Open and Transparent Quality Mark 2016/17 and 2017/18

Transforming lives and reducing crime through Mental Health Treatment Requirements

In her latest blog, Alison talks about Mental Health Treatment Requirements and how they can help reduce pressure on the criminal justice system.

Hazel Robert receiving a Commissioner's Award.
Left to right: PCC Alison Hernandez, Local Criminal Justice Board business manager Hannah Hart, non-executive director of Livewell Southwest Morris Watts and clinical lead for the mental health treatment requirement pilot in Plymouth Hazel Roberts


There’s no doubt about it. Certain crimes require people to be put behind bars. Prison gives communities respite from criminals and a chance for those individuals to re-evaluate and rehabilitate. When dealing with violent criminals and organised crime it’s often the right solution.

However, there’s an increasing body of evidence that suggests prison is not the correct option for some people who have found themselves the wrong side of the law, and in certain situations it can make things worse.

One area where a great deal of improvement still needs to be made is in the locking up of those people who have committed crimes while being mentally unwell.  Around a quarter of women who we incarcerate in this country, and 16 per cent of men, have received treatment for a mental health problem the year before they entered custody, according to the Ministry of Justice. And a 2016 Prisons and Probation Ombudsman report showed that of the prisoners who take their own lives while behind bars 70 per cent had been identified as having a mental health issue.

A large part of my remit is to prevent crime. Therefore my team and I take a close interest in reoffending rates, which are significantly higher for those released from short-term prison sentences. 

If we can reduce the number of mentally ill people going to prison and instead get them treatment and help then there’s a better chance they won’t end up back behind bars, lives can be put back on track and pressure on the Prison Service relieved.

There’s also a huge opportunity to save public money. It costs around £35,000 per inmate to jail someone for a year, yet a pioneering project in Plymouth which is costing £50,000 is already preventing mentally ill people from being locked up by providing an alternative sentence. Known as a Mental Health Treatment Requirement, this sentence ensures that offenders who suffered from poor mental health while breaking the law get some intensive and high quality help over a period of up to 12 weeks instead of being sent to prison.

My office helped the Criminal Justice Board set up this scheme and I am grateful to Hannah Hart, the board’s business manager who has led this work for us all. Since December it has given magistrates and district judges the chance to approve mental health treatment orders therapy provided by mental health workers from Livewell Southwest. The team has begun 21 treatments with three being completed to the court’s satisfaction so far. In all 35 offenders have been assessed as suitable for the order, nine women and 26 men.

On a recent trip to Plymouth to see how the scheme was progressing I was incredibly impressed by the passion and enthusiasm those working on this scheme had for their clients. It is led by Hazel Roberts, who has a background as a psychiatric nurse. She and her team work with range of offenders, not all of whom will have been diagnosed with a mental health disorder at the time of the offending. Many arrive with chaotic lives, addictions and poor coping strategies which mean that when faced with a stressful situation they react badly, ending up in a system which has until now has treated them in much the same way as it deals with criminals who are not mentally unwell.

A significant number of offenders have experienced adverse childhood trauma (ACE) - traumatic incidents which can have negative and lasting effects on health and wellbeing. These incidents range from physical, emotional, or sexual abuse to parental divorce or the incarceration of a parent or guardian. Overwhelmingly, academics and practitioners across the country tell us that ACEs have been shown to have the strongest correlation to adverse adult experiences. They correlate strongly to a significantly increased risk of involvement with crime, drugs, self-harm and suicide and the risk of people becoming offenders and/or victims in the future.  So we – and our partner agencies are committed to exploring ways in which we can help people to deal with such trauma where we can.  

Some of the help Hazel and her team give out are straightforward. Often mentally ill offenders have chaotic lives, leaving them stressed and less able to cope with situations they find themselves in. Helping them to overcome personal difficulties and use coping mechanisms to think through the consequences of their actions are simple measures which means they are less likely to reoffend.

The Mental Health Treatment Requirements aren’t a soft option. Progress is carefully monitored by the team and the threat of prison can remain for those who don’t complete the course to the court’s satisfaction, but the early signs are extremely encouraging. Having an option like this gives real focus on an individual. It puts some focus and help in their lives. It’s about looking at a human being and asking ‘what’s stopping you from being able to function.

I find it extraordinary that in the most part the criminal justice system treats mentally ill offenders in much the same way as those without mental health problems, that it expects them not to reoffend after putting them through the additional trauma of a prison sentence.

It’s heartening though, that with a little bit of planning, a modest sum of money and some incredibly dedicated people a solution that will help transform lives and reduce crime appears to have been found right here in the Westcountry.

Alison Hernandez