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Liaison and diversionfor BME service users:

A good practice guide for courtdiversion and criminal justicemental health liaison schemes

---A Nacro good practice guide

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Park Place10-12 Lawn LaneLondon SW8 1UDTel 020 7840 1209Fax 020 7840 1213Email [email protected]

www.nacromentalhealth.org.uk

www.nacro.org.uk

© Nacro 2009

Nacro is a registered charity, no. 226171.

Nacro welcomes a wide circulation of its ideas and information. However, all reproduction, storageand transmission must comply with that allowed under the Copyright, Designs and Patents Act1988, namely for the purposes of criticism or review, research or private study, or have the priorpermission in writing of the publishers.

ISBN 0-85069-224-5

Do you need this good practice guide in another format?

Tel: 020 7840 7220

This good practice guide was funded by the Department of Health and has beencompiled with the assistance of the Nacro Mental Health Reference Group and anexternal expert reference group of liaison and diversion scheme practitioners.


Introduction page 3

1 The background page 5

2 The foundations of asuccessful scheme page 7

Staff page 7

Equitable treatment page 8

Policies and protocols page 10

– Scope and importance page 10

– Bullying page 11

– Equality and diversity page 11

– Equality impact assessmentpage 12

Management page 13

Publicity page 14

3 Assessments page 16

Obtaining information andconsent page 16

Meeting cultural and religiousneeds page 17

Assessing risk page 20

Following the assessment page 21

4 Use of interpreters page 22

The interpreter’s role page 22

The practitioner’s role page 24

Building partnerships page 26

5 Recording and monitoringinformation page 28

Why monitor? page 28

What should schemes monitor?page 29

How information should becollected page 30

What should happen to theinformation? page 32

6 Networking and partnerships page 34

Why partner? page 34

Who should schemes partner? page 35

How should schemesengage? page 38

7 Training and staffdevelopment page 40

Scope and importance page 40

Reports and guidance page 41

8 Next steps page 43

Review page 43

Development plan page 44

9 Summary and conclusionpage 45

Appendix 1 Informationleaflet for service userspage 46

Appendix 2 Department ofHealth 16+1 nationalstandard ethnicmonitoring form page 47

Appendix 3 Comprehensiveethnic monitoring formpage 48

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Contents

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Introduction

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A significant number of service users from black and minorityethnic (BME) communities access mental health services viaaversive pathways, including the criminal justice system.1 Courtdiversion schemes and criminal justice mental health liaison(CJMHL) schemes, or similar arrangements, can play a vital rolein facilitating the transition for these individuals between thecriminal justice system and the health and social care sectors.A recent study by the Sainsbury Centre for Mental Health arguesthat well-designed arrangements for diversion have the potential toyield multiple benefits, including an average of £20,000 in crime-related costs per case, reductions in reoffending and improvementsin mental health.2 Successful schemes can:

� facilitate the early detection of people with mental healthneeds in the criminal justice system and ensure appropriateand effective outcomes

� ensure that all people with mental health needs who comeinto contact with the criminal justice system receive speedyand appropriate mental health assessments and thatrequests for further assessments are facilitated

� facilitate a multi-agency approach from all relevant agenciesworking with offenders with mental health problems

� provide advice and information to criminal justice agencies,including making appropriate recommendations

� liaise with a range of service providers, including thevoluntary sector and community-based providers

� assist with obtaining court reports

� assist with and facilitate disposal options.

However, even where such initiatives exist, the specific needsof BME service users are not always properly assessed or met,


either as a result of scheme practitioners not recognising andaddressing their particular requirements, or because of ascarcity of local resources.

This guide sets out good practice and guidance which willassist schemes to provide a more inclusive and responsiveservice to those from BME communities. Recognising that someschemes may be unable to attract the necessary resources tobring about significant change to their practice, it concentrateson an incremental approach to change, and wherever possiblemakes resource-neutral recommendations.

The guide is aimed at practitioners working on court diversionand CJMHL schemes, as well as their managers and thecommissioners of such services. It is based on the expertiseNacro has gained from its local development work, research,anti-discriminatory practice and national work with schemes,3 aswell as on input from Nacro Mental Health Unit’s own mentalhealth reference group4 and an external expert reference group.5

Although the focus is on court diversion and CJMHL schemes,much of the good practice will prove valuable to those workingat other key decision-making junctures along the offender mentalhealthcare pathway as well as to others working outside thecriminal justice system. Nacro’s Mental Health Unit has alsoproduced another good practice guide which examines goodpractice in relation to diverting all offenders with mental healthneeds, rather than specifically those from BME communities.6

Footnotes1 Reports with this finding include:� Browne D (1990) Black People, Mental Health and the Courts London: Nacro� Department of Health (2003) Inside Outside: Improving mental health services for black and minority ethnic

communities in England London: Department of Health� Sainsbury Centre for Mental Health (2002) Breaking the Circles of Fear London: Sainsbury Centre

for Mental Health2 Sainsbury Centre for Mental Health (2009) Diversion: A better way for criminal justice and mental

health London: Sainsbury Centre for Mental Health3 Nacro conducted a survey on court diversion and CJMHL schemes in England and Wales. This

covered key issues such as the assessment process, recording and monitoring, referrals, outcomesand collaborative working. To view key findings from the survey, go towww.nacromentalhealth.org.uk/templates/publications/resources.cfm?frmSiteID=2, select ‘diversion’from the drop-down list and then select ‘liaison and diversion for BME service users: a survey’.

4 All Nacro’s mental health work is overseen by a reference group. To view a list of the group’smembers, go to www.nacromentalhealth.org.uk/templates/publications/resources.cfm?frmSiteID=2,select ‘diversion’ from the drop-down list and then select ‘liaison and diversion for BME serviceusers: a survey’.

5 To view a list of the members of the external expert reference group, go towww.nacromentalhealth.org.uk/templates/publications/resources.cfm?frmSiteID=2, select ‘diversion’from the drop-down list and then select ‘liaison and diversion for BME service users: a survey’.

6 Nacro (2006) Liaison and Diversion for Mentally Disordered Offenders: A mental health good practiceguide London: Nacro

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Liaison and diversion for BME service users:A good practice guide for court diversion and criminal justice mental health liaison schemes


Chapter 1 The background

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The differential treatment of BME people who become involvedin the criminal justice and/or the psychiatric systems is arecognised and long established problem. Research and datamonitoring have consistently shown that those from BMEcommunities, particularly black communities, aredisproportionately represented in both the criminal justice andmental health systems.1 And this is further compounded by thefact that both these systems appear to further disadvantageBME individuals once they fall within their remit.

In recent years, a gradual shift has taken place in studies onthis subject away from a focus on disproportion to increasinginvestigation of the pathways by which BME people end up inthese settings. Following Inside, Outside,2 a document aimed atimproving mental health services for BME communities inEngland, and the Independent Inquiry into the Death of DavidBennett,3 the Department of Health published Delivering RaceEquality.4 This set out a national strategy for greater communityand partnership working between mainstream and statutoryservices on the one hand and BME communities on the other,recognising the role that the latter had to play in thedevelopment and delivery of services.

In addition, the significance of Delivering Race Equality was thatit proposed:

� the recruitment of community development workers to workat a senior level and alongside the regional race equalityleads in health and social care to improve commissioning,access, experiences and outcomes for all BME communities

� the mainstreaming of mental health services for BMEcommunities

� continuing work to ensure equal access to services


� promoting increased confidence among BME groups in thestatutory services.

In order to improve mental health for offenders, it is vital thatthe principles contained in Delivering Race Equality underpinthe development of the court diversion and CJMHL schemesand the integration of the same into mainstream services.

