A service user voice can impact and inform improvement on delivery and development of a service. We would like to hear examples of how the standard service specification has impacted on services users in the form of case studies. To hear the journeys of service users is a way of sharing good practice and providing a real picture of how L&D can change lives. Below are some of case studies submitted from our trial schemes:
If you would like to contribute case studies on the standard service specification please complete the case study template.
Hear from service users Pat and Jeff on their journey in an L&D service.
St Helens and Knowsley Criminal Justice Liaison Team (CJLT)
Mr X was diagnosed with Bi-Polar disorder and had disengaged from mental health services over time. As he relapsed, his alcohol consumption increased, he stopped taking his medication and began to cause distress to the local housing tenants. Breaching his bail conditions, Mr X ended up in prison where he became quite psychotic and was subsequently referred to CJLT via the mental health single point of access in the prison. As his property was in a serious state of disrepair the housing association took Mr X to court in an attempt to evict him. This would have been a catastrophic outcome as he would be homeless putting himself and the neighbours at risk as well as himself at risk of further offending. A plan was therefore put in place where Mr X would be referred to the local Community Mental Health Team (CMHT) and in the meantime CJLT would visit him in his temporary accommodation until CMHT had taken over his care. The Judge suspended the eviction order and requested he be provided with a written report by CJLT detailing Mr X’s progress and compliance before the next hearing. On his return to court, CJLT was able to show that Mr X had fully engaged with mental health services and was doing well. The judge therefore suspended the eviction order for 5 years pending Mr X’s further co-operation with mental health services. To date, there have been no further offences.
Mr Y had assaulted his wife and a restraining order was put in place. Following this he was admitted to hospital expressing suicidal ideas and he was diagnosed with organic personality disorder and depression. Upon his release from hospital, he consumed a bottle of vodka and began banging on the door of his wife’s house. She was frightened and rang the police. Mr Y was arrested and was brought to court from police custody. CJLT were called out and assessed him. They contacted the local home treatment team, explained the situation and requested intervention. The local home treatment team agreed to provide follow up and deliver Mr Y’s medication if he were released. CJLT gave verbal testimony to the judge outlining the current situation and proposed a plan to manage Mr Y. Consequently, the judge was minded to impose a curfew on Mr Y rather than a remand to prison.
Mersey Care Criminal Mental Health Liaison Team (CJLT)
Mr C is 32 years old and known to local services through the Early Intervention in Psychosis Team (EIT). His normal type of offending is alcohol-related and his engagement with services had been a cause for concern as his compliance with prescribed treatment was believed to be poor. He was deemed an escalating risk as he was homeless and increasingly chaotic in his behaviour in the community due to his heavy alcohol misuse.
The care team therefore liaised with CJLT Liverpool who facilitated a CPA risk review and consideration was given to how to best engage with Mr C. So it was decided that a silver PNC (police national computer) alert marker was placed on the PNC which flagged him to custody staff when arrested as requiring a mental health assessment by CJLT Liverpool whilst in custody.
Mr C was then arrested for stealing alcohol from a shop, the PNC alert was triggered and CJLT attended the police station to conduct as assessment with the care coordinator. It was deemed that he posed a significant risk to himself as his problems were both multiple and complex. This resulted in an informal admission to the acute services locally.
The police too no further action and he was discharged with accommodation in place and EIT supporting him at home. He was also referred to alcohol services.
Mark Sergeant, Operational Manager with CJLT, commented: “Having a pre-arranged plan in place meant that Mr C received an appropriate and timely assessment when he next came into contact with the justice system. This pro-active approach ensured he accessed the appropriate service and long-term care to address his mental health, alcohol, and offending needs.”
Mr B is 78 years old, unknown to mental health services and of good character with no previous contact with the criminal justice system. He was arrested for assaulting several school teachers on a beach in front of schoolchildren.
He was assessed by doctors who raised concerns but considered him fit for interview and detention. However, the Custody Sergeant had a different view and liaised with Liverpool Criminal Justice Liaison Team (CJLT) who carried out a Mental Health Act assessment whilst Mr B was in custody. After being assessed under MHA 1983, he was detained subject to section 2 and then further detained under section 3 after being diagnosed with dementia with psychotic features.
Mr B was not deemed fit for interview and after high level liaison with police, Criminal Prosecutors (CP’s) and partner agencies, a decision was made to take no further action on the basis of the public interest. Mr B was discharged to 24-hour nursing care and has not come to the attention of mental health services or the police since. He is now being attended to by the older persons Community Mental Health Team (CMHT) as well as social services in the community which provides support with his health and social care needs.
Dr Jenny Holmes, Lead Forensic Medical Examiner Merseyside Police and, Speciality Doctor in Psychiatry, commented: “Without the foresight of the custody sergeant and the expertise of the Liverpool CJLT it is very likely that Mr B would have been interviewed, charged and, possibly, remanded in custody. Instead, the intervention of the CJLT means that he now receives the care and treatment his condition necessitates so reducing any future risks he may pose to himself or others.”
Youth Support Team in Gloucestershire
Mr A, a 17 year old, was arrested and subsequently released pending further enquires for criminal damage to the property of his ex-girlfriend. He had kicked down a brick wall and damaged the front door of the family home after not being allowed in by his ex-partner. She was expecting his child and Mr A claimed she was being unreasonable in not allowing him any contact. Mr A admitted the offence when questioned under caution. A Youth Justice Liaison and Diversion interview was then completed with Mr A as part of his ‘point of arrest’ offer and this gave rise to issues regarding emotional and mental health, including suicidal thoughts and self harming. Mr A also stated that he was using illicit substances to cope and was thinking of dropping out of college.
