If there is something I could ban in the police / mental health debate, it would be the use of the word ‘diversion’: literally, banned! Perhaps we could legislate?! And ‘liaison’ isn’t much better and should also be avoided. Let me explain:
If I get in my car in Birmingham to drive to Cardiff I will begin to follow a certain route having determined my destination before departure – I always enjoy the M50 / A40 route through Herefordshire and Gwent, stopping somewhere around the border for coffee. But were I to find I need to ‘divert’ to Bristol, I would have to start to undo my route and find a new one, but not from Birmingham. Had I known in Birmingham I needed to go to Bristol, I’d have driven straight there, down the M5. It wouldn’t have been a ‘diversion’ at all. So I ‘divert’ not from Birmingham, but from somewhere like Monmouth or Usk, to Bristol. And when I get there, I am in Bristol, not Cardiff.
It is utterly impossible to be in both Bristol AND Cardiff simultaneously.
Of course, if at the start I do not know where I need to end up, I’d either stay at home until I knew; or drive to the point in the journey but no further, where I’d need to make the decision. (There is excellent coffee at the services at Junction 8 of the M5.)
And this is why ‘diversion’ is not the word we need: it is perfectly possible, in fact often it is desirable, that someone is within both the Mental Health and Criminal Justice systems and whilst the first destination may be prison, it may that we could not possibly know this when we set off. But set off, we must. Mental health care can be provided in prisons by ‘inreach’ teams before identifying a need to move to hospital, but still subject to criminal justice frameworks within the Mental Health Act (ie, a restricted transfer direction under s47/49 MHA). It may then be that the person is remitted back to prison, once treatment for mental disorder has been effective enough to ensure that the patient no longer needs inpatient mental health care, but may again receive ‘inreach’ mental health care from the NHS.
The hypothetical person in the above paragraph is in constant contact with mental health AND criminal justice structures – is not ‘either / or’ and this would remain true for most international jurisdictions like Australia and Canada, etc., where parts of the mental health system can only be access via criminal justice processes and who have also come to rely on policing as a frontline emergency psychiatric service following the deinstitutionalisation era. And I don’t like ‘Liaison’ either, I’m afraid! Apart from the fact that the word is too frequently used in policing to mean nothing at all, and all too frequently spelt with just one ‘i’; it also implies something about mental health and criminal justice which doesn’t reflect what we’re actually doing.
So here’s a touchy subject: we know that many people in prison have mental health problems. Some of these are addictions which led to the need for acquisitive offending in the first place, but whilst addictions are ‘counted’ as mental disorders, they are not always disorders that require inpatient mental health care. Other prisoners have psychotic conditions and campaigners have argued that more of the psychotic prisoners need to be move across from prison to health. No argument about that here.
Professor Jill PEAY from the London School of Economics – one of our foremost academics on mentally disordered offenders, whose book Mental Health and Crime is a seminal text – wrote about a “model of plurality” in her article on Mentally Disordered Offenders in the Oxford Handbook of Criminology (4th Edition). She argued that we must increasingly recognise that not all mental health care for offenders needs to be provided within the mental health estate and accept the inevitability of just some, lower-level mental health care being provided in prison. We need to recognise the need for the provision of mental health care within prisons. Just like much other healthcare is delivered within prison.
Of course this is like arguing for the need for Cardiff to be IN Bristol whilst simultaneously Bristol is WITHIN Cardiff: it sounds more like the premise for an episode of Doctor Who than a structure by which to determine the pathway through two mammoth systems of state coercion and control.
I object to ‘diversion’ for one more reason: it implies ‘this’ or ‘that’. A bifurcation in structure which simply doesn’t reflect the way we have philosophically constructed our legal frameworks and which doesn’t address the complexity of whether mental health causes crime or vice versa; or whether they are coincidental concepts?
And because we’ve allowed this bifurcated, unsophisticated approach to emerge as a result of our lexicon, we have had to find something which is a single determination of whether someone is ‘mad’ or ‘bad’. We have decided that it is whether or not someone is ‘sectionable’ under the Mental Health Act when arrested and the first part of this post shows why we didn’t need an overly simplistic division between ‘this’ or ‘that’.
So we are in a place where some mentally disorder offenders who are ‘sectionable’ are not prosecuted in the public interest when indeed they should be, to ensure that Part III of the Mental Health Act balances risks, assessment and treatment needs. We are also potentially criminalising mentally vulnerable people who are not (quite) ‘sectionable’, when a diversionary-style approach may be the one which best mitigates against future re-offending risks.
So the challenge is two-fold:
- How do we conceptualise the relationship between mental health and criminal justice in a way which avoids the ‘either / or’ of liaison and diversion?
- How do we ensure an approach which avoids unnecessary ciminalisation of vulnerable people through over-simplification?
And(!) – WHICH WORD SHOULD WE USE?
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2012
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
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Mental Health Cop 
Again a most sensible reprise.
May I ask you about a definition of “MAPPA”.
It states it is not an organisation in its own right but MULTI-AGENCY PUBLIC PROTECTION ARRANGEMENTS.
That in London refers to “OFFENDERS”.
May i enquire what precisely this term “offenders” means? Is it someone who has been already convicted?