Two further initiatives are currently underway. Thegovernment’s offender health strategy, Improving Health,Supporting Justice 5 should ultimately provide a template formeeting the needs of all offenders along the criminal justicepathway. In addition, an independent review by Lord Bradley isexamining the extent to which offenders with mental healthproblems or learning disabilities might, in appropriate cases, bediverted from prison to other services. Central to the successof both initiatives will be ensuring that the services whichresult from them specifically address the needs of BME serviceusers.

Footnotes1 Fernando S (1991) Mental Health, Race and Culture London: Macmillan/MIND Publications2 Department of Health (2003) Inside Outside: Improving mental health services for black and

minority ethnic communities in England London: Department of Health3 Norfolk, Suffolk and Cambridgeshire Strategic Health Authority (2003) Independent Inquiry into the

Death of David Bennett: An independent inquiry set up under HSG (94)27 Cambridge: Norfolk,Suffolk and Cambridgeshire Strategic Health Authority

4 Department of Health (2005) Delivering Race Equality in Mental Healthcare: An action plan forreform inside and outside services (including the government’s response to the independent inquiryinto the death of David Bennett) London: Department of Health

5 Department of Health, Children, Schools and Families, the Ministry of Justice, the Youth Justice Boardand the Home Office (2007) Improving Health, Supporting Justice – A Consultation Document: Astrategy for improving health and social care services for people subject to the criminal justicesystem London: Department of Health

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Chapter 2 The foundations of asuccessful scheme

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StaffThe services provided by court diversion and CJMHL schemesmust reflect the needs of the communities they serve. As such,they should comprise a diverse workforce which isrepresentative of the local community, both in relation toethnicity and gender. Not only will this ensure that the schemereflects the community it serves, it also allows a service user tochoose whether they wish to be assessed by someone of thesame gender and the same (or similar) minority ethnic group.People from BME groups will often feel more comfortableaccessing services where some staff are from their ownbackground,1 which can also result in a better qualityassessment as the service user is more engaged in the process.

Schemes must also ensure they meet the diverse needs of thecommunities they serve. As such, they should be both multi-agency and multi-disciplinary to enable a rounded assessmentand ensure access to a variety of disposal options. They shouldmirror the elements of a community mental health team andinclude (or have input from) the following: psychiatry,psychology, community psychiatric nursing (CPNs), social work,community support workers, criminal justice staff (inparticular, probation) and an administrator or secretarialsupport.

The reality, however, is currently very different. Many schemesare operated by only one practitioner whilst others do not havea diverse workforce2 and major changes in staffing may beunrealistic. In such cases, a strategy should be put in place toboth meet the needs of service users from BME communities inthe short term and develop a multi-disciplinary and diversestaff team in the long term.


As a short-term measure, those schemes unable to offer choiceshould negotiate arrangements with other more diverse teamsto assist with assessments, such as psychiatric transculturalteams3 and/or black mental health teams.4 In the long term, adevelopment plan should be drawn up to transform the schemeinto the multi-disciplinary model set out in the Offender MentalHealthcare Pathway.5 To ensure diversity, the plan should:

� identify the ethnic make-up of the geographical area inwhich the scheme operates and analyse this against thecurrent staff team to identify gaps

� ensure that future posts are advertised in a variety of waysto both inform and attract applicants from a range ofminority ethnic groups, particularly those from communitieswhere gaps have been identified

� encourage and enable existing practitioners to apply to thescheme by providing training and secondments, and ensurethat the scheme’s operational practice does not adverselyimpact on any particular group’s culture, faith or lifestyle.

Equitable treatmentAll schemes should embrace the principles of equality anddiversity. Equality means allowing everyone access to the sameservices and ensuring the best possible treatment and outcomefor each individual. Diversity is about the recognition andvaluing of difference in its broadest sense – creating a workingculture and practices that recognise, respect, value and harnessdifference for the benefit of the organisation and theindividual.

While many schemes claim they operate a ‘colour-blind’approach or assert that ‘everyone is treated the same’, such astance can disguise the fact that the specific needs of BMEservice users have either not been thought about or have beenignored. Fernando6 has argued that this stance – often thoughtto be liberal and progressive because the client appears to beconsidered as an individual irrespective of their cultural orracial background – can, in fact, have the opposite effect. An

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Chapter 2 The foundations of a successful scheme

assessment of a person cannot be carried out properly unless aperson is seen in context, and this context includes culture,race and faith.

Therefore, unless schemes proactively consider how they mightmeet the specific needs of BME service users, the result is likelyto be both an under-development of policies and the absence ofa systematic approach to meeting needs, as well as the fosteringof stereotypes and racist attitudes to BME communities. What isneeded is an approach that ‘moves away from the notion of “anaverage citizen” to an acknowledgement of the diversity of needand required services’.7 It is imperative therefore that schemesensure equal access to diverse services, equitable treatment andequitable outcomes. These efforts will, in turn, promoteincreased levels of confidence from BME service users andcommunities in statutory services.

Schemes can demonstrate their commitment to equitabletreatment and outcomes by implementing the followingmeasures:

� Creating systems for monitoring and tracking the number ofBME people with mental health needs who come into contactwith the criminal justice system, their experiences and whatoptions are made available to them. This information canthen be used to develop services with equitable provisionwhich meet the needs of each group.

� Incorporating anti-racist practice into the planning anddelivery of their service.

� Developing a range of appropriate responses incollaboration with BME communities to meet the needs ofBME service users.

� Ensuring their recommendations for outcomes followingintervention and assessment reflect the cultural andreligious needs of the individual.

� Liaising with BME service providers, including the voluntarysector, to ensure appropriate account is taken of culturalissues and access to a wide range of resources is available.



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� Ensuring that their development and service deliveryreflects their agency’s race equality scheme and diversityagenda.

� Ensuring that their operational protocol and associatedpolicies include statements on equality and diversity.

Policies and protocols

Scope and importanceFor the day-to-day operation of the scheme to be effective itmust be supported by an operational protocol. This shouldinclude information on:

� the aims of the service

� what the service offers

� who staffs the scheme and their roles and responsibilities

� the geographical area the scheme covers

� who is seen by the scheme

� criteria for referral to the scheme

� how to make a referral

� where the scheme is located

� the sites at which it operates

� the hours of operation

� contact details

� management and reporting structures.

The presence of a protocol clarifies what the process of theservice is, not just the elements that make it up. It is importantthat the protocol is jointly agreed by all key stakeholders toencourage ownership and accountability.

A protocol enables a scheme to have something against whichto measure itself. It also helps guarantee the continuity of thescheme should key individuals leave, while allowing newlyrecruited staff to gain an understanding of the scheme’s aimsand its overall operation.



Bullying

Reference should also be made in the protocol to dealing withbullying, harassment and discrimination (both direct andindirect) directed at service users or staff. This can occur in avariety of forms (whether physical, verbal or non-verbal) andcan range from an overt abuse of power, coercion or violence toless extreme forms which, nevertheless, can still have anadverse impact on the recipient. The following statement is anexample of what might be included in the operational policy.

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Harassment, discrimination and/or bullying of service usersor staff is not acceptable.

Every scheme member has a responsibility to ensure thathe/she does not incite, perpetuate or condone any form ofharassment, discrimination and/or bullying.

Managers and key stakeholders are responsible for ensuring

that harassment, discrimination or bullying of service users or

staff does not occur and there should be clear procedures (both

informal and formal) for dealing with such complaints.

If the scheme is operated by one single agency, then the

protocol needs to complement that organisation’s race equality

scheme. If operated by more than one agency then it needs to

complement the race equality scheme of each of the agencies

represented by the scheme.

Equality and diversity

Any such protocol should include a statement on equality and

diversity to ensure that these principles are reflected in the

way the scheme operates, the service it offers and the way it

values the diverse nature of its staff. An example of such a

statement can be found in the box overleaf.


Scheme A is committed to promoting equality anddiversity in all its activities for black and minority ethnicmen and women, people of all ages, people withdisabilities, people of every sexual orientation, refugeesand asylum seekers, people of all religious faiths andbeliefs, those with diverse communication needs, andoffenders and ex-offenders.

