Interagency training to support the liaison and diversion agenda.

Abstract

Background In England and Wales there are an unacceptably large number of people in prison or in contact with the criminal justice system who have mental health issues. Integrated and effective interagency collaboration is required between the criminal justice system and mental health services to ensure early diagnosis, treatment, appropriate sentencing or diversion of these individuals from the criminal justice systems into mental health services. Liaison and diversion schemes are proposed as a means to integrated service provision through positioning mental health professionals within the criminal justice system. These schemes were recommended by the Bradley Report (2009) to be rolled out for all police custody suites and courts by 2014 in a National Diversion Programme. Working within these schemes, at the interface of the criminal justice system and mental health services, has its challenges (Hean et al., 2009) and the workforce from both systems must be prepared to address these. This was recognised by Bradley when he recommended that: “where appropriate, training should be undertaken jointly with other services to encourage shared understanding and partnership working. Development of training should take place in conjunction with local liaison and diversion services (p111; Bradley, 2009). The form this joint training should take is as yet unexplored. We have proposed elsewhere that joint training should equip different agencies and professionals with the skills and knowledge required to collaborate effectively, and not only focus on mental health awareness courses for those in police, prison and courts services (Hean et al. 2011). The criminal justice system and mental health services need to come together to learn about, from, and with each other in interagency training. Aim We present in this report our vision of what this joint interagency training between the criminal justice and mental health services should contain, how it may be delivered and its potential benefits. We explore the receptiveness of professionals from the criminal justice and mental health services to interagency training and explore their perceptions of the challenges to interagency working between the two systems. We focus particularly on one particular dimension: an interagency crossing boundary workshop and its theoretical underpinnings. We explore professionals’ expectations of this type of intervention as well as their perceptions of the knowledge and skills required to deliver the emerging liaison and diversion agenda in general and the content and delivery of interagency training in the future. These findings are synthesized into a series of recommendations and a model of interagency training that will prepare professionals in both agencies to respond to the liaison and diversion agenda more effectively and work collaboratively in the interest of the mentally ill offender. Method A crossing boundary workshop (Engeström, 2001) was delivered in December 2011 to a sample of 52 professionals from a range of non-health professionals associated with criminal justice system (probation, police and courts) and professionals from the mental health system or health domain (learning disability, substance misuse and mental health services). The receptiveness of criminal justice system and mental health service professionals to interagency training was assessed through the Readiness for Interprofessional Learning Scale (Reid et al., 2005) administered to respondents before the workshop. Perceptions of the challenges facing interagency working and the expectations of the workshop were explored through interactive exercises. Professionals from both agencies participated in a series of 6 parallel focus groups to discuss how to prepare the workforce to respond effectively to the liaison/diversion agenda and the constraints they worked under in terms of commissioning, delivering and attending this training. Findings Professionals from both the mental health and criminal justice systems need to build empathic relationships with staff from other agencies. They stressed the importance of actual face-to-face contact between professionals from different agencies to achieve this and saw interagency relationships as being built through increased knowledge of other agencies and the orchestrating of formal facilitated contact between them. They were strongly in favour of interagency training and its contribution to enhanced collaborative competence across the workforce and, in the long term, improved offender mental health. They believed interagency training would develop in the workforce a greater knowledge of other agencies and help them understand other professionals’ roles and responsibilities. They believed interagency training should occur pre-qualification, through into continued professional development and contain a variety of interagency training experiences. Professionals from both systems shared a high level of person centredness in their approach to their practice and stressed the importance of training being grounded and delivered in a real world environment. Participants acknowledged that training opportunities are under threat due to financial and time limitations and that joint commissioning, shared resources and economies of scale must be considered. Recommendations • A training package should be developed to prepare professionals both from the mental health and criminal justice system for the liaison and diversion agenda and integrated service provision. This training must offer a strong interagency component aimed at developing interagency collaboration skills and interagency knowledge. A four-stage training model is proposed in this report. This incorporates pre-registration or undergraduate training for trainee professionals in the mental health services and criminal justice system, general awareness training, interagency training for continuing professional development and the development of interagency reflective practice opportunities. This model may be supplemented by a variety of on-line resources, some of which are described. • These interagency training models should be developed in partnership between universities and local facilitators from within the criminal justice system and mental health services to provide both the theoretical and evidence based rigour associated with developing collaborative practice curricula alongside the real world contextual knowledge required of these programmes. • In the long term, interagency training should be delivered in practice by practitioners to ensure the continued validity and sustainability of these programmes. Training should be sensitive to changes in the workforce due to turnover and the pressures of organisational change. • In times of economic constraint, training should be well targeted at staff and organisations essential to the liaison and diversion agenda. • An interagency commissioning approach will be required to deliver the training package outlined to support the liaison and diversion agenda, and especially if there is to be joint training and sharing of resources.