Phil Garnham, Forensic Nurse at the Bracton Centre, Oxleas NHS Foundation Trust, developed a project with Kent Police to improve relationships and outcomes with service users in the Bracton Centre.
Many Mentally Disordered Offenders admitted or transferred to secure mental health settings have had difficult and challenging early experiences, often culminating in negative experiences with the youth offending services, police, criminal justice system and other systems of authority e.g. schools. The risk factors for poor mental health overlap with those for offending and substance misuse. About 5% of children aged 5-10 have conduct disorder and the rate is twice as high in boys as girls. Rates of conduct disorder are higher in children from disadvantaged backgrounds and the effects of early behavioural problems on children’s life chances mean they are:
- Twice as likely to leave school with no qualifications
- 3 times more likely to become a teenage parent
- 4 times more likely to be dependent on drugs
- 6 times more likely to die before the age of 30
- 8 times more likely to be on the child protection register
- 20 times more likely to end up in prison.
Many Mentally Disordered Offenders will have experienced a number of the above factors in their early childhood development and are often particularly negative towards their experiences with the Police, having formed a very negative view of authority.
The Police liaison project with Kent Police & the Bracton Centre was set up to improve relationships between offenders and police. It has seen significant improvements in the understanding of the police of mental health and associated behaviours, which in turn has improved case work understanding as well as community work.
The partnership was created out of crisis as Kent police suffered significant demand from mental health facilities and the community and demand outstripped resources daily. Investigations were taking too long and were poor resulting in an increasing number of complaints from patients and the NHS. A mental health liaison team was developed and the police officers on the team took courses on personality disorders and other mental health conditions. They now go to the Police training school to help inform new recruits about mental health, concerns and best practice.
As patients have a mistrust of police due to poor experiences in the past the police liaison team only wear uniform on the hospital sites in emergency situations. The Bracton Centre not only allowed access to the police on the team but issued them with passes for free movement inside the facility to allow frustration free investigation of crimes. Police presence in and outside the secure perimeter has allowed the development of positive relationships with both staff and service users through the pro-active and positive handling of offending behaviour through justice resolution, community meetings, joint learning and judo classes. This is all helping to change perceptions and develop positive and sustainable relationships going forward.
All crime reports generated at the hospital sites are handled by the mental health liaison team therefore reducing demand on other patrols and creating a single point of access to consultants at the facility. Engagement with consultants and senior nurses has been open and the mental health liaison team attend the Security Forum and Senior Nurse meetings and share an office with staff at the centre. All of this has been possible through a willingness to work together, to understand the issues both organisations face and with commitment and support from senior management on both sides.
The police have provided a supportive and helpful resource which has promoted learning from each other and challenge to existing ways of working. The project has improved engagement and relationships with both staff and service users and has helped to humanise the police within the community.
The Judo Project was initially greeted with scepticism and the belief that patients would be given skills to enable them to fight more effectively. However, the core values of judo are: courage, sincerity, self-control, honour, modesty, friendship and politeness, all positive traits, physical exercise is beneficial to all patients, but self control and discipline are corner stones of what the team wants to achieve. Obviously risk assessments are taken for all participants.
This work has created a new relationship between the police and the patient as they are now learning, teaching and playing together. It has allowed closer integration between mental health services and the police, the development of best practice within the services and the identification of further training and understanding for all police officers.
The nursing and police team at the Bracton Centre are continuing to work together and are being supported by the Institute of Integrated Care to analyse the data they have collected and to publish this work.