Evaluating liaison and diversion schemes: an analysis of health,criminal and economic data

Introduction: Liaison and Diversion (L&D) currently serves 50% of the population of England. L&D relies on modified working practices with key delivery partners, especially the police. Service evaluation data is thus presented from both police and health services. Method: A before and after intervention review of 3 months of operational data of L&D in Cornwall focusing on health, criminal and economic outcomes. Results: After L&D intervention individuals’ contact with the police as either victim or perpetrator reduced significantly. Implications: Preliminary findings suggest that L&D enabled reduced use of police and criminal justice resources. National reporting procedures may be unable to demonstrate the multi-agency impact if criminal justice data are not considered within the outcome data-set. Recommendations echo international observations that specifying outcome measures and the consistent definition of L&D services would enable generalisation of findings.     

A prospective comparative evaluation of a Criminal Justice Liaison and Diversion Service in Belfast

There is continued interest in the planning, development and implementation of services designed to identify detainees with mental illness and connect them to health and social services. However, currently, little is known about how best to configure, organise and deliver these services. The study employed a prospective follow-up design with a comparator group to describe and evaluate a police mental health liaison service based in Belfast. Participants were recruited from two neighbouring police stations, only one of which provided a mental health liaison service. Outcomes including mental health status, drug and alcohol misuse, risk-related behaviour and ‘administrative’ outcomes were assessed at the time of arrest and six months later. The service was successful in identifying and assessing detainees, though there appeared to be similar between-group levels of mental health problems over time. Results highlight a need to develop firmer linkages and pathways between criminal justice liaison/diversion services and routine health and social services.     

A mixed methods study of the mental health and criminal justice histories of missing persons

Approximately 35,000 people are reported missing each year in Australia; rates elsewhere are even higher, with a recent UK study suggesting that a person goes missing every 2 min. Missing persons place a significant burden on police services; it is interesting, therefore, that very little research attention has been paid to this topic. This mixed methods study aimed to address this significant gap by analysing the mental health and criminal justice histories of a sample of missing persons and comparing them to rates in the general community. The study found that both mental health and criminal justice histories were significantly overrepresented among missing persons compared to those in the general community, and that young people reported missing commonly displayed suicidal behaviour. Results highlight at risk groups and suggest that criminality is much more commonly implicated in missing person incidents than previously thought.     

Information pathways into prison mental health care

Police and court liaison and diversion services provide important specialist mental health input along critical stages of the criminal justice pathway. Effective sharing of information between the services and relevant justice agencies is essential. However, various problems exist with the flow of information between agencies and services across the criminal justice pathway. This service evaluation explored how clinically relevant information is transferred, by drawing on the perspectives of prison health care staff in a large urban UK male prison. A qualitative service evaluation was conducted using semi-structured interviews with a purposive sample of 11 prison staff. The main themes included: gaps in the transfer of essential information, (particularly concerning risk and offending information); information gathering to fill these gaps; the importance of professional relationships, information sharing between agencies; and information solutions. Improving information transfer across the criminal justice pathway could prevent treatment delays and ensure more timely mental health care in prison.     

Crisis intervention team training: when police encounter persons with mental illness

Abstract

The Crisis Intervention Team (CIT) model is an established training program used to improve police response to encounters involving persons with mental illness (PwMI). Diversion of PwMI from the criminal justice system to appropriate treatment providers in the community is one of the primary goals of CIT. The present study examines characteristics and outcomes of encounters between citizens experiencing mental health-related crises and CIT-trained patrol officers. Findings of this study indicate encounters involving PwMI and CIT-trained officers often result in diversion to mental health services. Implications for policy and future research are discussed.     

