Health, Social Work and Related Services for Mentally Disordered Offenders in Scotland. Page :1

Health, Social Work and Related Services for Mentally Disordered Offenders in Scotland.

Dear Colleague

HEALTH, SOCIAL WORK AND RELATED SERVICES FOR MENTALLY DISORDERED OFFENDERS IN SCOTLAND

Summary
1. With this letter we enclose copies of the Scottish Office policy governing health, social work and related services for mentally disordered offenders in Scotland which was launched by the Minister for Health and the Arts on 28 January 1999.

Background
2. The attachment to this letter was the subject of extensive consultations between 15 April and 31 August 1998 and now sets out the policy for the best organisation of care, services and support for mentally disordered offenders in Scotland.

3. The overall aim of the policy is to co-ordinate care and support for the benefit of the individual and to ensure public safety. The paper sets out steps that will involve multi agency and multi-disciplinary working to organise services which:

provide care under conditions of appropriate security with due regard for public safety have regard to quality of care and proper attention to the needs of individuals where possible provide care in the community rather than institutional settings provide care that maximises rehabilitation and the individual’s chance of an independent life.

4. Agencies should be aware of 3 reviews which are in progress, or about to commence, and which may affect legislation and practice covering the detention, treatment and supervision of mentally disordered offenders. These are the review of the Mental Health (Scotland) Act 1984, under the chairmanship of the Right Hon Bruce Millan; the review of sentencing and treatment of serious violent and sexual offenders including those with personality disorders, under the chairmanship of the Hon Lord MacLean; and the Expert Panel on Sex Offending, under the chairmanship of the Hon Lady Cosgrove. The Millan and MacLean reviews are expected to report during the year 2000. The Expert Panel, which was announced in December 1997 to take forward key areas of ‘A Commitment to Protect’ (the ‘Skinner Report’), will report annually to the Secretary of State on its past and planned work during its 3 year term.

Action
5. Health Boards, NHS Trusts, local authorities, the Scottish Prison Service, the Crown Office, the Police and other recipients are asked to ensure that this letter and attachment are distributed widely to all staff involved in the planning and delivering of services, care and accommodation for this care group (ie those who have committed an offence and also have a mental illness).

6. Each Agency is also requested to take the necessary steps to implement the recommendations within the attachment to this letter. Progress towards implementation will be monitored by The Scottish Office under established arrangements for these purposes. Where appropriate further guidance will issue in due course relevant to the action points identified in the attachment to this letter.

7. A copy of this letter and attachment are available on the internet (at www.scotland.gov.uk)

Yours sincerely

GEOFF SCAIFE	J HAMILL
Chief Executive, NHS in Scotland	Secretary, The Scottish Office Home Department


Addressees	Enquiries to:
For action: General Managers, Health Boards General Manager, State Hospitals Board for Scotland Chief Executives, NHS Trusts Directors of Social Work/Chief Social Work Officers Directors of Housing/Chief Housing Officers For information: Chief Executives, Local Authorities Chief Executive, COSLA Chief Executive, Scottish Homes General Manager, Common Services Agency Executive Director, SCPMDE Mental Welfare Commission for Scotland General Manager, HEBS	Health Mr P Harley Tel: 0131 244 2426 Fax: 0131 244 2970 Social Work Community Care: Dr D Bruce Tel: 0131 244 5458 Fax: 0131 244 5315 Criminal Justice: Ms F Hird Tel: 0131 244 5470 Fax: 0131 244 3548 Crown Office Mrs C McDivitt Tel: 0131 225 5806 Fax: 0131 226 6910 Scottish Prison Service Mr J McNeill Tel: 0131 244 8622 Fax: 0131 244 8691 Police Miss A Ross Tel: 0131 244 2149 Fax: 0131 244 2666

PART I: REMIT AND GUIDING PRINCIPLES

1.1 This policy statement examines the provision of mental health and social work services for mentally disordered offenders (and others requiring similar services) in the care of the police, prisons, courts, social work departments, the State Hospital and other psychiatric services in hospitals and in the community, and makes proposals for the organisation and development of these services throughout Scotland. This review does not in any respect change the role and responsibilities of Scottish Ministers in relation to State patients and is without prejudice to the work of the Millan Committee set up to review the provisions of the Mental Health (Scotland) Act 1984.

1.2 For the purposes of this paper ‘mentally disordered offenders’ covers those who are considered to suffer from a mental disorder as defined in the Mental Health (Scotland) Act 1984, whether or not they are, or may be, managed under its provisions and come to the attention of the criminal justice system. "Mental disorder" is used to cover those people with a mental illness or learning disability. The issues for people with a personality disorder, who do not commonly come under this heading, are also specifically considered. The term ‘mentally disordered offender’ covers wide variations in the state of mental health, in the severity of incidence in one individual over time and in the seriousness of actual or potential offending behaviour.

1.3 The overall objective is to promote the provision of a sufficient and effectively co-ordinated range of services (including health, criminal justice, social care, housing, education and employment and benefits advice) to meet the individual needs of mentally disordered offenders and the public interest. The public interest covers both the protection of the public and the most effective use of resources consistent with high standards of public safety.

1.4 In 1992 the Department of Health published the Review of Health and Social Services for Mentally Disordered Offenders and others requiring similar services (The Reed Report)(1) which related to England and Wales. This report has been widely accepted by clinicians and has become a part of the culture and working practice of forensic psychiatry in Scotland at a clinical level.

