South-west region works to ensure the needs of children and young people are fully understood and addressed
The south-west region has commissioned a deep dive review into the Children and Young People (CYP) using its Liaison and Diversion (L&D) services. The review aimed to find out why such low numbers of CYP were taking up the offer of support from L&D and to ensure there were specific pathways in place to support CYP, which also recognise that CYP have their own specific needs and are not just ‘small adults’ using the service.
The deep dive also aimed to understand where effective local practice could be shared as well as any challenges from the wider system that may impact on service delivery and investigate how these could be addressed. Several common themes emerged as part of the review.
Using the national service specification as a foundation, most CYP pathways within the south-west L&D services have developed in a variety of forms, growing organically with local structures and responding to local need.
The issue of speech, language and communication needs was highlighted as a significant and often overlooked CYP-related vulnerability within the youth justice system. While not a direct cause of offending, communication difficulties can be mislabelled as behavioural problems, particularly when appropriate strategies of support have not been put in place. L&D services in the south-west would benefit from a greater focus on this issue and are planning to do so as services emerge from the impact of COVID-19-related restrictions.
All services recognised that CYP who offend often have multiple vulnerabilities. Mandatory services, such as Child and Adolescent Mental Health Services (‘CAMHS’), often have high eligibility criteria that results in CYP not receiving effective support prior to contact with L&D services.
The review noted that there could be more general awareness of the role of L&D services for CYP. Each L&D service within the south-west is aligned with local Youth Offending Teams. This enhances multi-agency working, including with the voluntary sector, to divert and reduce the number of CYP entering the youth justice system.
Recent COVID-19 related restrictions have significantly altered how L&D services operate, which has impacted both the number of CYP that are offered the support of L&D services and (anecdotally) the cohort of CYP coming into police custody. Many third party organisations that previously offered informal early intervention and/or core support networks are currently not able to.
Practitioners are required to work remotely and CYP are largely not engaging with the virtual support offered. This is likely because virtual relationships are harder to develop with CYP. There is concern that the rate of adverse childhood experiences will increase due to the lack of access to education and also domestic related distress. Some L&D services have already experienced an increase in the number of CYP that are arrested for the first time as well as assaults against parents. Other L&D services are reporting an increase in number of CYP with complex needs being seen.
The current response of the L&D services for CYP reflects the parameters outlined in the government Infection Protection guidance. There is an acknowledgement by all services that the long-term effect of these changes upon the resilience of CYP remains to be seen.
New films: supporting children and young people using L&D
The youth pathway of the Stoke and Staffordshire L&D service, Midlands Partnership Trust, recently commissioned 3 films which cover the work the L&D service does. These explain the ways they help children and young people and includes two stories from young people with lived experience of the criminal justice system and using L&D. The Trust uses the clips to promote the service and other agencies such as the youth offending service and the police are using the clips for awareness training with their staff.
In the films, two young people who have used the L&D service, Luke and Ryan, explain how they got into trouble, how the L&D service helped them and how they were able to turn their lives around. The third film covers how the youth pathway of the L&D service helps the children and young people they see.
The service sees children and young people up to the age of 18 who have come into contact with the criminal justice system. Research suggests that those children and young people who are at risk of offending or already engaged in offending behaviour are often dis-engaged from mainstream services, in particular mental and physical health service and education. They are more likely to misuse drugs, have mental and physical health problems, report disabilities and to self-harm. Their lives are often further complicated by complex social and personal issues.
The L&D service provides short-term, targeted interventions and referral to the appropriate treatment and support services. The service includes staff with lived experience, themselves arrested when under 18 years old, working as peer mentors to help the children and young people using L&D.
Developing pathways for women using Liaison and Diversion
When females enter the criminal justice system, they enter a system designed predominantly for men. However, in many cases, the nature of female offending differs from male offending and once in custody women have different and specific needs. Research suggests that over half of females entering the criminal justice system have been sexually, emotionally or physically abused and mental health problems are far more prevalent among women. Many women end up in prison for less serious offences as a result of repeat offending and a failure to respond to non-custodial alternatives.
In 2007, the Corston Report outlined the need for a distinct, radically different, holistic, women-centred approach to improve approaches, services and interventions for women in the criminal justice system. In 2016, Dr. Phillip Lee, Parliamentary Under-Secretary of State for Justice, stated that women who commit offences are often some of the most vulnerable in our society. He emphasised the need for early intervention and a criminal justice system which can take proper account of the specific needs of women. The national L&D programme therefore is encouraging services to prioritise meeting the needs of women using L&D.
In February 2018, the L&D central team welcomed Nicola Tutty as the new national lead for women’s L&D pathways. Nicola is an experienced female specialist practitioner who, for the last 10 years, has worked holistically with women and girls involved in a range of criminal justice settings.
