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Frequently Asked Questions
Mentally Disordered Offenders - Who are we talking about? A fundamental question that arises when looking at the problems that 'mentally disordered offenders' present is who we are talking about when we use this term. This is not merely a semantic argument. All too often, where attempts have been made to define this client group, the debate has tended to be framed by who is included or excluded, the implication being that definition and ownership (i.e. responsibility for providing or paying for services) are inextricably linked. Several attempts have been made to define the term, linking together mental disorder and offending. For example, the Reed Review (Review of Health and Social Services for Mentally Disordered Offenders and others requiring similar services, 1992, HMSO) used the working definition: 'A mentally disordered person who has broken the law.' For the purposes of the Mental Health Act 1983 (MHA), four specific categories of mental disorder are defined:
This legal definition of mental disorder is the basis for the imposition of compulsory hospital detention. It does not, however, provide much help in suggesting what the criteria for intervention by different agencies might be. Often the basis for intervention may be a mental disturbance that does not fall within the criteria of the MHA. Nacro adopts a broader definition so as to avoid excluding those whose mental health problem may not be sufficiently serious to satisfy the legal criteria contained in the MHA. Nacro's definition is: "Those who come into contact with the criminal justice system because they have committed, or are suspected of committing, a criminal offence and:- who may be acutely or chronically mentally ill; those with neuroses, behavioural and/or personality disorders; those with learning difficulties; some who, as a function of alcohol and/or substance misuse, have a mental health problem; and any who are suspected of falling into one or other of these groups. It also includes those in whom a degree of mental disturbance is recognised, even though that may not be severe enough to bring it within the criteria laid down by the Mental Health Act 1983, and those offenders who, even though they do not fall easily within this definition - for example, some sex offenders and some abnormally aggressive offenders - may benefit from psychological treatments." This broad definition reflects Nacro's concern to concentrate not just on a narrow group of mentally disordered offenders whose mental disorder can be assessed as falling within the criteria laid down by the MHA, but to address the wider range of problems associated with those who have some degree of mental disturbance and warrant a range of care and support and, in some cases, treatment. However, any definition needs to be set against the criteria different agencies apply to assess who should have access to services. Some of these may actually be contradictory for mentally disordered offenders with complex needs. Therefore, it might be more useful to consider what elements might need to be present for someone to be considered as a mentally disordered offender. These could include:
Although the majority of people who fulfil these criteria are adults of working age, there is no age limit. Are people with mental health issues more likely to offend? By definition, the label 'mentally disordered' implies that an individual's thought processes, and possibly behaviour, are different to what we would consider the 'norm'. In many cases, the difference may not be pronounced enough to be noticeable to anyone other than a trained psychiatrist or mental health worker but in others the difference may be apparent to most people. Clearly, behaviour which is different or bizarre, and which attracts attention, can give rise to concern about the individual in respect of his or her own welfare or the wellbeing of others. If a person behaves strangely in a public place, this may lead to the police being involved. This can either be because an offence may have been committed or because the police have a specific power under section 136 of the Mental Health Act 1983 to deal with people in public places, who appear to be mentally disordered, whether or not any offence has been committed. The police may also be called in by concerned neighbours or relatives. A consequence of the police becoming involved can often be that they deal with the person formally because a minor offence - often a public order offence - has been committed. Many people believe that people with mental health problems are likely to be violent and that they are a risk to others. Available data, such as those from 'Avoidable Deaths: five year report of the national confidential inquiry into suicide and homicide by people with mental illness', do not support this view. However, because the behaviour of mentally disordered people is more likely to bring them to the attention of the police, it is also more likely that they will be arrested more frequently than others. It may also be that the police feel constrained, when exercising their discretion, to deal with the mentally disordered person formally, in the hope of ensuring that he or she will receive appropriate support, whereas if they were dealing with an offender who was not mentally disordered they would decide to take no further action. Since people with mental health issues are more likely to come to police attention in a public forum, it is also more likely that they will be arrested for particular types of offence, such as minor public order offences and criminal damage. Similarly, mentally disordered people who are having difficulty maintaining a stable lifestyle - and who may be homeless - are also likely to be at a greater risk of committing relatively minor offences associated with obtaining food and shelter. This was shown very clearly