Evening Seminar

Innovation to increase the use of

Community Sentence Treatment

Requirements

Mignon French │Programme Manager │ CSTR Programme

Vince Treece │Programme Support CSTR │NHS(E)

Nino Maddalena │CJ Manager, Alcohol, Drugs and Tobacco Division, PHE

26 April, 2018

@academyjustice

Academy forJustice

Commissioning

Academy Overview

• The Academy’s mission is to bring people together to share

knowledge, skills and practice and to promote excellence in social

justice commissioning

• The Academy was created in 2007 and now has over 3800 cross

sector members

• Services are designed to support the development of social

justice commissioning and include nationwide events, eLearning,

commissioning themed learning groups and web pages offering

commissioning information

The CSTR Programme

The Programme will:

• Test and evaluate the effectiveness

of the protocol

• Evaluate the Protocol in a number of

testbed sites

• Be for adults 18 years + whose

offence falls within a CO/SSO range

• Involve Local testbeds: partnership

with L&D, NPS, CRC , SM , HMCTS,

Health providers, LA and Police

• Be supported by CSTR

Programme Board and local

programme support

Many offenders suffer from mental

health and substance misuse

problems but the use of treatment

requirements as part of a

community order is very low.

A protocol has been developed

setting out the action required by

health and justice staff to ensure

pathways are developed into timely

and appropriate treatment.

This protocol along with improved

partnership working should increase

uptake of treatment requirements

with a view to reducing short term

sentences for those with multiple

vulnerabilities that could be managed

within a community setting.

The CSTR Programme: Background

• CSTRs : Drug Rehabilitation Requirements (DRRs), Alcohol Treatment Requirement

(ATRs) , Mental Health Treatment Requirement (MHTRs) have been available to the courts

(either Crown or Magistrates’) for offenders aged 18 + as part of a community order (CO)

or suspended sentence order (SSO) since 2003 via the Criminal Justice Act (CJA).

• They can be either standalone requirements or one of a number of requirements of a

CO or SSO.

• In 2012 The Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO)

amended the CJA to make it easier for courts to use the MHTR as part of a CO or SSO

by simplifying the assessment process.

• These changes enabled the courts to seek views and assessments from a broader range

of suitably trained mental health professionals rather than a Section 12 registered

medical practitioner as had previously been the legal requirement.

• A CSTR can last for a maximum of three years as part of a Community Order and two

years as part of a Suspended Sentence Order

• CSTRs may be given alongside other requirements depending on the level of the

offence and needs of the Offender

• Consent is required for all three Requirements

The CSTR Programme: Background

Mental Health Treatment Requirement ( MHTRs)

• MHTR can be used in relation to any mental health issue, including personality

disorders

• Treatment offered can cover a wide range of interventions from therapy for depression

and anxiety through to secondary and psychiatric care.

• An MHTR can only be given when arrangements have been or can be made for the

treatment which will be delivered under the requirement and the offender consents.

• Suitability of an offender for an MHTR has to be assessed by a suitably qualified

medical practitioner

• This practitioner will assess the offender for suitability, explain the treatment requirement

and if suitable gain their consent to treatment.

• If the practitioner is not the Clinical Lead (CL) providing the treatment the CL will need to

agree to and oversee the proposed treatment..

• MHTRs can be provided by a broad range of clinicians as long as the requirement is

clinically supervised by a Psychologist or Psychiatrist

The CSTR Programme: Background

Drug Rehabilitation Requirements ( DRR)

• Court have to be satisfied that the offender is dependent on or has a propensity to

misuse drugs; and that the dependency or propensity is such as requires and may be

susceptible to treatment

• Can only be given when arrangements have been or can be made for the treatment

which will be delivered under the requirement (including arrangements for the reception

of the offender where required to submit to treatment as a resident)

• The requirement has been recommended to the court as being suitable for the offender

and the offender consents

Alcohol Treatment Requirements (ATR)

• Targeted at offenders assessed as alcohol dependent and require intensive,

specialist, care-planned treatment e.g. day programmes, detoxification, residential

rehabilitation

• Can only be given when arrangements have been or can be made for the treatment which

will be delivered under the requirement (including arrangements for the reception of the

offender where required to submit to treatment as a resident) and the offender consents

• Offender’s dependency on alcohol does not have to have caused or contributed to

the offence(s) for which s/he has been convicted

The context

There are 13 Community requirements available to the courts for

sentencing which includes three treatment requirements :

1. Unpaid Work

2. Rehabilitation Activity Requirement

3. Accredited Programmes

4. Alcohol Treatment Requirement

5. Drug Treatment Requirement

6. Mental Health Treatment Requirement

7. Residence Requirement

8. Attendance Centre

9. Curfew

10. Exclusion

11. Prohibited Activity

12. Foreign Travel Prohibition

13. Attendance Centre ( under 25)

Offender

Court

Community

sentence

Custodial

sentence

Community Order/

Suspended

Sentence OrderPrison

• In 2016 the percentage of treatment requirements commenced as part of a

community order or suspended sentence order was:

• MHTR = 0.3% (669)

• DRR = 5% (9,698)

• ATR = 3% (6,064)

• Community Sentences have decreased by 25% between 2009 -2016:

