The Bradley Report - The Learning Exchange

1 The Bradley Report Lord Bradley s review of people with mental health problems or Learning disabilities in the criminal justice system April 2009 The Bradley Report Lord Bradley s review of people with mental health problems or Learning disabilities in the criminal justice system April 2009 1 Contents Contents Foreword 4 Setting the scene 6 Introduction 7 The problem 7 The policy context 9 The review 15 Methodology 22 Structure of the Report 23 Early intervention, arrest and prosecution 28 Introduction 29 Early intervention for children and young people 29 Police 34 Arrest and police custody 38 Role of the Crown Prosecution Service 50 Summary 54 The court process 58 Introduction 59 Context 60 Remand decisions 61 Information for the court 68 Specialist courts/problem-solving courts 75 Liaison and diversion schemes 81 Summary 87 3 2 1 2 Contents Prison, community sentences and resettlement 90 Introduction 91 Community sentences 92 Custodial sentences 97 Resettlement 112 Delivering change through partnership 122 Introduction 123 Building partnerships 123 Leadership 128 Delivering change 130 Supporting change 142 Conclusions and next steps 149 Annexes 152 Annex A: Reference group membership 154 Annex B: Working group membership 155 Annex C: List of events, visits and meetings 156 Annex D: List of respondents to the call for evidence 162 Annex E: Glossary 166 Annex F: Acronyms 170 6 5 4 3 Foreword Foreword In December 2007 I was pleased to be asked by the Government to undertake a six-month independent review to determine to what extent offenders with mental health problems or Learning disabilities could be diverted from prison to other services and what were the barriers to such diversion.

2 As a former Home Office Minister I was well aware of the large number of people with mental health problems or Learning disabilities in our prisons and was therefore determined to examine whether prison was always appropriate for them, but always mindful of the need to maintain public confidence in the criminal justice system. The initial focus of the review was the organisation and effectiveness of current court liaison and diversion schemes. However, it was very soon apparent that merely analysing such schemes would be a missed opportunity and a more comprehensive consideration of the offender pathway and the associated mental health services would be more productive. It was agreed, therefore, to extend the review period to 12 months, and I reported to the Government in February 2009. I was also very conscious that in the time available it would be important to understand the real practical barriers to effective diversion, so I undertook a wide-ranging series of visits throughout the country to police stations, courts, prisons, secure accommodation and mental health facilities in order to fully appreciate the complex issues that needed to be addressed.

3 I talked extensively to staff at all levels and organised regional conferences to ensure that people working within the criminal justice system and in mental health care, as well as carers and service users, could contribute fully to the review. My recommendations are therefore based on what I believe is a real understanding of the current situation and will, I hope, establish a new baseline of services for the future. I hope they will ensure that over time offenders with mental health problems or Learning disabilities are properly identified and assessed, appropriately sentenced and helped with their rehabilitation and resettlement, thus reducing the number in prison and impacting on their offending. 4 Foreword 5 It is not possible to thank everyone who helped with this review by name, but I am extremely grateful to all those who so generously gave me their time and imparted their considerable knowledge. I am particularly grateful to Rethink and the Prison Reform Trust for ensuring user and carer involvement in the review.

4 My reference group was an invaluable source of expertise and I was ably supported by senior staff in the Department of Health, the Home Office and the Ministry of Justice, particularly Savas Hadjipavlou, who helped establish the review. I would also like to acknowledge the contribution of the University of Manchester. Finally, I would like to thank Richard Bradshaw, Director of Offender Health, and his team for their support and encouragement throughout, and especially Dawn Anderson, who managed to organise my visits and engagements so efficiently. Most importantly, I pay tribute to Susannah Nisbett, who, as project leader, guided the review from start to finish, prepared briefing papers and the substantial drafts of this Report . Her commitment and support were immense. The Rt Hon Lord Bradley Setting the scene 1 Setting the scene This chapter sets out the objectives of the Report . They are to examine, where appropriate, alternatives to prison for offenders with mental health problems or Learning disabilities and to make recommendations to bring about improvement.