From information provided to the investigating Police officer the case was brought to the Gloucestershire Youth Conditional Caution (YCC) panel for a decision. Panel members included a Police Inspector, Youth Support Team manager and a Restorative Justice Gloucestershire (charity) member. As result of this process, referrals were made to the Health Team within Youth Support for mental health and substance misuse assessments. Mr A’s NEET (Not in Education training or Employment) Youth Support Team (YST) worker was informed of the concerns raised from the initial YJLD interview and was able to offer extra support.
The YCC Panel felt that a Youth Conditional Caution was appropriate and Mr A was allocated a Criminal Justice worker who co-ordinated the balance between Mr A completing the Conditional Caution with the appropriate mental health and substance misuse support.
At the end of Mr A’s work on the YCC he has maintained his college placement, is now in contact with his ex-partner and working towards becoming an active parent. He has reduced his substance misuse and concluded his work regarding his mental health concerns.
Louise Brannon, Fast Track Team, Gloucestershire, says: “In this case, the voluntary engagement of Mr A with YJLD prior to the Youth Conditional Caution Panel enabled speedy referrals into the specialist Health Team within YST. Mr A was also able to demonstrate voluntary engagement with services that would have been appropriately considered by the YCC Panel. As a result of the information before the Panel Mr A was diverted from Court and is currently engaging in a Conditional Youth Caution.”
Mr B, a 15 year old, was questioned by Police after an allegation of Rape and Sexual Touching was made against him by another student at his residential school. He was released for further enquiries, having not admitted to the offence and the school suspended Mr B until further notice. The Police raised further concerns as Mr B had been either excluded or moved from two previous schools when allegations of a similar nature had been made before these were dropped by the (alleged) victim. Due to the nature of the offence, a YJLD worker contacted the Police case officer initially to confirm any issues or risks. The YJLD worker was informed that Child and Adolescent Mental Health Services had become actively involved with Mr B due to his having several emotional ‘upheavals’ in the course of the previous 18 months.
A YJLD interview was completed with Mr B and his mother where support was offered. However, Mr B demonstrated some quite manipulative behaviour and it was concluded he represented a potential suicide risk after his mother raised concerns about his state of mind. Mr B stated how much weight he had recently lost, his disturbed sleep patterns and his lack of friends. Despite this, the YJLD noted his positivity when he stated that most young people in his town knew him and how ‘out there’ he was. Mr B felt that as he was being supported by a psychiatrist, had joined a local rugby club and was being assisted by his parents, he did not merit further support.
The YJLD worker then contacted his psychiatrist and discussed Mr B’s manipulative behaviour during his interview, including his refusal to discuss his self-harm issues. The psychiatrist confirmed his weight loss was not a major issue and there were no self harm concerns. However, the psychiatrist was aware of the allegations against Mr B. Therefore, the YJLD worker duly completed standardised information sharing with the Crown Prosecution Service and the Police regarding ongoing services to engage and support Mr B in the future
Whilst engagement in YJLD did not instigate access into specialist health teams as Mr B was already engaging with Children’s and Young Peoples Service (CYPS), YJLD liaised with CYPS to ensure appropriate information was shared with them by the Police.
Louise Brannon says: “This liaison function assisted CYPS to gain a fuller understanding of Mr B’s link with the Police. The family were also put in touch with an organisation to help them deal with some of the wider issues they will have experienced.”
North and East London L&D Trial Scheme
Mrs S is a 43 year old woman with a history of Borderline Personality disorder and depression. Mrs S was homeless and sleeping on the streets at the time of contact with the Liaison and Diversion service at court. She was socially isolated, without a support network of friends or family in place, and had been involved in street prostitution. She had been the victim of a sexual assault that the police were investigating at the time she was arrested. Her alcohol use and lack of an appropriate and stable accommodation increased her vulnerability and made her susceptible to exploitation by others.
She presented as very anxious and was withdrawing from alcohol. Mrs S had previously experienced auditory hallucinations and had been prescribed olanzapine in the past. At the time of her arrest she was not on any medication and had disengaged from mental health services. Mr S has a history of self-harm but there has been no evidence of suicidal intentions – although she confessed that some time ago she had tried to throw herself in front of a car while under the influence of alcohol. Mrs S also has a history of cocaine use but denied any use at time of contact.
Mrs S was arrested for a public order offence, following heavy alcohol use. She first came into contact with the criminal justice system in 2007 and has a history of offences, including theft, common assault and criminal damage. The Women’s Forensic Mental Health practitioner met Mrs S in the court custody suite and provided a report to the court to highlight her distinct needs and to make recommendations on the assistance required.
As Mrs S was already known to a number of services, it was important for all the agencies to work together to assist with housing:
- Police were investigating the rape case and were seeking stable accommodation for her;
- Outreach and street rescue service were trying to assist her with housing;
- the Drug Intervention Programme were also involved as Mrs S had a keyworker.
The L&D practitioner initiated communication between all these different agencies in order to effectively support Mrs S and found suitable accommodation in a hostel in the neighbouring borough. Mrs S was also referred to the local women-only one stop-shop which provided further support through providing outreach to engage her with services.
Matina Marougka, a Women’s Forensic Mental Health worker in the L&D scheme who is project managing the implementation of the service specification for the London trial Scheme, added:
“As a result of my intervention, the magistrates had all the relevant information they needed to make an informed decision on the day. Mrs S received a conditional discharge for the offence before the court and was moved to safe accommodation. With a stable address she was now able to engage with the drug and alcohol service and then with her GP, who was monitoring her mental health.”