Niacro

NIACRO’S RESPONSE TO THE BAMFORD REVIEW OF MENTAL HEALTH AND LEARNING DISABILITY (NORTHERN IRELAND)

FORENSIC SERVICES WORKING COMMITTEE

1.        INTRODUCTION

1.1NIACRO, the Northern Ireland Association for the Care and Resettlement of Offenders, is a voluntary organization, working for 35 years to reduce crime and its impact on people and communities.  NIACRO provides services under the headings of: promoting safer communities; working with children and young people who offend; providing services to families and children of offenders; supporting offenders and ex-prisoners in the community; working with prisoners.

1.2NIACRO’s vision is to be acknowledged as making a unique contribution to the development of a society in which the rights and needs of everyone, including offenders, are equally respected.

1.3The Mission – NIACRO’s Mission Statement is as follows:  “NIACRO – working to reduce crime and its impact on people and communities”.

1.4NIACRO welcomes the opportunity to respond to this consultation given the organisation’s involvement in the Criminal Justice System across its many elements reflected in the areas covered by the Forensic Services Working Committee.

1.5NIACRO has had 35 years experience of delivering services within the community and within institutions dealing with offender, ex-offenders, prisoners and ex-prisoners.  Many of these individuals have experienced problems in respect of mental health as well as learning disabilities.

2.         RESPONSE TO CONSULTATION

2.1Chapter 1 – NIACRO is aware that those most in need of quality forensic services are least able to access them compared to citizens not located within the criminal justice system.  This chapter refers to what are essentially psychological barriers to positive mental health.  NIACRO would argue that the causes of mental health problems can also be attributed to poor accommodation, lack of adequate financing, lack of welcoming social networks, difficult to access training and employment opportunities as well as programmes that address individual behaviour.

2.2       NIACRO welcomes the report’s call to, “address the wide range of problems specific to each individual with the aim of helping him or her integrate into society”. 

NIACRO fully welcomes the call in respect of the needs of carers and has experience of providing such care to ex-offenders, ex-prisoners and their families.

2.3      Chapter 2 – the recommendation to establish a Regional Forensic Network to co-ordinate and lead the strategic planning of forensic services in Northern Ireland is welcomed by NIACRO as is the reference to the principal of “equivalence” in respect of people in the criminal justice system.  The gathering of evidence should include individual testimony and feedback from service users.  Joint co-operative planning is essential.

2.4       This consultation seeks to improve access to mainstream psychiatric/forensic services.  This assumes that these services are of an acceptable quality.  There are many who would dispute this and no doubt this is addressed by other committees of the Bamford Review.  It would therefore be useful if this was referenced by the Forensic Services Working Committee in the final document.

2.5       A key theme throughout the review will be the need to address resourcing as well as communication/information sharing between agencies.  These themes are priorities for those commissioning services for detained persons. 

2.6       The difficulties in managing people viewed as suffering from a personality disorder should be addressed.

3.POLICE STATIONS

3.1Advocacy services for people with mental disorder should be developed for those held in police stations. 

3.2While accessibility to health records by police FMO is desirable there should be safeguards applied to protect the individuals right to confidentiality. 

3.3A review of the appropriate adult scheme should include feedback from those who perform this role including relatives.   

3.4A Review of the Appropriate Adult Scheme should include feedback from those who performed this role, including relatives.  Joint protocols for the assessment and management of mentally disordered people in custody are required and need to be properly understood by all relevant personnel.

3.5An agreed risk assessment and management framework is a necessity.  Quality standards should be developed and audited but the processes kept as straight forward as possible to ensure good practice. 

3.6Appropriate training properly resourced is required.

4.BAIL

4.1Those released on bail access what is termed mainstream psychiatric/forensic services – the issue of quality has been referred to already.  It is a fact that individuals experiencing mental health problems, within the criminal justice system and relocating to a new environment such as a bail hostel are likely to experience significant upset.  Services provided need to take this into account – not only in terms of the individual but also the hosting accommodation whether this be organizational,  familial or something in between.

4.2NIACRO welcomes the recommendation to NIPS to carry out research into the needs of those currently held in remand custody. It is NIACRO’s view that the current system and the lack of adequate provision in the community significantly delays effective resettlement/ social integration. Furthermore, the experience of remand custody compounds the problems experienced by many people with mental disorder in terms of accommodation, employment, sustaining relationships, and making financial arrangements, etc., making it even more difficult to achieve stability post sentence.

5.COURTS

5.1NIACRO welcomes the proposed approach to developing services in the Courts through forensic mental health and learning disability services, and agree that guidance for assessment of ‘fitness to attend court’ should be prepared along with guidance on ‘fitness to be interviewed’ in police stations.

5.2       As stated above, access to health records needs to be facilitated from custody to the community, but with safeguards agreed around the sharing of that information.

6.PRISONS

6.1NIACRO welcomes the decision to transfer responsibility for the healthcare of prisoners to DHSSPS, and that in partnership with NIPS, should ‘develop a prison environment that actively promotes mental health and well-being’.  It is our view that a high level of change is required to achieve this, acknowledging the concerns highlighted in section 6:5; pg 34 of the review.

