Mental Health Treatment Requirements (MHTRs)
Background
Many people across the criminal justice system present with a range of underlying mental health, neurodiversity, substance misuse and social care challenges, but the use of treatment requirements as part of a community order or suspended sentence order remains low.
There are thirteen requirements which may be included in a community order, with the purpose of addressing offending through punitive and/or rehabilitative requirements as described in A Smarter Approach to Sentencing. Within these requirements, there are three treatments which are called mental health treatment requirements (MHTRs), drug rehabilitation requirements and alcohol treatment requirements.
Treatment requirements may only be included within a sentence if the individual consents to the treatment pre-sentence.
NHS England is responsible for commissioning the MHTR Service, which identifies, screens, assesses and provides psychological interventions and support to those sentenced to an MHTR.
Improved partnership working and dedicated new mental health teams now support the increased use of MHTRs. These provide the judiciary with the option to sentence robust and effective community orders, and in some instances an alternative to short custodial sentences.
Individuals may be sentenced to an MHTR if they present with a range of mental health issues, including those:
- whose mental health needs require help from secondary care services
- who present with lower level mental health needs and may be supported within the community. This particular need is supported in a new service, commissioned by NHS England, called the Primary Care MHTR Service.
Who are mental health treatment requirements for?
Mental health treatment requirements (MHTRs) are for adults (aged 18 years or above) who have been charged with committing the type of offence that is eligible for a community or suspended sentence order and who have a mental health condition, such as depression, anxiety, dual diagnosis (with drug or alcohol issues), personality disorder, neurodiversity, trauma, abuse and a range of social issues.
As part of this, treatments can be provided to people with various neurodevelopmental disorders and neurodivergence (for example, autism or attention deficit hyperactivity disorder), as the appropriate reasonable adjustments will be made to accommodate individual needs in accordance with the Equality Act (2010). These individuals typically have high levels of complex health and social care needs, which are contributing to their offending behaviour.
Many of the individuals sentenced to an MHTR present with histories of trauma or abuse and may not have previously been supported by statutory services until this point.
Primary care mental health treatment requirements
Primary care mental health treatment requirements (MHTRs) are for individuals whose mental health issues do not reach the threshold of secondary care services. They have been designed to meet a gap in provision for those with lower-level mental health and dual diagnosis issues in the community. Subject to the individual’s consent, primary care MHTRs provide a psychological approach with clinical staff who screen, assess and provide psychological interventions. This is overseen by a qualified psychologists as described within this Clinicians Manual.
Individuals sentenced to a primary care MHTR will receive a high-quality, responsive assessment and interventions that are integrated into local court and probation processes within the sentenced community order.
Secondary care mental health treatment requirements
Secondary care mental health treatment requirement (MHTRs) guidance describes how these are provided and overseen by secondary care service providers and for individuals whose mental health needs can only be supported through specialist services. The Royal College of Psychiatrist Position statement describes how clinicians assess individuals and oversee the delivery of the MTHR acting as the responsible clinician(s) for the delivery of treatment during the order.
If an individual is receiving a secondary care MHTR, the type of support received is very similar to the interventions offered by community mental health services.
Examples of the treatment requirement process
- The court probation team will discuss with liaison and diversion and legal representatives, cases that may lead to a treatment requirement assessment.
- Where a defendant pleads guilty, a pre-sentence report is requested, which will include the recommendation to sentence to a mental health treatment requirement (MHTR) (if assessed as suitable by the MHTR practitioner).
- The treatment requirement provider assesses the individual’s suitability for an MHTR, alcohol treatment requirement and/or drug rehabilitation requirement. If suitable the individual will consent to treatment, along with approval from the substance misuse provider for alcohol treatment requirement/drug rehabilitation requirement or the clinical lead for MHTR.
- The court probation team discusses the outcome of the treatment requirement assessment with the provider and includes recommendation(s) within the pre-sentence report.
- If the sentencer is in agreement with a treatment requirement recommendation, they will confirm that consent (legal requirement) has been gained from the individual, the provider or clinical lead is in agreement to oversee the requirement and a date has been provided for the first appointment.
- The court probation team undertakes a post-sentence interview with the individual to check their understanding of the sentence, provide details and make a treatment requirement appointment with appropriate provider. The case is then allocated to a probation practitioner.
Delivery
Mental health treatment requirements (MHTRs) are provided by primary care practitioners overseen by qualified clinical psychologists in partnership with probation, courts and the judiciary.
The clinical lead has overall responsibility for the MHTR Service and will develop and agree personalised case formulations for each individual. They will also provide clinical supervision to MHTR practitioners and interventions for individuals with more complex needs. The MHTR Service will make sure individuals are registered with a GP before the first MHTR intervention is delivered, described within the Primary care Practitioners Manual.
MHTR practitioners will then deliver short and personalised one-to-one psychological interventions, usually weekly, based on the care plan that is overseen by the clinical lead.
The range of interventions will be agreed by the clinical lead and usually include psychological interventions, such as psychoeducation, emotional skill development, cognitive behavioural therapy, or trauma work.
Community sentence treatment requirements (CSTRs)
Community sentence treatment requirements (CSTRs) are a collective name for the three treatment requirements available in the Judiciary for sentencing within a community or suspended sentence order. These are mental health treatment requirement (MHTR), drug rehabilitation requirement (DRR) and alcohol treatment requirement (ATR).