NHS England recently held two workshops for all L&D services from across the country, highlighting the specific needs of women using L&D. The aim was to convey to L&D practitioners the extent to which a different approach is needed when working with female service users and to identify the next steps in developing an L&D pathway for women. Wakefield, Gloucestershire, London and Birmingham L&D services all presented at the workshops and provided case studies and good practice examples of work.
The workshops explored ways in which L&D services could develop their female pathways, including potentially appointing a dedicated female lead to help sensitively and holistically address the needs of female offenders as they enter the criminal justice system. It was recommended that services offer to see all females coming into custody and provide the option of seeing a female practitioner for their ongoing support. The workshops emphasised the need for L&D services to map all available local support services and to develop close relationships with them.
Nicola Tutty, along with Emma Griffin from the central team, will be visiting L&D services to offer help and advice on how services can develop their female pathways, the aim being to increase overall female engagements rates within L&D.
Practitioners at the women’s workshop: Niki Gould, Jolene Fear, Matina Marougka, Liz Mikolap, Andy Webb
Recent brain injury workshops for practitioners
There are approximately 500,000 people living with the long-term effects of a traumatic brain injury in the UK. suggest that within offender populations, brain injury has prevalence as high as 60% (Williams, 2010). Consequently, those with a brain injury are considered vulnerable, likely to come into contact with the criminal justice system and require support from L&D Services.
The national L&D team, along with the charity ‘Headway,’ held two workshops on brain injury to help ensure vulnerable suspects are appropriately supported by L&D services. All L&D services were represented and those in attendance were asked to cascade information learned back to their teams. The workshops aimed to enable L&D practitioners to identify people with a brain injury, to be aware of the effects of an ABI and make staff aware of services to refer to for further support.
A traumatic brain Injury involves a physical force being applied to the brain, which injures it in some way. Brain injury has a huge array of presentations, which can be both be visible or non-visible and vary in severity. This often means it can be hard to identify. Many of the symptoms may lead individuals to come into contact with the criminal justice system.
Being arrested can be traumatic for a brain injury survivor. They may experience severe confusion, emotion or anger about being confronted, left alone or being in a small, noisy space. In order to manage symptoms and refer on to appropriate services it is crucial to recognise the individual has a brain injury. It is important for L&D practitioner to ask the person about the effects of their brain injury and any medication they require.
To aid brain injury identification, Headway has provided a ‘Brain Injury Identity Card’ which is designed to ensure the survivor receives an appropriate response. The card is badged and supported by both Headway and the National Police Chiefs Council. The aim is for it to facilitate the identification of someone with a brain injury to ensure they receive appropriate help and potentially diversion away from the criminal justice system. It also to helps flag up the need for specialist legal representation through providing a number for 24-hour criminal legal assistance (0800 140 4031).
Headway has over 125 charities across the UK, which L&D services are able to signpost individuals to. Their website also contains useful information on brain injuries, along with a database of brain injury services across England.
The Headway workshops were very positively received. Everyone agreed that more needed to be done to ensure individuals with a brain injury are recognised and treated appropriately. Michael Blakely, service manager for Northumbria, noted the workshop was “extremely informative and interesting. Our team has fortnightly in-house training. I will book a slot to deliver the workshop [material] to our team.”
Linking with your local Community Forensic CAMHS
Specialist Child and Adolescent Mental Health Services for high risk young people with complex needs, (‘F:CAMHS’) are specialist community mental health outreach services, mediating transitions into and out of secure in-patient care and the children and young people secure estate and preventing admissions when meaningful alternatives are feasible. The services work with community and inpatient services, providing support and advice for professionals caring for this cohort. NHS England has commissioned 13 new F:CAMHS across the country. L&D services should link with their local F:CAMHS to develop a mutually beneficial working relationship. Contact details were recently emailed to all L&D services, or you can contact the L&D central team.
Two workshops were held recently for L&D practitioners to help services meet the needs of children and young people. The workshops included presentations from FCAMHS services, and discussions on trauma-informed practice and collaborative commissioning.
Supporting suspects and defendants with Learning Disabilities
Identifying and supporting suspects and defendants with learning disabilities is a core element of NHS England commissioned L&D services. People with learning disabilities in the youth or criminal justice systems are made more vulnerable by their situation and the setting and typically require additional help to navigate the system and to cope generally.
The research findings concerning the number of people with learning disabilities in the criminal justice system varies according to various factors. However, it is clear this is significantly higher than numbers in the community. One study by Forrester et al (2016) found that 6% of everyone referred to a mental health team by the police were found to have a learning disability.
