Abstract
In 2019, three internal studies were conducted in the Irish Probation Service exploring mental health among persons subject to probation supervision. This paper briefly considers, as context for the studies, the Irish and wider international literature exploring mental health problems among those engaged with probation services and outlines the key findings from the three studies. The studies though limited in scale, scope and methodology were consistent in identifying recurring themes supporting the broader research literature highlighting the prevalence of mental health problems among probation service clients. The paper discusses the key findings and implications for probation policy and practice, and looks to ongoing developments and related new initiatives in the field in Ireland.
Prior to 2020 there has been little published data or research on mental health problems among persons subject to Probation Service supervision in Ireland. A number of small-scale practitioner studies (Griffin 2008; Cotter 2015; Foley 2016) had highlighted concerns regarding the incidence of mental health problems among the population. The studies were limited in their focus but were instrumental in drawing attention to the field by identifying significant gaps in knowledge and the need for further evaluation and action.
A Vision for Change (AVFC), published in 2006 (Department of Health and Children, 2006), had established a government mental health policy framework for the model of Mental Health Service provision in Ireland continued to be the lead policy until 2020. It was described as a framework for building and fostering positive mental health across the community providing accessible, community-based, recovery focussed specialist services for people with mental health problems.
A Vision for Change (AVFC) highlighted that: “The Nationwide Probation Service carries an extensive caseload of ex-prisoners and people who have not served sentences. Many have had, or currently have, mental health problems. Some may be in contact with Mental Health Services and others may not be, even though they require such contact. Therefore it is essential that there are linkages between the Probation Service and the relevant generic mental health services and, where appropriate, Forensic Mental Health Services to ensure a linked approach and, particularly, continuity of care” (Department of Health and Children 2006: 141).
The AVFC outlined recommendations for forensic Mental Health Services for individuals with mental health problems who come into contact with the criminal justice system and those with aggressive or challenging behaviour (Department of Health and Children 2006: 39). The expert group emphasised that forensic Mental Health Services should have a ‘strong community focus’ and individuals in the criminal justice system should have the right to be treated in non-forensic Mental Health Services unless there are ‘cogent and legal reasons why this should not be done’ (Department of Health and Children 2006: 137).
There has been limited progress in this area following on from AVFC. Mental Health Reform (2017) 1 in a submission to a review of ‘A Vision for Change’, highlighted ongoing concerns regarding unmet need for Mental Health Services for those individuals who fall within the remit of the Criminal Justice System.
In June 2020, the new Mental Health Policy, ‘Sharing the Vision: a Mental Health Policy for Everyone’ was published (Department of Health, 2020). Disappointingly, ‘Sharing the Vision’ does not make reference to individuals who are subject to a Probation Supervision.
Moving forward together
In 2019, three internal research studies were conducted by Dr. Christina Power in the Irish Probation Service, exploring mental health among persons subject to probation supervision. These studies were published in 2020 as Moving Forward Together: Mental Health Among Persons Supervised by the Probation Service (Power, 2020). The report findings highlighted the unmet mental health needs among vulnerable men and women living in the community subject to Probation Service supervision in Ireland.
The overall sample of 500 included in the third study was based on five Probation Service community supervision teams representing approximately 8% of the population over 18 years of age and subject to supervision at the time of the study. The information collected was completed from the perspective of individual Probation Officers and based on their knowledge and experience of their clients. This could be limited if the client is new to the Service or not engaging with their Probation Officer.
Furthermore, it is recognised that the perspective of the client or service user has not been addressed in this study. There is a need to bring multiple perspectives together, including those of the client and other service providers, to develop a person-centred approach. Probation research has frequently overlooked the client’s voice raising wider methodological and ethical implications. Including the clients’ voice should empower clients to express their own assessment and experience of probation supervision and inform future better practice.
The Mental Health Service Evaluation (MHSE) questionnaire used in the studies was developed by Dr. Christina Power for this exploratory review in the absence of any other appropriate measure and is not validated in another setting. The GAF measure is a one-item rating scale and is limited in not taking into account the full complexities of mental health problems and scores can fluctuate. The GAF measure is useful in a generic group in this context and population and is used in Mental Health Services in Ireland.
