Thinking Local

Key Lessons from the National Development Programme

Thinking Local - Key Lessons from the National Development Programme

Contents Introduction Context Section 1

Lessons about the needs of people with multiple problems who are in contact with the criminal justice system

3 4 5

Section 2
Doing what works for people with multiple problems across the criminal justice pathway

Conclusion Summary of projects

13 14

Thinking Local - Key Lessons from the National Development Programme

Introduction
Revolving Doors is a charity working across England to change systems and improve services for people with multiple problems, including poor mental health, who are in contact with the criminal justice system.
Through our National Development Programme (NDP) which ran from 2007-2010, we established a network of nine projects across the country which tested out a range of approaches to working with this group. Figure 1 on page 4 shows the location of these projects and a short outline of each is included at the end of this report. Further information about the NDP and an independent evaluation1 which informed this Key Lessons report can be found on our website at www.revolving-doors.org.uk. This report briefly outlines the programme and sets out our key learning in two sections covering: The needs of people with multiple problems in contact with the criminal justice system What works in developing local responses to those needs. Throughout the process of the NDP, it became clear that when statutory and voluntary agencies saw the positive impact that partnership working could have on outcomes for people with multiple problems, they were more willing to create effective local solutions together. This paper has been designed to share our learning with leaders of health, social care, local government, criminal justice and voluntary sector agencies working in local areas, as well as national policymakers.

ABOUT THE NATIONAL DEVELOPMENT PROGRAMME Through its early service delivery work, Revolving Doors developed a model which facilitated multi-agency partnerships to provide evidence-based services for people in the revolving door group. The NDP set out to replicate this process nationally by bringing together local partnerships in eight English regions and in Wales. We used a three stage development process: Identification of needs

Demonstration of solutions

Shaping policy/commissioning The work began with the establishment of a local steering group. Composition of these groups varied but typically included commissioners or senior service representatives from health, social care and housing services and from criminal justice agencies including the police or HM Prison Service. Steering groups worked collaboratively to identify and evidence need before developing and demonstrating a solution to that need. Nine pilot projects resulted across the criminal justice pathway. Once established and evaluated, the emerging evidence from these was used in an attempt to shape policy and commissioning in the local area.

1 Kenny, S, & King, B. (2010 ) Final Report for the Evaluation of Revolving Doors Agency National Development Programme, London: Revolving Doors Agency & Centre for Public Innovation

Thinking Local - Key Lessons from the National Development Programme

Context
Partnership working and joined-up services have long been recognised as key to providing effective outcomes for people with a range of problems. Much progress has been made in these areas in recent years in both policy and practice; however in many areas joint working remains a challenge.
At a time of cuts in public expenditure, the capacity of partnership working to both increase efficiencies and reduce duplication makes it both a practical and financial imperative. Furthermore, with an increasing focus on localism, our evidence highlights the willingness and ability of local statutory and voluntary services to come together to develop imaginative local solutions for this group. The Coalition Government has recently identified the need to reduce numbers going to prison for short sentences. This paper highlights approaches designed to both intervene to reduce the numbers of people coming into contact with the criminal justice system and to effectively rehabilitate those who do.
Figure 1. The NDP Pilots

ABOUT MULTIPLE PROBLEMS We use the phrase multiple problems to describe people who have a range of needs. Other terms such as multiple needs or multiple disadvantages are commonly used but when we consulted members of the Revolving Doors Agency Service User Forum, they preferred the phrase multiple problems. While every persons experiences are unique, people often describe some of the following experiences: early adversity; behavioural problems giving rise to low educational attainment; low skill levels; and subsequent unemployment with associated poverty and debt problems. Many of the group experience poor physical and mental health, often in conjunction with drug and/or alcohol misuse. Problems with housing and or homelessness are also common. Contact with the Criminal Justice System NDP Pilots worked with people in contact with all criminal justice agencies. This ranged from people at risk of offending coming to the attention of neighbourhood police to repeat offenders leaving prison. In the context of prison we have a particular focus on those sentenced to less than a year in prison, a group who do not receive offender management supervision on release.