It will ensure equal access to services, equitabletreatment and equitable outcomes. It will also developspecialist provision where appropriate to meet thediverse needs of its client group.

Scheme A also recognises and values the diverse natureof its staff and the staff of partner agencies. It will workto ensure that the diversity of its staff reflects thepopulation it serves.

Equality impact assessmentA scheme’s protocol will need by law to be subject to anequality impact assessment (EIA). An EIA checks that the legalrequirements of race, gender and disability legislation are metto ensure that an organisation does not discriminate in the waythat it provides services and employment and that, wherepossible, it does all it can to promote equality and goodrelations between different groups. It does this by examining ascheme’s main functions and policies to see whether they havethe potential to affect people differently and to address real orpotential inequalities resulting from policy and practicedevelopment.

The EIA8 should:

� consider the needs, circumstances and experiences of thepeople (staff and service users) who will be affected by themain functions and policies of the scheme

� identify inequalities in outcomes, including unlawfuldiscrimination which can be real or potential

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� consider other ways of delivering a service or achieving theaims of the policy so that the impact is removed or minimised.

The EIA will be carried out by the agency that operates thescheme but the agency should consider involving partneragencies, other stakeholders and service users.

Firstly, any given policy will need to be assessed for itsrelevance to race equality. Once this has been established, a fullimpact assessment may be required. This should cover thefollowing elements:

� The policy aims – ie, what the policy is trying to achieve andhow.

� What data and research are available and relevant.

� The EIA process.

� What the actual and potential impact of the policy is on anyaspect of equality – this can be both positive or negative andintentional or secondary.

� Are there alternative policies if the existing one is likely tohave a negative impact on equality?

� Who are the relevant stakeholders to involve and consultand how can this be done?

� A report on the results of the EIA.

� Monitoring and review of both the existing arrangementsand any revisions that are made.

ManagementIt is vital that robust and co-ordinated arrangements are inplace to steer the day-to-day operation and future developmentof the scheme and link it with commissioners and managers ofservices. A steering group, consisting of representatives fromall relevant stakeholders, should meet regularly and at leastquarterly. It should have aims, terms of reference and a workprogramme. It must also be able to report directly to relevantagencies and other bodies.



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As well as key stakeholders (such as the police, health andsocial services, probation, the Crown Prosecution Service andthe courts) there should be representation from service users,carers and service providers and separate representation fromBME service users, carers and service providers. Where this isnot practical, there should be regular consultation ornetworking with these groups to ensure that their views andneeds are taken into account. This might be by directconsultation through existing channels or facilitated by aservice user organisation.

If there is a separate local or county-wide multi-agency group9

linked to commissioning and planning structures which co-ordinates strategy and which the scheme’s steering group canfeed into, then this too should have separate representationfrom BME service users, carers and service providers. Wheresuch representation is unavailable at either steering or localgroup level, a development or work programme should addressthis issue and develop a strategy to deal with it.

PublicityIn order to advertise the service and encourage referrals, thescheme will need to publicise itself in a variety of ways. Thismight include posters, flyers, leaflets or postings in agencies,on websites and in handbooks and other material. Agencies andwebsites providing services for BME communities in particularshould be targeted.

The nature of the material will vary depending upon themedium used, but it should include details of:

� where and when the scheme operates

� how to contact the scheme

� how to make a referral.

Promotional material on the scheme should be available atevery site the scheme operates from, and should also be madeavailable to the range of personnel who have input into the


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decision-making process along the offender mental healthcarepathway.

All material should prominently include a statement onequality and diversity, and indicate that anyone requiring theleaflet in another language or format should contact thescheme manager.

Footnotes1 Black and Minority Ethnic Health Equalities Action Team; Liverpool Health Authority (2001) Black and

Minority Ethnic Health Service Provision in Liverpool Primary Care Trusts Liverpool: Liverpool HealthAuthority

2 This finding resulted from a survey carried out by Nacro as part of its wider research on courtdiversion and CJMHL schemes in England and Wales (see footnote 3 on page 4 for more on this). Toview key findings from the survey, go to www.nacromentalhealth.org.uk/templates/publications/resources.cfm?frmSiteID=2, select ‘diversion’ from the drop-down list and then select ‘liaison anddiversion for BME service users: a survey’.

3 Transcultural teams consider the cultural and social context in which mental phenomena manifestand provide culturally congruent therapeutic interventions.

4 Black mental health teams provide support, advice and information for people with mental healthproblems who are from African, Asian, Chinese and African Caribbean communities.

5 Department of Health (2005) The Offender Mental Healthcare Pathway London: Department ofHealth

6 Fernando S (1991) Mental Health, Race and Culture London: Macmillan/MIND Publications7 North Wales Race Equality Network (2007) Race Equality in Practice Resource Pack: Supporting

advocates working with cultural diversity Penmaenmawr: North Wales Race Equality Network 8 For guidance on carrying out an equality impact assessment see www.nhsemployers.org/excellence/

excellence-1871.cfm.9 Often known as a mentally disordered offenders (MDO) group.


Chapter 3 Assessments

Assessment describes the process of gathering information onan individual for the purposes of identifying their needs. Itshould also include an assessment of risk. There are two mainelements to the assessment: the process itself (namely,gathering information) and the formatting of a care plan. Thisprocess needs to take full account of the service user’s culturalbackground and faith.

Schemes should aim to provide mental health assessments asspeedily as possible for all clients. There should be writtenagreement, in the form of agreed protocols, between thescheme, criminal justice agencies and health and social careprofessionals about the purpose of the assessment, how it willbe carried out and what outcomes might occur.

The assessment process should be underpinned by a coherentprogramme of training. Scheme managers, steering groupsand practitioners should actively search for culturalawareness training programmes and mental health trainingprogrammes for staff which incorporate anti-racist practice.These should constitute a mandatory part of schemepractitioner induction and ongoing training in general, but areof particular importance in relation to assessments and theassessment of risk.

Obtaining information and consentThe individual’s consent should be sought wherever possibleprior to confidential information being gathered and shared, orany advice being given. Where consent is not given, or isindeed impractical to obtain, there should be clear schemeguidelines (contained in jointly agreed information-sharingprotocols) about when and how information might be shared.

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Gaining the consent of individuals with mental health problemsis clearly never going to be a straightforward task. BME clientsmay have additional needs such as the need for languageinterpreters, and these will require additional attention andresources. Scheme staff should be aware of these issues andwork to promote local collaboration with interpreting agenciesand BME mental health groups in order to meet these needs.They should also be mindful of the fact that the dynamics andparameters of local need may change over time.

It is important to gather as much data as possible to assist withthe assessment. This should include information relevant tohealth and social care needs and cultural and religious needs.Information should also be sought from family and friends andfrom any service providers they are in contact with. Ifpractitioners are uncertain about the relevance of culturallyspecific information they should seek advice from BME serviceuser groups or other relevant organisations so that this can becontextualised. The key aim is to be objective, both in how theinformation is interpreted and in how it is used. This isparticularly important when it comes to the assessment of risk(see page 20).

Meeting cultural and religious needsThe assessment should be a positive process that helpsempower BME service users to articulate their own needs andidentifies appropriate outcomes. The specific cultural andreligious needs that a service user may have should beproactively identified and addressed. This should not be doneas part of a holistic assessment where issues may or may notbe raised, nor should practitioners make assumptions about aperson’s cultural background, language and beliefs. Instead,there should be a specific focus on it, with service users beingasked directly and sensitively about their cultural and religiousneeds and how these should be met. A member of Sheffieldtranscultural team who was interviewed by Nacro as part of itsresearch explained it thus: ‘We don’t just take it for grantedthat we know Pakistani needs and just offer them something

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based on that. We respect their views and will ask them whatwe can do for them.’

