10 May 2021

The NHS is everywhere including in the custody suites of the justice systems.

Last year around 3,500 were seen by the team. These people were arrested for crimes committed and 644 adults were diverted to other services, including 158 adults detained under the Mental Health Act.

The team has also seen more than 902 children and young people during this financial year.

They were assessed because they were deemed to be vulnerable, be that for issues relating to poor mental health, learning disability, substance misuse, alcohol or dementia.

Importantly with the team’s input, most have gained the care and support they needed.

The service is part of an NHS nationwide programme set up to address the needs of mentally ill and vulnerable offenders at the earliest opportunity in the criminal justice system – the point at which an individual is arrested.

In essence, the aim is to improve overall health outcomes and to support people in the reduction of re-offending.

It does this by supporting people through the early stages of the criminal system pathway, referring them for appropriate health or social care support or by diverting them into a more appropriate setting, if required.

There is also a specialised child and young person’s service for those aged between 10 to 18.

Teams also work in Magistrates and Crown Courts.

In the Magistrates Courts, teams will continue face-to-face assessment and work collaboratively with colleagues in probation, the courts, community and prison services such as Community Mental Health teams.

The main focus of the team in the Old Bailey, which often deals with high profile cases, is to make sure there is a robust and clinically sound pathway between the criminal justice and mental health services.

The team’s efforts have not gone unnoticed. Their work is respected across all branches of the criminal justice system and growing referral numbers speak to increasing awareness.

From April 2019 to March 20, 2,538 adults were referred to L&D. From April 2020 to February this year, the service had already seen 2,759 referrals for adults and by the end of this financial year the team will probably have seen more than 3,500 adults.

Of these, 644 adults were diverted to other services, including 158 adults detained under the Mental Health Act. It has also seen more than 902 children and young people during this financial year.

The CNWL service covers six custody suites, four magistrates’ courts, five Youth Offending Teams (YOTs) and the Old Bailey.

Its success lies in having good relations with the police, the Youth Offending Teams (YOTs), with the Approved Mental Health Professionals (AMHPs), the Probation Service, the Judiciary, the Crown Prosecution Service.

Service manager Roz Kerr says: “We know that those who are involved with the criminal justice system are often in crisis, have experienced trauma and have vulnerabilities. We understand how these experiences can increase offending; once you understand that, you can understand what services can best help support these individuals.

“The L&D service plays a critical role in collaborating with our health and criminal justice partners in diverting those away from custodial settings when appropriate.

“Those individuals may not have been given access to fair health care previously and L&D does help in closing that gap.

“In particular young adulthood is a critical time for such intervention. Some of these children and young people are living in chaos, poverty and have suffered traumatic experiences.

“The L&D service can support those young people to access the correct care and attention they need to either divert them away from custody or help support them in reducing their risk in offending.

“Our clinicians are very skilled in looking beyond the offence and consider what health and social interventions are required to support patients by assessing immediate health needs.”

Case Study the All Important Referral

The case against the defendant, a married man, indicated that they had carried out the alleged murder motivated by delusional jealousy, believing that their partner was having multiple affairs with other men.

Apart from the firm and fixed belief around the partner’s unfaithfulness, for which there was not a shred of evidence, the defendant appeared to be perfectly normal in every way.

In the prison environment, they would not present with any odd behaviours that would lead others to suspect that they had a mental illness.

They would pass unnoticed and the mental illness would go unidentified, and untreated. The Court Mental Health Team alerted their colleagues at the prison who assessed and confirmed the presence of a psychosis.

The defendant was transferred to hospital, and following treatment and reports by the Responsible Clinician and psychiatrists for both prosecution and defence, was able to enter a plea of ‘not guilty to murder but guilty to manslaughter by reasons of diminished responsibility’.

The Crown accepted the plea after careful consideration of all the facts and the Court made a hospital order by way of sentence. The end of a journey that began with the all-important referral.