Personalisation of resettlement services HMP Everthorpe You-Turn Community alcohol scheme and self-esteem building for women offenders, County Durham. The Revolving Doors Project (Warrington) Early intervention after contact with neighbourhood police. Improving custody planning for short sentenced prisoners HMP Styal, NW Mental health support for women with multiple problems using Anawim Womens Centre, Birmingham Hafal Resettlement of women returning to Wales from English prisons, Wales Diversion service in rural context based at police custody Barnstaple Navigator Support Screening and navigation to support at police custody, Watford HMP Lewes to Brighton Co-ordination for the short sentenced returning from HMP Lewes to Brighton & Hove
More information about each of the pilot projects can be found at the end of this report

Thinking Local - Key Lessons from the National Development Programme

Section 1 Lessons about the needs of people with multiple problems who are in contact with the criminal justice system.
This section describes our learning about the needs of people with multiple problems. It is drawn from quantitative and qualitative data collected as part of the local evaluations of individual pilot projects. Copies of these evaluations are available for download from our website. 1. We found evidence of people with multiple problems in a range of locations and across all stages of the criminal justice system.
It became clear to [a wide range of partner agencies and local services] that it was important not to underestimate the level of need of the target group and that a flexible approach to identifying and responding to their needs was essential. NDP Final Evaluation Report The existence of a group of people with multiple problems has been evident throughout our research and practice and was summarised recently in a report on learning to date2. We began this programme with a hypothesis that people with multiple problems could be found across the country in a range of locations and at all stages of the criminal justice system. The evidence from the pilot projects confirms that hypothesis. A recent study involving members of our Service User Forum3 reported that this group requires help from a large number of services, with participants experiencing an average of four needs each. The NDP pilots reinforced this evidence of multiplicity of needs. In Warrington4, individuals assessed revealed an average of four areas of significant need regardless of whether they had mental health needs or not. In North Devon, clients had an average of six needs. Our work, supported by external research, has taught us that these problems exacerbate and reinforce one another. This makes the revolving door cycle particularly difficult to break, and suggests that approaching each need in isolation is unlikely to have a sustained impact. The solutions to many of these problems lie outside of the scope of criminal justice agencies and people with multiple problems are likely to need help from a range of services working in partnership.

62%

of women at HMP Styal with multiple problems said they had been subject to abuse or neglect in childhood

2 Anderson, S. (2010) Summing Up: Revolving Doors Agency Key Learning 2000-2009, London: Revolving Doors Agency 3 Braithwaite, T, & Revolving Doors National Service User Forum (2009) Multiple Needs Service Users Perspectives, London: Revolving Doors Agency 4 MacGroaty, M & Honor, S. (2009) Revolving Doors Service Warrington: Evaluation of Year One, Warrington: Revolving Doors Service.

Thinking Local - Key Lessons from the National Development Programme

2. These problems often have their roots in early adversity.

I hated school and the teachers hated me. They said I was stupid and a waste of space. One day I just threw my book on the floor and walked out. No one came after me and I never went back. I was 13. Short Sentenced Prisoner HMP Everthorpe5 Short sentenced prisoners at HMP Everthorpe described early lives characterised by separation from one or both parents, a lack of educational attainment and being labelled as having behavioural problems. Among short sentenced prisoners using a service at HMP Lewes, the majority said that they had experienced some form of childhood abuse. Among women with multiple problems at HMP Styal6 62% said that they had been subject to severe abuse or neglect often before the age of 10. These findings point to and support the substantial existing body of evidence on the value of early intervention services for children and families at risk. It also underlines the critical importance of a special focus on young people in transition to adulthood who may be in contact with the criminal justice system7.

