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Download the Liaison and Diversion Bulletin: August 2015
Welcome to the latest edition of the Liaison and Diversion (L&D) Bulletin, bringing you L&D news and updates together in one place.
This month we meet the Lived Experience Team (LET) to find out how they are using their experiences – and those of other service users – to support the governance and decision-making of the national L&D programme. Plus, we find out what some schemes have been doing to involve those with lived experience in the planning, development and delivery of their services.
In this issue:
Lived experience feature – approaches to lived experience in Avon & Wiltshire
Lived experience feature – using support time and recovery workers in Liverpool
Lived experience feature – the work of the Lived Experience Team
News in brief:
London Liaison and Diversion wave 1 scheme scoops prestigious award
RAND Europe evaluation August update
New service user videos published
Equalities update
L&D feature on lived experience
People with “lived experience” of a vulnerability can offer unique insights into how the responding service could be designed. And when services are aimed at individuals with complex problems then lived experience insight can be particularly useful. These people may have direct experience of using L&D services, or may have the vulnerabilities and needs that would be identified by L&D and have had contact with the criminal justice system but no direct experience of L&D. Both groups will have views on what works, or would have worked for them. Their insight can be used to improve the planning, development and delivery of services, something which is recommended by the L&D operating model. In this edition, we take a look at what the wave 1 trial schemes in Liverpool and Avon & Wiltshire have been doing to address this.
Approaches to lived experience in Avon & Wiltshire
The Avon & Wiltshire wave 1 L&D scheme has been using a number of different approaches to engage with people with lived experience and use their insights to inform and strengthen the services that they deliver.
Fiona Banes (centre) with L&D colleagues, Dave Cooper and Carol Lewis
Engaging with young people
One of the biggest challenges for the team was to find ways of engaging with children and young people, as Fiona Banes, Criminal Justice Service Manager explains: “When we were first set up we only had experience of providing mental health support for adults, so we have had to find new and creative ways of engaging with children to help bring their lived experience into the work that we do.”
Kirsty Cochrane, Legal Advisor at Bristol Magistrates Court who sits on the L&D Project Board, suggested they approach the Broad Plain Boys Club in Bristol. The 100 year-old youth club, which is the biggest in Bristol, is also open to girls. Fiona Banes and Dave Spurgeon, Research and Development Manager at Nacro, went to speak to six young people that had been through the criminal justice system. Although none of the young people had direct experience of L&D, Fiona and Dave were able to ask them about their experiences of being in police custody and how they thought the under-18 L&D provision should be developed.
Most of them were very positive about the initiative. Questions included whether they would mind an L&D practitioner contacting their parents, guardians or carers, what factors would encourage them to engage with L&D, and what sort of issues they would look to L&D for help with. When asked about how they would like an L&D practitioner to approach them, for example, most stressed the importance of not being too formal, of being friendly and building up a rapport with them:
“Sit down, have a chat and be friendly, treat with respect, rather be straight and direct… confidential, [it] stays between us.”
“Have a bit of a chat first; [it] wouldn’t go down well if you just asked straight away about problems”.
HMP Bristol service user forum
The long-established service user forum at HMP Bristol is another avenue to get feedback from people with lived experience, and has been used by the team to seek input on the design of service leaflets and other paperwork.
Set up in 2012 to inform the transformation of an Avon & Wiltshire Mental Health Partnership healthcare wing into an intervention wing, the forum is still going strong. Fiona admits that they found it challenging to set up a forum specifically for L&D service users, so the HMP Bristol forum has been a good mechanism to engage with people that have been through custody and the courts.
Fiona explains, “Many of the service users that leave the police custody suite are not necessarily keen to be reminded of their time in police custody, or be identified due to their mental health and or learning disability issues. People may not want to attend a service user forum as they are worried that they will be identified by peers when they are on the street. So, we have had to find more creative ways of reaching out to our service users. One way to do this is to visit people in prisons. We have often asked the service user forum at HMP Bristol if they are willing to give us advice about L&D issues and innovation and have asked them to give us feedback on a variety of issues.
Service user focus groups
Of course the HMP Bristol forum isn’t the only avenue for feedback. The scheme seeks to engage as wide a cross-section of service users as possible, as Penny Stanbury, Service User Involvement Coordinator for Avon & Wiltshire’s specialised services explains:
“We have service users and carers who have been recruited over the past two years from AWP’s Specialised Mental Health and Criminal Justice Services.
