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?
The Mental Health Cop blog won
– the Mind 2012 Digital Media Award, in memory and in honour of Mark Hanson.
The Awards celebrate the “best portrayals of and reporting on mental health in the media.”
– a World of Mentalists 2012 #TWIMAward for the best in mental health blogs.
It was described as “a unique mix of professional resource, help for people using services and polemic.”