Scheme practitioners should seek to maximise the quality ofcultural information obtained during assessment by thedevelopment of a template or guide to gathering keyinformation. This should include:

� acknowledging the client’s culture and contextualising anybehaviours and feelings

� regarding culture as an integral part of the assessmentrather than as an external influence

� acknowledging the impact that race and racism may have onthe client’s presentation.

The key issue here is practitioner sensitivity to cultural issues,engaging with the service user and listening to their needs.Scheme personnel must provide a number of different optionslikely to meet the individual’s needs, of which assessment by amember of the same ethnic group is just one possible option.On occasion this option may have the power to change theassessment process from one in which the defendant is merelythe subject of an assessment to one in which he/she feelsempowered to give a full account of his/her feelings. But it mayalso be difficult to achieve ethnic matching (especially for thesmaller and newer migrant communities) and it should not bepresumed that people from the same ethnic background aremore likely to be empathetic towards a similar service user(different education and value systems and experiences ofclass, caste and migration can all come into play). It isimportant therefore that practitioners with a different ethnicidentity to the service user do not allow themselves to succumbto a feeling of disempowerment: ‘A white staff worker is no lessequipped to provide a culturally responsive service for BMEclients than a black or Asian staff worker. Competency andcommitment will cross all ethnic boundaries.’1

Practitioners should ensure they comply with the followingpoints of good practice:

� Recognise that attitudes to, and understanding of, mental ill

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health vary between cultures and that stigma may beattached to this.

� Provide, where possible, a member of staff from the same orsimilar minority ethnic group to complete the assessment.Service users should be asked which language they wouldprefer the assessment to be carried out in.

� Respect and meet the specific needs of women. For example,the assessment should not, in certain cases, be carried outby a male member of staff on his own.

� Understand and respect people’s routines, the lives theylead, the clothes they wear, the beliefs they have andinteract in a sympathetic way, taking their cue from theservice user.

� Proactively consider involving specialist agencies in jointassessments where BME service users are involved.

� When obtaining consent for the gathering and sharing ofinformation, full consideration should be given to anypotential language barrier or misinterpretation. Where thismight occur appropriate interpreting services should beused.

The nature of assessments within the criminal justice processoften means that they have to be carried out speedily. This canresult in staff feeling restricted in the latitude they can give tocollecting cultural information during an assessment, or feelingthat time does not permit them to arrange an assessment fromanother team. In such instances it may be necessary to conductan initial assessment or triage to ascertain whether there areany concerns before a full assessment is completed later. Wherethis is the case, discussions can be held with criminal justiceagencies to delay the process by adjourning a case or remandingthe defendant (either on bail ensuring there is communitysupport or in hospital including using Part III of the MentalHealth Act 2007 eg, s35) until a full assessment can be carriedout by an acceptable practitioner at a later date. (Note that aremand to custody is likely to mean that the defendant will beless easily available for further assessment and may also

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exacerbate any mental health problem present.) Additionally, amember of a local black mental health team or psychiatrictranscultural team could be seconded to the court diversion orCJMHL schemes to assist with such assessments.

Assessing riskA number of inquiries have shown that race and ethnicity areoften seen as an indicator of dangerousness.2 The SainsburyCentre for Mental Health has also shown that there is a historyof misunderstanding and/or discrimination when it comes tothe use of compulsory powers against African Caribbeans.3 It isvital therefore that practitioners guard against suchperceptions and instead assess risk against a set of constantparameters as follows:

� Any history of offending, including the severity of offences.

� Diagnosis, where relevant.

� Any deterioration in the person’s mental health, eg,experiencing delusions, having violent thoughts or hearingdestructive voices.

� Any history of substance and/or alcohol use.

� The stability of their living conditions.

� Any psychosexual assessment.

� The environment they live in and what opportunities, if any,there are to offend.

� An understanding of any significant dates, ie, anniversariesof significant life events or of previous offending.

� Their compliance with previous treatment/management/supervision.

� Any situations and circumstances known to increase the riskthey may pose.

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Following the assessmentOnce an assessment is completed a care plan should be formattedto meet the needs which have been identified. Schemes should beclear about what advice might be made available to criminal justiceagencies. If this is given verbally, it should always be supported bya written record. Recommendations following assessment byscheme practitioners should involve input from BME communityand mental health groups where possible, and certainly wheneverthey have been involved in joint assessment.

Footnotes1 Department of Health (2007) Positive Steps: Supporting race equality in mental healthcare London:

Department of Health2 These include:

� Prins H, Backer-Holst T, Francis E and Keitch I (1993) Report of the Committee of Inquiry into theDeath in Broadmoor Hospital of Orville Blackwood and a Review of the Deaths of Two Other AfroCaribbean Patients: Big, Black and Dangerous London: Special Hospitals Service Authority

� Norfolk, Suffolk and Cambridgeshire Strategic Health Authority (2003) Independent Inquiry intothe Death of David Bennett: An independent inquiry set up under HSG (94)27 Cambridge: Norfolk,Suffolk and Cambridgeshire Strategic Health Authority

3 Sainsbury Centre for Mental Health (2002) Breaking the Circles of Fear London: Sainsbury Centre forMental Health

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Chapter 4 Use of interpreters

Few of the schemes surveyed by Nacro’s research1 had bilingualstaff and none of these staff were used as interpreters. Reasonsfor this included the following:

� Individual staff were not confident about their language skills.

� Practitioners were worried about a potential conflict ofinterest between acting as an interpreter and subsequentlycarrying out an assessment of an individual.

� Individual staff members didn’t want to be seen as aresource for other agencies as this would impact on theirown workload.

Consequently most schemes used whichever interpreters wereavailable to the agency where the assessment was taking placeie, if at the police station then via the police, if at court thenvia the courts. Only one or two had access to a discrete service.Most schemes said that the time taken to access an interpreterwas a concern. Schemes were also worried about the potentialfor the nuances of a mental health assessment to be lost duringthe translation process.

Nonetheless, providing communications support to serviceusers is a legal requirement and not an optional extra.Legislation such as the Disability Discrimination Act 1995, theRace Relations (Amendment) Act 2000 and the Human Rights Act1998 requires public organisations to provide language andother communications support to individuals seeking help. Assuch, the use of interpreters must be seen as an integral part ofthe service a scheme offers.

The interpreter’s roleThe role of the interpreter is to facilitate communicationbetween two individuals where, typically, one is a serviceprovider and the other is a service user. It is important to note

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that interpretation and translation are different professions,although some people do both. Interpreters tend to work bothinto and hence from both languages (ie, the source and targetlanguage) whereas translators usually only work in onedirection – into their own native language. Both professionsrequire fluency in at least two languages: the native and thesecond language. The second language needs to be understood,written and spoken to near perfection.

It is generally considered that the use of a family member orfriend is not satisfactory to perform the service because:

� the service user may be unwilling to discuss confidential orsensitive information when the person interpreting is knownto them or lives in the same community

� the information may not be translated accurately in eitherdirection

� the person translating may be embarrassed at translatingsome of the questions and/or answers and may censor thelanguage

� the person translating may have insufficient experience,knowledge or vocabulary to translate effectively

� the person translating may have little or no understandingof clinical or mental health concepts or terminology and sowill experience problems in conveying information

� the person translating may transmit the wrong message,omit crucial information or add new information

� the person translating may have less proficiency in thetarget language than assumed

� there may be a lack of professionalism and no indemnity.

However, findings published by the Joseph RowntreeFoundation2 found that service users mostly prefer family orfriends to interpret for them as they have an ongoingrelationship with them that includes trust, emotionalcommitment and loyalty. In addition, the study found thatpeople were often able to distinguish for themselves betweensituations where they could get by with their own limitedlanguage, where they required help from a family member or

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friend and where they required the services of a professionalinterpreter. Specialist help was often seen as important inmedical or legal matters. Those who did value professionalinterpreters for their knowledge of systems, however, alsowanted the interpreter to help with their understanding ofprocedures, be proactive and be able to plead their case. Inaddition, while service users wanted interpreters to empathisewith them, in practice they often found them to be uncaring oreven actively against them. The Rowntree research shows thatthe character, attitude and trustworthiness of professionalinterpreters are crucially important and something thatschemes need to take into consideration.