Full details of the methodology, data analysis and findings in the three studies can be accessed in Moving Forward Together: Mental Health Among Persons Supervised by the Probation Service (Power, 2020).
Key findings
The Moving Forward Together studies indicated that, at least 40% of adults on a Probation Supervision Order, compared to 18.5% of the general population, present with symptoms indicative of at least one mental health problem. Women present with higher rates of active symptoms and higher rates of contact with services currently and in the past for mental health problems.
Approximately 50% of all people supervised by the Probation Service in the community that present with mental health problems also present with one or more of the following issues as well: alcohol and drug misuse, difficult family relationships and accommodation instability.
There are significant and unmet psychological and psychiatric needs among persons subject to Probation Supervision. These findings show that a need for improved access and engagement routes to mental health services, and cross agency working to ensure this can happen.
Key findings from the third and largest study in the Moving Forward Report indicate that:
43% of persons experienced Active Symptoms of Mental Health Problems (57% women; 40% men): 1. Most often anxiety and depressive symptomatology; 2. 10% experienced symptoms indicative of serious and/or severe and enduring mental health problems.
30% were engaged with a service for Mental Health Assessment and/or Intervention currently (49% women; 28% men): 1. Mostly through their Doctor/medication (20%) and most often women; 2. 1.4% are engaged with Primary or Secondary Care Psychology Services.
56% have had some form of Mental Health Assessment and/or Intervention in the Past (70% women; 52% men): 1. Most often through their Doctor with medication; 2. 11% of persons have had In-Patient Psychiatric Care in the Past.
41% were identified as having a known Mental Health Diagnosis provided by a qualified clinician (52% women; 38% men): 1. 16% Anxiety disorder and 15% Mood disorder; 2. 8% Schizophrenia/Primary Psychotic Disorder (1% general population worldwide). 3. 4% Personality disorder and related traits, comparatively low when compared to other Probation Service jurisdictions (e.g. 47%).
One in 10 persons supervised by the Probation Service in the community were identified as experiencing active Suicide ideation/plans (10%) (16% women; 8% men).
1.5% of men (6 men) were considered to be in severe distress and in imminent danger of causing harm to self and/or harm to others. • High mental health problem co-morbidity with: 1. Alcohol and drug misuse (51%); 2. Difficult family relationships (49%); 3. Accommodation instability (47%).
The research raises key issues for the Probation Service to address. There are significant unmet psychological and psychiatric needs among those persons subject to Probation Supervision who have limited access to and engagement with the community and forensic Mental Health Services. There is a crucial need to strengthen knowledge and develop skills-based training in mental health for Probation Service staff to aid in the early recognition of mental health problems to ensure that the appropriate services are involved in the assessment and/or intervention.
The Probation Service is well placed to lead and proactively advocate for and support the needs of service users with mainstream primary care and forensic and community mental health service providers in the development of joined-up strategies and interventions. This could be supported through collaborative joint working, case management and shared research. Going forward, individuals subject to probation supervision and in the criminal justice system, should be heard and represented as service users in mental health policy development.
A core theme through the consultation process was Probation Officer concern regarding client mental health problems and symptoms causing considerable psychological distress, which could be associated with increased risk of offending. Probation Officers reported considerable unmet mental health need among their clients and identified difficulty getting their clients access to appropriate mental health services to address their needs. It was often acknowledged that many individuals had become engaged with the Criminal Justice System due to unmet mental health needs.
International experience
Internationally, there is a high prevalence of mental illness and high rates of co-morbidity among persons on probation (Sirdifield, 2012). Mental illness does appear to be associated with non-compliance with probation and to influence offending. Treating mental illness has been identified as potentially improving criminal justice as well as health outcomes (Brooker et al., 2020).
The prevalence of mental health disorders amongst Probation Service clients is as high, if not higher, than in prison populations (Geelan et al., 2000; Brooker et al., 2012; Sirdifield, 2012). However, the nature of disorders is complex with high levels of co-morbidity including personality disorder, substance misuse and psychosis.