The L&D central programme team recently investigated how services are identifying people with learning disabilities, as some services were identifying lower than expected numbers of people. The findings of this deep dive will shortly be made available to all services via commissioners. The report highlights 12 potential barriers to optimal rates for people with learning disabilities using L&D services. Some examples include:
- The level of knowledge and awareness of the police about both learning disabilities and also the role of an L&D service and the ways they can help (and that they provide more than just mental health support);
- Whether all agencies are recording relevant information/flags on their respective systems (and the national dataset) and checking the appropriate systems of partner agencies regularly (including community records and Special Educational Needs databases);
- Whether L&D services have learning disability practitioners who work with the rest of the team and other stakeholders to ensure general awareness, screening, appropriate referral and support pathways, etc.
The national L&D practitioner guidance on supporting people with known or suspected learning disabilities provides more details on the expectations set out in the national L&D Service Specification. It also covers the common difficulties people with learning disabilities often face and ways L&D services can support them, including communication adjustments to make.
Avon and Wilshire Mental Health Partnership NHS Trust have produced a video about people with LD in the criminal justice system, including using L&D services. Ensuring a joined up approach within the criminal justice system, including having established pathways of support, with partner and other local agencies is vital in meeting the needs of suspects and defendants with learning disabilities. Any service which clients access should also be aware of its legal duties to ensure a person can understand and take part in any processes involved. L&D services should have a learning disability practitioner who is part of the team and is regularly working with staff to raise awareness and helping to put all recommendations in place.
Some of the L&D services are delivering learning disability awareness training to their teams and others they work alongside, to help ensure people with learning disabilities do not ‘slip through the net’ and go on to miss their chance for equal access to care and support and also the right to a fair trial.
Mick Lambert, a learning disabilities nurse in the Wakefield L&D service, is currently training criminal justice colleagues on learning disabilities awareness, having recently trained probation officers based at Leeds Crown Court. He is also working with the Leeds community learning disability team to develop on a mutually beneficial two-way process to support people with learning disabilities in the criminal justice system. This will involve sharing information, making referrals, advising the courts and preparing support for people with learning disabilities already known to services who will be coming through the courts and/or working with probation. It will also facilitate potential referrals back to the local learning disability services where needed and allow for advice on appropriate sentencing.
Mick comments, “I want to raise awareness to all parties as I feel that people with learning disabilities are not as well identified throughout the CJS as they ought to be, which means that there is an impact on [them having] reasonable adjustments.”
All L&D services should be offering literature that is accessible to people with communication needs, such as people with learning disabilities and others who may opt for this ‘Easy Read’ information. Services are encouraged to promote the use of Easy Read to police and courts colleagues and to also to share best practice examples of their Easy Read leaflets, forms, posters and letters.
A number of examples of Easy Read can be found online. For more information on Easy Read in L&D services or to share your examples please contact Neisha in the central team. You can also contact Neisha for a copy of the national deep dive report mentioned above if you work for an L&D service and would like to receive a copy directly.
What should Liaison and Diversion be doing for Gypsy, Roma and Traveller populations using their service
The term Gypsy, Roma and Traveller (GRT) is a collective term used to describe a wide variety of cultural and ethnic groups that include Roma and Slovak communities and Traveller and Gypsy communities. The recent Lammy Review (2017) included concerns about the over-representation of GRT people in the criminal justice system, particularly children and young people in youth custody, making up 12% of children in secure training centres.
All L&D services must understand their local population demographics and design their service accordingly, to meet the different needs of everyone they may serve. This includes having up to date Health Needs Assessments of local population need as well as annual Equalities Impact Assessments and accompanying action plan.
L&D services with local GRT communities should have pathways of support in place as well as ensuring general staff awareness of the potential different cultural needs of these communities. Services have a duty under the Equalities Act (2010) to meet the needs of these ethnic groups. Services should also be aware that two-thirds of people from gypsy and traveller communities live in residential housing and one-third live on sites. Local Authorities should be able to provide useful data on local populations.
There are often barriers to registering with a GP and receiving health screening, etc. People from these communities often end up accessing healthcare via A&E in the later stages of an illness. Also, babies have a higher mortality rates as families are less able to access the right level of care, or receive vaccines and general health information.
Other considerations outlined in the film include the need for cultural awareness concerning what gypsies and travellers often prefer or require. The example given is how many people prefer to see the same sex healthcare practitioner and how some may feel uncomfortable or reluctant to speak with a practitioner of the opposite sex about health concerns.
Natalie of Gypsy Life also notes that “Ensuring front-line staff have adequate cultural awareness training and understand Gypsy and Traveller communities will help enable better access [to services] and break down barriers to accessing health care. Having effective equality and diversity policies within organisations will also help and lead to better and more appropriate access in the long term.”