The practitioner’s rolePractitioners should check with service users whether or notthey feel competent to participate in the assessment process. Ifa service user wants to have someone to interpret for them,then a further discussion needs to take place about who thatmight be – a lay interpreter (ie, family member, friend ormember of the local community) or a professional interpreter.

It should be recognised that this process may not be an easy taskwhen someone is unwell and where English is not their firstlanguage. There may also be additional pressures imposed by thecriminal justice process, for example an impending courtappearance. At this juncture in particular, the presence of familyand friends as cultural interpreters or sounding boards in assistingthe assessment process can be important. In such circumstancesthe practitioner may have to make their own judgement as to whatwould be appropriate. Such decisions should be made on the basisof what is best for the service user and not on what is the mostexpedient course of action.

Prior to the assessment taking place, the practitioner shouldspend time with the interpreter discussing the process andestablishing the way in which they will work together. While theresponsibility for the interview lies with the practitioner, he orshe must also show respect for the interpreter (whether lay orprofessional) and their skills. The practitioner needs to ensurethat the interpreter:

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� speaks the same language and dialect as the service user

� understands that the content of the interview remainsconfidential

� understands that they should translate exactly what is saidand not paraphrase the interview

� makes notes or uses some method to record exactly what issaid rather than relying on their memory

� will interrupt the interview if they are not clear what isbeing said or if they feel that the practitioner hasmisunderstood what has been said

� uses direct address and not the third person.

The practitioner should ensure that they can pronounce theservice user’s name correctly – they may wish to ask theinterpreter to teach them the correct pronunciation – andshould make sure they use the correct form of address. Theyshould ensure that they have enough time to complete theassessment which is likely to take considerably longer –perhaps double the time it would take with an English-speakingservice user. Before the assessment starts, they should checkwith the service user that the interpreter is acceptable to themand explain what each of their roles are to the service user.They should also reassure the person that the interpreter willkeep the contents of the interview confidential. Thepractitioner should position him or herself directly in front ofthe service user with the interpreter to one side.

During the assessment the practitioner should speak directly tothe service user and not the interpreter. They should look atthe service user and not the interpreter, even when theinterpreter is speaking. They should use straightforwardlanguage in place of jargon and avoid complicated terms unlessabsolutely necessary. The practitioner should actively listenwhen the service user speaks, even though they mayunderstand little or nothing of what is being said. At the end ofthe assessment they should check with the service user thatthey have understood everything or whether they want to asksomething.

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If, during the interview, things seem to be going wrong thepractitioner should attempt to identify the problem byconsidering the following:

� Does the interpreter have sufficient language skills – both inthe service user’s language and the practitioner’s?

� Is the interpreter acceptable to the service user (eg, samegender, same minority ethnic group, similar age etc)?

� Does the relationship, if any, between the interpreter andservice user inhibit either or both of them?

� Has the interpreter understood the purpose of theinterview/assessment?

� Does the content of the assessment embarrass theinterpreter?

� Is the practitioner using simple, jargon-free language?

� Is the practitioner allowing the interpreter enough time?

� Is there a professional relationship between the practitionerand the interpreter with both valuing the skills of the other?

Once the assessment has been completed, the practitionershould make time to have a post-interview discussion with theinterpreter. This should include an understanding, from bothsides, of how the interview went and consideration of whetherthe information needs further clarification or additionalinformation should be sought.

Building partnershipsRather than simply relying on who might be available, schemesshould give active consideration to which interpreters might beused and when. BME voluntary sector organisations should alsobe actively considered as they provide a potential source ofinterpreters. Schemes should try and build up a relationshipwith the same (or same group of) interpreters depending upontheir language skills and acceptability to service users. Schemepractitioners should then discuss with this group what the aimof the scheme is, the purpose of assessment, the terms thatmight be used during the assessment interview and what thesemean. They should also emphasise the importance of accurate

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and exact translation – even when this appears odd or bizarre –as the nuances of language are often vital in such mental healthassessments. Where such local services are not available or arelikely to take a long time to put into place, practitioners shouldconsider using Language Line3 or a similar telephone interpretingservice.

The development of service level agreements in this area canhelp to ensure consistency and clarify the expectations ofprofessionals about the role of interpreters and the consistencyof their usage. Training for interpreters in mental health andcriminal justice issues is also something that should beproactively explored by scheme personnel and commissioners.

Footnotes1 This finding resulted from a survey carried out by Nacro as part of its wider research on court

diversion and CJMHL schemes in England and Wales (see footnote 3 on page 4 for more on this). Toview key findings from the survey, go to www.nacromentalhealth.org.uk/templates/publications/resources.cfm?frmSiteID=2, select ‘diversion’ from the drop-down list and then select ‘liaison anddiversion for BME service users: a survey’.

2 Alexander C, Edwards R and Temple B with Kanani U, Liu Z, Miah M and Sam A (2004) Access toServices with Interpreters: User views York: Joseph Rowntree Foundation

3 Language Line can be contacted on 0800 169 2879 or at www.languageline.co.uk.

Good practice example Sandwell Forensic Liaison Service provides a Monday toFriday service which covers two magistrates’ courts andworks with the probation service and prisons. They visit thecourts on a daily basis and find they have to use a localinterpreter service on average twice a month. Theinterpreter service caters for a wide range of languages andis available 24 hours a day, seven days a week. Prior tousing the service, the Sandwell team met with theinterpreters to discuss their needs and to provide trainingfor the latter on how best to provide an effective serviceunder difficult conditions, including how questions shouldbe phrased, what information it is important to translateand how. Sandwell believes that this proactive approach hasenabled them to provide a better service to their clients.

For more information, contact Sandwell Forensic LiaisonService, Churchvale, Lowry Close, Smethwick, WestMidlands B67 7QT, tel: 0121 612 6700.

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Chapter 5 Recording and monitoring information

Why monitor?All schemes should carry out recording and monitoringactivities. Without this hard data it is impossible to gauge howwell the scheme is operating and what, if any, identifiable gapsin provision there are. Nor is it sufficient to simply recordinformation: it must be collated and analysed to gain an overallpicture of how the scheme is operating, assess whether it isreaching a range of potential service users and to what extent itis meeting their needs.

Broad information and advice about what information shouldbe collected as part of any monitoring exercise is provided inthe Nacro good practice guide: Liaison and Diversion for MentallyDisordered Offenders.1

As part of the overall recording and monitoring process, ethnicmonitoring – the collection, analysis and use of ethnic groupinformation (and, where appropriate, related information onlanguage, religion and diet) – is essential. It allows agencies toassess and address access problems, health inequalities anddiscrimination experienced by BME service users or thecommunities they come from, and create a more equitable andappropriate service for service users, communities and staff.Although ethnic monitoring of services was introduced bymany local authorities in the 1970s, the practice only becamewidespread in the 1980s and was taken up even later bycriminal justice agencies. It is required by the Race Relations(Amendment) Act 2000 and is encouraged by the Department ofHealth through its health equality audits, its leadership andrace equality action plan and its performance assessments. Ona clinical level, ethnic monitoring helps an assessment of anindividual’s needs and circumstances, ensuring that access toservices and service delivery can be as personalised and

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appropriate as possible. For example, information on a person’sparticular background may assist with diagnosis, orinformation about a person’s main spoken language couldindicate a need for translation and interpreting services.