• MHTRs decreased by 9% between 2015 /16 and by 39% since 2009

• DRRs have decreased by 18% and 40% respectively

• ATRs decreased by 13% and 34% over the same time periods

• Since the introduction of the Rehabilitation Activity Requirements (RARs) in

2015 there has been significant use of the requirement

• In 2016: 74,192 RARs were given representing 37% of all requirements as

part of a community or SSO

The context

CSTR: Innovative approaches

• Addressing mental health and substance misuse needs at the point of sentence

• Enabling effective community orders by providing access to individualised

treatments

• Addressing mental health, substance misuse (and social care) issues, (personality

disorders not excluded)

• Providing trauma-informed approaches and support with domestic abuse/coercive

behaviours

• Sentencing multiple requirements within the one order (MHTR, DRR, ATR)

• Supporting effective Offender Management by Probation Services

• Supporting the most difficult to engage offenders into local health and social care

services

• On the day sentencing, via recommendations in pre-sentence reports (or if not

possible within 14 days)

• Service design developed locally through multi-disciplinary steering groups

• Integration into appropriate community services

CSTR Programme Overview

Assessment

1. Health, substance,

social, family and

relationships

2. Addressing core

issues

3. Consent (MHTR)

4. Offender centric

5. Solution focused

Intervention

1. Evidence based, NICE

approved

2. Trauma informed

3. Professionally

supervised

4. Coordinated by

Responsible Officer

(Offender Manager)

Review progress

1. Throughout sentence

2. Post-completion

3, 6, 12 month

3. DRRs lasting one year

or more must be

reviewed by the court

on at least a monthly

basis

Objectives

1. Reduce reoffending and improve health and social outcomes

2. Reduce short-term custodial sentencing through the use of integrated partnerships

3. By testing the CSTR protocol

• Liaison and Diversion (L&D) services cover over 80% of the population

across England and Wales, with full roll out expected in 2020-21

• The services provide assessment and diversion to appropriate treatment

and support for people with mental health, learning disabilities and

substance misuse issues from arrest to the point of sentencing

• Clinical staff are based in both police stations and court

The CSTR Protocol:

• CSTRs are to be developed through locally developed partnerships, led by

multidisciplinary Steering Group

• Advises that information from the L&D assessments may form part of the

pre-sentence advice provided to courts

• Sets out a court national minimum standard for access to treatment

• Reminds courts that they have the option to adjourn for further assessment

and to arrange treatment where necessary (but to sentence within 14 days)

• It reminds courts that MHTRs, DRRs and ATRs can be used in conjunction

with each other

Liaison & Diversion Services and the Protocol

Evaluation

Two phases:

• Phase 1 – feasibility/process study – January to June 2018

Qualitative data collection via DH-funded Policy Research Unit –

January to June 2018

Quantitative data collection from test bed sites and national datasets

• Phase 2 – longitudinal impact study Sept 2018 to Sept 2021 (subject to

results of phase 1 study)

Testbed support

• Ongoing testbed and Implementation support from the PST

• Steering group advice /set up and guidance

• Guidance/shared best practice around local awareness sessions

across: Judiciary, probation, health, police and court staff

• Process mapping

• Linking into other testbed, sharing practice and joint lerning

• Data collation

• Feeding back into CSTR programme board

Community Sentence Treatment Requirement (CSTR) Testbed

Process flow (Example)

Pre-sentence

The offence is likely to fall into the CO or SSO sentencing range

MHTR

(Magistrate

Court)

9.30 CDO Morning Pre- Briefing: for all parties to discuss the most appropriate options for the client, this will inform the planning

process for later in the day

a. Defence Solicitor/Court Duty Officer (CDO) discuss case after they have spoken to client. The offence is

within the Community Sentence bracket or higher.

9.45 CDO CDO takes the defendant to be interviewed, completes standard assessments and explains the CSTR process

10 Initial

screen

L&D or Link Worker: referral from solicitor, probation, self, carer. Brief screen along with vulnerability social care

measures, if screen indicates suitability the MHTR provider will be called to assess

10.30 onwards MHTR

provider

MHTR Provider: Assess using appropriate psychometric screening tools and write brief report, if suitable will gain consent

from defendant and agreement from clinical lead, and 1st appointment given to client

11

onwars

d

Provider

/CDO

MHTR Provider: information and appointment passed to Responsible Officer (RO)

DRR/ATR

(Magistrate

Court)

1. NPS/SM provider take the lead in completing DRR/ATR assessments, supported by provider who inform and

complete the assessments when required/available to meet demand.

2. If client is suitable for either requirement consent will be gained prior to sentence.

Crown Court

(DRR/ATR/MH

TR)

1. Jurisdiction is declined by the Magistrates Court and is sent to Crown

2. L&D or Link Worker and Providers completed in the Magistrates court (as per the 1st column)

3. Solicitor /RO information from assessments carried over to Crown Court

Sentence

Example Process Map

Some CSTR learnings to date:

• Partnerships: NPS/CRC/HMCTS/L&D/SM/NHS provider /Social

care/CCG/PCC

• Governance framework /data sharing agreement /Local protocol /TOR

• Detailed process mapping

• Clearly defined roles of responsibility across the pathways (who is

responsible for what)

• Clearly defined treatment provision along with referral and access

criteria

• Dedicated Responsible Practitioner for MHTR (Psychologist/

Psychiatrist)

• Awareness raising throughout the: Judiciary and Court staff, Probation

and healthcare

Thank You

Any Questions ?

@academyjustice

Academy forJustice

Commissioning