Key Change Area 4: Other Services and Populations
Mental Health and Offending
Within forensic services the Care Programme Approach (CPA) is used to manage the risks posed by restricted patients (patients who are subject to special restrictions applied by the court, because of the risk posed because of a mental disorder). The School of Forensic Mental Health has created a number of training modules focusing on risk assessment and delivered training to create capacity to deliver psychological therapies for mentally disordered offenders.
The Report of the Commission on Women Offenders100 identified mental illness and personality disorder as a key contributor to women's offending and to the likelihood of prison as a disposal. The report identified the need to improve the treatment and support offered to women with borderline personality disorder, the need to develop better approaches for short term prisoners to allow for interventions to start in prison and continue into the community, faster access to psychological therapies and a better capability within police, health care, prison and social work staff to understand the interaction between mental disorder and offending.
In its response, the Scottish Government made a series of commitments to continue to work to improve mental health services to address these challenges101.
Commitment 30: We will build on the work underway at HMP Cornton Vale testing the effectiveness of training prison staff in a 'mentalisation' approach to working with women with borderline personality disorder and women who have experienced trauma. The pilot will be extended in that prison and also introduced in HMP Edinburgh.
Commitment 31: We will also work with NHS Lothian to test an approach to working with women with borderline personality disorder in the community by extending the Willow Project in Edinburgh. We will use the learning from the test to inform service development more widely across Scotland.
As indicated above, over the period of this Strategy we will also build on existing work to improve access to mental health services, including the HEAT target to reduce waiting times for access to psychological therapies. The focus on people who experience distress, and the complex connections with eating disorders, depression, self harm, domestic violence, substance misuse, personality disorder and depression is particularly relevant to the work with women offenders.
In addition to this work, which has a particular focus on women offenders, we will also take forward other work focused on offenders. We have already committed to extending the current forensic work in NHS Lothian which supports justice staff working with sex offenders who have personality disorders, to include work with serious violent offenders.
We are also aware that there has been relatively limited use made of Community Payback Orders with a mental health condition. These orders were introduced under the Criminal Justice and Licensing (Scotland) Act 2010 with the intention of allowing for treatment in particular cases, to accompany a non-custodial sentence102. They are likely to be particularly appropriate for some people with personality disorders or developmental disorders, where treatment within the legal framework could potentially give quite different long term outcomes.
Commitment 32: We will promote work between health and justice services to increase the effective use of Community Payback Orders with a mental health condition in appropriate cases.
In the consultation on this Strategy we set out our view that the provision of specialist mental health services and associated supports for people with a range of neurodevelopmental disorders could be improved. The term "neurodevelopmental disorders" encompasses a range of conditions with features specific to each diagnosis but in common they can impact on social functioning and behaviour, sometimes quite severely, irrespective of the level of intelligence of the individual. Autism spectrum disorder (ASD) and Aspergers syndrome, attention deficit hyperactivity disorder (ADHD), and Tourettes syndrome and chronic severe tic disorders are among the neurodevelopmental disorders most frequently seen through childhood and into adulthood.
While developmental disorders are not uncommon - the prevalence of ASD in the general population is around 1% - there is a small number of people with ASD within Scotland who have particularly high levels of need, which makes providing their care that bit more complex. The response to the consultation confirmed that this view is shared and that there is a desire and need to deliver improvement which must start with addressing levels of awareness and skills amongst health and other professionals. This challenge crosses traditional boundaries between health and social care services and requires more work to make the linkages between this Strategy and the Scottish Strategy for Autism103 work for individuals and their carers.
Similarly there is work needed to improve diagnosis of and response to Attention Deficit Hyperactivity Disorder (ADHD). Work within NHS Lothian has established that people with ADHD are increasingly presenting to adult mental health services, but there are inconsistencies within mental health services in how this is responded to. ADHD is also known to be linked to higher rates of offending and we will make the linkage with justice services.
Commitment 33: We will undertake work to develop appropriate specialist capability in respect of developmental disorders as well as improving awareness in general settings. As part of this work we will review the need for specialist inpatient services within Scotland.
The Scottish Government has supported development and provision of specialist mental health and community outreach services for veterans. The Scottish Government funds the NHS-commissioned service delivered by Combat Stress at Hollybush House, which offers a wide range of specialist services to meet the needs of veterans with a mental health problem. Combat Stress is redesigning its service to provide 32 places for veterans resident in Scotland on a 6 week intensive Post Traumatic Stress Disorder course, in addition to delivering treatment to veterans as either an inpatient, outpatient or, where appropriate, in the community. Community outreach services run by Combat Stress have been developed to respond quicker and better to veterans' mental health needs and to improve access to NHS services. Two regional teams operate across the East and West of Scotland, with the Scottish Government funding the East Team.
Veterans First Point is a "drop-in" service for veterans based in the Lothians, providing support and advice covering a range of areas such as health, social, employment and education, with signposting where appropriate to other relevant agencies for further help and support. The service was evaluated positively by Sheffield University as one of 6 UK community mental health pilots and was the overall winner at the Military and Civilian Health Partnership Awards 2011.
Commitment 34: We will continue to fund the Veterans First Point service and explore roll out of a hub and spoke model on a regional basis, recognising that other services are already in place in some areas. We will collaborate with the NHS and Veterans Scotland in taking this work forward and will also explore with Veterans Scotland how we can encourage more support groups and peer to peer activity for veterans with mental health problems.