Some L&D services are working closely with their local communities and have developed guidance for their staff and specific pathways of support. Donna Beard, a senior practitioner/manager in the Sussex L&D service, explains how she works with her local GRT communities. “My current role as the Gypsy and Traveller Link Nurse allows for me to develop my skills when working with this group. I have completed a number of assessments, usually at their home address, due to their suspicion of others. It is this flexibility and developing relationships with family members that is an integral part of working with this group.”
Some L&D services have attended awareness training sessions. Catherine Palin, a support worker in the Nottingham L&D service notes that “Having attended a half-day training session by Gypsy Life, I feel very confident about how to engage with this diverse group. We were given so much information around their cultures, my understanding and future work with them will be enhanced… This group of people are frequently misunderstood and it can be down to simple language or use of certain words that can insult their beliefs and then prevent them from engaging further with health professionals.”
Claire Kemp, a practitioner in the Nottingham L&D service reported that ‘[receiving] training on GRT communities opens your eyes to their way of living and really myth busted how society’s view of this population is often incorrect… Listening to members of the community tell their story and suggest respectful ways of communicating with them, will have a big impact on our ability to engage individuals…in accessing health and social care services.”
The national L&D programme is feeding into a review of how all NHS England Health & Justice servicescurrently meet the needs of GRT communities, due for publication in 2018. This is likely to include recommendations for the L&D programme to help ensure it is doing all it can to meet the needs of this population.
If your L&D service is already successfully working with local GRT communities and you would like to share your experiences and practices for this report, please contact Neisha who can link you with the researchers. You can also contact Neisha for copies of the guidance documents produced by both Sussex and Nottingham L&D services to then build upon when developing your own pathways and approaches locally.
Supporting veterans that get arrested
Approximately 3.5 – 7 per cent of the prison population identify themselves as veterans of the Armed Forces. The term veteran is inclusive of all serving and ex-service personnel, regardless of the length of time they served for. The majority of veterans do well after leaving the Forces, however, the transition to civilian life can have a negative effect on a significant minority and common mental health disorders, such as anxiety and depression, have been found to be double that of the general working-age population.
For many, returning to civilian life involves an abrupt change in circumstance, whereby the support and structure they had in the Forces suddenly stops and they are left to find their own way and to adjust back into life in the community. Some Veterans also have to simultaneously cope with the legacy of having experienced unique and often traumatic events.
Liaison and Diversion (L&D) services are required to support people with mental health needs or other vulnerabilities as they enter the justice system and this includes having support pathways in place for veterans who present with any vulnerabilities. Many services now have positive referral services for all veterans.
Nottinghamshire L&D service has a successful pathway in place for veterans and also happens to employ three practitioners within their core team who are also veterans and are able to provide additional advice and champion the needs of veterans using the service.
Their current arrangement involves working closely with the Police and the SkillForce veterans’ programme. Police ask all those arrested whether they have served in the Forces and those who have are automatically offered a referral to L&D services.
The SkillForce veterans programme operates mainly in the East Midlands, plus some other locations across the country. Employing mainly veterans, it offers coaching and mentoring and refers people on to other services and charities depending on the needs of the individual. There are a variety of helpful services working on behalf of veterans, both nationally and locally, and it is important that L&D services are linked in with these.
Leicestershire L&D service also works with SkillForce. All veterans identified by the Police are first seen by the L&D Support Time Recovery worker, himself a Royal Navy veteran, who offers them support with things like organising finances, jobs, finding a GP and making contact with the right services. He is also currently undertaking mentor training with the organisation ‘Care after Combat.’
One service user, a young man arrested for a domestic violence offence and suffering with alcohol issues, said of his support from SkillForce before his Court hearing, “Just having that hour once a week to chat makes such a lot of difference to myself and your encouragement means the world to me…”
It is not uncommon for veterans to refuse support or not seek it out and they also may not be registered with a GP. Christian Sales, Assistant Psychologist in the Nottingham L&D team and former Intelligence Officer, notes “It is often frowned upon for an officer to seek emotional or psychological help when serving in the Forces. There is a stigma about asking for help and this mentality often continues well into civilian life.”
The Nottingham L&D service works to ensure that those initially opting to not engage with L&D or to accept referrals are given multiple chances to change their mind and receive the support they need. The service also provides leaflets and advice on local agencies that can help for when someone feels ready.
Veterans are most commonly arrested for sexual or violent offences. As well as potentially experiencing the effects of previous trauma, they may have post-traumatic stress disorder (PTSD), acquired brain injury, alcohol and addiction issues and may be experiencing homelessness or a serious breakdown of relations within the home. It should be noted, however, that whilst there has been an emphasis on PTSD, the actual rates for veterans (around 4-5%) is broadly equivalent to the incidence amongst civilians.
Nikki Chambers, Clinical team leader in the Nottingham L&D service and former Lance Corporal, reports that, “People don’t want to talk about what they experienced whist serving, they don’t want to open that can of worms and deal with the aftermath of that. As clinicians, we need to recognise and respect that and find them a safe time and space to address things in the right way.”
