| Popis: |
Background: High levels of mental health and substance misuse disorders within the criminal justice system (including prisons, courts and police stations) have been reported across the world. In responding to this challenge, some countries have developed liaison and diversion services. These services began in England and Wales in the 1980s, but their coverage and quality have been patchy and they have been less developed in police custody than in the courts. Studies reported in this thesis aim to evaluate one such service operating in police custody. Methods: A multiagency group including the Local Authority, Metropolitan Police and local Mental Health Trust obtained grant funds to introduce a mental health service innovation into two police stations in South London. The service became operational in 2012, and from the outset routine service and follow-up information was collected on consecutive referrals. Data covering an 18-month period were analysed using a statistical software package. Meanwhile, the effect of an open referral system on local prison mental health in-reach team referrals was evaluated using a before-after design. Results: The referred group (n = 1092) presented with very high levels of mental health and substance misuse morbidity, vulnerability, and suicide risk. Most had established mental health problems (66.8%) and histories of drug or alcohol use (60%) and an important number (144/888: 16.2%) presented with suicide ideation. Many (370/516: 71.7%) required onward referral to a range of services, and although existing service linkage was protective, male gender and current drug or alcohol use predicted non-engagement. Conclusions: It is possible for a mental health service to operate effectively in police custody, but such services require enough resources to deal with the high levels of presenting need and clinical risk. Service links appear protective and should be prioritised, but some referred groups require enhanced support to facilitate service engagement. |