Envisioning the next generation of behavioral health and criminal justice interventions

The purpose of this paper is to cast a vision for the next generation of behavioral health and criminal justice interventions for persons with serious mental illnesses in the criminal justice system. The limitations of first generation interventions, including their primary focus on mental health treatment connection, are discussed. A person–place framework for understanding the complex factors that contribute to criminal justice involvement for this population is presented. We discuss practice and research recommendations for building more effective interventions to address both criminal justice and mental health outcomes.     

Health characteristics of older police custody detainees in London,UK

The number of older adults involved in the criminal justice system is rising. Little is known about the state of health in older people who are arrested. This study compared characteristics and health care needs of older police custody detainees with their younger counterparts. The health characteristics of 57 police detainees aged over 50 were compared with 543 younger detainees. Older detainees had significantly higher rates of physical illness and risk of alcohol withdrawal. Although there were equivalent rates of mental disorder and drug taking compared with younger detainees, a higher proportion had presentations consistent with cognitive impairment due to possible dementing processes. Over 80% of older detainees were recommended to have a health assessment in police stations based on their presentation. Police detainees over 50 should be considered to have a health assessment as routine procedure. Further investigation should also be conducted into cognitive impairment in this group.     

The nature of police involvement in mental health transfers

During the course of their duties, police regularly have contact with mentally ill persons who are experiencing psychiatric crisis and require some form of mental health transfer. This study examined 2611 unique mental health transfers completed by police in the Australian state of Victoria over an eight-month period in 2009–2010. The overwhelming majority of mental health transfers performed by police during this period were the result of unplanned calls for assistance. Although police frequently requested assistance from other services, these were often not available. The study findings support a substantial body of anecdotal evidence from police citing lengthy involvement with people experiencing mentally illness, with the average mental health transfer consuming 2.5?h of police time. The frontline responses of police to people in psychiatric crisis need to be more formally acknowledged and creative solutions need to be sought with health and welfare services to better meet the needs of those who are falling between the cracks of community mental health care services.     

CIT in context: the impact of mental health resource availability and district saturation on call dispositions

The goals of Crisis Intervention Team (CIT) programs include improving safety during encounters between police and persons with mental illnesses, diverting persons with mental illnesses away from the criminal justice system, and increasing referral and access to mental health services. CIT is a systemic intervention, and as such, its implementation and effectiveness are influenced by existing practices and infrastructures. However, little research has considered the context in which CIT programs are implemented. In this paper, we present research on CIT in four Chicago police districts that vary in terms of two contextual factors hypothesized to influence the impact of CIT training on how calls involving persons with mental illnesses are resolved. Using data from 112 patrol officers in four Chicago police districts, we consider the impact of mental health services availability and CIT saturation (the percentage of district personnel that are CIT certified). Findings indicate that CIT training increased direction to mental health services primarily in districts with greater availability of mental health services. In districts with low service availability, higher CIT saturation increased direction to mental services. The opposite pattern emerged for contact only or informal call resolution. No effects were found for arrest as a call outcome.     

Mental health issues and the Canadian criminal justice system**

The critics assert that a significant proportion of incarcerated individuals suffers from mental health issues, i.e. ‘the criminalization hypothesis.’ The current paper reviews the scholarly literature to address five interrelated questions: (1) What are the risks of those classified as mentally ill for committing crimes and, in particular, violent crimes? (2) As the gatekeepers to the criminal justice system, what happens during ‘first encounters’ between the police with those who have mental illnesses? (3) What community-based services are available for effective diversions as an alternative to incarceration for those with mental illnesses? (4) What are the impacts of treatment options upon those experiencing mental illnesses while incarcerated, including the impact upon recidivism? (5) What types of pre-release planning and community responses have the most positive effects to help reduce recidivism and assist offenders in coping with mental health issues in the Canadian context? After summarizing key evidence pertaining to these questions, the paper presents case studies as exemplars of ‘best practices’ to illustrate promising directions conducive to integrated, holistic, and effective responses at the intersection of the criminal justice and mental health systems.     