5 There is a wide-ranging examination of the policy context and how proposals for reform have developed alongside key government themes and policy drivers. I then go on to define key terms like diversion , Learning disabilities and mental health in detail. I then examine the difficulties faced by particular groups: people with dual diagnosis, people from black and ethnic minority groups and women. Finally, I set out how evidence was gathered and how the Report is structured. 6 6 Setting the scene Introduction The Secretary of State for Justice asked me to undertake this independent review in December 2007, under the following terms of reference: -to examine the extent to which offenders with mental health problems or Learning disabilities could, in appropriate cases, be diverted from prison to other services and the barriers to such diversion; and -to make recommendations to government, in particular on the organisation of effective court liaison and diversion arrangements and the services needed to support them.

6 I kept the remit of the review as broad as possible within those terms so that it could incorporate the range of severity of mental health problems, and could include diversion in all its potential interpretations, from prevention and early intervention through all the stages of the criminal justice system and back out into the community. In acknowledgement of the breadth of the remit, the length of the review was extended from the initial six months to one year. I realised very quickly that if I looked at just diversion in its traditional sense, schemes set up in courts, an opportunity would be missed to look at the whole offender pathway and make effective changes that would impact on this population. The lack of progress in this area seemed to be caused, in part, by the continual development of policies and practice in isolation from each other, affecting only small parts of the system, or addressing one problem at a time. I did not want to compound this lack of progress by taking the same approach.

7 This review provided an excellent opportunity to take stock, look at the whole system and move the agenda forward. The problem While public protection remains the priority, there is a growing consensus that prison may not always be an appropriate environment for those with severe mental illness and that custody can exacerbate mental ill health, heighten vulnerability and increase the risk of self-harm and suicide. In addition, recent studies of mental health services for prisoners1,2,3 suggest that there is still some way to go in achieving equivalence with mental health services in the community. The 1998 publication of a survey for the Office for National Statistics on psychiatric morbidity among prisoners4 was a comprehensive attempt to provide robust baseline information about the prevalence of psychiatric problems among male and female, remand and sentenced prisoners. The information gained from this study has been invaluable; it set out the scale and nature of mental health problems among prisoners and has helped to inform policy decisions to this day.

8 7 Setting the scene Some key findings from this survey Report showed that: -over 90% of prisoners had one or more of the five psychiatric disorders studied (psychosis, neurosis, personality disorder, hazardous drinking and drug dependence); -remand prisoners had higher rates of mental disorder than sentenced prisoners; and -rates of neurotic disorder in remand and sentenced prisoners were much higher in women than in men. This information is now 10 years old, but it is still being referred to today. In the interim, smaller-scale studies, reports and research have suggested that numbers remain high. Since June 1995, the prison population in England and Wales has increased by 60%, or more than 30,000 people, to reach the record levels seen Figures for January 2009 put the prison population at 82, There is now an added sense of urgency attached to addressing these problems as the Government considers larger- capacity prisons in its response to increasing pressures on the system. The figures from the survey, if considered alongside the increase in the prison population over the last 10 years, suggest that there are now more people with mental health problems in prison than ever before.

9 Public opinion Concerns around the profile of the prison population are no longer exclusively felt by professionals and pressure groups. There is increasing evidence to suggest that they are finding their way into mainstream public opinion, including that of victims of crime. SmartJustice (an alliance of organisations currently based within the Prison Reform Trust), in partnership with Victim Support, published the results of a survey undertaken in 2006,7 which asked victims how they thought the criminal justice system should deal with people who commit non-violent crimes. The findings challenged many preconceived views that victims always want penalties to take the form of imprisonment. Instead, it demonstrated that they support a range of measures that they believe are more effective in stopping further offending. The survey showed that seven out of ten victims wanted to see more treatment programmes in the community for offenders suffering from mental health problems, and for drug addicts, to tackle the causes of non-violent crime.

10 Last year also saw a resolution at the Women s Institute s Annual General Meeting concerning the inappropriate imprisonment of the mentally ill. The resolution focused in particular on the impact on prisoners families and was carried overwhelmingly. The issue now constitutes one of the Women s Institute s current 8 Setting the scene The policy context So what work has been done over the years to try to reduce the high prevalence of mental health problems in prisons? As early as 1990, the Home Office issued Circular 66/909 to promote effective inter-agency working, so that wherever possible mentally disordered offenders should receive care and treatment from health and social services rather than be dealt with via the criminal justice system. This was followed by the 1992 Reed review of health and social services for mentally disordered The review recommended that there should be nationwide provision of properly resourced court assessment and diversion schemes to support this goal.