The Nottingham L&D veteran’s pathway makes sure that once it is established a person has served in the Forces, and that there may potentially be some vulnerabilities present, staff then proceed with caution and limit the extent to which a client is required to recall or re-live past events or the effects of such events. The service ensures that a full assessment is carried out by an experienced professional able to provide the longer-term support that veterans typically require.
There are also several regional pilots currently taking place, aiming to identify gaps in provision and seeking improved pathways and delivery for serving and ex-serving armed forces personnel.
The problems experienced by veterans who come into contact with the criminal justice system are also highlighted in the Gate to Gate: Improving the mental health and criminal justice care pathways for veterans and family members report, published last year. It commented that, “It is becoming increasingly recognised…that veterans with complex mental and related health needs…require appropriate assessment and treatment. Without the correct support, this patient group is possibly at risk of offending, often more serious offences and there are consequential impacts on the whole family, including partners and children and for society in general.”
Best practice examples which other L&D services may want to adopt include:
- Develop a pathway for how your service will meet the needs of all veterans, including those who served in other countries or as reservists (two groups often overlooked in provision).
- Develop partnerships with local Charities working to serve veterans in your area and try to join multi-agency partnership meetings for veterans that involve the NHS. Things often change so keep up to date on what is in your area. For information on registered armed forces charities in your area, visit Cobseo, The Confederation of Service Charities
- Once a relationship and protocol is developed, support the agency(s) in establishing themselves with the local police. For example, by inviting them to present at police training sessions your L&D service is running.
- Where possible, employ members of staff with experience in the Forces to help foster a shared understanding of the culture and the needs of veterans.
- Enable staff to undertake additional training on supporting veterans.
- To help increase understanding of the armed forces population and facilitate improved care and treatment, encourage staff to complete this e-learning programme developed by Health Education England.
- Try to make sure that all staff know the basic signs to look for and questions to ask regarding a person’s history in the Forces (and when to stop asking questions and ensure they are referred appropriately).
- Ensure your service, and the ways you can help, are referenced within information provided by local veteran charities.
- Link in with any veterans’ work your local NHS Trust is already doing and contact other L&D services working successfully in this area to share ideas.
Launch of new Brain Injury ID card for when people are arrested
His Royal Highness Prince Harry recently launched the Brain Injury Identity Card initiative run by ‘Headway,’ the brain injury association. Speaking to brain injury survivors and ID card holders at the launch event in Ipswich, Prince Harry said, “This surely is a life-changing moment for people with a traumatic brain injury, whether or not they ever get arrested. It can be quite terrifying if you’re by yourself being accused of something you haven’t done. This card is a saving grace for you guys and for the police as well. ”
Kate Davies OBE, NHS England’s Director of Health & Justice, Armed Forces and Sexual Assault Services Commissioning, said: “This is an excellent initiative that will help Liaison and Diversion services operating in police stations to identify brain injury survivors and provide early intervention. We look forward to continuing our partnership with Headway.”
The card has been developed as part of the charity’s ‘Justice Project’, which aims to raise awareness of brain injury within the criminal justice system, and ensure survivors are identified at the earliest possible opportunity to ensure they receive appropriate support.
Brain injury survivor Jamie Gailer describes why the card is so useful:
“Just because a person may not have big scars or holes in their head, the authorities fail to believe the scale of the injury or impact of that injury. In my everyday routine I can communicate well. However when I am faced with stressful situations, I can appear drunk because I have difficulties processing information and answering questions. Brain injury needs to be spotted quickly so that the person’s needs can be identified. The cards are a fantastic start to that identification.”
To access a Headway Brain Injury Identity Card, which is personalised to include the individual’s photo and lists some of the effects they commonly experience, applicants are asked to provide clinical verification of their brain injury. Find out more about the initiative here: www.headway.org.uk/idcard.
Video: How Liaison and Diversion helps people with learning disabilities
The Bristol Learning Disabilities service provides a specialist service to adults with learning disabilities who have offended, are alleged to have offended, or who are considered at significant risk of offending, It provides a service across Avon: Bristol, Bath & North-East Somerset, South Gloucestershire and North Somerset. The team aims to work with individuals alongside other agencies within health, social care and criminal justice services in order to help manage their risks, develop more social lives and reduce offending behaviours.
The service has recently produced an online video about how they support people locally with learning disabilities once in the criminal justice system and the type of needs and issues faced by this cohort. A practitioner from their local Liaison and Diversion service, Avon and Wiltshire Partnership NHS Trust, explains the role of L&D for people with learning disabilities, how they can help and how they work with the local learning disability team.