13%
of short term prisoners using the service at HMP Lewes had been subject to more than 30 custodial sentences

3. Short-term prisoners and repeat offenders have the highest levels of entrenched problems and multiple exclusions from services.
Things are getting better. If I have a major upset I dont drink anymore. Thats what I used to do in the past. In a years time I would like to be in my own accommodation but it frightens me in a way. I am never on my own. Living on the street, hostel, prison, street its a cycle street, hostel, street, prison. Short Sentenced Prisoner HMP Lewes8 Levels of mental health problems, substance misuse, problematic alcohol use and homelessness were all significantly higher among clients of the HMP Lewes service than among clients of community services in Warrington and North Devon9. Reported rates of substance misuse were 13% for clients of the Warrington service and 70% among clients of the HMP Lewes service. Of the short sentenced prisoners using the service at HMP Lewes, 75% had been subject to two or more custodial sentences and 13% had been subject to more than 30 custodial sentences. This was in contrast to the Warrington early intervention service where only 11% had had any previous contact with the criminal justice system.

5 6 7 8 9

Nicoll, T. & Moore, D. (2009) Getting a Blue Life, Personalisation and the Criminal Justice System, Yorkshire: YHIP & Revolving Doors Agency Revolving Doors Agency (2006) Working with Complexity: Meeting the resettlement needs of women at HMP Styal, London: Revolving Doors Agency See the Transition to Adulthood Alliance website: http://www.t2a.org.uk Rice, B. (2010) HMP Lewes to Brighton: Evaluation of Year One, London: Revolving Doors Agency. Forthcoming autumn 2010. Kenny, S, & King, B. (2010) Local Operational Report for the evaluation of Revolving Doors Agency National Development Programme South West, London: Revolving Doors Agency & Centre for Public Innovation.

Thinking Local - Key Lessons from the National Development Programme

4. Women face specific challenges

I just came because I thought: What have I got left to lose? Woman on why she used You-Turn Service Four of the NDP pilots worked specifically with women. This has helped to broaden our understanding of the specific needs of women with multiple needs in contact with the criminal justice system. Levels of current and previous victimisation were high. Of the women referred to the Mental Health Practitioner (MHP) at the Anawim project in Birmingham10, more than half had been subject to domestic violence and two-thirds to violence or abuse, either currently or in the past. A number of clients were also sex workers. Domestic violence was also found to be a significant issue for women at the community-based alcohol project in County Durham11. Additionally, at least 78% of the Anawim women had experienced relationship difficulties. Many of the women worked with are mothers. At least 66% of the women referred to the MHP at Anawim had dependent children; however the children were living with their mother in less than 50% of these cases. In 33% of cases children were looked after by social services or had been adopted. In a Revolving Doors needs analysis conducted at HMP Styal12 , 70% of the female prisoners with multiple needs interviewed had had children removed from them.

77%
of the men worked with at HMP Lewes had a history of problematic alcohol misuse

5. Needs related to alcohol misuse are common and often unaddressed by current services.
While only one pilot (You-Turn in Durham) specifically addressed alcoholrelated problems, we found evidence of need related to alcohol misuse in several projects and evidence of a lack of provision to meet this need. 77% of men seen at HMP Lewes had a history of problematic alcohol use and case notes indicated that this was often a contributing factor in violent offences. Despite this, only 20% had been in contact with alcohol services in the six months prior to their imprisonment.

6. The pilots saw people with a wide spectrum of need related to mental health and emotional well-being, including self-harming behaviours.
The NDP set out to target individuals with common mental health problems and multiple needs across the criminal justice pathway. The resulting pilots worked with people with a wide spectrum of needs related to mental health and emotional well-being. Qualitative interviews with clients of the Warrington and You-Turn services revealed problems with social isolation, stigmatisation and low self-esteem frequently associated with adverse life circumstances.

10 Evaluation of Anawim Project. Forthcoming autumn 2010. 11 Stephenson, M. (2009) You-Turn: Early Findings May 2009 - July 2009, Durham: You-Turn 12 Revolving Doors Agency (2006) Working with Complexity: Meeting the resettlement needs of women at HMP Styal, London: Revolving Doors Agency

Thinking Local - Key Lessons from the National Development Programme

More than two-thirds of men seen at the HMP Lewes project reported experiencing anxiety and depression while over half said they had problems with anger and over a quarter described problems with self-harming behaviour. Among women seen at the Anawim project in Birmingham, just under half had a history of self harming behaviour.