Interventions with women offenders: a systematic review and meta-analysis of mental health gain

Currently, a conjunction of policy, legislative change in health and social care and the criminal justice system, combined with funding for innovative services make it opportune to assess the evidence base for interventions with women offenders. Women offenders have a distinctive criminological, health and social profile and a gender specific approach to their difficulties is advocated. This systematic review and meta-analysis focus on mental health gain in adult women offenders in forensic health settings, criminal justice institutions and in the community, following therapeutic interventions. Interventions were assessed in terms of specific outcome measures of depression, trauma symptomatology and global mental health status. Comprehensive search strategies yielded 3018 articles, from which we obtained 199 full text articles. Seventeen articles were included in the final review, of which six were excluded from the meta-analysis as there was no comparator group. There is a modest, but increasing, body of evidence for the utility of some interventions, notably those addressing the consequences of earlier trauma, including interventions which also address comorbid substance misuse. This does not amount, to date, to a robust evidence base. Limitations of these studies are discussed and include small sample sizes, their restriction mainly to prison populations and that they were substantially undertaken in the US. Variations in outcome measures follow-up and the difficulties inherent in measuring change in this complex population are also detailed. However, the review delineates definite avenues for further work. To achieve this, those responsible for policy, practice and purchase of services should both be mindful of existing evidence and promote additional, high quality research into interventions which are designed around a coherent, theoretical approach.     

Treating offenders with mental illness: a research synthesis

The purpose of this research synthesis was to examine treatment effects across studies of the service providers to offenders with mental illness. Meta-analytic techniques were applied to 26 empirical studies obtained from a review of 12,154 research documents. Outcomes of interest in this review included measures of both psychiatric and criminal functioning. Although meta-analytic results are based on a small sample of available studies, results suggest interventions with offenders with mental illness effectively reduced symptoms of distress, improving offender's ability to cope with their problems, and resulted in improved behavioral markers including institutional adjustment and behavioral functioning. Furthermore, interventions specifically designed to meet the psychiatric and criminal justice needs of offenders with mental illness have shown to produce significant reductions in psychiatric and criminal recidivism. Finally, this review highlighted admission policies and treatment strategies (e.g., use of homework), which produced the most positive benefits. Results of this research synthesis are directly relevant for service providers in both criminal justice and mental health systems (e.g., psychiatric hospitals) as well as community settings by informing treatment strategies for the first time, which are based on empirical evidence. In addition, the implications of these results to policy makers tasked with the responsibility of designating services for this special needs population are highlighted.     

Mental health at the intersections: The impact of complex needs on police contact and custody for Indigenous Australian men

Indigenous Australians experience significant social risk, vulnerability and disadvantage. Nowhere is this more starkly demonstrated than in the levels of contact that Indigenous Australians have with the criminal justice system, particularly the police. Utilizing a linked dataset of extant criminal justice, human and health service administrative data in New South Wales (NSW) Australia, this paper explores patterns of police contact and custody for a cohort of Indigenous males with complex needs. Four significant factors are identified that alone or in combination appear to impact on the frequency with which these men experience police contact and custody, including young age at first police contact, experiencing out of home care as a child, alcohol misuse, and limited locational mobility. Whilst it might be expected that the presence of mental ill-health and/or cognitive disability would be a key predictor of the frequency and intensity of police contact and custody, the findings suggest rather that the presence of multiple disadvantages beginning in the early years and compounding throughout individuals' lives, in which mental illness may or may not be a factor, is more significant than the presence of any one diagnosis in precipitating police contact and custody for this group.     