This is a moving, powerful yet practical and helpful film about a person’s journey within the criminal justice system, with advice and tips that cover the Police, Courts and time spent in Prison. As well as including interviews with various practitioners it includes interviews with service users, outlining what works and the issues they faced. Please share this with others who may find it useful.
Wakefield Liaison and Diversion Service: Women’s pathway
Wakefield liaison and diversion (L&D) service have developed a gender specific pathway to support women using their service. The decision to do this was based on their experience to date as well as research highlighting that women in contact with the criminal justice system respond better within female focused environments. It also recognizes that the nature of female offending behaviour and reasons behind such action are often quite different to those of men.
The Wakefield L&D service have recruited a specialist female practitioner to work with all women referred into their service. The team have also worked with local police to develop a women’s specific conditional caution pathway, where women arrested by local police for a low level offence, following assessment by the L&D service, may be considered suitable for an out-of-court disposal and swiftly referred to the Women’s Centre.
Each individual is required to contact the L&D team within seven days to make an appointment to be seen by the L&D specialist female practitioner at the local Well Women’s Centre. The team identified that this is a much more conducive and safe environment for assessments to take place, enabling women to talk openly about themselves and their wellbeing.
Each session involves a thorough needs and well-being assessment, exploring health, emotional well-being, family relationships including domestic abuse, finances, housing, employment, and substance misuse. A restorative approach is used to address the offence that has been committed, exploring the impact of the crime, and how the individual could make better choices in the future to avoid similar situations. Once all areas have been discussed, a personal plan is drawn up with the female client to address identified needs and vulnerabilities and the individual is referred onto appropriate agencies or programs for further support.
Since the introduction of the women’s conditional caution pathway, an attendance and compliance rate of over 90% has been achieved. Police confidence has greatly increased regarding the L&D service and more conditional cautions have been issued to women within the Wakefield area than in surrounding neighbourhoods. This means that more women in Wakefield are being successfully diverted away from court as a direct result of the local L&D service.
Here we hear ‘Cathy’s story’ and how L&D services helped to steer her back on the right track.
Cathy was a victim of emotional, sexual and physical abuse from her partner for over two decades. Over time, Cathy’s self-confidence and self-esteem diminished which resulted in an emotional breakdown, and reduced ability to manage her household and care for her children in her usual manner. Her partner raised concerns to social services, which led to a local police safeguarding unit issuing a conditional caution to Cathy for child neglect and also the removal of her children from the family home.
The conditions of Cathy’s caution meant that she was required to attend a full wellbeing assessment with a female specialist from the local L&D team. The assessment was held at a local women’s centre, and Cathy was encouraged to speak openly for the first time about everything that had happened to her.
Following the assessment, it was recommended that Cathy attended a local group to help rebuild her self-esteem and improve her emotional wellbeing. Cathy agreed to attend the ‘Freedom’ programme which explored the tactics and beliefs of domestic abuse perpetrators and how this impacts upon the emotional health of their victims. Cathy’s emotional health improved immensely as she began to speak to other women attending the course and grew in confidence.
Cathy’s progress was observed by social services and her children were finally released back into her care. Cathy continued to access support at the local women’s centre and due to her progress, was invited to train to become a ‘Freedom’ course facilitator.
Cathy said: “It was the Freedom Course that helped me… Every time I attended a group, I would leave with another piece of the jigsaw puzzle that helped me understand what had happened to me… Without the support of my L&D worker, I would have never begun this journey. I often sit and wonder where I would be now if I had not received her support. Not only has this support helped me with improving my life, it has also improved my children’s lives. Now they have their mum back to herself and well again.”
Liaison and Diversion meeting the needs of people with Acquired Brain Injuries
There are estimated to be at least 1 million people in the UK living with the effects of acquired brain injury (ABI). Studies indicate that brain injury is over-represented in offender populations in the UK, with findings showing this to be found in 60% of prisoners, (Williams, W. H, et al (2010)).
A brain injury can lead to problems with memory and concentration; to depression and cognitive impairment and can affect a person’s control of their anger and emotions. These problems affect not just the person living with the injury, but their family and friends and the wider community.
Being arrested can be traumatic for a survivor of a brain injury. They may be confused, afraid and emotional, severely anxious or angry about being confronted, left alone or in a noisy environment. A person with an ABI can therefore greatly benefit from the assessment and support offered by a Liaison and Diversion (L&D) service.
’Basically I have been arrested three times. Each time, I was just seen as another drunk. Thrown to the floor, handcuffed, into the van, into the police station….. It was really horrible because I have never done anything wrong in my life and yet I was being treated like a common criminal and put into freezing cold, dirty, smelly cells…It just made me feel really bad. I thought, what has my brain injury caused? Is this going to happen to me every time I go out and have a drink? That is why I have stopped drinking because it’s just not worth it.’ Quote from a Brain Injury Survivor
A new project to support brain injury survivors coming into contact with the criminal justice system is to be launched soon. This includes a ‘Brain Injury Identity Card’, created by brain injury charity Headway, with the endorsement of the National Police Chief Council, which is designed to help police identify and, where appropriate, divert people with brain injury away from the criminal justice system.