It is important that schemes develop an information leafletexplaining the reasons for recording and monitoringinformation, and allaying any fears that ethnic groupinformation may be used to discriminate against individualsand groups. The leaflet should emphasise that while schemesand other local services highly value the information,individuals are not obliged to disclose their ethnic identityunless they so choose. The leaflet should be made available ina range of languages and mediums to meet the needs of thelocal population and its content and dissemination should bediscussed with local community groups. A sample leaflet isshown in appendix 1.

What should schemes monitor?Schemes should already be collecting information on:

� date and time of initial assessment

� site of intervention

� referring agency

� mental health state

� subsequent assessment details

� criminal justice history

� risk factors – both to self and others

� drug and alcohol concerns

� any recommendations (unless the scheme has practitionersfrom criminal justice agencies these should just be health-related recommendations, although they may comment onwhether or not someone may be suitable for a particularcriminal justice sanction)

� outcomes – including health, social care and criminal justiceoutcomes.

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The personal details section should include:

� name/address/age/gender/employment status/accommodation status/ethnicity

� first language

� preferred language

� the need for a translator

� nationality

� refugee status (if relevant)

� asylum seeker status (if relevant)

� faith

� previous contact with BME community mental healthorganisations

� preference for an assessor of the same gender

� preference for an assessor of the same ethnicity.

How information should be collectedIt is essential good practice that information on service users(including their preferred language, ethnic group and religion)is recorded and monitored in a consistent manner. Someservice users may give their religion when asked about theirethnic group. Where this happens, schemes should recordreligion separately but ask individuals to give their ethnicgroup as well, based on the categories they are using.

The information collected should complement, and allow foranalysis and comparisons with, statistics from other agenciesand services and local demographic data. Information shouldbe collected and recorded at the earliest possible opportunity.

Schemes can either replicate monitoring systems used by oneor other of the individual agencies contributing to the schemeor, alternatively, use those categories listed in the NationalCensus. The Department of Health recommends that NHS trustsand local authorities use the 16+1 code national standard (see

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appendix 2) as a minimum for collecting and reporting on theethnic group of service users and staff.2 This will ensure thatcomparisons can be made with local population figures andalterations can be made according to local or changing need.3

One scheme surveyed as part of research conducted by Nacroexplained their practice as follows: ‘We try to reflect the localpopulation, local need and local trends. We include Irish, Irishtravellers and Romany, and we’ve started to record contact withEastern European migrants and refugee and asylum seekerpopulations.’ An example of a comprehensive ethnic monitoringform, including faith and language categories, can be found atappendix 3.

Self-classification is an important part of how informationshould be collected, ie, service users select their own ethnicgroup from the codes on offer. In doing so, they should bemade aware of the different codes they may choose from. Thisis important since ethnicity is as complex to define as it ismulti-faceted. It is also subjective and while other people mayview an individual as having a certain ethnic identity, theindividual’s view of their own identity should always takepriority. Features that help to define ethnicity include:

� a shared history

� a common cultural tradition

� a common geographical origin

� descent from common ancestors

� a common language

� a common religion

� forming a distinct group within a larger community.

Occasions where third parties identify the ethnic group ofpatients and service users will be the exception and should behandled sensitively. Where another agency has alreadyindicated a particular ethnic group, then this informationshould be checked with the service user in person. Indeed, thisshould be routine for all personal information recorded.

Consent and confidentiality should also be respected at alltimes. No one should be forced into giving their ethnic group

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against their will and service users should be assured thatinformation they give will remain confidential unless they havegiven permission to share it or when other rules apply.4

What should happen to the information?Information should be routinely and regularly collated andanalysed and compared against local demographic data toensure that the scheme is reaching all communities.Recommendations and outcomes for different ethnic groupsand genders should be broken down and compared to identifywhether or not different groups have different experiences anddiffering needs.

It is essential that the scheme’s senior management, steeringgroup, commissioners and other relevant bodies demonstrate aclear commitment to monitoring, including ethnic monitoring.They should be able to demonstrate how they have used ethnicgroup and related data to influence their decision-making inrelation to commissioning and planning local services andensuring equality of access. As part of this, they should consultopenly with local communities and their staff over theirapproaches to ethnic monitoring.

The information collected should be used to inform servicedelivery, commissioning and the planning of new services andinitiatives. It is important that funders and other stakeholdersalso feed back information to schemes on a regular basis. Inresearch conducted by Nacro, one scheme’s practitionercomplained: ‘There’s very little information that comes back.Rather it’s the scheme itself that has always been the drivingforce behind any developments we’ve made. We’ve always beenthe ones to think about how the service might expand.’

One thing to bear in mind is that the the comprehensiverecording and monitoring of ethnic and cultural informationcan heighten expectations of change which it may then not bepossible to implement due to lack of local resources. Schemepractitioners need to be aware of this, while working hard toeffect as much change as possible. Therefore, while it is

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accepted that local services on offer may be scarce, it remainsincumbent on practitioners to monitor, map and make practicallinks with all potentially useful BME and community and healthagencies.

Good practice exampleSandwell Forensic Liaison Service records recommendationsand outcomes which are broken down and correlated withethnicity, so they can be compared across different ethnicgroups. Statistics are compared with those from theNational Census.

For more information, contact Sandwell Forensic LiaisonService, Churchvale, Lowry Close, Smethwick, WestMidlands B67 7QT, tel: 0121 612 6700.

Footnotes1 Nacro (2006) Liaison and Diversion for Mentally Disordered Offenders: A mental health good

practice guide London: Nacro2 Department of Health, Health and Social Care Information Centre, NHS employers (2005) Practical

Guide to Ethnic Monitoring in the NHS and Social Care London: Department of Health3 For an alternative expanded version of national census categories, see

http://83.137.212.42/sitearchive/cre/gdpract/em_cat_ew.html. 4 See Nacro (2005) Multi-agency Partnership Working and the Delivery of Services to Mentally

Disordered Offenders: Key principles and practice London: Nacro

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Chapter 6 Networking and partnerships

Why partner?The most effective way for court diversion and CJMHL schemesto meet the needs of service users from BME communities incontact with the criminal justice system is through apartnership or multi-agency approach, whether at a strategic,operational or individual case level. This allows for agencies,organisations and practitioners to work together with a sharedvision of the desired outcome for service users and how toachieve it. For partnership working to be truly effective it needsto be supported by strategic arrangements and joint protocols,with suitably resourced policies, initiatives and systems inplace to make it possible to measure outcomes and success.

Specific links with community-based BME organisations may beable to:

� contextualise information

� assist with translation

� act as an onward referral

� assist with training needs

� act as a link with other services.

Guidance on partnership working with offenders with mentalhealth needs – including the need for multi-agency trainingprogrammes – was initially contained in Home Office Circulars66/90 1 and 12/952 and the recommendations of the ReedReview.3 Significantly, Reed noted: ‘It is important thatdiversion schemes provide a service which is appropriate andacceptable. This will require the involvement of the AfricanCaribbean community in developing the service, as well as theinvolvement of staff who are sensitive to the issues of race andculture and the implications of socio-economic disadvantagefor ethnic minorities.’

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However, BME service users should not only be referred toservices designed specifically for BME communities. Rather, it isabout developing links with a range of potential providers sothat the most effective outcome can be achieved and where anelement of choice is available. In order for court diversion andCJMHL schemes to achieve this aim and produce effective andappropriate outcomes for BME service users, they must beintegrated and have a close working relationship with allmainstream services, including community services. Formallinks (ie, where there are agreed criteria and a protocol forreferral – including information sharing – and where there is aprocess to allow for an audit of referrals) should therefore beforged with a range of community providers to allow for avariety of disposals to take place.

Who should schemes partner?Schemes should place particular emphasis on linking with BMEwomen’s groups, as their needs tend to be neglected in thedevelopment of services. Scheme practitioners should ensurethey do the following:

� Develop proactive links with BME women-specific projects,including those for housing, employment and training, andchildcare: BME women are often under strong pressure tofulfil care roles (elder care, child care etc). As such,involvement with the criminal justice process will haveparticularly marked repercussions and has the potential tocause particular anxieties for this group.