7. Many people with multiple problems are victims of crime

It all started when I moved into a flatI was vulnerable, nave and the neighbours started coming round. I didnt realise they were druggies but they started preying on me, hassling me for money and eventually they just cracked me. I couldnt take it any more so I rang the police. Service user from Revolving Doors Service, Warrington Many people seen by the pilot projects experienced current or previous victimisation. Often, as in the quote above, they found it difficult to resist the advances of victimisers, even though by failing to do so, they risked committing criminal offences or jeopardising their own housing situation. Others, like 66% of those women using the Anawim Service had been subject to violence either currently or in the past, as described above.

66%

of the women at Anawim Service had been subject to violence

Thinking Local - Key Lessons from the National Development Programme

Section 2 Doing what works for people with multiple problems across the criminal justice pathway
The pilot projects intervened at various points across the criminal justice pathway. This section describes our learning about what works in developing and delivering services for people with multiple problems.

Community
Revolving Doors Project, Warrington

Navigator Project, Watford

Police Custody
You-Turn, Durham

Barnstaple Custody Centre

HMP Styal

Court

Personalisation HMP Everthorpe

Anawim, Birmingham

30%

In the first year of the Warrington pilot, anti-social behaviour reduced by

Re Do Pr W

HMP Lewes to Brighton

Prison

Comm
Hafal

Community

1. Think Local
The NDP helped to develop a structure on which to hang our ideas. Stakeholder quoted in Final Evaluation Report The NDP provided a catalyst which enabled local areas to think about effective responses to people with multiple problems in contact with the criminal justice system. The process began in each area with the establishment of a multi-agency partnership and an analysis of local need. This helped to ensure that each resulting pilot was firmly rooted within the local context, responded to local need and promoted local ownership. Many local service leaders were well aware of the problems facing people with multiple problems and were convinced of the cost benefit case for supporting this group. For other service leaders and commissioners, the NDP raised awareness of the existence of this group within the local area. Overall the programme demonstrated both the enthusiasm and abilities of leaders to develop service responses for people with multiple problems.

Thinking Local - Key Lessons from the National Development Programme

10

2. Intervene Early
Some people are calling the police nine times a day: They dont know who else to call and no one else is picking up on them. Perhaps 999 is the only number people know to call to get help. Police Officer in Warrington Revolving Doors Service Warrington provides a link between neighbourhood police and mental health services who then act as a gateway to a range of local support services. The service is run within mental health services and overseen by a multi-agency steering group. As an early intervention service, it identifies individuals with low-level mental health problems who are at risk and would not normally be helped until their condition has deteriorated much further. It then provides support and signposting to community services. In the first year of operation, anti-social behaviour was reduced by 30%. The scheme highlighted the potential for partnerships between the police and community services, which intervene early to prevent people with multiple problems getting caught up in the criminal justice system. It also demonstrated that, in many cases, a short low-cost intervention can both improve individual outcomes and potentially produce a long-term cost-saving for local services.

Navigators can help enable people with multiple problems to access the help they need

3. Navigate exit routes out of criminal justice

The Navigator Project in Watford is exploring how the police can better respond to people with mental health problems and other issues such as homelessness or substance use when they are arrested using volunteer navigators from a local voluntary organisation to offer support. In so doing, the pilot enables people with multiple problems to navigate a route out of the criminal justice system through greater utilisation of existing community services. At Anawim in the West Midlands, the Mental Health Practitioner (MHP) is acting as a bridge into mental health services for a vulnerable group of women, many of whom are known to the criminal justice system but who need a range of support services. As an employee of the local mental health trust, the MHP is well placed to act as a conduit for those who need a higher level of support. Both pilots demonstrate the importance of navigators to enable people with multiple problems to access the help they need, thereby providing them with an exit route away from the criminal justice system.