Law enforcement response to mental health crises: citizen risk factors and preferences for social policy*

Despite having the potential to affect cooperation and support for law enforcement, community preferences for police training are generally unstudied. This paper seeks to understand (1) general community preferences for police training for responding to mental health crises, (2) where the public prioritizes this mental health crisis training relative to racial bias training, and (3) whether these preferences vary depending on respondent demographics and risk factors for police contact. Survey data from a general sample of Portland, Oregon residents (N = 259) shows public support for police training on responding to mental health crises, but the public as a whole is split over whether mental health, or racial bias training, should be prioritized as the best use of police training time. Logistic regression analyses demonstrate three main findings regarding the impact of respondent characteristics on preferences for police training: (1) black respondents appear concerned that, by drawing attention to mental health crises, police will be more limited in their responses to racial bias; (2) respondents facing the greatest, and those with the least, amount of risk in police/citizen encounters are most supportive of mental health crisis training; and (3) mental illness itself does not appear to affect support for police mental health crisis training. These differences in support for training need to be understood before law enforcement can cultivate community support for police officers and their training practices.     

Mental health specialized probation caseloads: Are they effective?

With the large and growing number of persons with mental illnesses under probation supervision, a form of specialized probation called specialized mental health caseload (SMHC) has been implemented. This study explores the effectiveness of a prototypic SMHC implemented statewide. A quasi-experimental design was used to compare criminal justice, mental health, and community engagement outcomes among three caseloads: a newly established SMHC supervising no more than 30 clients per officer (N = 1367); an established SMHC supervising roughly 50 clients per officer (N = 495); and a traditional caseload of clients receiving mental health treatment and supervised by officers with average caseloads of over 130 clients (N = 5453). Using a mixed methods approach, we found that the SMHC was implemented with high adherence to fidelity, and comparisons based on different caseload samples generally support the effectiveness of the specialized mental health caseload, particularly on criminal justice outcomes. Future studies using random assignment are needed to examine the connection among mental health symptoms, compliance with treatment and probation supervision, and recidivism.     

Community-based forensic child and adolescent mental health services in England,Scotland and Wales: a national mapping exercise

Aim: We sought to ascertain the current nature of specialist community mental health provision for young people presenting with risk of harm to others or involvement with the youth justice system in England, Wales and Scotland. Methods: Questionnaire-based survey. Results: Fifty-five services were contacted, 48 responded and 35 of these were found to be providing some form of community mental health provision to high-risk young people. Thirteen services provided comprehensive community forensic child and adolescent mental health (FCAMH) services, whilst the remainder offered more ad hoc clinical input. Amongst the comprehensive FCAMH services, staffing, function, commissioning arrangements and population served varied widely. Conclusions: There is patchy geographical provision of comprehensive community FCAMH services across England, Scotland and Wales with heterogeneous commissioning arrangements, staffing and function. Development of a national commissioning strategy for community FCAMH services is required to ensure that the complex needs of high-risk young people are adequately addressed.     

Referrals to a mental health criminal justice Liaison and diversion team in the North East of England

There is growing interest in the health correlates of people detained in police custody, and a number of innovations have been introduced to try to meet the complex needs of detainees. The implementation of Criminal Justice Liaison and Diversion (CJL&D) Services commissioned by the Department of Health in England is a substantial part of this investment. In this paper, we describe data from 858 detainees who were referred to the CJL&D service of a busy metropolitan police station in the North East of England. The detainees referred to the service had complex mental health needs, substance misuse and a range of vulnerabilities requiring specific intervention. The effective operation of these teams and how they interface with health and criminal justice systems also depend upon a number of systematic issues that emanate both from within the teams, and from external policy drivers.     

The mentally retarded offender in the criminal justice system

The problem of the mentally retarded offender begins at the first encounter with the criminal justice system and continues through the correctional system. A recent survey compared attitudus of police and mental health professional. Police (78%) felt that disturbed person (including mentally retarded offenders) should be handcuffed when being transported. In contrast, mental health professionals (84%) felt no individual should be handcuffed. The mentally retarded offenders, once incarcerated, are a group that is confronted with problems beyond those usually associated with prison life. The authors examine the complex issued stemming from the special conditions of the MRO and suggest recommendations for developing rational attitudes and policies within the criminal justice system.     

The social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.