� Receive training to assist in identifying concerns such asself-harm, eating disorders, depression and anxiety.

� Understand the link between physical issues and mentalhealth problems eg, post-natal depression.

� Become aware of and enlist training on the needs of womenfrom BME communities eg, the potential sense of trauma andloss that can result from finding oneself a refugee or in needof asylum, or the grief and sense of bereavement that can

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follow finding oneself incarcerated in one country whilstone’s children remain in another.

Schemes should also be developing partnerships with serviceuser groups. Any information and feedback received shouldinform and assist the evaluation of the scheme’s operation.

Scheme practitioners should be looking to develop links with:

� translation services for people whose first language is notEnglish

� specialist services for men and women from BME groups

� local race equality leads

� locally based community development workers for mentalhealth

� housing and accommodation providers (who might be ableto offer services to those seeking asylum or those withrefugee status).

Any links that schemes do make should be more extensive thanjust making referrals on a case-by-case basis.

Good practice exampleA positive and proactive approach to collaborativeworking that schemes might do well to emulate isprovided by the Elmore team in Oxford. A practitionerfrom this agency summarised their approach as follows:‘If you work with different clients you need to build andmaintain relationships so that these organisations aremore likely to take your referrals. This involves visitingprojects, understanding their criteria, being seen as aresource and respecting and assisting the project.’

For more information contact the Elmore team at 174bBullingdon House, Cowley Road, Oxford OX4 1UE, tel: 01865 200 130, fax: 01865 246 039, email:[email protected].

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One potential resource that can successfully assist courtdiversion and CJMHL scheme networks is the communitydevelopment worker. This role was created as a result of thestrategy set out in Delivering Race Equality 4 to ensure greatercommunity engagement and partnership working betweenmainstream and statutory services on the one hand and BMEcommunity and mental health groups on the other. Thesepractitioners act as:

� a change agent eg, by identifying gaps and developinginnovative practice

� a service developer eg, promoting joint working, educationand training

� a capacity builder within BME communities

� an access facilitator to services, community resources,overcoming language and cultural barriers.

Schemes need to work with community development workers todevelop an agenda of engagement with BME service users,

Good practice exampleSheffield transcultural team hosts a transcultural interestgroup on the third Monday of each month. This is open toall people working locally who are interested in mentalhealth issues or working with BME communities.Practitioners from any discipline can attend to sharepractice and exchange ideas. This well-regarded initiative islinked into Sheffield Health and Social Care Trust and haspositively helped other services develop their own responseto BME service users.

For more information contact the manager at East GladeCentre, 1 East Glade Crescent, Sheffield S12 4QN, tel: 0114 271 6451.

Practitioners will also benefit from liaising and networking withspecific projects and teams who work with BME communitieson a daily basis.

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carers and service providers in order to facilitate theconstruction of effective and appropriate pathways for BMEservice users in contact with the criminal justice system.Community development workers can offer support and adviceto schemes and help them engage fully with BME networks.While community development workers are a useful aid,scheme practitioners should ensure that they themselves alsocontinue to make links with and engage with BME groups andservices.

How should schemes engage?For schemes to develop clear collaborative strategies forworking with specialist services for BME service users(including women) they should:

� map specialist services, not just in their region but alsofurther afield

� establish links, both formal and informal, with the servicesidentified including joint protocols

� establish clear lines of communication and methods ofreferral

� agree timescales with agencies to ensure that a timelyservice can be offered to BME clients

� work closely with BME service users to receive feedbackabout the scheme’s operation and effectiveness in this areaand assist with the evaluation process

� identify gaps in provision and work with others to resolvethese

� develop a handbook/directory of specific services.

Schemes should be able to provide a positive answer to thefollowing checklist of questions if they want to proactivelyengage with the BME voluntary sector, health and communityorganisations in their region:

� Do we have an effective equal opportunity policy and anequality action plan?

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� Have we implemented any staff training in culturalawareness and diversity issues?

� Have we mapped information about the relevant BME groupsin our region?

� Do we have any formal links with any of the relevantgroups?

� Do we keep them in the loop/are they part of our emailnetwork?

� Have we fostered any informal links through a developmentworker or community project?

� Have we been able to demonstrate that our service users(will) benefit from the partnership and the expertise offeredthrough collaboration?

The views of BME service users can be gathered in a variety ofways:

� satisfaction surveys

� good quality monitoring and evaluation

� a clear and accessible feedback and complaints procedure

� focus groups where verbal testimony might be gathered.

In areas where schemes see few service users from BMEcommunities and/or where there are few specific resources, itmay be even more important to proactively develop relevantpartnerships; practitioners need to be creative in enabling thisto happen. Schemes may need to look outside their own localgeographical area to identify where they may make referrals orseek advice. However, this should not be a substitute forincreasing their own knowledge base or working with others todevelop appropriate local resources.

Footnotes1 Home Office (1990) Circular 66/90 Provision for Mentally Disordered Offenders London: Home Office2 Home Office (1995) Circular 12/95 Mentally Disordered Offenders and Partnership Working London:

Home Office3 Reed J (1994) Volume 6: Race, Gender and Equal Opportunities, Review of Health and Social Services

for Mentally Disordered Offenders and Others requiring Similar Services London: HMSO4 Department of Health (2005) Delivering Race Equality in Mental Healthcare: An action plan for

reform inside and outside services (including the government’s response to the independent inquiryinto the death of David Bennett) London: Department of Health

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Chapter 7 Training and staff development

Scope and importanceTraining is crucial for practitioners to enable them toeffectively perform the tasks their role involves. Additionally,many staff will also be engaged with training as part of theirContinued Professional Development (CPD) requirements.Training plays a vital role in developing staff’s understandingof the key issues service users face and in underpinning thedelivery of good services. As long ago as the Reed Review in1994 it was noted that ‘all agencies involved with mentallydisordered offenders should establish strong proactive equalopportunities policies relating to race and culture which shouldbe reflected in staff training’.1 This is particularly important formany court diversion and CJMHL schemes where practitionersmay work on their own or where the scheme itself is isolatedfrom mainstream practice.

Training should focus both on the general needs of offenderswith mental health needs and how these should be met, andalso on the specific needs of offenders from BME communities.Recommendations from relevant reports, circulars and otherguidance which can inform both service delivery and individualworking practice should also be taken into account.

In relation to service users from BME communities, trainingshould include the following:

� The impact of the criminal justice system and mental healthsystem on BME communities.

� The needs of service users from BME communities,including the needs of foreign nationals, refugees andasylum seekers.

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� How to address cultural and religious needs as part of theassessment process.

� How those identified needs should be met.

� Anti-racist practice.

The training should be planned and delivered in conjunctionwith BME service users and carers in order to maximise itsimpact.

Equally, where training is delivered by schemes to otheragencies (Nacro’s research found this was most usually tomagistrates and the police) then equality and diversity shouldbe included, in addition to the points above.

Reports and guidanceWhile most scheme members receive equality and diversitytraining through the agency that directly employs them, Nacroresearch has found that this training is mainly in line with theparticular agency’s equality and diversity strategy and is notgeared to their needs as criminal justice practitioners. Onlyabout half of the schemes reported that they had seen or hadaccess to relevant and influential reports and guidance such asDelivering Race Equality .2 Worryingly, a number of schemes wereunsure of or couldn’t explain the process by which such reports(or the recommendations contained within them) would bepassed on to them, and said that the onus would be on them tosearch for such information. If scheme practitioners areexpected to search for relevant information themselves, it isimperative that they be allowed the latitude and time to do soand are provided with appropriate resources, such as access tothe internet.