Many people subject to probation supervision serving a Probation Order have at least one mental health disorder (Brooker et al., 2020). Despite the complexity of mental health disorders faced by this group, Mental Health Services and Probation Services working together have attempted to promote models that engage probationers and a number of these models have been evaluated. For example, Mitton et al. (2007) describe a diversion programme run in Canada to reduce re-offending and treat serious mental health disorders; use of Mental Health Services decreased as did visits to Accident & Emergency departments. At 6-month follow-up, however, 50% of the sample had been lost to attrition, so little is known about the longer-term consequences.
Research examining the effectiveness of interventions for this group is scant especially where a client might be experiencing a number of mental health disorders. A variety of different approaches have been undertaken to attempt to engage clients in mental health service delivery but are often devised solely as one-off studies.
The lack of impact and efficacy studies in this area is particularly significant. Research which takes into account the complex and often overlapping biological, psychological and social needs of service users is urgently needed to promote positive outcomes for service users and strengthen collaborative partnerships between all stakeholders.
In a series of innovative programmes, Skeem et al. (2006) described the use of ‘speciality caseloads’ in the United States. In this model of working, Probation supervisors work with reduced mental health caseloads, receive training and ongoing supervision in mental health and are also trained to use problem solving strategies. Skeem and Louden concluded that working in this way is more effective than traditional models of probation service delivery: well-being improves; treatment services are better engaged; and the likelihood of probation violations is lower. Finally, Herinckx et al. (2005) found that using a variety of approaches such as crisis intervention and medication monitoring had a meaningful impact on the length of in-patient treatment in a mental health facility. Probation Service clients face both system-level and personal-level barriers to accessing mental health care. Many people in contact with Probation Services are not registered with a doctor, and/or only access health care during crises (Revolving Doors Agency, 2017). Sometimes services simply do not exist to meet their needs, and sometimes services are difficult to access due to their location, problems with opening hours, restrictive referral criteria and poorly understood access routes (Brooker et al., 2012). Moreover, the health needs of people in contact with Probation, and how best to structure service provision to make health care accessible to and appropriate for this group, are rarely considered by health care commissioners, including in England (Brooker and Ramsbotham, 2014).
In a unique study by Fowler et al. (2019), all clients supervised by the Probation Service in London, were screened at assessment stage for mental health problems. A subgroup of 569 clients were identified and referred onwards to a specialist mental health service. Of those clients screened as positive, 301 clients were referred onwards for psychological assessment and intervention. A total of 75 clients completed the intervention.
A significant positive impact was reported in a 6-month follow-up across measures of depression, anxiety and general distress and social functioning. Furthermore, 74% of participants committed no further offences in the 12 months following treatment. Even accounting for the positive outcomes, 228 clients failed to engage with the initial engagement by not attending for their first appointment. It appears that there are additional factors which may impact on or influence client engagement with Services for mental health support.
Fowler et al. (2019) reported that a key issue related to client engagement with Mental Health Services was instability of housing/accommodation. This is consistent with Maslow’s theory of hierarchy of need (Maslow, 1943). That is, having basic physiological needs such as food, water, warmth and rest and safety and security needs, in place before addressing psychological needs, esteem needs, self-fulfilment and self-actualisation.
Discussion
The three studies comprising Moving Forward Together: Mental Health Among Persons Supervised by the Probation Service explored mental health among clients engaged with the Probation Service from the perspective of Probation Officers.
A significant incidence of mental health problems was identified in all studies. Over 40% of clients were identified as presenting with active symptoms of mental health problems in the pilot study, similar to 43% identified in the third study. These figures were consistent with Brooker et al. (2012) who estimated that approximately 39% of individuals in a UK Probation population were suffering from mental health problems. This figure is also consistent with the prison population and the World Health Organisation (WHO 2020) which estimates that up to 40% of the global prison population were persons with mental health problems.
