Tuesday 28 September 2010

A Shocking Statistic

It has been estimated that up to 90% of the prison population have a mental health problem. This is an official figure from the Office of National Statistics, but unfortunately no distinction is made between those individuals with a learning disability, as opposed to those with a mental health problem. Or indeed how many that might be personality-disordered or emotionally disturbed. Of course they are all very different conditions, possibly over-lapping, but each requiring specialist diagnosis and appropriate intervention. With something so complex, it's perhaps not surprising that there is often confusion in all parts of the Criminal Justice System. I've known professionals in court admit that they have no idea as to the difference between a psychiatrist and a psychologist and as a consequence request the wrong specialist report. A psychiatric nurse is trained to deal with mental illness, but a clinical psychologist will be more appropriate for someone with a learning disability and a specialist counsellor might well be required for a client suffering emotional distress.

Unfortunately this confusion was compounded by the well-intentioned Bradley Review set up by the last government to look into the whole issue. Even this august body had trouble in agreeing on terminology and failed to decide between 'learning difficulty' or 'learning disability' as a definition. I think it's most unfortunate that the experts seem unable to clarify the matter, as it would be an assistance to the Criminal Justice System in deciding how to deal with such people appropriately. We know that many learning-disabled end up incarcerated, due as much as anything to a basic lack of understanding of the condition and how it differs fundamentally from a mental health issue. I firmly believe that 'learning disability' is the appropriate term as this accurately describes a state from which an individual cannot significantly improve. It is not a 'difficulty' which implies a minor condition that could be overcome. 

As part of the last governments' response to the Bradley Review, Jack Straw set up two experimental Mental Health Courts in Stratford, East London and Brighton and their work is being evaluated. They are modelled on the Drug Review Courts that have been running successfully in many areas, the idea for which having been borrowed from North America. The aim is to ensure that an offenders state of mental health and level of intellectual functioning are accurately assessed, prior possibly to the imposition of a Community Order with appropriate conditions. Progress is reviewed at regular intervals by either a District Judge or Lay Justices. In the case of a mental health issue, a Mental Health Treatment condition might be appropriate. 

Of course this type of condition has been around for a very long time, previously as part of a Probation Order and more recently a Community Order, but in my experience they are about as rare as hens teeth. This is borne out by the statistics. Between July 2008 and June 2009 there were 754 compared to 13,000 Drug Rehabilitation Orders and 5,800 Alcohol Treatment Orders. The discrepancy being basically because probation officers know only too well that it is pointless going down this route as the appropriate medical and social service provision will not be available. It would be especially naive to believe that NHS managers, GP's, consultants, psychiatrists or psychologists are the slightest bit impressed by Court Orders and that they might feel obliged to do their bit in ensuring their success. I think some believe treatment associated with any form of requirement goes against their professional ethics. 

Apart from mental health issues, I'm not at all sure how those with learning disabilities are intended to be dealt with by these experimental courts. Such people don't require 'treatment' but they almost certainly do require sheltered housing; ongoing community support; probably a social worker and ideally special help with employment. As someone who has tried to supervise such cases, I'm very interested to know how a court disposal will ensure these services are provided by Local Authorities and the NHS, because in my experience they are not available. As an example, I've been told in one particular area, there simply is no Adult Clinical Psychology provision at all. How can that be in what is supposed to be a national service? In my view, this particular field of professional expertise is so necessary for some probation clients that I have long-argued we should employ our own. 

 It has always amazed me how a learning-disabled person can pass through State Education, come into contact with various parts of the NHS and reach the age of 18 with no definitive diagnosis or assessment of IQ or mental capacity. It often takes a court appearance and possibly a remand in custody and a PSR request before a probation officer suggests it might be a good idea to get some answers to some very basic questions such as 'does this person have the capacity to understand what is going on?' or 'why don't we know the level of intellectual functioning of this person?' These experimental Mental Health Courts might well be a way forward, but the questions are firstly, will there be any money to fund them with court closures looming and secondly, will the specialist service provision they will undoubtedly identify as being necessary actually be available? I doubt it.

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