The card will enable easy identification of brain injury survivors and will also display a 24-hour legal helpline number putting police in touch with specialist solicitors trained to have an understanding of brain injury.
“Just because a person may not have big scars or holes in their head, the authorities fail to believe the scale of the injury or impact of that injury. In my everyday routine I can communicate well. But away from it, I am like a drunk and very much slower to understand and to answer…The ID cards are one of the best ideas so far. It needs to be spotted quickly, if there is doubt there needs to be actions in place to make this an easier and smoother procedure to identify and acknowledge.” Quote from a Brain Injury Survivor
Headway is working closely with police forces across the UK to raise awareness of brain injury and the new scheme. Liaison and Diversions services are currently working with Headway to explore opportunities to deliver ABI training to Wave 3 L&D schemes. Keep an eye out for more news in future bulletins.
Find out about the day centres run by Headway across the country
You may also wish to read the blog by Headway’s Chief Executive in which he describes his experience and views concerning people with ABI’s coming into contact with the Criminal Justice System.
You can find out more about the ID card project by contacting email@example.com.
Local Equalities Impact Assessments
We are encouraging all L&D schemes to perform an Equalities Impact Assessment (EIA) each year. We also recommend including equalities issues and actions as a standing agenda item reviewed regularly at project board meeting, so both health and criminal justice partners can understand the relevant issues for each locality and work together to address these.
This approach helps to ensure that services have the best chance of reducing health inequalities and of advancing equality of opportunity whilst capturing the evidence of this and meeting your legal duties according to the Equality Act (2010) and the Health and Social Care Act (2012). This work is integral to purpose of L&D services. An EIA provides an evidence based approach, allowing providers to demonstrate that they understand local need and are taking active steps to promote equality and reduce health inequalities. An EIA is completed for the national programme each year
EIA’s should be shared, and regularly reviewed, with regional health and justice commissioners. Commissioners should be seeking evidence of how schemes are actively promoting equalities issues and reducing health inequalities. They may wish to include EIA reviews as part of contract meetings, for example.
Schemes may have their own EIA pro-forma or we have a partially completed template available which requires schemes to add to the background information provided by inputting relevant local population data/issues plus doing an action plan. EIAs do not have to be sent back to the central programme team. However, we are on hand should you have any questions. For more information please contact Neisha.Betts@nhs.net.
An interview about the joint partnership work of Essex L&D and Children Affected by Parental Imprisonment schemes
Staff from the Essex ‘Children Affected by Parental Imprisonment’ (CAPI) scheme, give us their thoughts about the success of the scheme so far and the benefits of working closely with their local L&D team.
How does the CAPI scheme support children and young people?
We work with children and young people on a daily basis who are feeling lost, alone and often traumatised by having a parent arrested, in custody or going through the criminal justice system.
Children and young people find it hard to express how it feels for them as the non-offender. They often struggle with feeling helpless or feel that no one is listening to them.
Our service gives them a voice to express themselves and we work with them to find the solutions and support that can help them overcome their distress.
How does the CAPI scheme work with L&D to offer support?
This new way of working with L&D services enables us to offer intervention and support to families and their children at a much earlier stage. Prior to this new model, many of the cases we received would either be referred after the offender had been imprisoned or when they were about to be released, it is vital that families get the support they need before then.
We have seen that a high number of parents struggle to come to terms with the how their partners’ (the offender) behaviour and actions have caused drastic changes in their daily lives ranging from practical issues, such as changes to benefits and housing, to the emotional impact of feeling judged and isolated. Many feel stigmatised and often face backlash from other family members or their local community along with possible retaliation when an offender’s actions have featured in the media. Some parents can become dependent on alcohol or drugs to help them cope. Many do not understand how the CJS works and are left trying to find advice and support themselves.
Now that we are working with the local L&D service we are able to provide practical and emotional support and advice at an earlier stage, to help ensure parents receive the help they need. This helps to strengthen families and build up resilience to cope with any further court proceedings and ongoing placement into custody.
What does a typical day look like for CAPI scheme support worker after an L&D referral?
Once a referral is accepted we will make arrangements to visit the family as soon as possible, normally at home or at school, and the type of support we offer varies depending on the needs of the situation.
