Liaison and diversion and forensic learning disability services can make a big
difference to whether a person offends again – but services are patchy across the country and improvement is needed. Editor Dan Parton reports:


When Home Secretary Theresa May delivered a speech in July at an event hosted by the Care not Custody Coalition, she reaffirmed the government’s commitment to liaison and diversion services in the criminal justice system for people with mental health issues or learning disabilities. This, allied to £25 million in funding for liaison and diversion that was announced in January, points to a brighter future for the services.

Liaison and diversion – which seeks to identify, provide support for and, where appropriate, divert people with mental ill health or learning disabilities away from criminal justice settings such as police stations and magistrates’ courts and into specialist treatment or social care services – has had political support for some years, going back to the previous Labour administration. Yet progress in developing a national service has been frustratingly slow.

Indeed, in 2011, the government announced plans for liaison and diversion services to be rolled out nationally by 2014 – but it didn’t happen for a variety of reasons, according to Jenny Talbot OBE, director of the Care not Custody programme.

“It is quite a complex formula, in that we need to have health, social care and criminal justice working effectively together in order to realise comprehensive liaison and diversion services,” she says. “It is a massive undertaking.”

Additionally, the evidence base for the effectiveness of liaison and diversion is still being developed. “Intuitively liaison and diversion makes sense, but when it was first thought of as a centralised development… the data collection, analysis and evaluation wasn’t consistent, so the evidence that people were hoping for didn’t exist,” Talbot adds.

But now it is under NHS England’s control and a dataset and rigorous evaluation process, involving 10 trial sites, has been devised. “That should provide the evidence the treasury needs in order to approve the business case that then goes to ministers for year-on-year availability of funding,” Talbot adds. Now, the target for national rollout is 2017, and Talbot is hopeful that this revised date will be met.

Gaps in services
For the moment, liaison and diversion services remain patchy, as do forensic learning disability services, as Tracy Hammond from learning disability support provider Keyring, notes: “Especially for those with learning disabilities going through the mainstream criminal justice system who find themselves in prison.

"The whole system is practically impenetrable for someone with a learning disability from being arrested, understanding what they’ve been accused of, all the way through the courts [and to] what might happen as a result of a conviction.

“I’ve heard stories of prison officers having to deal with somebody who has been sent to prison and has never understood that they couldn’t go home at the end of the day.”

Research by the Prison Reform Trust found that discrimination experienced by prisoners with learning disabilities across the criminal justice system was personal, systemic and routine (Talbot, 2008).

While the Joint Committee on Human Rights reported concerns about “the rights of people with learning disabilities to a fair hearing” and “serious failings in the criminal justice system” (JCHR; paragraph 212, March 2008).

Hammond adds: “Then upon release it is about finding the right support for people and that isn’t always happening. There are issues about recognising that someone has a learning disability in the first place and people are slipping through the net. And if they aren’t recognised in the first place they aren’t getting the service they need.”

Responsibility for adult social care in prisons, which hitherto has been a somewhat confused picture, has been clarified by the Care Act 2014. From April 2015 adult social services will be responsible for providing adult social care for prisoners with eligible support needs. This should help to ensure the necessary support for people with learning disabilities while in prison and upon their release.

Forensic versus community
Some of the difficulties in finding the right support are availability of provision and increasing thresholds to access support. “Sometimes people can be passed from one service to another and then slip through the gap – and this can especially be the case for people caught up in the criminal justice system,” says Talbot.

Commissioners can also be cynical about forensic services. “We are always hearing that commissioners want cashable savings,” says Hammond. “We [service providers] can potentially keep someone out of prison by giving them the right support at the right time but that doesn’t close a prison or reduce the number of prison officers required, so that isn’t a cashable saving in one way.”

It costs about £40,000 to put someone in prison for a year, but substantially less to provide services to someone who may just need relatively low-level support to enable them to live in the community and stay out of trouble, Hammond notes.

“There is also still a lot of silo thinking at a local level, in my opinion. So a commissioner will not have to pay for someone in prison, but if they come out they often fall into the social service budget.”

Better links
Silo thinking can also extend to private organisations that run learning disability hospital settings, according to Richard Curen, a consultant forensic psychotherapist at Respond.

“We don’t seem to get people referred to Respond who have been in private hospital settings. You might expect on discharge that the person might need on-going treatment of some kind,” he says.

“There is an issue around places where there doesn’t seem to be a desire for people to be moved back into the community. It’s sad. This situation is partly because of funding issues – some providers are businesses that need to make money – and there is a sense that some do hold onto people longer than necessary.

“There has been a big move to get people into local services but little coordination, especially with forensic services.” The value of forensic services should not be underestimated, Curen adds.

“It can make a huge difference to a person’s life if they get effective treatment,” he says. “When someone has been given the opportunity to talk about things that have been hidden for years but their behaviour has led them to do things, when they do get to talk, often their behaviours recede or stop altogether.

“There is often something in a person’s past that is the key to why they act in the way that they do. To talk about the offending issue, their previous history – such as abuse, adoption, living in an institution – we often uncover what happened when they were younger and how it leaves a legacy on their life. To get a grip on that is quite complex.

“At Respond, we try to manage the risks but help the person to have as much freedom as they can within a risk-assessed system. There is a balance between protecting the person and protecting the public.”

Hope for the future
More people should begin to benefit from liaison and diversion services in the coming years. “There is a huge amount of work to be done and some good progress is being made,” says Talbot.

“People are now much more aware that individuals with learning disabilities do come through the criminal justice system and that particular support needs to be put in place. Liaison and diversion services will increasingly work with criminal justice staff to help identify people with learning disabilities at the earliest possible stage. They will help to secure necessary support both within the criminal justice system and in the wider community and, where appropriate, may suggest diversion away from criminal justice and into treatment and care.

“Most criminal justice staff have limited experience of working with people with a learning disability and it would be really helpful if those who work in learning disability services can… contact criminal justice services in their localities to see what they can do to support the liaison and diversion agenda.”

The Care not Custody campaign is led by the National Federation of Women’s Institutes and the Prison Reform Trust

References:
Talbot J (2008) Prisoners Voices: Experiences of the criminal justice system by prisoners with learning disabilities and difficulties. London: Prison Reform Trust.
Joint Committee on Human Rights (2008) A Life Like Any Other? Human Rights of Adults with Learning Disabilities. Seventh Report of Session 2007–08.
London: TSO.