“These individuals are involved in the design, delivery, development and evaluation [of services]. They often take part in projects, focus groups and steering groups. We facilitate bespoke training to prepare service users for sitting on interview panels and leading group work sessions and mutual aid groups.
“I recently contacted service users who have experienced the criminal justice system. They were invited to give feedback on the healthcare services they received in police custody, courts and prisons.”
Penny Stanbury, Service User Involvement Coordinator, Specialised Services, Avon & Wiltshire Mental Health Partnership Trust.
Penny kick-started her focus group by giving the participants some easy-read leaflets and a booklet that explained what the L&D service offers and delivers. They were then asked: “If you were in custody and were offered this service, would you want it?” She also asked them to provide reasons as to why or why not.
Although there were some reservations, most of the feedback was very positive:
“It’s really helpful to have a service that can offer the choice to whether someone liaised with other services, and that it’s voluntary.”
“I’d want your service.”
“If I was arrested, I would be knocking on your door.”
Using support time and recovery workers in Liverpool
The Liverpool L&D team. Front row (left to right): Kerry Roberts, Rebecca Jones, Mark Sergeant, Helen Guerrini and Kelly McDonnell. Back row (left to right): Gary Smith, Gerry Butler, Rebecca Storey, Marian Bullivant, Brian Harrison and Stephen McGrath.
It’s been more than a year since we first reported on the Merseyside L&D trial scheme. The scheme, which is run by Mersey Care NHS Trust, has gone from strength to strength. The team now has 15 L&D practitioners and three managers. And, with a full roster of support time and recovery (ST&R) workers, they are also able to assist people with short-term practical interventions in addition to supporting them into services. Of these, two are recruited for their lived experience of mental health issues.
As Rebecca Jones, Criminal Justice Liaison and Diversion Team Manager, explains: “Merseyside has always been very forward thinking when it comes to lived experience. We have Service User Care Assemblies and forums as well as a People Participation Team. Mersey Care Recovery College also delivers a comprehensive range of courses and learning programmes for people who use services, care for someone who does, or work in services as a route to recovery. They offer an accredited Peer Support Worker certificate and we decided that this would be a good place to find suitable people who, from their own experiences, will inspire hope and belief that recovery is possible in others.”
The ST&R workers with lived experience provide support and practical assistance to service users to help them regain control over their lives and their own recovery processes. This can be on a one-to-one basis or through group work.
Their roles and responsibilities include:
Establishing supportive, respectful and trusting relationships with service users
Supporting service users to identify and overcome their fears
Helping service users to identify recovery goals and develop recovery plans, drawing on their own experiences, as well as coping and self-help techniques, to share ideas about how they can achieve them
Accompanying service users to appointments, meetings and activities
And, promoting a recovery-orientated environment within the L&D team by identifying recovery-focussed activities, information and education.
We spoke to Stephen Jeffery, who explained what his role involves: “I have been both a service user [of mental health services] and volunteer with Mersey Care for nine years.
“My work involves supporting people who are using, or have used mental health services and are going through the justice system. I will often meet with them before they go to court to find out if there is anything that we can do to help them. While the L&D practitioner will make an assessment, I am on hand to offer help and support both during and following their court appearance.
“Service users appreciate it when they know that there is support from someone who has experienced similar difficulties to themselves and uses language that they understand. I am able to offer them a little bit of hope. Ultimately it’s about building trust with a person so that they engage with us, because the more we know about a person, the more we can understand, and the better equipped we are to help and support them.”
Steve’s case study
“I am currently working with a young man in his early twenties who I shall refer to as John [not his real name].
“I met John at Liverpool Crown Court just prior to his first appearance to hear the charges against him and to enter a plea. He was with his mother and two sisters, a very close and supportive family group. Because of John’s learning difficulties he has been known to Mersey Care for some years, so I and a qualified RMHN colleague were able to complete a mental capacity assessment there and then. My colleague informed John’s legal team that he may not have the capacity to understand why he was there, let alone enter a plea. I remained with John and his family and explained what was happening and what the next steps would be.
“It is this ability to offer time, explanations and support at times of great stress, which begins the trust-building relationship, so necessary to ensure that someone like John is helped to navigate the justice system in a fair and safe way.
“John’s case started in April and is ongoing. I have visited John at his home as a way of strengthening that trust, and I telephone his mother prior to each court appearance (three so far) to check that everything is ok and to reassure them I will be there. His mother also has my contact details in case she feels there is anything I need to know. When his case is concluded, John is hoping to have a look at our Recovery College courses in the hope of finding new ideas and challenges.
