Quality statement 2: Mental health assessment | Mental health of adults in contact with the criminal justice system | Quality standards

Quality statement

Adults in contact with the police because of a suspected offence who have suspected mental health problems are referred for a comprehensive mental health assessment.

Rationale

A comprehensive mental health assessment, which includes information about the person obtained from relevant sources, can provide a detailed picture of the person's mental health. This means they can be referred to the appropriate services to receive the care and support they need. For some people, a comprehensive mental health assessment may result in referral from a police station or custody to liaison and diversion services. Support can then be provided for people with mental health problems throughout their contact with the criminal justice system.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements of joint working between the police and mental health services to ensure adults with suspected mental health problems are referred for comprehensive mental health assessments.

Data source: Local data collection, for example established local referral pathways.

Process

Proportion of adults in contact with the police because of a suspected offence identified as having suspected mental health problems who are referred for a comprehensive mental health assessment.

Numerator – the number in the denominator who are referred for a comprehensive mental health assessment.

Denominator – the number of adults in contact with the police because of a suspected offence identified as having suspected mental health problems.

Data source: Local data collection, for example audits of attendance and custody records and referrals.

Outcome

a) Number of adults with mental health problems in contact with the police referred to liaison and diversion services.

Data source: Local data collection, for example audits of attendance and custody records.

b) Number of mental health assessments undertaken following referral from police services.

Data source: Local data collection, for example audits of attendance and custody records.

What the quality statement means for different audiences

Service providers (police services, liaison and diversion services and mental health teams) ensure that training is in place for staff to identify possible mental health problems in adults in contact with the police because of a suspected offence. If a mental health problem is suspected, a referral system is in place for the person to receive a mental health assessment.

Police and mental health practitioners (such as police officers, custody sergeants and liaison and diversion practitioners) ensure that the possibility of mental health problems is considered in adults who are in contact with the police because of a suspected offence, and ensure that they are referred for a mental health assessment if they have a suspected mental health problem. The assessment can take place after release into the community or in prison if they are remanded in custody.

Commissioners (police and crime commissioners, NHS England and clinical commissioning groups) ensure that commissioned services work together to ensure comprehensive mental health assessment referrals can be made and information is shared for people identified as having a suspected mental health problem when they are in contact with the police because of a suspected offence.

Adults suspected by the police of committing an offence who may have a mental health problem are identified by the police officers looking after them. If the officers think they may have a mental health problem, they are referred to a mental health professional for an assessment to make sure they receive the care and support they need. The assessment may take place after they leave the police station, are released from police custody or, if they are remanded in custody, in prison.

Source guidance

Mental health of adults in contact with the criminal justice system. NICE guideline NG66 (2017), recommendations 1.3.1, 1.3.8 and 1.8.1

Definitions of terms used in this quality statement

In contact with the police

Adults are in contact with the police when they are taken into custody or they voluntarily attend a police station because they are suspected of committing an offence. At these times, the police service has responsibility for their wellbeing. [Expert opinion]

Suspected mental health problems

This is when an adult's history, presentation or behaviour suggests they may have mental health problems. This can include, but is not limited to:

reported history of mental health problems, including self-harm or suicidal thoughts
changes in behaviour (including unusual or late-onset offending behaviour) which may indicate the onset of, or changes to, mental health problems.

[Adapted from NICE's guideline on mental health of adults in contact with the criminal justice system, recommendation 1.9.4 and expert opinion]

Comprehensive mental health assessment

An assessment of a person's mental health that takes into account:

the nature and severity of the presenting mental health problems (including cognitive functioning) and their development and history
coexisting mental health problems
coexisting neurodevelopmental or cognitive impairment disorders, for example acquired brain injury, dementia and learning disability
coexisting substance misuse problems, including novel psychoactive substances
coexisting physical health problems
social and personal circumstances, including personal experience of trauma
social care, educational and occupational needs
people's strengths
available support networks, and the person's capacity to make use of them
previous care, support and treatment, including how the person responded to these
offending history and how this may interact with mental health problems.

The assessment should include obtaining, evaluating and integrating all available and reliable information about the person, for example current and previous:

person escort record
pre-sentence report
all medical reports
custody reports
Assessment, Care in Custody and Teamwork (ACCT) document
reports from other relevant services, including liaison and diversion, substance misuse services, social service or housing services and youth offending services
Offender Assessment System (OASys) or other assessment tools.

[Adapted from NICE's guideline on mental health of adults in contact with the criminal justice system, recommendations 1.1.3, 1.3.14 and expert opinion]

Equality and diversity considerations

Adults in contact with the police because of a suspected offence who have a learning disability, cognitive impairment (for example brain injury, dementia or autism) or a communication difficulty (for example, language, literacy, information processing or sensory deficit) should be provided with information about the assessment that they can easily read and understand themselves, or with support, so they can communicate effectively with police and mental health services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.