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Download the Liaison and Diversion Bulletin: November 2014.
Welcome to the monthly Liaison and Diversion (L&D) Bulletin, bringing all news and L&D updates together in one place. Key steps of the L&D pathway are the identification, assessment and referral of service users into treatment and support services provided by partner organisations. Each month we will be looking at how a particular L&D scheme is successfully developing effective collaboration to share their experiences and to highlight the importance of good partner relationships for the service user. This month we report on the Avon and Wiltshire L&D trial scheme and how it has developed its provision in the courts to become an indispensable service for magistrates and judges. In other news, we bring you the latest news on the announcement of the wave 2 L&D trial sites, further details of December’s National Conference, and an update from RAND Europe’s ongoing evaluation.
In this issue:
L&D news report
Avon and Wiltshire L&D – A Court-grown service
Avon and Wiltshire L&D – Informing the courts
Avon and Wiltshire L&D – A community presence
Avon and Wiltshire L&D – Engagement worker
Avon and Wiltshire L&D – A court perspective
Avon and Wiltshire L&D – Supporting probation
Avon and Wiltshire L&D – Commissioner’s view
Avon and Wiltshire L&D – Informing the courts – a case study
News in brief
Wave 2 announcement
National Conference
RAND evaluation
L&D news report:
Avon and Wiltshire L&D – A Court-grown service
The Avon & Wiltshire L&D trial scheme is a trust-wide service covering an area over two police forces – Wiltshire and most of Avon and Somerset. The L&D provision started as a court-based service but now serves all police custody suites as well as criminal courts in this wave 1 area.
The service hub of the Avon & Wiltshire L&D trial scheme is based in Warmley – roughly at the centre of the large geographical area covered by the scheme. The journey from Weston Super Mare at one end to Salisbury at the other takes two hours by car. An online rota lets staff know their whereabouts 6 weeks ahead, so they can plan in advance.
The trial scheme provides coverage 7 days a week 8am to 8pm, with an on call overnight service with access to the duty manager of the Avon and Wiltshire Partnership Trust. Of the L&D practitioners working in the scheme, one is a learning disability practitioner and the rest are registered mental nurses and social workers.
Fiona Banes, Criminal Justice Community Services Manager for Avon and Wiltshire Mental Health Partnership Trust, sees the current L&D trial period as a real opportunity to explore ways of improving coordination, look at alternative ways of deploying staff, and to investigate the optimum locations where L&D can best interact with service users: “People can tend to refer the more demanding louder service users , L&D has to ensure that the quieter silently psychotic service users comes to our attention too through proactive screening that picks them up without just relying on police screening. Avon and Wiltshire L&D trial scheme have decided, where feasible, for L&D practitioners to go through every person in custody to screen them using our database and we are seeing people being taken into custody on occasions where there is a suspicion of a mental health issue – where a simple referral to L&D should be enough. One thing we are looking at is using voluntary attendance to allow people to report to their local police stations and from there be referred directly to L&D hopefully obviating the need for them to go into police custody. “
Avon and Wiltshire L&D – Informing the courts
Bristol has had a court L&D service since 2006 – and was one of the first pilots in the area. Since 2007 the pre-trial L&D service (known locally as the Court Assessment and Referral Service or CARS) has entered into a service level agreement with HMCTS for provision of formal psychiatric reports to the courts for sentencing. This activity sits outside of the L&D service specification scope, but they complement each other by supporting the overall vision of improving health and justice outcomes. Being able to offer the appropriate NHS trust psychiatrist from the service user’s own locality to write the report has ensured that the psychiatrist owns the assessment and is in a position to get the necessary funding for any hospital place needed. This has meant an end to delays in finding the appropriate psychiatrist which used to result in people spending longer on remand than necessary. Awarding the contact to the local L&D service resulted in a standard waiting period of 12 to 16 weeks slashed to 3 to 4 weeks. The use of proformas jointly drawn up by L&D practitioners and court clerks meant that the staff on the mental health side knew what the magistrates needed to know in order to make the various orders.
Another unusual aspect of the existing Avon & Wiltshire L&D provision was the presence of nurses in the 5 prisons that lie within the area of the Trust – responsible for mental health provision of inmates and support for people with learning disabilities. Nurses were originally taken out of the prison service and brought into the NHS as part of Changing the Outlook strategy in 2001 and ensured that people with significant community experience were employed in prisons, all under the same NHS management structure and talking the same NHS language. This presence allows reports to be used across both courts and prisons with no duplication of work and also provides advance notice to L&D staff inside and outside the prisons of anyone who is not divertible because of the seriousness of the offence. This saves a lot of time and resources which might otherwise be spent on assessing individuals who present as demanding and challenging but who are in fact not mentally ill – because the homework to establish that has already been done. All L&D practitioners in the trial scheme are able spend some of their time working inside the prisons and vice versa.
