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Evidence of what works

Adults :: Offenders :: Evidence of what works

Crime and Offending
Breaking the cycle: Effective Punishment, rehabilitation and Sentencing of offenders[1]

The Ministry of Justice identifies the need to bring together agencies involved in criminal justice to provide a more coherent and coordinated approach, including engagement of health services for offenders with mental health, alcohol and substance misuse problems. It focuses on the increasing role of the police in turning offenders away from crime and the importance of the court system in protecting the public and reducing reoffending through the use of community orders for drug treatment. Police, probation and other agencies are already working closely together in Medway in the management of prolific offenders. There is an Offender Management Unit that brings together police and probation. The Medway Drug and Alcohol Team is actively involved in supporting offenders with substance misuse problems and there is a Forensic Mental Health Team that works with the police to divert mentally ill offenders into appropriate treatment and provide court reports to support appropriate sentencing. Locally, West Kent is a pilot site, leading to the commissioning of a new service to provide an integrated drugs and alcohol service based on payment by results, which if successful may be rolled out across Kent and Medway.

Mental health and substance misuse
No health without mental health. A cross government mental health outcomes strategy for people of all ages[2]

This strategy aims to improve the mental health and well-being of the population and improve outcomes for people with mental health problems through high-quality services that are equally accessible to all. The incidence of mental health problems can increase in times of economic and employment uncertainty, and there are indications that behavioural and emotional problems are now more prevalent in young people. The strategy promotes early intervention as it can improve health and well-being and prevent mental illness, but also reduce costs incurred by ill health, unemployment and crime. There are critical priorities in the strategy which are relevant to the lives of offenders such as supporting young people and their families, improving parenting skills to reduce the generational cycle of offending, improving access to psychological therapies, reducing drug use, supporting the positive mental health from employment and improving access to services for those who are homeless. It is estimated that 90% of all prisoners have a diagnosable mental health problem with or without a substance misuse problem. The strategy aims to reduce this by recommending that more individuals with mental health and learning difficulties are diverted away from criminal justice agencies and into treatment and social support.

Anti-social personality disorder

Many offenders can be identified as having an anti-social personality disorder. The National Institute for Clinical Excellence estimates that half of the prison population has such a disorder. Following consultation on offender personality disorders, the government's response[3] indicates the need for criminal justice agencies and the NHS to work more closely together to ensure patients get access to the services, recognising that the affected individuals may be in prison or in the community. The protection of the public from the more serious cases would fall to the prison service. The National Offender Management Service (NOMS) and NHS are encouraged to work together to develop services along the offender pathway, providing psychological support by appropriately qualified staff. There was a particular focus on the needs of young people to prevent reoffending and the intergenerational cycle of crime. Agencies should ensure that services are targeted with an emphasis on screening and assessment. Appropriate treatment programmes should be provided within prisons or NHS secure estate supported by psychologically informed planned environments. The existing MAPPA (Multi Agency Public Protection Arrangements) programmes should have extra support to manage offenders in the community. The National Institute for Clinical Excellence has produced guidelines on the treatment, management and prevention of anti social personality disorder for adults over 18 years of age.[4]

The Drug Strategy 2010: Reducing demand, restricting supply, building recovery[5]

Drug use by young people has fallen by a third in the last decade, but the UK still has the highest rates of cannabis use and binge drinking amongst young people in Europe. This strategy focuses particularly on the impact of drugs and alcohol on young people and especially vulnerable groups, such as those in contact with criminal justice agencies, excluded from school or with parents with drug and alcohol problems who need targeted support and early intervention. Early drug and alcohol use is related to a host of educational, health and social problems.

The strategy requires that young people will get rapid access to specialist support for both drug and alcohol problems. The service should be recovery based both in the community and in treatment based accommodation, supported by CAMHS (Child and Adolescent Mental Health Services), the Public Health grant and the Early Intervention grant. There is particular emphasis on liaison and diversion from police and courts.

A third of the adult treatment (drug or alcohol) population has parental responsibility for a child, but there are family focused interventions, which provide evidence of reduction in anti social behaviour, crime, truanting and domestic violence. There is also a need to develop recovery-based services in prisons.

The Patel Report[6]

The Patel report reviewed substance misuse therapies available in the prison and community setting by looking at reduction in drug use and reoffending. It also looked at how current regimes improved social functioning and relationships or improved employment or workforce skills. However it found a need for greater continuity in management for substance misusers between prisons and community agencies including housing.

Children and young people

Healthy children, safer communities - a strategy to promote the health and well-being of children and young people in contact with the youth justice system[7]
Many children and young people in the YJS (Youth Justice System) come from vulnerable families living in disadvantaged areas where health outcomes are noticeably worse than for other children; particularly so for children from black and minority ethnic (BME) groups. High numbers of children and young people in the YJS experience domestic violence, neglect, and physical and sexual abuse within their family. These are risk factors for the development of mental health problems as well as for offending. For those in the secure estate there are particular concerns in relation to restraint, bullying, self-harm and the risk of suicide.

Many are not registered with a GP, increasing the risk that screening and developmental checks for children will be missed. In addition, many of these children and young people suffer from physical health problems such as poor oral health, respiratory problems, smoking, sexually transmitted diseases and pregnancy.

The strategy recognises the need to identify mental health problems, learning disabilities and communication problems when children and young people are in police custody, because such problems increase children's vulnerability. Understanding a child's health problems will also help the police, the Crown Prosecution Service (CPS) and the Youth Offending Team (YOT) to decide the most appropriate action to take and wherever possible divert them from criminal justice agencies towards more appropriate treatment and support services.

Looked After Children and Young People (NICE Guideline 28)[8]

The guidance covers children and young people from birth to age 25, wherever they are looked after. The guideline applies to secure settings such as young offenders institutions (e.g. Cookham Wood and Rochester), recognising the constraints of working with some of the most challenging behaviour and attitudes. It is recommended that services are commissioned which are dedicated to looked after children and young people that are integrated, preferably on the same site, and have expert resources to address physical and emotional health needs. These services should have links with universal services, be friendly, accessible and non-stigmatising.


References

[1]   Ministry of Justice. Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders 2010; Ministry of Justice.
[2]   HM Government. No health without mental health: a cross-government mental health outcomes strategy for people of all ages 2011; Department of Health.
[3]   Department of Health. Response to the offender personality disorder consultation 2011; Department of Health. http://www.dh.gov.uk/health/2011/10/offender-personality-disorder-consultation-response/ .
[4]   National Institute for Health and Clinical Excellence. CG77 Antisocial personality disorder: Treatment, management and prevention 2009; National Institute for Health and Clinical Excellence. http://publications.nice.org.uk/antisocial-personality-disorder-cg77 .
[5]   HM Government. Drug Strategy 2010 Reducing demand, restricting supply, building recovery: supporting people to live a drug free life 2010; HM Government. http://www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/drug-strategy/drug-strategy-2010?view=Binary .
[6]   Professor Lord Patel of Bradford OBE. The Patel report: Reducing drug-related crime and rehabilitating offenders 2010; Independent Prison Drug Treatment Strategy Review Group. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_119851 .
[7]   Department of Health , Department for Children and Schools and Families , Ministry of Justice , et al. Healthy children, safer communities -- a strategy to promote the health and well-being of children and young people in contact with the youth justice system 2009; Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109771 .
[8]   National Institute for Health and Clinical Excellence. PH28 Looked-after children and young people 2010; National Institute for Health and Clinical Excellence. http://www.nice.org.uk/PH28 .