6.2It is our experience that whilst there are examples of emerging good practice in attempting to address the needs of people in prison, there are significant obstacles to ensuring equity of provision across the prison estate.

6.3Moreover, it should also be acknowledged that meeting the complex needs of the client group is made more difficult as a result of the experience imprisonment. We do however welcome the commitment to also including those suffering from personality disorder and alcohol and substance abuse.

6.4       Developing explicit values and principles for DHSSPS & NIPS is essential, however, it must be acknowledged that there is a risk that they may not translate into operational services compatible with the role and functions of prisons.

6.5       It is important that all prison staff receive training at some level to ensure positive impact on the services available for people in prison, given the totality of institutional life, and the impact of imprisonment on individuals.

6.6       We welcome the recommendation that service users and carers are involved in the development, delivery and monitoring of services and would suggest that the independent sector would have a significant role to play in facilitating this process, as well as in the promotion of advocacy services and complaints procedures, particularly with this client group.

6.7       Whilst the recommendation (number 47) must be supported, the suggested timeframe of April ‘07 is perhaps unrealistic, given the serious lack of appropriate services for people leaving prison at present.

6.8       Moreover, addressing the range of resettlement needs can include issues such as finding suitable accommodation, and for people suffering mental illness, learning disability, personality disorder or alcohol and substance misuse, this problem alone can be difficult to overcome.

6.9       Addressing the need for services for people in prison who have personality disorders needs to translate into consistent delivery of services across all custodial establishments.

6.10    NIACRO supports the view of developing alternatives to custody for women suffering from mental disorder. 

6.11    Suitable alternatives to custody in respect of men serving short sentences should be explored.  

6.12    As regards to the needs of young offenders, who traditionally serve shorter sentences in prison, developing continuity of care from prison to the community is critical.

7.         PROBATION

7.1There is little doubt that a significant number of those involved with the Probation Service experience mental health and learning disability problems. 

7.2Key to any intervention from Probation is the carrying out of risk assessment followed by case management.  This needs to be harmonised across the criminal justice system.

7.3The report references the, “significant and well established working partnerships with voluntary agencies in Northern Ireland”.  There needs to be some discussion as to whether Probation should develop mental health and learning disability services “in house” and/or relationships be developed and strengthened with direct providers.

7.4As stated elsewhere NIACRO would welcome the “hardening up” of the role of the Regional Forensic Network. 

7.5NIACRO would wish to be considered for inclusion in the partnership referred to in recommendation 74.

7.6NIACRO would wish to be considered for inclusion in respect of developing standards for joint working, opportunities for mental health promotion, research as well as having access to learning and development arrangements.

8.SECURE INPATIENT SERVICES

8.1The point about equivalence has already been made and is of primary relevance in the context of secure inpatient services. 

8.2In respect of high secure services i.e. The State Hospital, Carstairs, Scotland, a mechanism that maintains positive links between him/herself and family and/or partners would assist in facilitating transfer back to Northern Ireland.

8.3The difficulties experienced by women (again equivalence) in the mainstream penal system may be replicated in the recently opened Shannon Clinic Regional Secure Unit.

8.4The low secure services refer to the 150 locked ward beds in Northern Ireland.  The final report needs to reflect that services provided could be of higher quality, better resourced and on many occasions be more imaginative i.e. less dependent on drug intervention as a form of treatment and more creative e.g. more use of variety of therapies delivered.  Again this is probably reflected in other parts of the Bamford Review.

9.COMMUNITY FORENSIC SERVICES

9.1It is NIACRO’s view that the prison population is has a significant number of individuals who should not be incarcerated e.g. fine defaulters and some who have mental health issues. 

9.2If adequately resourced Community Forensic Services were provided it is likely that this would lead to a decrease in the numbers involved in the criminal justice system in general and the prison system in particular. 

9.3For this to be realized requires a relocation of ideology (from punishment to treatment) and resources (from increasing the numbers in prison to developing appropriate, impactive intervention(s)).

10.       FORENSIC LEARNING DISABILITY SERVICES

10.1    NIACRO would have experience of working with people who have learning disabilities and would fully support the recommendations contained in this chapter.  It recognizes that there are other organizations better qualified to comment.

11.SPECIFIC ISSUES

11.1NIACRO has already made comment in respect of the assessment and management of risk as well as advocating the need for better services for women.  In respect of personality disorder, autistic spectrum disorder, and forensic psychotherapy, NIACRO recognises that there are other organisations better qualified to comment.

12.IMPLEMENTING CHANGE

12.1NIACRO would wish to contribute to and be part of the establishment of a Regional Forensic Network. 

13.CONCLUSION

13.1It might be useful if the Committee were to consider the effects of institutionalization not only with respect to individuals with mental health and learning disability issues but also institutions that are seeking to deliver care to these individuals.  Particular attention should be paid to devising mechanisms that seek to combat this and ultimately provide the highest standards of interventions possible. 

13.2Consideration should also be given to a review of advocacy leading to a strengthening of representation with respect to those engaging the criminal justice system and psychiatric/forensic services.