in a study in the late 80s of remand prisoners at Winchester Prison (Coid J (1988) 'Mentally abnormal prisoners on remand: rejected or accepted by the NHS' British Medical Journal 296: 1779-82). What are the rates of mental illness in the prison population? The Office for National Statistics published a report on the Psychiatric morbidity among prisoners in England and Wales in 1998. This found that in the 12 months before entering prison, about 20% of male prisoners, both remand and sentenced had received help or treatment for a mental or emotional problem. The proportions among female prisoners was double: 40%. Looking at the corresponding proportion of prisoners who had received help in prison, they were about 15% for male remand and sentenced prisoners, 23% and 30% among female remand and sentenced prisoners respectively. Another study using this data also focussed specifically on women prisoners. In addition, a similar study was also carried out using this data on young offenders aged 16 to 20 years which highlighted a parallel distinction between morbidity amongst male and female offenders. In the 12 months before entering prison, 11% of sentenced and 13% of remanded male young offenders had received help or treatment for a mental or emotional problem compared with 27% of female young offenders. Nearly 1 in 10 of the female sentenced young offenders reported having been admitted to a mental hospital. What is diversion? Diversion describes a process of decision-making, which results in offenders with mental health issues being diverted away from the criminal justice system to the health and social care sectors. Diversion may occur at any stage of the criminal justice process: before arrest, after proceedings have been initiated, in place of prosecution, or when a case is being considered by the courts. If a prosecution is initiated, the Crown Prosecution Service (CPS) might decide to discontinue it, or, if the offender is prosecuted because prosecution is appropriate, the courts might opt for a relevant disposal under the Mental Health Act 1983, such as a hospital order, in place of a criminal justice disposal, such as imprisonment. The policy of diversion, aimed at ensuring that, where possible, offenders with mental health issues are referred to health services, social services and voluntary sector organizations for support and treatment, rather than punished via prosecution and prison custody, has been consistently reiterated by Government Ministers and backed up by guidance in the form of Home Office Circulars 66/90 "Provision for Mentally Disordered Offenders" and 12/95 "Mentally disordered offenders: Inter-agency working". These are available from the Home Office website. Diversion and discontinuance are not synonymous and should not be confused with each other. Criminal proceedings are initiated by the police but the decision whether to proceed with a prosecution lies with the CPS. The CPS will weigh up various factors in determining whether to continue with a prosecution. If it decides not to do so, this is referred to as discontinuance. There is no hard and fast rule for the best way of dealing with offenders with mental health problems. They should be dealt with on a case-by-case basis taking account of the needs of the individual and the safety of the wider community. There are a number of options which might be pursued and a number of factors need to be taken into consideration in reaching a decision. Issues that should be considered prior to a decision being made would include:
Whatever the outcome, the decision-making process should be a joint one involving as many key players as possible. Clearly, information sharing is crucial to this process with the final decision balancing the various needs and providing an outcome that contributes both to the care of the individual and the needs of the wider society. What are Court Diversion or Criminal Justice Mental Health Liaison Schemes? These are schemes which seek to work in a multi-disciplinary way to ensure that, where appropriate, offenders with mental health problems are diverted away from the criminal justice system to care and treatment from the health and social care sectors. They also seek to ensure that, where a prosecution is to be pursued, relevant information about an offender's mental condition is made available to the courts. The schemes vary considerably in the way they operate, the locations they cover and their hours of operation. For example, some schemes cover a variety of criminal justice locations, including the police station, the courts and prisons, whereas others work in the courts only. The schemes may be staffed by a single community psychiatric nurse or by a multi-disciplinary team, including psychiatrists, social workers and probation staff. The purpose of such schemes is to identify offenders with mental health needs as early as possible with the aim of getting them access to services and support appropriate to their needs. Such schemes may also be known as MDO Diversion or Court Assessment Schemes and are, very often, crucial to the decision-making process within the criminal justice system. Our database holds information about schemes throughout England and Wales and we can provide contact details for these schemes. For further information, Contact Us. What is Nacro's policy on offenders with mental health needs? Nacro believes that, where relevant and appropriate, responses to offenders with mental health issues should focus on their care and treatment, rather than punishment. Sometimes, it may only be possible to access an appropriate level of care and treatment by progressing a case through the criminal justice system, for example, so that a hospital order could be imposed under the Mental Health Act 1983. When compulsory detention is necessary to ensure the protection of others or for the safety of the individual, this should usually be in a psychiatric hospital or special unit with the required level of security and not in prison. Nacro believes that prison does not provide an appropriate environment for the majority of mentally disordered offenders and, therefore:
Does Nacro offer training relating to offenders with mental health needs? Nacro offers training on a variety of subjects relating to the issues and can assist in putting together programmes for training days for multi-disciplinary groups. Topics covered include:
Our training aims to promote multi-agency working and effective communication at all levels. For more information, see Training. Our agency is looking for assistance with writing protocols - can you help? Nacro has worked with agencies in a number of areas helping them to improve the effectiveness of their arrangements for offenders with mental health issues, including the development of multi-agency protocols relating to different aspects of operational procedures. Our database includes information about which areas already use written protocols to facilitate their work and we can put you in touch with relevant contacts. Nacro's Mental Health Unit holds samples of written protocols on a variety of topics, which can be used as the basis for the development of protocols elsewhere. Topics include:
Contact us for more details. Do you offer advice for families or individuals? Please ring Nacro's FREE Resettlement Helpline prisoners, ex-offenders and their families on 0800 0181 259. The helpline also produces a booklet "Outside Help" for the families of people in prison, which is available to download for free from our website. Rethink National Advice Service ( 020 8974 6814) The Service is available from Monday to Friday 10am – 3pm, except Tuesday and Thursday 10am - 1pm and gives information about mental health services and your rights. Mind Infoline (0845 766 0163) can give legal information, information on mental health services. Their database contains details of local Mind associations and other organisations so people can find help in their own areas. SANELINE (0845 767 8000) offers advice to individuals experiencing mental health problems as well as families who are concerned about family members with mental health issues. Lines are 1pm until 11pm everyday. For support outside these hours please consider calling the Samaritans on 08457 90 90 90 or email SANEmail Shelter's free housing advice line (0808 800 4444) can give immediate, practical assistance, tell you your rights, offer advice and guidance and suggest specialist or local support services to help you longer term. Citizens Advice Bureau run the Advice Guide website which has useful factsheets on benefits, debt, housing and employment, and you can also look up your local citizens advice bureau who will help you resolve any problems. What do I need to tell my employer about my criminal record and/or mental health? For information on disclosing criminal convictions and mental health history please contact the Resettlement Helpline on 0800 0181 259. Nacro also produce a wide range of advice leaflets on finding a house, guides to unemployment benefits and applying for work with a criminal conviction, which can be obtained via the Helpline or through the Resources area of our website. Please select 'Resettlement' under 'browse by category'. Where can I find the latest statistics and information on offenders with mental health issues? In 2008 The Home Office (020 7273 2084) published the 'Statistics of Mentally Disordered Offenders 2006' showing some of the highest figures for a decade of prisoners with mental health problems transferred to hospital. For information about patients subject to a restriction order please contact the Ministry of Justice Mental Health Unit. Discussion forum lists and message boards
NAPICU key aims are to advance psychiatirc intensive care and low secure services, improve mechanisms for the delivery of psychiatric intensive care, audit effectiveness and to promote research, education and practice development within the speciality. An open discussion group for forensic psychiatric/mental health nurses and others with an interest in the care of those people who might be described as mentally disordered offenders, ie people who use mental health services through some contact (or potential contact) with the criminal justice system. It is expected that members will primarily be nurses who work in prisons, Secure Hospitals and related community services. Those involved in management, education and research in relation to forensic nursing care are also welcome.
The Offender Health Research Network is funded by Offender Health at the Department of Health, and is a collaboration between several universities, based at the University of Manchester. Aims and Objectives: - to develop a multi-disciplinary, multi-agency Network focused on offender health care innovation, evaluation and knowledge dissemination
Does Nacro provide services for people with mental health needs? Nacro Housing provides some supported housing schemes which accept offenders with mental health problems, supporting tenants in attaining the skills for independent living. For details of Nacro's schemes click here Where can I find out about vacancies within Nacro? All of Nacro's vacancies are advertised in Wednesday's Guardian and can also be found on our main website. Where can I find out about volunteering work within Nacro? As a volunteer you can help with a wide range of activities. These include: supervising and coaching sports activities, helping young adults apply for work or mentoring young people with problems. You can offer as little or as much time as you want. You will be trained and supported to carry out all the work you are involved in. For an application form or information about projects in your area contact Diane Cater on 0121 250 5232 or email diane.cater@nacro.org.uk
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