Criminal Justice Pathway Research Articles

Costs attributable to criminal justice involvement in injuries: a systematic review

ContextCosts related to criminal justice are an important component of the economic burden of injuries; such costs could include police involvement, judicial and corrections costs, among others. If the literature...

A qualitative exploration of the views of people with lived experience of suicide within the criminal justice system

ABSTRACT Background: Little evidence exists on how individuals in the criminal justice system (CJS) can discuss their experience of self-harm, suicidal ideation and behaviors. They are a valuable resource for suicide prevention in the CJS worldwide. Aims: To explore the views of those with lived experience on what the CJS can do to help support and improve services for those at risk of self-harm and suicide across the criminal justice pathway. Method: Five focus group discussions with 21 experts by experience were analyzed using thematic analysis. Results: The qualitative analysis identified three themes relevant to the process of assessment and prevention of suicide and self-harm risk: knowing my history, being treated as an individual and being able to express vulnerability. Limitations: The focus group design may have made the participants more reluctant to share experiences representing alternative perspectives or personally sensitive information. Conclusion: The findings of this study suggest the CJS needs improved connections across teams to promote continuity of care and the quality of information flow to enable institutions to become more therapeutic. By developing the use of key individual relationships this will ensure that people are treated as individuals, with safe spaces to reveal vulnerabilities.

Prosecuted for Attempting Suicide: A Retrospective Study in a Malaysian Forensic Psychiatric Unit

Introduction and Study Objectives: Criminalization of suicide attempts is an archaic barrier to suicide prevention. Malaysia remains one of the few upper middle-income countries that still criminalizes suicide attempts. Globally, clinical profiles of prosecuted suicide attempters are an under-researched area. Recognizing the prosecuted would aid in understanding the survival and help in the narrative for the need for decriminalization of suicide attempts. Method and Materials: This retrospective study of clinical notes aims to describe the clinical profiles of individuals who were charged for attempted suicide and subsequently sent for criminal responsibility and fitness to plead evaluation in a forensic psychiatric unit in Malaysia from January 1, 2008, to December 31, 2019. Results: We identified 22 cases who were mostly adult males (90.9%) and half of the individuals were hospitalized post-attempt due to lethality of method. Seventy-three percent have a psychiatric disorder. Mood disorders were more prevalent (32%) followed by psychotic disorders and substance use disorders. For most of these individuals, this was the first contact with any form of mental health services and 41% defaulted their treatment before arrest. Notably, a large portion of the sample (72.7%) had no additional criminal charge. Conclusion: Criminalization of suicide attempts complicates the care pathway for individuals who attempt suicide in Malaysia. The criminal justice pathway can significantly delay treatment. Legal processes and assessments that persons prosecuted for suicide attempt have to undergo may take precedence over mental health care. The clinical outcome post-discharge is largely unknown to a group that is at increased risk of suicide. Therefore, this sample illustrates a vulnerable group who has been and will be disengaged with mental healthcare. Future research is warranted to further investigate mechanisms that are effective in addressing unmet needs of persons in suicidal crisis as opposed to utilizing the criminal justice pathway include the need for decriminalization of suicide attempts.

Prevalence of Mental Health and Addiction Service use Prior to and During Incarceration in Provincial Jails in Ontario, Canada: A Retrospective Cohort Study.

Individuals with mental illness and addiction are overrepresented in prisons. Few studies have assessed mental health and addiction (MHA)-related service use among individuals experiencing incarceration using health administrative data and most focus on service use after prison release. The objective of this study was to determine the prevalence of MHA-related service use in the 5 years prior to and during incarceration. We used linked correctional and administrative health data for people released from Ontario provincial jails in 2010. MHA-related service use in the 5 years prior to the index incarceration was categorized hierarchically into four mutually exclusive categories based on the type of service use: psychiatric hospitalization, MHA-related emergency department (ED) visit, MHA-related outpatient visit (from psychiatrist or primary care physician), and no MHA-related service use. Demographic, diagnostic, and incarceration characteristics were compared across the four service use categories. MHA-related service use during the index incarceration was assessed by category and length of incarceration. A total of 48,917 individuals were included. Prior to incarceration, 6,116 (12.5%) had a psychiatric hospitalization, 8,837 (18.1%) had an MHA-related ED visit, and 15,866 (32.4%) had an MHA-related outpatient visit. Of the individuals with any MHA-related service prior to incarceration, 60.4% did not receive outpatient care from a psychiatrist prior to incarceration and 65.6% did not receive MHA-related care during incarceration. Despite a high prevalence of mental illness and addiction among people experiencing incarceration, access to and use of MHA-related care prior to and during incarceration is poor. Increasing the accessibility and use of MHA-related services throughout the criminal justice pathway is warranted.