The findings from the studies also indicate a higher prevalence of mental health problems than those reported in the general population in Ireland. According to the Health at a Glance Report (OECD/EU, 2018), Ireland has one of the highest rates of mental health problems in Europe, joint third of 36 countries, with 18.5% of the Irish population reported as having a mental health problem such anxiety, bipolar disorder, depression or alcohol/drug use in 2016. The Healthy Ireland survey in 2015 found that probable mental health problems (PMHP) are indicated by 9% of the Irish population aged 15 and over (IPSOS/MRBI 2015).
Mental health diagnoses
The most frequently reported formal diagnoses were anxiety disorders and mood disorders. More than 40% of clients in study three and 31% in study two had a known formal mental health diagnosis. The most frequently reported formal diagnoses were anxiety disorders and mood disorders, similar for men and women and consistent with previous research (Brooker et al., 2012) exploring mental health problems among probation supervision clients elsewhere.
Diagnosis of personality disorder and related traits was similar in both studies (5% and 4%) but low compared to studies in other jurisdictions (Brooker et al., 2012). This difference may reflect underassessment due to mental health legislation, policy and practice in Ireland, paucity of specialist assessment and intervention services or non-identification.
Low rates of other types of mental health diagnoses were identified including, learning disability, communication difficulties including speech and language disorders and acquired brain injury. This is surprising given that prisoners with psychosocial and intellectual disabilities are disproportionately overrepresented in the global prison population 2 . This may indicate further underassessment or non-identification issues. The findings from the current studies may, therefore, also be an underestimate of other issues co-occurring with mental health problems among clients engaged with the Probation Service. However, the focus of the Moving Forward Together studies has been solely on mental health.
Active symptoms indicative of mental health problems identified by Probation Officers
Probation Officers most often identified symptoms of low mood and anxiety, as found in previous studies (e.g. Brooker et al., 2012). The most commonly identified symptoms of anxiety and low mood are also consistent with the findings from the GAF measure where over half of clients in both studies were identified in the ‘slight impairment’, ‘mild’ or ‘moderate’ range on the Global Assessment of Functioning (GAF).
Providing Probation Officers with training in mental disorders, particularly those most commonly identified, such as mood disorders and anxiety disorders, would likely increase understanding and recognition of the types of symptoms, and some insight into the evidence-based interventions which may be open to clients. This may help Probation Officers to support their clients to access and engage with the most appropriate services. The Probation Officer may be the only person aware of their clients’ mental health problems. Competent assessment, knowledge of available local and national Services and referral pathways are essential.
Based on the differences in reporting both within teams and across teams, it appears that some individual Probation Officers have a high level of knowledge and experience of mental health. Some Probation Officers identify symptoms of mental health problems more often and appear more confident making referrals and linking directly with local Services. Having Probation Officers with this level of experience and interest in the area of mental health is a significant strength for the Probation Service that should be developed further. There may be a strong case for specialist mental health Probation Officers, who hold ‘speciality caseloads’ (Skeem et al., 2006) described earlier.
Complex mental health problems and past in-patient psychiatric care
Both team studies identify approximately 10% of clients with complex mental health problems and past in-patient psychiatric care. Of those identified as experiencing active symptoms of mental health problems, 50 clients were identified with GAF scores within the serious and severe range, similar for men and women. Six clients were rated as ‘in almost constant danger of self-harm or harm to others’, all of whom were men. Both studies identified approximately 10% of clients as having had previous contact with in-patient Psychiatric Services. Notably this figure varied across teams with one team identified 17% of cases as having had received in-patient psychiatric care in the past.
Although it is not possible to make direct comparisons, the figures reported in these studies are considerably higher than those for the general population. The Health Research Board (2019) Irish Psychiatric Units and Hospitals Census reported a hospitalisation rate of 48.5 per 100,000 population based on 2308 patients resident in Irish Psychiatric Hospital units on 31 March 2019.
One of the five Probation Service teams in the third study identified more clients with complex needs and more serious symptomatology than the other teams indicative of mental health problems and fewer clients were linked in with any service for mental health problems. This indicated a necessity to identify the specific needs of each team and to respond and adapt service and training to meet specific needs identified and development of closer links with community and forensic mental health services.
