2000 and2005 and the majority of prisoners who commitor attempt suicide have a history of mental13, 18disorder.Substance misuse is common, with femaleprisoners more likely than men to be dependenton opiates. 15 In a sample of 301 women from 10prisons, 34% reported hazardous levels ofdrinking in the year before prison and 43%reported use of crack cocaine and 44% use ofheroin in that time frame. Over a quarter (27%)had used heroin and 9% had used crack cocainewhile in prison. 19 Unsurprisingly, there is also ahigh degree of comorbidity: one study found that83% of female remand prisoners and 70% offemale sentenced prisoners had two or moremental disorders. 15 Other issues includeexperience of violence: 50% of women prisonershave experienced domestic violence and about athird have been sexually abused. 132