Diversion and liaison services in England and Wales for mentally disorder offenders – a narrative review

AimsTo critically examine the development of L&D services in England and Wales and critically appraise their evidence base.BackgroundHigh levels of morbidity across the criminal justice pathway are well established. Although the strongest evidence has emerged from prison studies, the court literature also confirms these high levels. In acknowledgment of this, there have been a range of initiatives to improve access to services for mentally ill individuals involved with the criminal justice system. Once such initiative has been the development of court liaison and diversion services (L&D).MethodRelevant literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the development of L&D services and their evidence base.ResultThe provision of L&D services has increased substantially since their first introduction in England and Wales in 1989. Early L&D services were largely small-scale, unfunded local schemes, and were dependent upon the energy and interest of clinicians who chose to lead in this area. This led to geographical variations in provision and variations in L&D model delivery. The Bradley Report (2009) recommended that a national L&D model be created. The roll-out of a national L&D model meant that half the population of England was covered by 2015, with funding assured for a final wave of L&D services to provide for total population coverage.Where implemented, L&D services have been shown to lead to increased numbers of local team referrals. They may reduce court adjournments and the overall amount of time spent attending court. There is also some evidence of an association with improved mental health among both adults and young people, with reductions in re-conviction rates amongst the later. There remain deficiencies in the evidence base with regards to the economic impact of L&D services. The majority of economic assessments of L&D services have been performed in the United States with fewer studies in the UK.ConclusionAlthough there is evidence that liaison and diversion can produce benefits, there is a general recognition that a higher standard of evidence is required, including experimental work and assessment of economic impact. L&D services carry a financial burden, but this may be offset by incorporating the value of the health improvements that may be brought in those who might otherwise not have received treatment.

Psychologically informed practice (PIP) within the offender personality disorder pathway: Towards establishing an evidence base for approved premises.

The United Kingdom (UK) government has commissioned numerous interventions across all stages of the criminal justice pathway for managing offenders likely to have a personality disorder, with the intention to reduce reoffending, improve psychological wellbeing, and develop workforce capabilities. Psychologically Informed Practice (PIP) models underpin these. To evaluate a modified PIP model within the post-imprisonment community stage of the Offender Personality Disorder (OPD) pathway, specifically workforce development, within all London (UK) probation supervised hostels (approved premises), we used both non-equivalent control group and pre-post repeated measure designs to compare changes in staff and offender outcomes before and after introduction of a PIP model across all 12 London approved premises. Findings revealed statistically significant improvements in a number of workforce outcomes (measured using the Personality Disorder - Knowledge, Attitudes and Skills Questionnaire and Maslach Burnout Inventory) which were moderated by age and gender. Data did not support associated improvements in resident offender outcomes (progressive moves, rearrests/reoffences, or breaches leading to recalls). The modified PIP is an effective intervention model for improving some workforce outcomes among probation supervised hostel staff, particularly for women, but our findings suggest that intervention development may be required for significant improvements to be observed in resident offending outcomes. In addition, further research is necessary to determine the longer term effects of PIP on absenteeism, employee turnover, quality of resident-staff interactions, and overall culture change among staff working within the post-imprisonment community stage of the OPD pathway.

The early identification of people with personality disorder in the criminal justice system.

The prevalence of personality disorder is very high among criminal justice (correctional) populations, yet our understanding of this condition as it arises in police custody is presently limited. Although healthcare screening has a well-described role within criminal justice settings, including police custody, specific screening for personality disorders has hardly been considered. Yet such screening is broadly in keeping with the aims of liaison and diversion services and the general healthcare principle of early identification, has the potential to inform future care pathways and ameliorate risk and could in some cases inform future sentencing arrangements including community alternatives. Therefore, there is a need for research to consider the design and implementation of a suitable screening tool for application as early as possible in the criminal justice pathway, either as a stand-alone instrument, or as part of a wider package of healthcare screens. It will be important to consider the feasibility of any such design, given environmental and time limitations within police custody and the high levels of substance misuse, with issues relating to intoxication and withdrawal.

Mental health and offending in older people: Future directions for research.

The number of older people and their proportion of the prison population in high-income countries is increasing substantially. This pattern is mirrored by the age profile in forensic hospital services, and both trends seem counter to the age-crime curve concept. How do we understand this and what are the mental health needs of this growing group? The aim of this review is to identify existing research robust enough to inform policy and practice in relation to mental health in older offenders and the knowledge gaps that should drive future research. A keyword-based search strategy of the databases Embase, PsychINFO, Medline, and grey literature 2008-2018. Article selection was limited to empirical research with the potential to inform policy or practice and findings synthesised narratively. Much of the research in this field focuses on prevalence and the increased psychiatric morbidity of the older offender population. Older prisoners and those older patients in secure hospitals have needs that differ in some respects from their younger counterparts and community-dwelling older people. There are few studies of interventions for mental health in older prisoners or into the challenges of timely release given their complex needs. Discharge of older individuals from secure settings is also an area where further research is required in order to inform policy and service provision. The older population in prisons and secure settings is growing, and there is much concern as to how far facilities and services have been able to identify and meet the mental health needs of those of older age. Cooperation between researchers and services and between disciplines will be essential if we are to secure a more robust evidence base in this respect. Engaging service users in such research and considering the whole criminal justice pathway including diversion remains a priority.