Suicidal ideation and self-harming behaviour
Suicidal ideation and self-harming behaviour is reported similarly in the studies and is of significant concern for the Probation Service and the wider Health Services. These findings are consistent with Philips et al. (2018), who found the suicide rate among people under probation supervision, including those serving a community order, suspended sentence order or on licence/post-release supervision, is significantly higher than the general population and also higher than in prison. According to Skinner and Farrington (2020) ‘Shared responsibility lies with the prison, probation, health and social services to develop more collaborative practices in providing services for this high-risk group’ (pg. 6).
Based on these findings and in line with national guidelines, raising awareness and providing education and training to Probation Service staff on the Connecting for Life National Strategy (Department of Health, 2015) to reduce suicide should be a priority. The aim of the Strategy is to reduce suicide rate and presentations of self-harm in the whole population and among specified priority groups. The role of the National Office for Suicide Prevention is to support, inform, monitor and co-ordinate the implementation of Connecting for Life.
To address this risk would necessitate a co-ordinated approach in partnership with National and Regional Suicide Resources Officers for Suicide Prevention. Ongoing support and encouragement by Probation Service management will be essential to ensure staff participation in Skills Training on risk management and self-harm training (STORM) to develop and enhance skills and confidence in assessment and management of self-harm. The consistent and comprehensive collection of national data on suicide attempts, suicides and deaths among persons supervised by or otherwise engaged with the Probation Service will be important in informing policy and practice developments and in monitoring intervention outcomes. This data will enable the Probation Service to better identify risk factors to intervene earlier and coordinate more closely with health colleagues where necessary.
Access to and engagement with community and forensic services for mental health problems
A considerable number of clients in each of the studies were identified as experiencing serious mental health problems but not accessing any Service for assessment or intervention. This finding is consistent across the three studies. Understanding the reasons for this and the challenges service users experience in accessing and engaging with Services for mental health support is complex.
In these studies, along with difficulties accessing and engaging with mainstream Mental Health Services, client motivation to engage with services was a significant barrier identified by Probation Officers, along with other issues such as client lack of insight. There is a role for Probation staff motivating and supporting all clients to seek appropriate mental health assistance and advocate on their behalf for access to Services, where necessary. This includes recognising symptoms, having good knowledge of the Services available and of the formal referral pathways and confidence in initiating the referral which can be a challenge without training and support.
Offering access to Services for mental health alone, may not be sufficient to engage clients. Probation clients face multiple social, economic and psychological challenges and obstacles, internal and external. Engaging with Services for mental health support can be incredibly challenging for Probation Service clients, particularly where there is considerable instability and unmet basic physical and safety needs. Some significant challenges and additional barriers included limited access to services in rural or isolated areas.
A further challenge identified in the present studies is continuity of care particularly in transition from custodial settings into the community. Many Probation Service clients have been supported for serious mental health problems by psychiatry and psychology and other Healthcare Services whilst in custody. Clients who transition from custody where they were receiving treatment or psychological intervention for mental health problems may have difficulty accessing and sustaining an equivalent level of care and support in mainstream community and forensic Mental Health Services. Negotiating care and continuing treatment pathways can, in some instances, be problematic for some individuals. It may require joint interagency negotiation on access and to sustain client engagement with forensic or mainstream community mental health services. This is further complicated where there are multiple needs such as co-occurring substance misuse and/or lack of accommodation. Similar to findings by Fowler et al., insecure accommodation and housing instability were key consideration in the studies. Nearly half of all clients in the third study were identified as having accommodation instability.
It is understandable that clients may not prioritise their mental health needs in the absence of basic physiological and safety needs such as housing, food and sleep; motivation decreases when these needs are not met. Not having these basics in place should not be an exclusion criterion in having access to the appropriate Mental Health Services at the appropriate time. Clients may lose contact with referred Services and existing health care providers if they move out of a defined catchment area. Some clients may be of no fixed abode and not be engaged with a Doctor. This need for accommodation security can be particularly stressful and threatening especially where there are other aggravating difficulties such as mental health problems, speech and language and other communication difficulties that make it much harder to seek help when needed.
