IN-CJ Podcast: Serious Mental Health – International Challenges for Criminal Justice

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The IN-CJ Webinar ‘Serious Mental Health – International Challenges for Criminal Justice’ held on 7^th May 2024, covered the challenges related to mental illness in the criminal justice system across multiple countries. Dr Coral Sirdifield of the University of Lincoln School of Health and Social Care, facilitated the discussion, which explored the need for interdisciplinary collaboration between various agencies, and the importance of involving individuals with lived experiences in co-designing support systems. The discussion explored the challenges related to mental illness in the criminal justice system, and how they are manifest across multiple countries, the need for interdisciplinary collaboration between different support agencies, and the importance of involving individuals with lived experiences in co-designing support systems.

International Challenges in Criminal Justice and Mental Health

Tonya Van Deinse, a research associate professor at the University of North Carolina, gave an overview presentation on serious mental illness and challenges for the criminal justice system internationally.  Tonya, with her background in mental health treatment, discussed the high rates of serious mental illnesses among people who generally interwact with the criminal justice system, and the need for system-level interventions. She emphasised the complexity of the issue, including cultural, sociopolitical, and legal contexts.

Tonya also touched on the different ways mental disorders are diagnosed and the need to consider severity and chronicity. She highlighted the disproportionate contact of people with mental illnesses with the criminal justice system and stressed the importance of addressing system-level challenges related to mental health. She outlined the topics for the upcoming discussion, including the nature of serious mental illness, the needs of people with serious mental illnesses, and the challenges faced by justice systems.

Tonya discussed the challenges faced by individuals with serious mental illnesses in the criminal legal system, emphasising the need for a multi-level approach to interventions addressing various contextual factors. She suggested utilising a sequential intercept model to promote collaboration across different systems and highlighted the importance of addressing the needs of individuals with mental illnesses before they come into contact with the criminal justice system. Tonya also underscored the necessity of organisational capacity, including screening, assessment, and follow-up processes, as well as the training of corrections officers and community supervision officers. She emphasised the need for a balance between public safety and the provision of treatment for individuals with mental illnesses.

Panel Views

After Tonya presented her work, the panel, consisting of Coral, Charlie and Shelley discussed the implications of Tonya’s concerns. Shelley, who is based in Victoria, Australia and has experience in forensic mental health, shared her views on issues that resonated with Tonya’s presentation. These included shared complexity in dealing with the nexus between serious mental illness and criminal justice, stigma, issues of intersectionality, significant overrepresentation of Aboriginal and Torres Strait Islander people in detention, workforce challenges, and privatisation. Charlie from the UK expressed his interest in learning more about community correctional services in Australia.

Charlie went on to discuss the results of a survey on probation services across Europe, with a focus on mental health policies and suicide rates. He noted that many European countries did not record suicide rates in community probation services, despite high rates. He emphasised the need for comprehensive mental health training for probation officers and questioned the effectiveness of current mental health treatment requirements. Charlie also highlighted the role of childhood trauma in the criminal justice system and expressed doubts about the current preparedness of staff to address these issues.

The discussion then opened up for audience questions and Charlie elaborated on the situation in England and Wales, while Tonya began to share her perspective on the situation in the US. Tonya and the team discussed the challenges and potential solutions for improving probation and parole governance in the US, with a focus on mental health-focused approaches. They discussed ongoing projects in Ireland and Germany, and the importance of addressing the complexities of interdisciplinary working between mental health services, mainstream health services, and criminal justice.

Maureen raised concerns about the current system’s lack of understanding of mental health issues in dealing with individuals who are both mentally ill and considered missing persons. She proposed a more comprehensive approach that involves the community, including individuals with lived experience, to design appropriate solutions. Coral and Shelley agreed with Maureen’s points and discussed the challenges faced by people with lived experience of mental illness and their caregivers, particularly in relation to the forensic mental health system. Shelley is working with colleagues to develop better support for forensic families and carers and to address the stigma and additional shame experienced by these groups.

The panel discussed the importance of co-designing and involving service users and their families in shaping support systems, while acknowledging challenges around power dynamics. Shelley emphasised practicing effective communication, cultural awareness, and de-escalation skills through experiential training methods. Tonya noted variability in training approaches, highlighting opportunities to incorporate evidence on adult learning. Everyone agreed that giving people with lived experience decision-making roles is crucial for meaningful system change.

