Polyclinics could be focus of care for offenders with mental health problems, author of report says

Polyclinics could become the focal point for healthcare services for people in England with a mental illness who have offended or are at risk of doing so, says the author of a new report on mental health services for prisoners.

The long awaited report by the Labour peer Keith Bradley was commissioned by the government in 2007 to look into whether people in the prison system with mental health problems or learning disabilities could be diverted to other services and how court liaison services could be improved. In fact Lord Bradley’s final report is far wider ranging than this. Speaking at the launch of his report he said, “It became clear to me it was otherwise going to be a huge missed opportunity.”

Among his recommendations Lord Bradley calls for better provision of primary care so that people with a mental illness or learning difficulty can get the sort of support—such as cognitive behavioural therapy—that might help reduce the risk of them offending in the first place.

And he wants more training for GPs so that they can recognise patients whose mental health puts them at a high risk of offending.

“I’m not criticising GPs,” he told the BMJ. But because of the demands on their time, he said, they were not always in a position to recognise that a patient may have problems. “What I am asking the government to do is develop a range of primary care services that the GP can refer them to.”

Polyclinics could offer the opportunity to provide GPs and other support services under one roof, he told the BMJ after the press conference, acknowledging that many traditional general practices may not be eager to have offenders with such problems on their lists.

His report, which has been widely welcomed by mental health and prison reform groups, calls for a national network of criminal justice mental health teams to divert people from the criminal justice system to more appropriate services.

It also recommends better commissioning of psychiatric reports on people facing court hearings to remove the current lengthy delays in getting the reports to court.

Lord Bradley also wants the NHS to take over commissioning of health services for people in police custody. These are currently commissioned by each police force, which, he said, means a “considerable variation” in provision.

He wants community sentencing to be offered more often as an alternative for people with a mental illness or learning disability. Where a custodial sentence is necessary, he said, the person’s condition needed to be assessed accurately early in the process. He recommended that all prison officers have awareness training in mental illnesses and learning disabilities.

The government has welcomed Lord Bradley’s report and has accepted his recommendation to set up a national programme board to oversee the development of a national model for criminal justice mental health teams. The board is due to meet in May and will develop a delivery plan by October 2009.

Andrew McCulloch, chief executive of the Mental Health Foundation, said that although he welcomed Lord Bradley’s “detailed and far reaching report,” the fact that this “vital” area of public policy had been left for so long was “scandalous.”

Steve Shrubb, lead for the NHS Confederation’s mental health network, said he was “especially pleased to see recommendations on criminal justice mental health teams and the commissioning of mental health services in police custody suites.”

Angela Greatley, chief executive of the Sainsbury Centre for Mental Health, said: “We endorse Lord Bradley’s call for all prison hospital transfers to be completed within 14 days. It is unacceptable that many prisoners wait for months to go to hospital when they are acutely unwell. But to achieve this change we are going to have to explore better ways of using secure hospital facilities.”