Police interactions and interventions with suspects flagged as experiencing mental health problems.

Interactions between individuals experiencing mental health (MH) problems and the police are complex, and effectiveness of innovative support and diversion models in England and Wales not yet fully evaluated. Our aims were to examine police interactions with suspects and to measure the immediate effectiveness of police/NHS MH interventions, including liaison and diversion and embedded staff in police contact and control rooms. We hypothesised that those with an MH flag would have significantly greater benefit from such interventions than those without in terms of how far they are taken down the criminal justice pathway and how long they spend in police custody. We examined police interactions with suspects with and without flagged MH problems in relation to key outcome measures over a 15-month period, overall or when flagged by nurses alone. 'MH flagging' is defined as the presence of a marker on police systems, including both historical and current information, that alerts control room staff and response officers that the call may involve an individual/s with MH problems. Serial cross-sectional analysis of material from a database of individual cases integrating information from three police sources (N=13,472) was used to test for associations between 'mental health flagging' and outcomes. Individuals with an MH flag have almost identical police dispatch response profiles to those without; they were arrested for and charged with similar offences. Those with an MH flag were significantly more likely to be charged with a criminal offence, less likely to receive a caution and spent longer periods in police custody than people under similar accusations but no MH flag. MH flagging appeared to disadvantage the people flagged, despite the presence of theoretically appropriate interventions. Further research is needed to understand this. It may be that indicating this form of vulnerability if the person is not judged to qualify for a MH service is discriminatory and may even account for excessive rates of mental disorder among prisoners.

Information pathways into prison mental health care

Police and court liaison and diversion services provide important specialist mental health input along critical stages of the criminal justice pathway. Effective sharing of information between the services and relevant justice agencies is essential. However, various problems exist with the flow of information between agencies and services across the criminal justice pathway. This service evaluation explored how clinically relevant information is transferred, by drawing on the perspectives of prison health care staff in a large urban UK male prison. A qualitative service evaluation was conducted using semi-structured interviews with a purposive sample of 11 prison staff. The main themes included: gaps in the transfer of essential information, (particularly concerning risk and offending information); information gathering to fill these gaps; the importance of professional relationships, information sharing between agencies; and information solutions. Improving information transfer across the criminal justice pathway could prevent treatment delays and ensure more timely mental health care in prison.

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

The 43 police forces in England and Wales have made over 13 million arrests in the last decade. Yet, despite this high volume criminal justice system activity, and evidence of substantial health morbidity across the criminal justice pathway, mental health services in police custody have only been patchily developed, and the literature in this area is limited. Referrals (n = 1092) to a pilot mental health service operating across two police stations in a London borough were examined over an 18-month period in 2012/2013. The referred group had high levels of mental health and substance misuse problems (including acute mental illness, intoxication and withdrawal), self-harm, suicide risk and vulnerability (including intellectual disability), with some important gender differences. Although this work has limitations, the findings are broadly consistent with the small existing literature and they confirm the need for services that are sufficiently resourced to meet the presenting needs.

Prison health‐care wings: Psychiatry's forgotten frontier?

There is worldwide evidence of high rates of mental disorder among prisoners, with significant co-morbidity. In England and Wales, mental health services have been introduced from the National Health Service to meet the need, but prison health-care wings have hardly been evaluated. To conduct a service evaluation of the health-care wing of a busy London remand (pre-trial) prison and examine the prevalence and range of mental health problems, including previously unrecognised psychosis. Service-use data were collected from prison medical records over a 20-week period in 2006-2007, and basic descriptive statistics were generated. Eighty-eight prisoners were admitted (4.4 per week). Most suffered from psychosis, a third of whom were not previously known to services. Eleven men were so ill that they required emergency compulsory treatment in the prison under Common Law before hospital transfer could take place. Over a quarter of the men required hospital transfer. Problem behaviours while on the prison health-care wing were common. Prison health-care wings operate front-line mental illness triaging and recognition functions and also provide care for complex individuals who display behavioural disturbance. Services are not equivalent to those in hospitals, nor the community, but instead reflect the needs of the prison in which they are situated. There is a recognised failure to divert at earlier points in the criminal justice pathway, which may be a consequence of national failure to fund services properly. Hospital treatment is often delayed.