The main issues discussed in the webinar include:

• Challenges of Serious Mental Illness in the Criminal Justice System: The panel explores the systemic challenges of addressing serious mental illnesses within the criminal justice system across different countries. This includes the disproportionate representation of individuals with mental illnesses in these systems and the need for systemic changes rather than just individual treatments.
• System-Level Focus: There’s an emphasis on discussing system-level interventions rather than solely focusing on individual treatment approaches. The discussion highlights how policies and the interplay between different systems (like health and legal) can impact individuals with serious mental illnesses.
• International Variability: Panellists bring perspectives from different countries, underscoring how sociopolitical contexts and resource availability vary internationally. These variations affect how mental illnesses are managed in criminal justice systems across different regions.
• Workforce Challenges: There’s an acknowledgment of the need for trained professionals who can adequately address the needs of individuals with mental illnesses within the justice system. This includes training in mental health for law enforcement and other personnel to better manage and support affected individuals.
• Stigma and Misunderstanding: The stigma surrounding mental illness and criminal behaviour is addressed, with discussions on how it affects the treatment and management of individuals in the criminal justice system.
• Need for Comprehensive Approaches: The necessity for multi-level interventions that include community services, law enforcement training, standardised screenings, and more integrated health services is highlighted. These are seen as essential for effectively supporting individuals with mental illnesses and preventing their unnecessary involvement with the criminal justice system.

The discussion identified several next steps and recommendations for addressing the challenges of serious mental illnesses within the criminal justice system:

• Enhanced Training and Education: There is a call for increased and ongoing training for law enforcement and criminal justice personnel on recognising and appropriately responding to mental health issues. This training should include de-escalation techniques and understanding the specific needs of those with serious mental illnesses.
• Improvement of System-Level Interventions: The discussion emphasises the importance of system-level changes over individual interventions. This includes developing policies that facilitate better integration between mental health services and the criminal justice system, and tailoring interventions to the specific sociopolitical and cultural contexts of each country or region.
• Cross-System Collaboration: Enhancing communication and collaboration between different systems, such as healthcare, social services, and criminal justice, is seen as crucial. This can help create a more cohesive approach to managing and supporting individuals with serious mental illnesses.
• Community-Based Resources and Supports: There is a recommendation to increase community-based resources, such as crisis intervention teams and supportive housing, which can prevent individuals with mental illnesses from entering the criminal justice system unnecessarily.
• Research and Data Collection: The need for more research and better data collection on the intersection of mental health and criminal justice was highlighted. This can help inform policy decisions and ensure that interventions are evidence-based and effective.
• Addressing Stigma: Continuing efforts to reduce stigma associated with mental illness within the criminal justice system and society at large is recommended. This can help improve the treatment and outcomes for individuals with mental illnesses.
• Tailored Approaches: Recognising that one sise does not fit all, there is an emphasis on developing tailored approaches that consider local resources, needs, and cultural factors. This can include adapting successful models from other regions to fit local contexts.

These steps aim to create a more informed, compassionate, and effective approach to managing serious mental illnesses within the criminal justice system, with a strong focus on prevention and appropriate support rather than punitive measures.

The panel discussion on addressing the health needs of people with serious mental illnesses in the criminal justice system highlights several core issues and paths forward that could be integrated into the professional work of the panel members, including:

1. Disproportionate Representation: People with serious mental illnesses are overrepresented in the criminal justice system, which underscores the need for targeted interventions and policy reforms.
2. Systemic Challenges: The systemic nature of the problem requires changes at multiple levels of intervention, from policy formulation to practice implementation.
3. Variability Across Jurisdictions: Different regions and countries face unique challenges based on their sociopolitical contexts, resources, and legal frameworks, making universal solutions impractical.
4. Workforce Preparation: There is a critical need for training law enforcement and criminal justice personnel on mental health issues to improve responses and outcomes.
5. Stigma and Misunderstanding: Stigma around mental illness and criminal behaviour persists, affecting the quality of care and support individuals receive.
6. Need for Comprehensive Strategies: Addressing the issue requires a multi-level approach that includes not just healthcare or law enforcement, but also community support structures, housing, employment, and more.

Matters of Professional Integration:

7. Education and Training Initiatives: Panel members involved in research and training can develop and disseminate educational programs aimed at law enforcement and justice personnel. This training can focus on mental health awareness, de-escalation techniques, and the legal rights of individuals with mental health issues.
8. Policy Development: Those in senior research or administrative positions might use insights from the discussion to advocate for or help draft new policies that promote better integration between mental health services and the criminal justice system.
9. Community Collaboration: Professionals can work towards building stronger ties between mental health services and community resources to create support networks that prevent individuals with mental illnesses from entering the criminal justice system unnecessarily.
10. Research and Advocacy: Panel members involved in academia or research institutions might focus on conducting studies that provide evidence for the effectiveness of new interventions or policies. They can also advocate for changes based on this research.
11. Systemic Reforms: For those in leadership or influential roles, there is an opportunity to push for systemic reforms within the criminal justice and healthcare systems to better address the needs of those with serious mental illnesses.

Conclusion

The panel effectively delineates the complexities and challenges at the intersection of mental health and criminal justice, providing a robust framework for future action. By integrating these strategies into their professional activities, panel members can contribute to more nuanced and effective solutions, ultimately leading to improved outcomes for individuals with serious mental illnesses involved in the criminal justice system.