The findings and themes identified in the Moving Forward Together studies, incidence of mental health problems, suicidal ideation and self-harm, interpersonal violence, difficult family relationships, early adverse childhood experiences and chronic misuse of drugs and alcohol, indicate a need for a trauma-informed approach in Probation Service practice (McCartan 2020). This will involve proofing policy and practice documents in relation to their impact on a client’s mental health and reviewing training needs.
The Moving Forward Together Report made a series of recommendations based in its findings: 1. Develop a Probation Service Mental Health Engagement and Support Strategy that will build on the current findings and can be implemented nationally and locally. 2. There is a need for stronger links in supporting clients’ engagement with Services and in developing multi-disciplinary partnerships and active working with Mental Health professionals and services to maximise benefits of supervision and to reduce offending behaviour. 3. Increased Mental Health skills training for Probation Officers focussing initially on identification of mild to moderate mental health problems including mood disorders (e.g. depressive disorders) and anxiety disorders (e.g. social anxiety, health anxiety and generalised anxiety and OCD). 4. A tailored approach, with guidance, to addressing the mental health needs of clients engaged with the Probation Service is required. This will involve working with individual teams to develop an engagement strategy and skills, particularly for those clients presenting with active symptoms but not currently engaged with necessary services. 5. Provide support in the form of evidence-based interventions, including reflective practice facilitated through a psychologist and appropriate supervision, to support staff who are managing complex and challenging cases where mental health is of significant concern. 6. Review and if appropriate, revise current systems for recording deaths of persons on Probation Service supervision to ensure relevant data is captured. The Probation Service should continue to deliver the STORM skills-based training for Probation Officers in light of the increasing concern regarding suicide among Probation clients. 7. There is a need for further research, particularly including a study with a representative cohort of persons supervised by the Service to explore mental health needs from a client perspective. Research should also be conducted on effective mental health interventions for probation clients and formal pathways for them. 8. Support The Probation Service to work towards becoming a trauma informed organisation. Deliver training that focuses on trauma and its close links with offending behaviour and mental health. The Service should continue to work closely with other related services currently developing, implementing and evaluating their trauma informed practice. This is consistent with the Service Delivery Principles identified in ‘Sharing the Vision’ (Department of Health, 2020). 9. Substance misuse and co-occurring mental health problems is highly prevalent and problematic among Probation Service clients. Substance misuse and co-morbidity issues are often reported as a barrier to accessing and sustaining engagement with services for mental health problems. More collaborative and joint working with services that are multi-disciplinary and offer out-reach services is required to address the co-occurring conditions. 10. Personality Disorder is not recognised in the Irish Mental Health Act 2001 (Irish Statute Book 2001) which may, at least in part, explain why Personality Disorder as a formal diagnosis was reported as low. This may indicate that personality disorders are largely unaddressed and under diagnosed when compared with other jurisdictions. A psychosocial multi-disciplinary approach would enhance outcome benefits in working with presenting with complex mental health problems and co-occurring difficulties such as dual diagnosis, addiction, personality disorder and neurodiversity issues.
What is happening now in mental health in probation and criminal justice?
Following the launch in 2021 by the Minister for Justice and the Director of the Probation Service (Department of Justice 2021), of Moving Forward Together: Mental Health Among Persons Supervised by the Probation Service (Power 2020), the Service began the implementation of a Moving Forward Together Action Plan to address the recommendations in the Report.