“On the two occasions that he has had to enter the dock, I have been invited to join him and allowed to explain what is happening and at times act as a conduit for information, something for which both Prosecutor and Judge have expressed their appreciation.
“John will be in court again at the end of September and I, and the rest of the L&D team will be there to offer any support he and his family may require.”
The work of the Lived Experience Team
Last year, NHS England commissioned the Offender Health Collaborative (OHC) to carry out an independent consultation with those with lived experience on their views of the national operating model for liaison and diversion. Revolving Doors Agency, as part of the OHC, was tasked with delivering this piece of work.
In total, 52 service users were consulted at six different workshops. Each one brought together people from a different cross section of society: women, young people, older people, people from minority ethnic groups, those with learning disabilities, and individuals with substance misuse problems. Reactions to the concept and key features of the national operating model were overwhelmingly positive – especially the holistic approach and 24/7 access to L&D. But, the participants also made 16 recommendations as to how it could be strengthened.
Representatives from each of the focus groups presented their findings to the November Programme Board and, out of this, an eight-strong team was established. Supported by Revolving Doors Agency, the Lived Experience Team (LET) was set up to reflect the experiences of a wide variety of individuals that come into contact with the criminal justice system and who have vulnerabilities, and to use this expertise to support the governance and decision-making of the national L&D programme.
The current Lived Experience Team members are Alan, Adellah, Danny, Joe, Leanne, Pat and Rae-Anne.
Their role is to:
hold the L&D Programme Board to account for taking forward the findings from the November 2014 service user report
support the Programme Board by working to further develop key findings from the report, and
provide lived experience insight to the wider work of the Programme Board.
To enable and empower this, Revolving Doors Agency provides the team with training and support. They prepare briefing materials and reports, facilitate events and workshops, hold regular meetings with the team and prepare members for and support them at meetings.
In just a few months, the LET has become an integral part of the national programme, with a packed schedule.
Two members attend each Programme Board, reporting back on the work of the group, in particular the implementation of an action plan arising from the report recommendations.
The team has also visited schemes to see how they are already addressing some of the recommendations. Two members visited the London wave 1 scheme in June, while a visit to Liverpool is in the pipeline to find out more about their use of support time and recovery workers with lived experience.
Finally, their recommendations have fed into two major national pieces of work. LET members have participated in workshops to better articulate the service specification around wider vulnerabilities, screening tools and pre-release assessment. And they have also contributed to the work led by KPMG with the OHC to assess the possible options for integrating L&D with adjacent health and justice services.
As part of this last assignment, the LET designed and facilitated a service user workshop to seek perspectives on integrated service delivery from a group of over 20 service users, many of whom had direct experience of L&D services. This is part of a model where the LET are supported to gather and represent the views of a large number of people with lived experience, many of whom have very recent experience of the criminal justice system. Their presentation back to the final KPMG stakeholder workshop ensured that their experiences and insight were at the forefront of participants’ minds as they discussed how services could be better integrated to improve service user journeys and outcomes.
Twenty-five year old Rae-Anne from Coventry was 11 years old when she first came into contact with the criminal justice system. She spent 14 years in and out of young offenders’ institutions. She has since reformed her life and now works with User Voice and Revolving Doors Agency to help offenders to conquer their problems.
She said: “I have experienced mental health issues, substance misuse and homelessness and realise that people that fall into this category need support and not criminalising. Our role is to ensure that vulnerable people’s needs are met and that they are being supported.”
Today, Leanne, another LET member, is happily settled with her partner and three children. She says: “I am passionate about ex-service users becoming involved within facilitation of services. Being involved in the Lived Experience Team has been both productive and interesting and has given us the chance to voice our views and the views of service users on the support available within the criminal justice system.”
Left to right, top to bottom: Leanne, Rae-Anne, Danny, Pat, Adellah, Joe and Alan
The work of the Lived Experience Team is a powerful demonstration of how people’s experiences can be used to better understand what works and what can be done to improve services.
Christina Marriott, Chief Executive of the Revolving Doors Agency, comments: “We are really proud of the impact the Lived Experience Team are having on L&D. There are a few key features that are making this possible. Firstly, there is the enthusiasm, commitment and knowledge of the team members and their skills in presenting their insights. Secondly, NHS England has let the LET into the heart of decision-making and been open to really listening – this is vital if lived experience is to have impact. Thirdly, through support and training, the LET bring the relevant insights of a much wider group; this is not a lone voice on a Board, but a supported number of voices bringing the insights of many, many more.”