As part of the important process of developing mainstreamingin schemes’ work, there should be a formal process for thedissemination of guidance in reports and policy documents toscheme practitioners. This should be part of an internalcommunications strategy within the agency (or agencies)employing the practitioners. The cascading of this information

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Chapter 7 Training and staff development


is important to ensure that practice remains informed, andcould form the focus of specific training sessions or bedisseminated by line management at team meetings, steeringgroup meetings and in individual supervision sessions. As wellas the circulation of reports, summaries with key action pointsshould also be compiled by the agency involved.

Good practiceNacro Mental Health Unit’s website and monthly digeston mental health and criminal justice contain up-to-daterelevant information on the issues discussed in hissection.

The website is at www.nacromentalhealth.org.uk. Tosubscribe to the digest send an email [email protected] with the word ‘subscribe’ inthe subject bar.

Footnotes1 Reed J (1994) Volume 6: Race, Gender and Equal Opportunities, Review of Health and Social Services

for Mentally Disordered Offenders and Others requiring Similar Services London: HMSO2 Department of Health (2005) Delivering Race Equality in Mental Healthcare: An action plan for

reform inside and outside services (including the government’s response to the independent inquiryinto the death of David Bennett) London: Department of Health

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Chapter 8 Next steps

ReviewTo ensure a scheme meets the needs of service users from BMEcommunities (including foreign nationals, refugees and asylumseekers) there should be regular review of its operation andpractice, including of any protocols and policies that exist. Thisreview should be completed by an independent body butcarried out in conjunction with the steering group, BME serviceusers, carers, providers, staff and other relevant stakeholdersto ensure that there is equal access to services, equitabletreatment and outcomes and that the needs of staff fromdiverse backgrounds are considered and met.

The review should take into account new reports, guidance andresearch and cover the following areas:

� Staff make-up and recruitment plans.

� The scheme’s development plan.

� The assessment process, including whether an assessmentcan be completed by (or with the assistance of) someonefrom the same minority ethnic group, whether cultural andreligious needs are considered and identified, and how.

� The use of interpreters and their effectiveness.

� The ethnic classifications used in recording and monitoringand whether information is collated and analysed.

� Links with BME service user and care groups and serviceproviders.

� The policies and protocols that are in use and whetherreference to equality and diversity is included.

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� Equality and diversity training, including the needs offoreign nationals, refugees and asylum seekers.

� How reports and guidance are used to inform both thedevelopment of the scheme and individual practice.

Development planA development plan and work programme should be drawn upas a result of the review to address gaps and meet new aims,and it should be agreed with stakeholders and service users.Equality and diversity should be a key component both of anyreview and development plan. Additionally, any protocols andpolicies that have not already been subject to an EIA shouldundergo this assessment.

Where gaps are identified these should be incorporated into thedevelopment plan and work programme to be progressed bythe scheme’s steering group and/or management. Communitydevelopment workers have the potential to be an importantnew resource in taking this forward.

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Chapter 9 Summary and conclusion

Court diversion and CJMHL schemes (or similar) play a vitalrole in facilitating the transition between the criminal justicesystem and the health and social care sectors. In order that thespecific needs of BME service users are properly assessed andmet, schemes should:

� ensure the staff make-up reflects the communities it serves

� ensure that BME service users, carers and service providersare part of the governance and consultation arrangements

� ensure that staff are trained in cultural competencies

� ensure that the assessment process proactively considers anindividual’s cultural and religious needs and that these areaddressed by any care plan

� ensure that the assessment of risk is objective and that raceand ethnicity are not seen as an indicator of dangerousness

� develop effective arrangements with interpreting services

� ensure that ethnicity, language and faith are recorded andmonitored and that all statistics are analysed to ensureequality of access to services

� develop effective networks and partnerships with a range ofappropriate service providers underpinned by referral andinformation-sharing protocols

� ensure that operating protocols include a statement onequality and diversity and that all policies and protocols arethe subject of an EIA

� ensure practitioners receive both anti-racist practice andequality and diversity training

� develop effective communication mechanisms within theiragencies to allow for guidance from reports, circulars andinquiries to be distributed among staff at all levels.

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Collecting information about your ethnic groupWe want to ensure that our services are reaching all of our localcommunities and that we are delivering our services fairly toeveryone who needs them. We also want to better understandthe needs of our service users from differing groups. This willhelp us to provide a better and more appropriate service foryou. As a result we are asking people seen by [insert name ofscheme] to provide information, including a description of theirethnic group. This is crucial to our efforts to combat racediscrimination and complies with the Race Relations (Amendment)Act 2000 which requires public bodies to promote race equalityand good race relations.

The different ethnic categories we use help us to compareinformation about the groups using our services with informationfrom the census, which tells us about our local population.

It is important to us that you are able to describe your ownethnic group. The list of groups is designed to allow mostpeople to identify themselves. If you need to complete any ofthe boxes labelled ‘any other group’ then please give somedetails so that we can better understand your needs.

You do not have to complete the question, but this informationis very important to us. It will help us better assess your needsand it will also help us to plan and improve our service.

The information you provide will be treated as confidential andwill not be shared with any other person or organisation unlessyou give your consent. We have strict standards regarding dataprotection and your information will be carefully safeguarded.

If you have any concerns or questions regarding this request oryou want to make any comments or complaint about thecollection of this information or the way in which you have beentreated by staff requesting this information, please contact[insert name and contact details of scheme manager ].

Appendix 1 Information leaflet for service users

46



What is your ethnic group?

Choose one section from A to E, then tick the appropriate box toindicate your ethnic group.

A White

British

Irish

Any other white background (please write in)

B Mixed

White and black Caribbean

White and black African

White and Asian

Any other mixed background (please write in)

C Asian or Asian British

Indian

Pakistani

Bangladeshi

Any other Asian background (please write in)

D Black or black British

Caribbean

African

Any other black background (please write in)

E Chinese or other ethnic group

Chinese

Any other (please write in)

Not stated

Appendix 2 Department of Health 16+1 national standard ethnic monitoring form

47

Appendices


Ethnic origin, faith and nationality

White

British Irish Irish traveller

Romany Eastern European (please specify)

Other (please specify)

Mixed/dual heritage

White and Asian White and black African

White and black Caribbean Other (please specify)

Asian or Asian British

Bangladeshi Pakistani

Indian Other (please specify)

Black/black British

African British

Caribbean Other (please specify)

Chinese

Any other ethnic group (please specify)

Language (please specify)

Faith

Buddhism Christianity Hinduism Islam

Judaism Rastafarianism Sikhism None

Other (please specify)

Nationality (please specify)

Appendix 3 Comprehensive ethnic monitoring form

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Nacro’s Mental Health Unit has been working totackle problems faced by offenders with mental healthneeds since 1990. We work with government agenciesat a national and local level to develop more effectiveservices for this client group. We provide a range ofservices: information and advice; policy developmentand other consultancy services; and training. We alsorun a major annual conference on mental health andcrime.

Nacro has a specialist mental health website(www.nacromentalhealth.org.uk) which offersinformation and support for practitioners and policy-makers working in the field of criminal justice andmental health. To find out more, visit the website orcontact the Mental Health Unit (tel: 020 7840 1209, fax: 020 7840 1213, email:[email protected]).



£5

A significant number of service users from BME communities accessmental health services via aversive pathways, including the criminaljustice system. Court diversion and criminal justice mental healthliaison schemes can play a vital role in facilitating the transition forBME service users between the criminal justice system and thehealth and social care sectors, and in ensuring that their needs areproperly assessed and met. Yet there is currently little guidanceavailable on this subject.

This new guide is aimed at scheme practitioners as well as theirmanagers and the commissioners of such services. It sets out goodpractice and guidance which will enable schemes to provide a moreinclusive and responsive service to those from BME communities.Although the focus is on court diversion and criminal justice mentalhealth liaison schemes, much of the good practice provided willprove valuable to those working at other key decision-makingjunctures along the offender mental healthcare pathway, as well asto others working outside the criminal justice system.


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