The Moving Forward Together Plan and actions includes commitments to:
Develop a 5 year Mental Health Strategy in the Probation Service: A Probation Service Vision for Mental Health;
Probation Service Senior Management will lead engagement at a Departmental level with Health and Justice regarding the high incidence of mental health problems among those persons subject to Probation Service supervision and access to Forensic and Community Mental Health Services and Primary Psychology Services for those identified as presenting with a range of unmet mental health needs;
Design a skills-based training programme for Probation Service staff including knowledge of mental disorders, recognition of symptoms and best practice and evidence-based interventions. Identify relevant resources to include in the Offender Supervision Framework toolbox for Mental Health and identify local and national formal pathways for mental health support;
Continue to support the delivery of STORM training to Probation Officers across the Probation Service to address the ongoing concerns regarding risk of suicide among Probation clients;
Review and if appropriate, revise current systems for recording deaths of persons on Probation Service supervision to ensure relevant data is captured accurately;
Research and identify Probation Services internationally with access to Mental Health Services and with existing models of good practice;
Research and evaluate the role of Specialist Mental Health Probation Officers to assist, as part of their role, gathering and recording data relating to clients experiences of accessing and engagement with Community Mental Health Teams;
Develop links and pathways with existing national and local services dual diagnosis services;
Improve access to specialist services and collaborative joint working with services that are multi-disciplinary and offer specialist assessment/intervention to those presenting with complex mental health problems and co-occurring difficulties such as dual diagnosis, addiction, personality disorder and neurodiversity issues;
Establish links with local health services including Forensic and Community Mental Health Teams and General Practitioners explaining the role of Probation and the significant concern regarding unmet mental health need among probationers;
Utilise basic, well validated, screening tools as an aid to early identification of symptoms indicative of mental health problems to inform assessment and supervision plans;
Develop a Guidance Document detailing current research and best practice in relation to how the complex mental health needs and co-occurring difficulties of Probationers are addressed across jurisdictions.
High level taskforce report
In September 2022, the Ministers for Justice and Health published the final report and recommendations of the High Level Taskforce to consider the mental health and addiction challenges of those who come into contact with the criminal justice sector (Taskforce, 2022).
The Taskforce had been established in 2021 to meet the government’s commitment to ensure the critical mental health needs of people in prison are met, addiction treatments are provided and appropriate primary care supports are available on release, in order to ensure improved outcomes for the individuals concerned and for society as a whole. One of the subgroups, chaired by the Director of the Probation Service examined community issues and through-care upon release from custody.
Overall, the Taskforce made 61 recommendations emphasising the shared responsibility of government departments and agencies to deliver on meeting the needs of those with mental health and addiction challenges who come into contact with the criminal justice system.
The community-based recommendations echo many of the principles and recommendations made in Moving Forward Together: Mental Health Among Persons Supervised by the Probation Service. In particular, it recommends reinforcing the interconnections between the relevant stakeholders (HSE, criminal justice agencies and Local Authorities) to deliver a partnership approach by endorsing the HSE Single Integrated Case Management model and the extension of that pilot and its alignment with case management models in place in both the Probation Service and the Irish Prison Service.
Conclusion
This article provides a background to developments in addressing mental health factors and issues in probation supervision in Ireland based on key findings from the three studies which comprise the innovative Moving forward Together Report. The Report highlights key issues and has contributed to a raising of awareness of mental health as a priority area for attention by the Probation Service.
Going forward, it will be important that the Probation Service continues to progress its Mental Health Action Plan addressing the findings and recommendations of the Moving forward Together Report. Along with recommendations for the development of a joined-up and co-ordinated approach to address mental health needs within the criminal justice system, and others echoed in the recent High Level Taskforce Report, it will also be important to strengthen Probation Service staff knowledge and skills-based training in mental health to build necessary competence and confidence in the early recognition of mental health problems to ensure that the appropriate services are involved in the assessment and/or intervention.
The Moving forward Together Report, on which this article is based, was the first large scale study in Ireland exploring the prevalence of mental health issues among persons subject to probation supervision. There are gaps in information in the report. It will be important to conduct further in-depth studies to examine, among other factors, the clients’ voices as well as views of Forensic and Community Mental Health Service professionals and community and voluntary support services. Exploring the multiple perspectives will enable all to have a better understanding of the individual, service level and system challenges, and to collaboratively implement an integrated and co-ordinated approach and pathway to addressing those challenges.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
