I’d been thinking about how to give a better service to people with mental health problems within the criminal justice service for a while before the Kay Carmichael award came up. The experience of being in custody can be very detrimental for these offenders. Criminal justice workers then have to supervise people on release in the community who are not unwell enough to be hospitalised or have a compulsory treatment order, but not well enough to engage with the kind of work we would do normally, which is cognitive work that requires some sort of stability in their lives. They fall between the gaps.
That got me interested in diverting people with mental health problems away from the criminal justice system and, specifically, how we can improve the process to try and make any intervention more specific to their treatment needs. I did some initial research, but when I found out about the Kay Carmichael award, I started looking at organisations I could visit abroad and found a project run by the National Alliance on Mental Illness (NAMI) in Minnesota.
NAMI runs diversion, rehabilitation and release planning projects for people with mental health problems. At the diversion stage, teams comprising the police, social workers and medical professionals attend at the point of arrest and look at how they can intervene to divert people away from the criminal justice system (in other words, custody and court). So instead of arresting someone, the police could sign them over to social services, which could divert them to hospital or community-based services.
Police here would be quite rightly reluctant to take on the role of assessing somebody to determine whether they could be given treatment there and then or diverted away from police cells. They will look at mental health services at the time of arrest, but it’s not a specialised service. But I think the police would be much more willing to take that on if it was a joint venture. In Minnesota, community care and criminal justice professionals are joint trained with the police and they attend incidents together.
Mental health court and release planning
The second strand of the NAMI initiative oversees the mental health court, which has an emphasis on drawing up short-term care plans instead of putting people in custody or general supervision orders. For example, an offender might be told to engage with a certain community-based service for six weeks before returning to court. It’s similar to what we know as a deferred sentence, but much more specialised in terms of mental health treatment. Edinburgh has recently introduced a domestic violence court, so it would be interesting to see if a similar arrangement could work for mental health.
The third strand will see me visiting local prisons, where they have a release planning system focused on mental health. They come up with a tailored plan for people with mental health problems in the run up to their release, linked closely to organisations in the community. That’ll be interesting, because people here often come out of prison to minimal support and are quickly returned to custody because they’re not getting the right treatment.
I like this three-pronged approach. NAMI is trying to make the journey through the system more fluid, so if people with mental health problems aren’t picked up by diversion, they would be picked up by the mental health court, or, if they went into custody, there would be proper release plan in place. The projects are having an impact locally and as a result the reconviction rate has reduced.
Such initiatives are unlikely to be directly transferable to our situation here in Scotland and any change in the services we offer would take time to get off the ground. However, I think current financial constraints could be a breeding ground for innovative thinking and I am excited about exploring the possibilities on a local level. Most people acknowledge there are gaps in services here. I want to consider if it is possible to put in a system that’s better and ultimately will save money in the longer term. It may be possible to run similar projects using a seconded system, where you take people from existing social work teams and rotate them into joint mental health and criminal justice teams.
I don’t see a trip such as this as a short-term piece of work, but the start of a discussion to consider the improvement of mental health services and more effective integration of relevant areas of criminal justice, community care social work and health.
Nic Middlemiss is a criminal justice social worker from Edinburgh council.