Thinking Local - Key Lessons from the National Development Programme

11

4. Support Holistic Rehabilitation and Recovery

If I dont get out If I just go back there, then I know how it will be. Theres no chance it can be different. What can I do? Short term prisoner HMP Everthorpe Clients of the pilot projects, like the man quoted above, wanted to move away from offending and change their lives. As described earlier, most had a range of problems and needed help if they were going to succeed. Yet, most had not previously been offered this help. Men at HMP Everthorpe recognised that they needed help and wanted more support from their personal officers while in prison. Our work at HMP Styal, a womens prison, clearly showed that the many demands of prison officers mean that providing this support can be very challenging. In common with other offenders serving less than a year in custody, clients of the HMP Lewes service received no support on release, despite the fact that the majority had a number of previous convictions and a range of problems. Effective rehabilitation for people with multiple problems must include offering ongoing holistic through-the-gate support to enable a move away from offending.

In the current financial climate reshaping existing services can be the the most cost effective way to improve outcomes

5. Make use of existing community resources

The NDP has demonstrated that in most cases, the services that people need already exist but people with multiple problems are unable to access them or receive a poor service from them. Stakeholders at a local event in Brighton prior to the launch of the HMP Lewes pilot agreed that while many services existed to support the target group in the city, there was poor co-ordination between these services and between community services and the prison. Often, what is required is a reshaping of existing services or pathways to better engage people with multiple problems in contact with the criminal justice system. This approach may be cost neutral or require only small amounts of funding and be easier to mainstream. We believe that this approach has the greatest potential to secure lasting changes for the target group. It is clear that in the current climate of reductions in public spending, the reshaping approach provides the most cost effective way to improve outcomes for the people with multiple problems in contact with the criminal justice system.

Thinking Local - Key Lessons from the National Development Programme

12

6. Work in partnership
Effective partnership has matured in the area as a result...its about the person, not individual agencies, and we have all worked together to resolve these individuals problems and issues. Stakeholder in Final Evaluation report Given the focus on people with multiple problems, multi-agency partnership working was a key feature of the development model and all pilots were overseen by a steering group drawn from a range of local heath, social care and criminal justice agencies. Local leaders in health, social care and criminal justice contributed to the convening of partnership groups, made resources available and became passionate advocates for the mainstreaming of services after the pilot period. Much of the success of the programme is attributable to their leadership and willingness to innovate. We learned that the success of the programme was to a large degree attributable to local ownership and consensus; in other words, to the permission given by several commissioners and organisations to projects operating according to a more flexible and responsive set of rules.

Engaged partners can become passionate advocates for services

7. Involve users in designing and delivering services

Service user involvement is integral to this pilot and the views of those being helped are sought throughout the process so that the project and organisations involved can consider their experiences when reviewing or adapting their system. Regional Advisor South West We worked to involve people with direct experience of multiple problems and the criminal justice system throughout the programme. In some areas this was challenging due to the invisibility of the group within existing services or because of transport difficulties in rural settings. We found that this was most effectively done (at the Navigator and You-Turn projects) by actively engaging existing local service user forums. Our national service user forum will help us take forward the lessons from the NDP.

8. Deliver services that believe in people and their capacity to change

Finally, this programme was underpinned by a core belief that people with multiple problems in contact with the criminal justice system can change and be supported to reach their potential leading to a reduction in offending, fewer victims of crime and safer communities. In developing services for people with multiple problems, there is a risk that we focus on deficits. Some partners who were new to developing services for this group were often surprised by the extent of their needs. Others (like many in the prison service) were all too aware of the level of need but workloads meant that they were unable to meet needs. In both cases it is important to focus on strengths and resilience and to recognise that by working together we stand a greater chance of delivering services which can help people make real and lasting changes in their lives.

Thinking Local - Key Lessons from the National Development Programme

13

Conclusion and next steps

The NDP has confirmed that people with multiple problems in contact with all stages of the criminal justice system can be found across the country from Durham to Devon. It has demonstrated that solutions can be developed to help this group, however entrenched their problems may appear. Most strikingly it has shown that local services can successfully work in partnership to develop these solutions. At the heart of the success of this project, there has been a deep vein of committed local leadership, with a willingness to innovate, to share resources and to work in partnership. In the coming months and years we will be reaching out to the wider community of local leaders and developing a range of tools and resources designed to strengthen their hand in developing services for people with multiple problems. We are developing an economic model in partnership with the Department of Health. This will make the cost benefit case for interventions with people with multiple problems. Local leaders who worked on our programme valued the opportunity to meet others engaged in similar work. We are planning to develop an online network of local leaders who can share experiences and resources in developing services for people with multiple problems. Each of the pilot projects generated a great deal of learning through the development and delivery process. In the coming months, we will be writing up this learning and sharing the tools developed via our website. The learning from the programme will form a significant strand in our work to develop a green paper setting out how the government could establish a policy framework that delivers effective and cost-effective help across the country. The final word must be one of thanks to the funders of this programme: Department of Health Offender Health, The Esme Fairbairn Foundation and the Lloyds TSB Foundation for the support which enabled this work to take place.

