A large proportion of the prison population suffers from mental vulnerabilities including learning difficulties and social disadvantage. Taking steps to address these issues can contribute to reducing levels of reoffending. The Integrated Healthcare in Custody and wider Liaison and Diversion Service in Greater Manchester aims to do just this by diverting vulnerable people away from the criminal justice system towards services better able to tackle the root causes of their behaviour.
The service was jointly commissioned by Greater Manchester Combined Authority and the Greater Manchester Health and Social Care Partnership in February 2017, and has been developed since then. The service’s full launch was held in November 2017 at a time when industry and national press was full of conflicting views on the success of attempts to integrate health and social care. Given that controversy, its progress is likely to be scrutinised.
Greater Manchester is the first area of the country to commission this ground breaking integrated service which works with people in custody, with the courts, and within the community to offer vulnerable people the support they need and to address reasons for offending. The new service looks not only at the crime but at other factors in an offender’s life which may have led them to commit crime. It questions why a person is in crisis and how can they be helped to access the right services to make a difference to their life.
Deputy mayor for policing and crime, Baroness Beverley Hughes has said ‘While keeping the public safe is the number one priority, it’s clear that a custody cell or prison is not always the right place for vulnerable people, such as veterans with PTSD, homeless people, or people with learning disabilities. The criminal justice system doesn’t solve their problems and doesn’t stop them reoffending.’
The service, delivered in partnership by Mitie Care and Custody, North West Boroughs Healthcare NHS Foundation Trust, and Cheshire and Greater Manchester Community Rehabilitation Company, supports both adults and young people affected by a wide range of issues including physical and mental ill health, learning disabilities, debt, homelessness, drug addiction and PTSD.
Health liaison and diversion facilitators are based in each of the region’s custody suites and carry out one-to-one assessments of vulnerable people brought into police custody. With the detainee’s consent, staff screen and assess the individual and share relevant information with criminal justice agencies to inform charging and sentencing decisions. They also review mental health needs, and signpost individuals on to other services able to meet their needs, such as mental and physical health care, social care, substance misuse services, and safeguarding support.
Community support navigators help people to access services after release acting as a link to local services so people can access the support they need to change their lives for the better.
The new service uses a single case management system and simpler referral pathways to better support vulnerable people. Speaking at the launch event, author of the independent review into the Crisis Care Concordat, Lord Bradley, highlighted the importance of data and information sharing to enable the integrated services to achieve their full potential. In his report published in April 2017, he praises the effectiveness of the current IT system which allows information gathered in the custody environment to flow quickly into court, and on to the community support navigators. Further improvement is technologically possible and would see an even more integrated system which shares information from a range of partners, including GPs, broader mental health records, and the police. In his view this would make for the most effective form of liaison and diversion because it would allow for the ‘fullest, best-contextualised picture of need to be clear to practitioners at each point of contact’.
Jon Rouse, chief officer of Greater Manchester Health and Social Care Partnership has said ‘We’re committed to improving the health and wellbeing of Greater Manchester residents. This means stepping outside those environments traditionally associated with the NHS, such as hospitals or local health centres, to ensure vulnerable people have the support they need.’
Early indications are that the new service is working well and there has already been positive feedback. Its longer-term success remains to be seen and like much of the transformational work in Greater Manchester and the rest of the UK, the rewards will be better measured in years rather than months. However, if it works (and we must hope that it does) the new service marks a real shift in how health and social care services are provided by recognising that health is intrinsically linked to other aspects of a person’s life. As Baroness Beverley Hughes put it ‘Too often criminal behaviour is directly linked to problems in other areas of their life – a disruption in taking prescribed medication, problems managing debt, alcohol addiction, housing problems. These are the issues that need resolving.’ If we can improve those aspects, we can improve people’s lives, whilst also reducing the longer-term demand on the criminal justice and healthcare systems.