‘This Has Honestly Changed My Life’ – Evaluating the Efficacy of Community Sentence Treatment Requirements

Abstract

There is significant evidence of a strong relationship between contact with the criminal justice system and substance use and poor mental health (Wakeling and Lynch, 2020). The Criminal Justice Act 2003 provided a sentencing option – a Mental Health Treatment Requirement – which considered a person’s mental health, but uptake has historically been low (NOMS, 2014). Prison populations are disproportionately affected by poor mental health, with one study over a decade ago determining that only ‘24% of male prisoners were affected by neither drug use problems nor mental health problems’ (Friestad and Kjelsberg, 2009, p.237). The prison population has almost doubled since this study and the system faces unprecedented challenges of staff shortages, real-term budget cuts, overcrowding, lack of educational opportunities, health inequalities, unsuitable estates and an increase in interpersonal violence (Howard League, 2014) even prior to the pressure from the Covid-19 pandemic.
The need for further support in the Criminal Justice System (CJS) was also identified as part of a wider approach in a seminal NHS report which laid out a roadmap to tackle mental ill health, titled ‘Five Year Forward View for Mental Health’ (FYFVMH) in 2016. The FYFVMH aimed to transform mental health provision through a holistic and multifaceted approach. While it did not focus specifically on the CJS, it did provide a backdrop for related agencies and the NHS to pilot a programme which focused on reducing custodial sentences by utilising Community Sentence Treatment Requirements (CSTRs) specifically, Mental Health Treatment Requirements (MHTRs). MHTRs require an individual to undertake therapeutic intervention as part of their sentence, so provide access to mental health services whilst also removing the risk incarceration can pose to further exacerbating poor mental health (see ‘Context’ below).
This chapter will examine how greater use of CSTRs, with a specific focus on MHTRs, was facilitated through a multi-agency approach to improve outcomes for those suffering from poor mental health (and frequently substance and/or alcohol use too). The CSTR protocol was piloted in 2017, with larger rollouts being conducted following a pilot of five sites in England. It also provides an overview of mental health issues in the CJS during the initiation of the CSTR pilot, demonstrating how this programme emerged and why. Recognising this is still a relatively new approach, this chapter will examine the efficacy of the CSTR protocol by reviewing data from its early implementation and focus on one of its initial testbed sites – Sefton Magistrates’ Court – as a case study. It will then consider to what extent the programme has met its aims and how this can further develop in future. In doing so, this chapter offers a focused analysis of a new and innovative approach to tackling mental ill health in the CJS, which has so far yielded positive results.
To ensure consistency when utilising data from across the different partner agencies, the term ‘service user’ (rather than offender or client etc.) will be used for all instances when discussing those who are engaged with a treatment requirement.