The recent Bradley report looked at how people with mental health problems and learning disabilities can be diverted from prison. Louise Tickle looks at one service featured in the review
You are homeless, you have paranoid schizophrenia and you are charged with an offence. You’re locked up for the night in the local jail, and next day appear at a magistrates’ court. You’re frightened, your medication regime has crumpled and you’re about to enter a plea about an incident you can recall only hazily. You’re also exhausted, because the voices you hear have been talking at you relentlessly all night.
The prospect of briefing your defence solicitor accurately is not, at this stage, looking good. Nor is the eventual outcome of your case, as none of the community mental health team who try to look after you are even aware that you are in court.
Although it is obvious to the court that you are not well, it’s easy to see how you could be remanded into custody pending further assessment, where your mental health may deteriorate further. Bail is unlikely because you look to be a danger to yourself, never mind other people. No one explains that you have an appointment with a community psychiatric nurse later in the week to review the management of your condition nor that you may have to bring it forward. You have no idea that having your mental health worker meet you from court and escort you back to your hostel might reassure the magistrates enough to bail you.
Step in the forensic mental health practitioner service provided by Together, a charity that works with people with mental health probelms. The charity’s mental health workers arrive at their nine local magistrates’ courts in London each morning to identify prisoners with mental health needs whose cases are due to be heard.
“On a typical day, I’d go down to the custody suite and look through the paperwork on the people being held,” says Jessie Gallagher-Michaels (pictured right), one of Together’s forensic mental health practitioners. “Often too, the officer in charge will alert me to a case he thinks needs to be seen. I’ll then talk to them for half an hour – or more if needed, but that’s how long it usually takes – and do the assessment.”
Gallagher-Michaels will also assess every female prisoner brought to the court, whether or not they have been flagged up as having mental health needs, under a new protocol Together recently introduced. This is in response to the specific risk factors that women in the criminal justice system experience.
She is working under considerable pressure of time, as the court swings into session upstairs. “We have a standard assessment form that we use, which aims to find out about their previous contact with mental health services,” she says. Just 45 minutes after first meeting the prisoner, she will have her report written and ready to go.
The evidence of Together’s forensic mental health practitioners can change the outcome of a case, although the service’s manager Linda Bryant points out that this type of “court diversion” work is not about clearing people who should be convicted.
“We know that many people in prison have mental health needs,” she says. “Our intervention doesn’t mean they’re diverted out of the criminal justice system entirely, but if they’re on a community order, say, it can help to ensure that their mental health issues are recognised in the court and that there is good community management of that person.”
If someone is charged with a more serious offence where bail isn’t an option, Gallagher-Michaels explains that she would contact the mental health in-reach team at the prison in advance of their arrival. The overall aim of the service is to break the cycle of reoffending by ensuring offenders with mental health problems are being supported.
After busy mornings in court, afternoons are spent working at the offices of Together’s partner, the Probation Service, to ensure there is support in place for people on community service orders, or those who have been released from jail on probation.
Together says that this joint court-probation role is unique. The scope it offers for influencing outcomes was cited as an example of good practice in the recently published Bradley review, which examined the extent to which offenders with mental health problems or learning disabilities could, in some cases, be diverted from prison to other services – and the barriers to such a diversion.
What would happen to prisoners with mental health needs if Gallagher-Michaels didn’t knock at the door of their cells every morning?
“There would be no mental health input to the court’s decisions,” she says. “They might still be bailed rather than remanded in custody of course, but they might well not be supported in the community because no information had been given to the mental health teams.”
Bryant observes that, if a person simply receives a fine or a caution rather than a community penalty, a prime opportunity has been lost to help a person who is ill. For instance, she explains, “male offenders from the African-Caribbean communities are more likely to first access healthcare through the criminal justice system”.
There are other schemes, such as one run by the NHS, “but they only operate maybe one morning a week, and only take referrals, rather than taking a proactive approach and seeking out the information as we do”.
This article is published in the 21 May issue of Community Care magazine under the heading Last line of defence