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.

2 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.

3 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.

4 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. 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.

5 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.

6 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 .

7 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. 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.

8 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. 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.

9 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.

10 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.