Improvements will come through the active engagement of service users

Thinking Local - Key Lessons from the National Development Programme

14

Summary of projects
Anawim mental health project is a partnership between the Anawim day centre for women (in particular those with a history of sex-working) and local mental health services. A mental health professional seconded from secondary health services provides mental health assessment within the centre and works to develop clear mental health care pathways for those women with complex mental health and other problems, who currently receive poor care from health services despite high levels of need. Barnstaple police pilot is based in Barnstaple Custody Centre, this project worked in partnership with existing drug and alcohol arrest referral workers to identify people with mental health problems and other complex needs, then signposting them to local services that were able to provide appropriate support. The project also aimed to address access issues that impacted on engagement with support services in a rural area. It ran from January to December 2009. Criminal Justice Link Service, Wales is a project supporting women with mental health problems returning to Wales following a period of imprisonment in English prisons (there is currently no womens prison in Wales). The project, run by the Welsh mental health charity Hafal, identifies mental health and other problems prior to release, and eases reintegration into the local community by ensuring an appropriate package of care is available. Custody planning for short sentenced women at HMP Styal, Cheshire. Revolving Doors Agency is working with HMP Styal to develop and pilot a tool to improve the custody planning for women serving short sentences. The tool will aid Personal Officers to ensure that shortsentenced women prisoners under their care are linked with the appropriate in-house health and social care services in good time prior to release. HMP Lewes to Brighton. This project, run by Brighton Housing Trust, works with short term prisoners with multiple problems returning to Brighton and Hove, in particular targeting those who are deeply entrenched in a cycle of homelessness, substance abuse and repeat offending. A Project Coordinator within the prison works with support services in Brighton to create a comprehensive package of care on release with clear care co-ordination, to improve tenancy sustainment, engagement with services and reduce re-offending. The Navigator Project, Watford is enabling the police in Watford to better respond to people with multiple problems, including poor mental health, following arrest by developing an accessible mental health screening tool. The police are then able to link those needing support with volunteers (facilitated by the local charity, Viewpoint), who can help them navigate local support services to access appropriate care. Personalisation at HMP Everthorpe, Brough. This project aims to put offenders at the centre of their resettlement plans by involving them in the development of a personalised resettlement service. This project started with a period of action research where researchers worked with prisoners to ascertain what a personalised service might look like and how it would work. Following this, a pilot period is about to commence where personalised care plans and individual budgets for selected short-sentenced prisoners will be co-ordinated by a worker within the prison. The Revolving Doors Service, Warrington. Neighbourhood Policing Teams in Warrington identfy vulnerable people within the community who they believe are at risk of victimisation or offending and refer them to a team of two social workers, based within the Criminal Justice Liaision Team in mental health services. These workers offer brief interventions with these vulnerable people, listening to their concerns and linking those with mental health needs or other problems with a full range of services in the community. You-Turn, Durham works with women in County Durham with alcohol and low level mental health problems who are in contact with the criminal justice system or at risk of offending. The project provides a self-esteem and confidence building course which accompanies womens work with the local Community Alcohol Service, improving engagment and outcomes for those who have not previously been able to progress within alcohol treatment services.

Revolving Doors Agency The Turnmill Units 28 and 29 63 Clerkenwell Road London EC1M 5NP T: 020 7253 4038 F: 020 7553 6079 www.revolving-doors.org.uk
Revolving Doors is registered as a company limited by guarantee in England N. 02845452 and as a Charity N. 1030846.