Evaluation of a liaison and diversion Court Mental Health Service for defendants with neurodevelopmental disorders

Over 30 years of liaison and diversion in England and Wales: How far have we come, and what is now needed?

“…• What health and justice outcomes arise following L&D interventions, and how might they be further improved? • Are adaptations required for particular groups, such as women, or people with learning disabilities, given emerging evidence of the effectiveness of specific interventions in these areas 10,21 • How can we move the focus of these services away from site specific triage and referral interventions, to the provision of wider oversight across healthcare pathways in the criminal justice system? • As the excitement of the initial national rollout fades, how do we best ensure that L&D services are fully supported over time, so that they do not drift away and become mere satellites of the wider health service?…”

“…However, not all is lost, and it is now time for us to frame some fundamental questions to guide the next steps. How can we move away from a focus on severe mental illness towards the all-illness model originally envisaged? What health and justice outcomes arise following L&D interventions, and how might they be further improved? Are adaptations required for particular groups, such as women, or people with learning disabilities, given emerging evidence of the effectiveness of specific interventions in these areas 10,21 How can we move the focus of these services away from site specific triage and referral interventions, to the provision of wider oversight across healthcare pathways in the criminal justice system? As the excitement of the initial national rollout fades, how do we best ensure that L&D services are fully supported over time, so that they do not drift away and become mere satellites of the wider health service? In our view, the improvements that have so far taken place in L&D services in England and Wales have largely been quantitative in nature, with an increase in geographical spread and the introduction of a national specification. However, the next phase in the evolution of these services must include qualitative improvements, such as moving towards an all-illness model, and away from single-event triage and referral models towards whole-pathways oversight.…”

“…Are adaptations required for particular groups, such as women, or people with learning disabilities, given emerging evidence of the effectiveness of specific interventions in these areas 10,21…”

Severe mental illness, common mental disorders, and neurodevelopmental conditions amongst 9088 lower court attendees in London, UK

“…The main focus of CMHLDS is on people who present with major mental illness; however, their remit can include other vulnerable groups including people with Neurodevelopmental Disorders (NDD)s, substance and alcohol misuse or those at risk of selfharming and suicidal behaviour [1,8]. To date, little research is available regarding the characteristics of court defendants referred to CMHLDS.…”

“…To date, little research is available regarding the characteristics of court defendants referred to CMHLDS. Referrals are received from several routes including Forensic Mental Health Practitioners, probation (who will often provide initial screening), health agencies, Magistrates, court detention staff, police and voluntary services [1]. In England and Wales, key national reports have highlighted deficiencies in existing CMHLDS and described the inequalities experienced by people from groups that have not traditionally been prioritised within these services, including those with intellectual disability (ID) [9,10], autism spectrum disorders (ASD) and attention deficit and hyperactivity disorder (ADHD) [2].…”