1.5 The Scottish Office policy on the delivery of these services is based on the same set of guiding principles and should be read with the Framework for Mental Health Services in Scotland (10). Mentally disordered offenders should be cared for:-

with regard to quality of care and proper attention to the needs of individuals;
as far as possible in the community rather than in institutional settings;
under conditions of no greater security than is justified by the degree of danger they present to themselves or to others;
in such a way as to maximise rehabilitation and their chances of sustaining an independent life;
as near as possible to their own homes or families if they have them.

Services for mentally disordered offenders should include careful assessment and management of risk in appropriate facilities. Where possible general health and social care

services for the mentally ill should be used for treatment and support. The offenders’ rights as citizens should be respected. Care should be provided with attention to the specific and sometimes different needs of those in a minority by virtue of ethnic group, gender, creed or religion.

1.6 This review paper covers the services provided for ‘adults’, that is those aged 18 or over. The services may however on occasion be expected to deal with those aged from 16 to 18. The needs of children and adolescents are very specific and every effort should be made so that they are dealt with separately. It is acknowledged that young mentally disordered offenders are particularly vulnerable. The transfer of responsibility from teams concerned with children’s and young persons’ services to teams providing adult services should allow some flexibility. The appropriate age for transfer will vary from case to case and depend on the nature and complexity of the individual’s condition.

Background

1.7 Service provision for mentally disordered offenders is a complex and difficult field. It covers many different agencies and professional groupings throughout the public, private and voluntary sectors. The boundaries between some of the service areas and the responsibility for co-ordination of services may be only partially or not sufficiently defined. There is a need to consider the effectiveness of the system as a whole and this paper attempts to do this by bringing forward a series of proposals for each of the individual service areas. At the same time it identifies the tasks to be addressed by health and social care service providers and those who require access to these services, including decision makers in the criminal justice system, eg procurators fiscal, the courts and the Parole Board. Given the interdependence of health boards, social work departments and voluntary agencies who are responsible for the bulk of service provision, there are many opportunities to create new working partnerships and to strengthen key areas, such as joint planning for the future of the services.

1.8 Although many mentally disordered offenders may be diagnosed as having more than one psychiatric condition, it is often the combination of medical and social factors which leads to their offending behaviour. The route to services for this group may be through social, criminal justice or health care agencies. The stated policy objectives should be effective joint responses for all, regardless of the severity of the presenting disorder, the seriousness of the offence, or the initial referral route.

1.9 Action will be taken forward by the relevant agencies which work together in this complex field. There are costs involved in providing the existing range of services and although additional costs may be associated with some of the key proposals there will be limited offsetting savings to be found elsewhere. The costs will have to be met within existing public expenditure totals.

Co-ordination of Services and Public Safety

1.10 The co-ordination of services for mentally disordered offenders sets a special challenge. A large number of agencies is involved. From The Scottish Office point of view a range of financial and statutory relationships have to be accommodated within any overall plan. From the public point of view there is a need for reassurance that any dangerous behaviour by this group of offenders can be satisfactorily managed and contained at each level of service provision. Every stage of treatment should be preceded by a careful and detailed assessment of all the risks involved.

1.11 The mentally disordered offender is an individual who is entitled to treatment of his or her underlying condition and respect of their rights, as is any other individual. This is a matter which must take into account clinical and public protection issues. A variety of social and clinical facilities and treatments will be required within different settings and with varying levels of security so that the individual may be appropriately placed. Depending on the needs of the individual some of these facilities will be in hospital, some in prison and some in the community.

1.12 Providing the right services at the right time in the right place is particularly important for mentally disordered offenders. Thus, suitable psychiatric care or intervention may prevent or reduce offending behaviour. The right kind of secure hospital facilities will reduce pressure on the State Hospital. Good community support and related services will enable rehabilitation to take place in the community. The key to effective co-ordination is a clear overall framework with specific identification and acceptance of responsibilities. This paper sets out this framework.

The Framework

1.13 This paper examines the criminal justice process, the health and social care services and announces the policy for responding to the needs of the mentally disordered offender. A recurring issue in each section is that of sharing information between agencies. It is a basic principle that information about the health and welfare of a patient is confidential; that it must be safeguarded and that it should not be disclosed without the consent of the patient. Similar protections exist in relation to the information held by other agencies. There are, of course, circumstances where information can be disclosed without the patient’s consent including where disclosure is in the public interest. For example where disclosure will prevent serious risk of harm to the individual or others and where it is necessary for the prevention, detection or prosecution of serious crime. The need for sharing or disclosure of information should be a consideration that is an integral part of clinical risk management.

1.14 While it is clearly important to safeguard patient information it is also essential that this should not act as a barrier to the provision of an integrated service. The decision to share information where it is in the interests of the patient and where appropriate safeguards are in place must be taken locally by a senior health professional or appropriate senior professional within other Agencies. Ideally this should be done with the agreement of the patient. The Scottish Office, Department of Health recognises that there needs to be a consistency of approach in this area however. It is therefore the intention to take forward work with other Departmental interests to identify the key principles and practical issues relating to the sharing of information and to develop guidelines and protocols are required and which can be adopted locally. These will be developed taking account of professional guidelines including those of the GMC and UKCC.