For example, we recently received a referral from the local L&D service concerning a mother that had been arrested for assaulting her children’s father and for criminal damage. The mother had been a victim of domestic violence for over seven years, with her children witnessing incidents on many occasions. During one incident, the mother threw a whisky glass at the father and it broke. The father called the police asking to have the mother charged. Our team was able to ensure that the mother and children received appropriate support to recover from the many years of dealing with domestic abuse, and was able to provide specialist advice to overcome concerns about losing employment due to a criminal record now being in place.
Outcomes from each family visit or session are recorded, with any follow up actions and further support needs prioritised. We often see increased confidence, positivity and self-esteem following sessions with our team, as parents receive much needed advice, signposting and referrals to organisations that can really help, which they would not have found by themselves.
Thanks to Suzanne Page and Ross Allen from CAPI for this interview.
Liaison and Diversion (L&D) working to help the families of people using their service
Existing evidence suggests that children with parents, particularly mothers, in prison require extensive support. In comparison to their peers, these children are twice as likely to experience mental health problems, and three times more likely to have a history of poor living conditions and contact with youth justice services. Early support can help to reduce the damaging generational impact and disadvantages of parental imprisonment.
In February 2016, a new local partnership arrangement was developed between Barnardo’s and the L&D service provided by the South Essex Partnership University NHS Foundation Trust. This idea for collaborative work followed a reducing reoffending seminar for local leaders organised by the Prison Reform Trust.
Children Affected by Parental Imprisonment (CAPI) is a project run by Barnardo’s across the country. It provides early intervention and support to children and young people that have a parent or carer in contact with criminal justice services. Individuals seen by the L&D service are now offered family support from Essex CAPI services who can deliver both community and prison-based support.
CAPI offer both emotional and practical support to children and their families, ranging from help with debt management and housing to arranging prison visits. CAPI takes a whole family approach to providing support, with a focus upon reducing offending by strengthening relationships and maintaining family ties, working with parents, carers, grandparents, foster carers and young people up to the age of 18 years.
The partnership is cost neutral for both organisations involved and it provides an effective and easy to replicate best practice model for other L&D services across the country.
The workshop referred to, held by the Prison Reform Trust, resulted in the following report.
To find out more about L&D family and carer work you can also read in the article: Families and Carers of people using Liaison and Diversion (L&D) services.
Linked to the work of CAPI is an online resource, ‘I-HOP’ ,which provides materials for professionals working with children that have a parent in prison.
For further information on the work described, please contact: Suzanne Page at Barnardo’s, firstname.lastname@example.org; and Denise Cook at the L&D service in the South Essex Partnership University NHS Foundation Trust: Denise.Cook@sept.nhs.uk.
Working with ABI survivors at our North London Liaison and Diversion Scheme
In 2015 two schemes in London worked with the Disabilities Trust to collect prevalence information with the Disability Trust’s own screening tool, the Brain Injury Screening Index (BISI). Practitioners attended ABI awareness training and were instructed on how to use the tool.
Matina Marougka, Project Manager at the North London scheme, notes that “Once trained, staff found the tool very easy to use. Knowing when someone had an ABI meant we were able to provide the right reasonable adjustments for that individual, ensuring they understood and could take part in the process. We included information about a person’s ABI in court reports and for the police also. As a result, we had a person referred on for further specialist assessments at the court’s request, so the court knew exactly how this person’s ABI affected their behaviour.”
Matina also highlighted the usefulness of the training, noting that “the training helped staff understand why they were screening for ABIs in this population. Especially when we found out that offenders, young males and homeless people, etc. all have high rates of ABIs.”
Researchers for the Disabilities Trust analysed the data collected by the London schemes during 2015/16. They found that 12% of those screened were identified as having moderate to severe ABI. In addition, brain injury was found to be more prevalent in male service users. Those identified with ABI also had a higher prevalence of physical disabilities and social & communication difficulties not associated with Autism Spectrum Disorder.
For more information on the Disability Trust’s work on ABI, visit the brain injury section of their website.
For information on ABI screening as part of your L&D service please contact Neisha.Betts@nhs.net.
Developing mental health services for veterans in England
NHS England has published a report into the findings on NHS veterans’ mental health services. The report is informed by views received from over 1,270 veterans, their families, services charities, mental health clinicians and other individuals and organisations involved in the care of veterans with mental health difficulties.
The findings are now being reviewed, along with the outcome of three pilots that NHS England recently funded to test enhanced models of mental health care for veterans, to help inform improvements to current NHS veterans’ mental health services and shape future services that will be in place from April 2017.
There is also another report entitled “Gate to Gate: Improving the mental health and criminal justice care pathways for veterans and family members” which is a Community Innovations Enterprise publication on a programme of work undertaken on behalf of NHS England, to explore the effectiveness of health and criminal justice care pathways for veterans with complex mental health needs.
Please contact Neisha.Betts@nhs.net if you have any questions or news concerning working with veterans as an L&D service.