Richard Evans, the L&D manager from the Avon & Wiltshire L&D trial scheme has been sharing their expertise in “Nursing in Criminal Justice Service” published last month. The book “Nursing in Criminal Justice Service” published last month. The book addresses some of the broader issues facing nurses working in criminal justice settings and takes the reader along the health and justice pathway, from initial patient contact with nurses in police stations, to nursing care in courts, through prison nursing services and finally into the work of the multi-disciplinary team in the community, where nurses work alongside the probation services.
Avon and Wiltshire L&D – A community presence
Avon & Wiltshire’s history as a court grown L&D service has very much led to it being used as a community resource. At Bristol Magistrates, the L&D team’s room is situated next door to the solicitor’s consultation room with probation just one floor up:
Dave Cooper, L&D practitioner: “Ushers in court have referred people to us – and families and carers often knock on the door. This way L&D can provide assistance to people coming to court but who haven’t been in custody. Solicitors also make referrals to us. Probation officers also ask us to screen people or they might make an appointment with us to get information for a pre-sentence report.
“Our L&D trial scheme has becomes a service within the court system: people get to know we are here. They get to know what we do; we have become part of the furniture – a shop window.
“L&D practitioners also find themselves providing education on learning disability / mental health issues, explaining to someone for example that they are in fact suffering from depression – a possible explanation of their behaviour – and can provide information about simple ways to improve their mental health with fresh air, exercise and diet and direct them to resources such as the MIND website for example – thereby helping them with their own recovery and giving them hope.”
Avon and Wiltshire L&D – Engagement Worker
An L&D assessment will often contain a referral to the L&D Engagement Worker present in court. The engagement worker is where the court referral service ends and the community begins. L&D allows people entering the CJS access to mental health services – but cannot force people to engage with services. However, the engagement workers enable service users to comply with the directions of the court – not only ensuring people attend referrals, but also supporting people who have difficulty using transport to attend their next court hearing.
Carol Lewis, L&D Engagement Worker: “The focus of this work is about keeping people out of custody – being remanded could mean someone loses their tenancy. The presence of an engagement worker can give magistrates the reassurance they need to grant bail – therefore it changes outcomes. Engagement workers are important not only to help people with mental health issues, but also for guiding those with learning disabilities through the court process, sitting with them during their hearing and providing reassurance to them.”
Avon and Wiltshire L&D – A court perspective
One clear sign of L&D success is that, where L&D are involved and able to follow up, magistrates and judges feel more assured in giving bail or granting a community disposal.
Kirsty Cochrane, Legal Adviser at Bristol Magistrates Court who sits on the L&D project board: “Magistrates see L&D as part of the furniture. As a city court, they have always been used to dealing with people with mental health problems, but they almost take it for granted that the assessments and reports can be provided so easily. An assessment by the L&D practitioner allows the bench to be both sympathetic and robust – it gives the bench the information they need if they are to remand someone for their own protection, or it lets them know that someone can be safely bailed because there is no concern that they might hurt themselves or anyone else. They value those assessments and see them as part of the arsenal of information to make a decision with.
“Before the L&D court service, magistrates would hope they were doing the right thing for someone, but now with the necessary information they are able to make a reasoned decision about what to do with that person – they are confident in remanding Defendants and confident to bail them.”
District Judge Lynne Matthews sits at Bristol Magistrates: “With the assistance of L&D assessment reports I am able to take a clear course of action. I can take a view of the offence committed in light of any relevant mental health issues which the Defendant has. The reports are invaluable in helping me ascertain the appropriate steps to take when dealing with a defendant about whom little is otherwise known and who is exhibiting concerning behaviour. Without input from L&D there would be delays in dealing with such cases, particularly where a defendant is unrepresented.”
Avon and Wiltshire L&D – Supporting probation
Multi-agency work is vital to divert individuals out of the CJS. The assistance of L&D allows probation workers to get a more thorough understanding of an individual showing what support they have already been offered and which organisations they are receiving help from.
Hannah Weston, Court Duty Officer for Bristol Probation (left): “We need to collect as much information about people to draw up a pre-sentence report. We are able to interview them, but sometimes we are worried about their presentation or they might disclose information that gives us concerns. I can pop into the L&D office and ask if this person is on their radar.”