News in brief
London L&D wave 1 scheme scoops prestigious award
From left to right: Colin Burgess, Operations and Development Manager, Together for Mental Wellbeing; Leah Glass, L&D Practitioner, Together for Mental Wellbeing; Maria Thorn, North East London NHS Foundation Trust (NELFT); Rhodri David, East London NHS Foundation Trust (ELFT); Becks Linguard and Professor David Wilson, Birmingham City University.
Congratulations to the North and North East London L&D team who have won the Howard League for Penal Reform’s Community Award for Liaison and Diversion. The Award was presented at a ceremony held at The King’s Fund in London.
The service, which is delivered in partnership by Together for Mental Wellbeing, North East London NHS Foundation Trust and East London NHS Foundation Trust, was selected out of six shortlisted projects as the first recipient of this award. It was recognised for its commitment to helping people tackle the underlying causes of their offending, thus reducing the likelihood of reoffending.
Since April 2014, when the first phase of the trial began, 4,152 people have benefited from this service, which ultimately has contributed to a reduction in future arrests and the use of police and court time.
Linda Bryant, Director of Criminal Justice services at Together for Mental Wellbeing, said: “We are delighted that our Liaison and Diversion service in London has been recognised for its ongoing commitment to ensuring that people’s mental health needs are met at the earliest opportunity when they come into contact with the criminal justice system. This award is a fantastic acknowledgment of how by working in partnership we can build better outcomes for individuals.”
Maria Thorn, NELFT assistant director for mental health services, Redbridge, said: “I’m thrilled we won the Howard League for Penal Reform Award. This is a vital service to ensure vulnerable people in contact with the criminal justice system have access to mental health services and I’m delighted this has been recognised by the award panel.”
Further information can be found on the Together website.
And if you have a good news story to share from your scheme, send it to england.liaisonanddiversion@nhs.net. You don’t have to have won an award in order for your story to be included!
RAND Europe evaluation August update
The research team have completed all their fieldwork. A web-based survey, open to a wide range of stakeholders, closed on 13 July, and a survey for judges and magistrates closed on 17 July. Thanks again to all those who contributed to and participated in the evaluation.
The RAND team have also completed their analysis, pulling together the data to answer the evaluation questions. These relate to impacts on:
The availability to the criminal justice system of information about vulnerabilities
Service users’ health, as a result of referrals to appropriate treatment services and interventions
The criminal justice process (adjournments, speed of decision making etc.), as a result of information about vulnerabilities
Criminal justice outcomes (diversion and sentencing), as a result of information about vulnerabilities, and
Service delivery agencies (housing, health and social care services), as a result of referrals.
This has been a complex process, involving the synthesis of information from a range of sources and across sites, and making the best use of available data.
The final report should be available to the public later in the year. It will be drafted for policy and practitioner audiences, focused on identifying lessons for wider roll-out and operation of L&D schemes across England and Wales.
New service user videos published
Films highlighting service user journeys from all wave 1 sites have now been published and can be viewed below or on the L&D playlist on the NHS England YouTube channel. We would like to thank all schemes for participating in filming and production.
Three films are being showcased on the NHS England website. At the moment it’s the turn of the Wakefield, Avon & Wiltshire, and Sunderland and Middlesbrough schemes. The selection will be updated every two weeks but all can be viewed on the YouTube channel.
Equalities update
The programme is keen to ensure that issues concerning equalities and health inequalities are factored into all decisions and plans made, both at a national level and for individual schemes. The work is steered by the programme’s equalities and health inequalities working group which meets bi-monthly to review issues, assess local data on equalities, and provide guidance to other aspects of the programme or to individual schemes, as required.
The national programme recently undertook its annual Equalities Impact Assessment (EIA), drawing on evidence cited in the recent literature review as well as actions and plans already made by the programme to address equalities and health inequalities issues. The EIA will form an appendix to the Full Business Case as well as being a “living document” which the programme will continue to reflect on and revise.
All schemes have been provided with the literature review and the NHS England Equalities Impact Assessment template, partially completed with general background information. They are encouraged to complete this template annually – or their own local version – and ensure that their regional commissioner is made aware of the EIA and any accompanying equalities action plan.
If schemes have any questions about the EIA template or any other equalities or health inequalities questions they can contact the working group via the administrator: Neisha.Betts@nhs.net.