Is it referring to someone who is a SUSPECT but not convicted?
The PACE rules seem to be at odds with MAPPA where adult safeguarding and Care First are involved, I aver, as doctors and nurses and social workers all collaborate behind the backs of the “alleged victim” without the “alleged victim’s” knowledge or consent and without gaining their express permission for obtaining their medical records and DPA1998 records held by the local authority and local mental health services. If a person has never been in receipt of the services of the mental health services in question and then it is taken to a Magistrates Court where an approved social worker [before 2009 changes] claims that the person is needing a Section 135[1] on the grounds of a long psychiatric history with a working diagnosis of schizophrenia and the person is a “client” – how is that tenable if the person has NEVER been a client of theirs and has NEVER been diagnosed with schizophrenia face-to-face with any doctor or psychiatrist?
To me, this is potentially a legal nightmare for any police to execute such a warrant given in such circumstances.
I would like to have police opinion on this as it is a very contentious issue in my opinion.
Thank you very much for your excellent blog.
Best wishes
Rosemary Cantwell
MAPPA arrangements come into play for several categories of convicted offender, being a suspect is insufficient. Those convicted for a ‘relevant offence’ (see the guidance below) and then sentenced to more than 12 months in prison or to a restricted hospital order under (s37/41 of) the Mental Health Act; also applies to people who have previously been convicted and how are regarded as posing particular dangerous risks.
s135(1) relates to warrants issued by Magistrates upon application of AMHPs (Approved Mental Health Professionals) and they may be lawfully exercised subject to certain criteria where there is grounds for believing that a person suffering from mental disorder is on the premises and is neglected, ill-treated of kept otherwise than under proper control; OR that they are living alone and unable to care for themselves.
Whether or not someone is known to MH services is not the only point; althought it is obviously relevant – suggestion of mental disorder could come from relatives (who have a statutory right to request that an AMHP consider an assessment) and / or from the police / ambulance services or from a GP. The safeguards against potential abuse of the Mental Health Act, is the Magistrate who has every right to ask difficult questions about why the grounds for a warrant are met and they often turn down applications where they are not satisfied.
I think that where the AMHP has secured a warrant, it is not a massively contentious issue because the police are then obligated to execute the warrant, to allow the AMHP to make their assessment or to remove the person to a place of safety for that assessment. By then, the police are merely agents in the process to ensure safety, if you like.
Does that answer your questions? Full MAPPA Guidance is here: http://tinyurl.com/76xzdcq
Hi
I admit that this is an area I don’t have much experience in as an AMHP and don’t have as many language issues as you but obviously it’s not an either/or dichotomy and the perception is that it can be. The language simplifies what is actually a very complex process as regards the relationship between crime and mental health. Also I think it’s really really important to differentiate between people who meet the criteria for compulsory admission under the Act (or sectionable as I think you say (!)) and those who can have enduring mental health issues without meeting those criteria. That’s the importance of good in-reach work because offenders have the right to quality health care just as we all do and it’s vital that is preserved.
As for Liason, is it just the spelling that irritates? 🙂
I like what you did there >>> I’m now physically irritated at the sight of it, and thinking of editing your comment with my powers of blog-ownership!
If it’s any consolation, it almost physically hurt me to type it..
Agree with most of the post there are plenty of people who would not meet the criteria for detention but may not be responsible for their actions which leaves us with a conundrum as in how to work with them in or out of prison. From those i know who have worked and our working in prisons there is a huge lack of resources for any effective work which when combined with how the prison environment conflicts with the stress vulnerability model the number of offenders with ongoing mental health issues comes as no surprise. What we really need is the level of resources we see in most medium level secure units which as you say produce good outcomes for all parties both in prisons and the community but until that day we will have to continue with what at times seems pot luck and of course trying to get best practice as the norm for all .
How many violent people are in prison today? And how many of them have mental health problems?
Depends how you are defining ‘mental health problems’, particular whether you include addictions.
As per always, you are spot on.
What indeed IS the legal definition of “mental health problems”.
And what precisely is “addictions”.
And what precisely is “violent offenders”.
These questions go to the heart of our legal and enforcement systems but nobody has a categoric DEFINITION OF THE LEGAL STATUS OF “MENTAL HEALTH PROBLEMS”.
For if you look on the internet and read the history of “MIND” the organisation it straddles “mental hygiene” and “mental health” and that there has been a PARADIGM SHIFT in what actually terms mean.
And this seems to be where great confusion lies.
What are your views on this please?
Dear Michael, firstly thankyou for taking an intrest in and time to type blogs describing, examining and sharing your opinions of different subject areas in Mental Health and Criminal Justice as a whole. It is warmly appreciated by and proves helpfull to many people, both proffessionals and suffers alike. Secondly, my hope is that your projects will endeavour and contribute to more exact methods in prevention of Mental Illness, narrow the gap between proffessionals and suffers, challenge standards and improve the level of engagement, and aid us all in working more closely together and with a greater harmony to achieve the best outcomes for sufferers and proffessionals personally, socially and systematically. I have made notes which contain some answers and indicate direction which may be of use later on. Well done. Miss Elizabeth Walton.