Evaluating the criminal justice mental health pathway

    Student thesis: Doctoral ThesisDoctor of Philosophy


    High levels of mental health and substance misuse disorders within the
    criminal justice system (including prisons, courts and police stations) have been
    reported across the world. In responding to this challenge, some countries have
    developed liaison and diversion services. These services began in England and
    Wales in the 1980s, but their coverage and quality have been patchy and they
    have been less developed in police custody than in the courts. Studies reported
    in this thesis aim to evaluate one such service operating in police custody.
    A multiagency group including the Local Authority, Metropolitan Police
    and local Mental Health Trust obtained grant funds to introduce a mental health
    service innovation into two police stations in South London. The service
    became operational in 2012, and from the outset routine service and follow-up
    information was collected on consecutive referrals. Data covering an 18-month
    period were analysed using a statistical software package. Meanwhile, the
    effect of an open referral system on local prison mental health in-reach team
    referrals was evaluated using a before-after design.
    The referred group (n = 1092) presented with very high levels of mental
    health and substance misuse morbidity, vulnerability, and suicide risk. Most had
    established mental health problems (66.8%) and histories of drug or alcohol use
    (60%) and an important number (144/888: 16.2%) presented with suicide
    ideation. Many (370/516: 71.7%) required onward referral to a range of services, and although existing service linkage was protective, male gender and
    current drug or alcohol use predicted non-engagement.
    It is possible for a mental health service to operate effectively in police
    custody, but such services require enough resources to deal with the high
    levels of presenting need and clinical risk. Service links appear protective and
    should be prioritised, but some referred groups require enhanced support to
    facilitate service engagement.
    Date of Award2017
    Original languageEnglish
    Awarding Institution
    • King's College London
    SupervisorLucia Valmaggia (Supervisor) & Thomas Jamieson-Craig (Supervisor)

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