Mental health is rightly moving up the agenda in London. The Mayor of London has launched Thrive LDN, a city-wide movement, to raise awareness and challenge the stigmatisation of mental health issues. But does it ignore offenders and ex-offenders?
Here at the London Assembly Health Committee we have been investigating access to mental health support for marginalised groups. We spoke with expert guests in the sector, front-line workers and ex-offenders themselves. And the message was clear: offender and ex-offender mental health is an overlooked area of mental health.
But we can't afford to overlook offender and ex-offender mental health. The mental health outcomes are shocking. Prisoners are four times as likely to suffer depression as the general population. Male prisoners are ten times as likely to have experienced a psychotic episode in the last year. And these issues can ultimately lead to suicide. The British Medical Association told us that 46 per cent of female offenders have attempted suicide at some point in their lives, compared to 6 per cent of the general population.
So we need to get our interactions with these vulnerable people right from the very start. And that means from the very first point of contact with the police.
The Mayor's Office for Policing and Crime says that one in every ten calls the Met gets is related to mental health. All those we spoke to echoed Lord Adebowale's recommendation made four years ago for comprehensive officer training to recognise and de-escalate those suffering a mental health crisis.
To its credit the Met has recognised the problem. All officers receive compulsory mental health training. Pilots are starting in North and East London for special Mental Health Investigation Teams and the Met is developing a triage service to divert women with mental health needs away from the criminal justice system in the first place. We need to get these schemes fully up and running, in order to save lives.
"People come in [to prison] and they come out worse"
Prison is not meant to be a pleasant experience. But everyone deserves a second chance and our current prison system - violent, overcrowded and under-funded - far too often destroys any hope at a second chance.
Core London prisons, such as Wandsworth, Brixton and Pentonville are all overcrowded. Wandsworth holds 50 per cent more prisoners than it was designed to. It's too easy to get hold of drugs. One in five heroin users reports first trying it in prison. Not enough staff means prisoners are in lock-up more often, unable to mix or go to classes. This isn't a healthy environment by any stretch of the imagination. We even heard of prisoners not being allowed to attend support services because there wasn't a guard free to accompany them. This is unacceptable.
And leaving prison is just as bad. Continuity is severely lacking. Even if you managed to see a mental health professional whilst inside, too often you are starting at square one on the outside. Ex-offenders told us how common it was to leave prison without a job or a stable living situation lined up. This is a huge suicide risk. One in five of all ex-offenders who try to commit suicide do so in the first 28 days. If the Mayor is serious about a zero-suicide city, this time point - the first 28 days - is when we really need to get it right.
So who is at fault? Some blame the way that probation is managed in London. For three years now the London Community Rehabilitation Company (CRC) has managed the majority of offenders in London (high-risk offenders are still managed by the Ministry of Justice). Regulators say probation services have deteriorated and that London is "now poorer than any other area that has been inspected." Of course the CRC say they are going to fix this. The Mayor needs to keep the pressure up, and make sure that offender mental health is firmly on the agenda for the CRC.
What can we do?
Firstly, if the prison environment is so disastrous for mental health, we need to help people stay out in the first place. There are a myriad of reasons why people offend, but early intervention is always going to be a good thing. Everyone we spoke to praised Liaison and Diversion (L&D) services, small teams who operate in custody suites and try to identify vulnerable people and divert them away from the criminal justice system and into more appropriate settings. We at the London Assembly fully support L&D teams and hope the Mayor and others in the criminal justice world will support their expansion across London.
Secondly, the Mayor has powers over housing. No one should leave prison to then immediately be homeless. Barnado's says that children as young as 13 are being released from custody with nowhere safe to go. Supported housing is a post-code lottery, with different thresholds in each borough. Rehabilitation officers have to navigate this complex environment, but ultimately if the borough doesn't deem an offender a priority case then housing is very hard to come by. The Mayor needs to explicitly address this in his housing strategy and homelessness programmes.
Thirdly, from 2019 the Mayor will run all employment support programmes in London. This is a real opportunity to better target programmes at this marginalised group. Meaningful employment is a significant driver of good mental health and is shown to reduce re-offending by up to 50 per cent. But having a criminal conviction is heavily stigmatised, and many routes into employment remain blocked. 60 per cent of those leaving prison do not have employment on leaving prison. The Mayor needs to lead by example too. We heard that public sector organisations have a particularly poor record in London for hiring ex-offenders. We can turn this around and the Mayor and the GLA can show leadership in this area.
Ultimately it is about being there. Being present at the right time, at a person's most vulnerable point. That might be when they first come into contact with a police officer, first time in a custody suite, first night in prison, or the first month after release. If we can support people when they are at their most vulnerable, then they no longer need to be offenders or ex-offenders, just citizens.