Mental health of adults in contact with the criminal justice system

Context

Mental health problems are very common among people in contact with the criminal justice system, with the amount of people affected ranging from 39% in police custody up to 90% in prison. There is also evidence that certain mental disorders, like personality disorders and psychotic disorders, are more prevalent in the prison population than the general population. It has also been reported that certain groups like females, black and minority ethnic groups, people older than 50 years and people with comorbid disorders are over-represented in prisoners with mental health disorders.

The underlying mechanisms between crime and mental illness are still not yet well understood. There are some suggestions that pre-existing social factors, for example homelessness, may be associated with increased offending. In other areas, such as substance misuse, the urge to use illicit drugs may drive people to commit crimes such as theft. In some cases, the links may relate to either poor adaptive functioning or the consequence of offending and contact with the criminal justice system upon mental health.

Currently, NHS England is responsible for commissioning healthcare provision including mental healthcare for people in contact with the criminal justice system, with the exceptions of police and court custody. There is also a joint care pilot scheme between the criminal justice system and NHS funded by the Department of Health, with initiatives such as 'street triage' schemes. However, identifying mental health problems in police custody is complicated by the lack of training, education and a standard assessment. There is also a lack of clarity on appropriate signposting and prompt access to a mental healthcare.

This guideline covers recognition, assessment, treatment and prevention of mental health problems in adults who are in contact with the criminal justice system (police and court custody, prison custody, street triage and liaison and diversion services, as well as probation service providers). Mental health problems include common mental health problems, severe mental illness, paraphilias, neurodevelopmental disorders and acquired cognitive impairment. There are recommendations on care planning and pathways, and organisation and structure of services, as well as training for health, social care and criminal justice professionals and practitioners. Although the focus of this guideline is on healthcare, the Care Act 2014 has relevance to people in the criminal justice system, in the community and in prisons. This may be of particular relevance for people with neurodevelopmental disorders, including learning disability and autistic spectrum disorders.