Angela Stuart-Gentle, Team Manager for Bristol Probation (right): “All we have to go on is what the defendant says in a 20 minute conversation without the ability to do our own pre-screening. We can lose people who fall though the net on the other side of sentencing. Signposting before sentence day is important as we don’t have the option to pick up afterwards if they are presenting issues. L&D can give us that right information so that we can coordinate specific work with other services as part of sentence planning to ensure ongoing engagement.”
Avon and Wiltshire L&D – Commissioner’s view
Cliff Hoyle, Health and Justice Commissioner (Mental Health) is confident about the quality of service provided by the NHS England L&D operating model in the Avon & Wiltshire L&D trial scheme: “As a commissioner for NHS England for mental health, I am very optimistic about what liaison and diversion can achieve. Early identification of people experiencing mental health difficulties and further assessment of complex need will improve outcomes for service users and providers offering the services. There is already evidence of this in the successful diversion from criminal justice pathways; available information to sentencers helping to speed up the judicial process for all involved and effective information sharing of those going into custody thus providing the opportunity for rapid response to need.”
Avon and Wiltshire L&D – Informing the courts – A Case Study
L was arrested by the police on allegations of threats to harm others – her first contact with the criminal justice system. L was taken into custody, charged with these allegations, kept overnight and was taken to Bristol Magistrates Court the following day.
During her time in custody, L had disclosed thoughts of self-harm and was therefore referred to the Avon & Wiltshire L&D service. Her details were checked against the NHS Trust’s electronic database and it was found that she was currently engaged with a secondary mental health service and had a diagnosis of Emotionally Unstable Personality Disorder.
While in custody, L consented to a mental health assessment by the L&D practitioner, the outcome of which was documented in a report which was submitted to court at her appearance. The report outlined L’s involvement with a secondary mental health service, her diagnosis and the current problems she was experiencing.
On reading the report and considering all the circumstances of the case, the Magistrates – now aware of L’s mental health difficulties – felt an immediate Conditional Discharge of 12 months without any further court hearings was the most appropriate disposal of the case. A Conditional Discharge means that an offender will not be sentenced for an offence unless a further offence is committed within a stated period.
This was a positive outcome for L as she avoided the possibility of both remand and of any further pending court appearances which would have caused her further stress and anxiety.
L was referred back to her community mental health team who would also have access to the L&D assessment which would be added to their shared electronic database.
L has continued her mental health recovery with professionals with whom she has a good therapeutic relationship and in an environment with which she is familiar and comfortable. L fed back her views about her experience via a service user survey and expressed how helpful and beneficial the L&D service had been to her.
News in brief
Wave 2 announcement
The list of wave 2 schemes – which will start to implement the new service specification from 1 April 2015 – is in the process of being finalised. December’s bulletin will carry profiles of all the new sites which will extend the national provision of L&D services to 53% of the population.
National Conference
The second National Liaison and Diversion Conference, Maintaining the Momentum, organised by the Offender Health Collaborative (OHC) on behalf of NHS England, will take place on Tuesday 2nd December 2014 at The Queen’s Hotel, Leeds.
The event has generated much interest and is expected to have over 200 delegates, pulling together a highly targeted audience of liaison and diversion schemes, commissioners, providers, police and stakeholders. It will be a key opportunity to identify the steps needed for mobilisation and implementation to ensure the delivery of consistent, quality liaison and diversion services across England.
The programme aims to demonstrate the benefits of L&D and the new model, and its impact on its service users. It will also demonstrate how far L&D has come in the past year through expert speaker contributions from The Rt. Hon. Norman Lamb MP, Minister of State, Care and Support at the Department of Health, The Rt. Hon. Lord Keith Bradley, Kate Davies OBE, Head of Public Health, Armed Forces and their Families and Health & Justice, NHS England, and Dave Burton Liaison and Diversion Programme Director, NHS England. The conference will be chaired by Graham Beech, Strategic Development Director, Nacro. For further information on the event, contact caroline.fuller@nacro.org.uk.
RAND evaluation
A short update from the RAND evaluation team this month which is busy preparing a scoping and feasibility report, to be delivered to the Central Programme Team before the end of November. The report will set out preliminary findings from the interviews conducted so far, and provide details of the proposed approach to the evaluation over the next 9 months.
Next month’s bulletin…
Next month’s L&D Bulletin will look at how the Leicester L&D trial scheme links the NHS England L&D operating model with other non-model services it provides – and how this has benefited service users.
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