Britain’s Secretary of State for Justice, Chris Grayling, is accustomed to harsh criticism from prisoners’ rights organisations condemning his hardliner policies as doing more harm than good.
But it seems he has done something right this time in pledging £75 million for a nationwide liaison and diversion scheme. This is designed to enable police to recognise among the people they apprehend or pick up those who have mental health problems, and to call in professionals to do assessments and divert them to appropriate care rather than keeping them in police custody.
The initiative has won approval from such reformist organisations as the Prison Reform Trust, the Centre for Mental Health and Just For Kids Law. Grayling will be under considerable pressure to make the initiative effective.
The policy of locking up people with mental health issues and particularly vulnerable children and young people that the initiative is intended to replace has proved dangerously high-risk.
According to Inquest, the charity that campaigns on the issue of contentious deaths in custody, vulnerable mental health is a recurring feature among those who die in all kinds of custody and detention. They report that inquests frequently reveal shortcomings in the ability of the police and prisons to offer appropriate care to these individuals. Nigel Newcomen, the Prisons and Probation ombudsman and a former youth offending team (YOT) worker, points to Ministry of Justice statistics revealing that self-inflicted deaths in custody are currently at a ten-year high in adults and young people.
Too few alternatives
This worsening situation occurs despite a clear policy, in place since 1990, that police custody should be used only as a last resort. The police can use section 136 of the Mental Health Act to pick up someone behaving in a bizarre (but not necessarily criminal) way when they are in a public place. And they are often the first to respond in an emergency when someone suffers a breakdown or psychotic episode. Nationally around 20 per cent of police time is spent dealing with people suffering mental health problems and the police frequently are obliged to place someone with vulnerabilities in a cell for want of suitable alternatives.
This is likely to be done without knowledge of a person’s mental health background. Fiona Bawdon, development manager at Just For Kids Law cites the case of 17-year-old Kesia Leatherbarrow who had a long history of self-harming and mental health problems when police arrested her in December 2013 for having a small amount of cannabis.
“She was kept in the cells all weekend, where she became distraught, banging her head and pulling out her hair, before being sent to court on Monday morning. The court bailed her to come back the next day but a few hours later she was found dead in a friend’s garden.”
Kesia had spent five weeks in a hospital mental health ward, having become depressed and suicidal after starting secondary school.
“The weekend before her death she was arrested for breach of the peace after she threatened suicide on the street and she was put in cells overnight,” Bawdon explains. It is a clear illustration of what is clearly mental health distress not criminal activity, being treated punitively.
Grayling’s initiative, which is backed by the Care not Custody Coalition representing two million people across the health, social care and justice sectors, is welcome, says Andy Bell, deputy CEO at the Centre for Mental Health. But he adds: “We have been campaigning a long time for liaison and diversion, particularly for the young who are treated the same as adults. We now hope to see a national network of specialists set up including nurses who police can call on at short notice to make sure that people with mental health needs are not put in police custody but into treatment or social care settings.”
It is at this point, however, that a large elephant appears in the room. If more people picked up are identified as having mental health needs -- an estimated two-thirds of all men, women and children in prison have two or more mental health problems -- what provision is there to follow on from the “liaison and diversion” intent? At present, Bawdon points out, there are just 161 places of safety in England as an alternative to police custody. A third of these do not accept children.
Without further properly funded interventions and provision for those with mental health problems, the £75 million can do only a very limited amount to help, says Dinah Morley, former deputy director of the YoungMinds charity.
“Ideally we need far more ways that mental health problems can be picked up earlier in young people’s lives. There is a far better chance of helping them then than when they have begun getting into trouble. But cuts have hit interventions in early life when there may be problems at home, at school, in relationships. Children in care may need a good deal of help if they have had a chaotic time.”
Solving the real issues
Morley points out that around the country just about every CAMHS (child and adolescent mental health services) has been cut. “What we see is young people in real need having to wait weeks for a first appointment and if they are then referred for therapy they may wait months. So if, say, you pick up an autistic young person in need of CAMHS attention, but it’s not available, what do you do? Take them to A and E? And then what? We are a long way from solving the real issues around young people, mental health and custody.”
Andy Bell argues: “There is cast iron evidence that investing in mental health needs early helps families and society for comparatively low cost. But of course some young people will end up in custody if their crimes are serious enough. When this is the case we believe they need to have mental health care assertively offered.”
Much as he welcomes the promise of £75 million, Bell stresses that it needs to be an annual spend to keep the scheme on line, and that broad-spectrum children’s mental health provision is also badly needed.
Juliet Lyons, director of the Prison Reform Trust, says she is “hugely appreciative” of Grayling’s initiative: “because too many youngsters are slipping through the net of care and support.”
But Lyons does not want to see mental health provision in prison being too greatly improved. There is a risk, she argues, that this could encourage courts to see prison as a gateway to treatment. She tells how the governor of a woman’s prison asked for their mental health unit to be closed because it was being overused.
“We have to be cautious about something that on the face of it is good. At PRT we are absolutely focused on care in the community whenever possible,”
Which brings us back Grayling’s initiative. Has he understood that the approval he has won for an initiative to divert the mentally unwell away from custody and into treatment has further consequences? It will mean funding the CAMHS budgets to meet demand, and improving other care and support services in the community, particularly those for children and young people.
There will be no gain if vulnerable people, diverted from custody as a result of their mental health needs being assessed, are not then offered follow-on treatment and care.
Sarah Brennan, director of the YoungMinds charity is unequivocal: “A very high number of children who offend have health, care and education needs. If we don’t get these children the support they need early on then we are not only destroying their lives, we are failing to protect communities and wasting money.”