Literature Reivew

I N V I T E D S P E C I A L I S S U E A R T I C L E

Mental health in the criminal justice system: A pathways approach to service and research design

Andrew Forrester1,2 | Gareth Hopkin3

1Edenfield Centre, Greater Manchester

Mental Health NHS FoundationTrust,

Manchester, UK

2Offender Health Research Network,

University of Manchester, Manchester, UK

3Department of Health Policy, London School

of Economics and Political Science, London,

UK

Correspondence

Andrew Forrester, Greater Manchester

Mental Health NHS FoundationTrust,

Edenfield Centre, Bury New Road,

Manchester, M25 3BL, UK.

Email: andrew.forrester1@nhs.net

Abstract

Background: Care pathway approaches were introduced

into health care in the 1980s and have become standard

international practice. They are now being introduced more

specifically for health care in the criminal justice system.

Care pathway delivery has the theoretical advantage of

encouraging a whole-systems approach for health and social

care within the criminal justice system, but how well is it

supported by empirical evidence?

Aims: The aim of this study is to review the nature and

extent of evidence streams supporting health care delivery

within interagency pathway developments since 2000.

Method: We used an exploratory narrative method to

review the nature and extent of evidence streams

supporting health care delivery within interagency pathway

developments since 2000. The available literature was

reviewed using a keyword search approach with three data-

bases: PubMed, Medline, and Google Scholar.

Findings: Research in this field has covered police custody,

courts, prisons, and the wider community, but there is little

that follows the entire career through all these elements of

offender placement. Main themes in the research to date,

regardless of where the research was conducted, have been

counting the disorder or the need, development and evalua-

tion of screening tools, and evaluation of clinical interven-

tion styles. Most evidence to date is simply observational,

although the possibility of conducting randomised con-

trolled trials of interventions within parts of the criminal

justice system, especially prisons, is now well established.

Received: 1 August 2019 Accepted: 1 August 2019

DOI: 10.1002/cbm.2128

Crim Behav Ment Health. 2019;29:207–217. wileyonlinelibrary.com/journal/cbm © 2019 John Wiley & Sons, Ltd. 207

Conclusions: Access to health care while passing through

the criminal justice system is essential because of the dis-

proportionately high rates of mental disorder among

offenders, and the concept of structured pathways to

ensure this theoretically satisfying, but as yet empirically

unsupported. Further, substantial cuts in services, generally

following government economies, are largely unresearched.

Considerable investment in new possibilities, driven by both

pressure groups and government, tend to be informed by

good will and theory rather than hard evidence and are

often not evaluated even after introduction. This must

change.

1 | INTRODUCTION

In the health sector, the organisation of care delivery into care pathways has become a standard international

process in the period since the concept was first introduced in the mid-1980s (Vanhaecht et al., 2006). The

purpose of these care pathways is to describe how, in general, optimal care should proceed, including how,

when, and by whom assessments and interventions should be delivered for any given condition or group of

conditions. As such, they are meant to offer a mechanism by which clinical services can be both organised and

measured. They therefore also offer the theoretical potential to set up a cycle of improvement in the quality of

care (Cheah, 1998).

Although evidence supporting the use of these care pathways has been mixed, they can be effective within a

number of limited circumstances and contexts. Successes include ensuring timely assessment and interventions, pro-

moting adherence to guidelines, and supporting decision making (Allen, Gillen, & Rixson, 2009). In the years since

they were first described, however, numerous different terms have also been used to document ways in which clini-

cal care can be organised. Terms such as “care model,” “care map,” or “multi-disciplinary care” have been used to

denote a similar meaning, causing some confusion within the developing literature (Kinsman, Rotter, James, Snow, &

Willis, 2010). In recognising these terminological difficulties and to provide some clarity, the European Pathway

Association (2019) has produced a consensus definition, which states that “care pathways are a methodology for the

mutual decision making and organisation of care for well-defined groups of patients during a well-defined period.”

Reflecting this literature, it has become fashionable to describe the journeys taken by people who enter the crim-

inal justice system and who access health services within it, in terms of pathways (National Institute for Health and

Care Excellence, 2019). In part, this reflects the theoretical progress that is made as people move from one part of

the criminal justice system to another and the need to undertake assessments and make clinical decisions at a num-

ber of defined stages, such as upon entering prison. This apparent pathway starts in the community at the point of

arrest and sometimes before in cases where people are already known to health or justice services. It continues fol-

lowing entry into police custody and attendance at lower (Magistrates') and upper (Crown) courts if required. It then

extends into prison custody for those who are sent there on remand (pre-trial) or after they receive a sentence,

before then returning to the community at the point of release from prison. In real life, of course, this theoretical

pathway structure is often messy, with arrests and rearrests, multiple court attendances at different levels, bail and

community orders providing additional stages and complexity to the pathways followed by many. Nonetheless, the

idea of a progressive pathway running through the core of the criminal justice system—a spine, as it were—is a useful

208 FORRESTER AND HOPKIN

conceptual model around which to consider the delivery and development of services and the organisation of

research priorities.

This paper aims to use this underlying pathways model as a conceptual guide to explore the extent to which

there is existing mental health research at each broad landmark on the criminal justice system pathway and consider

what is now required.

2 | METHODS

We used an exploratory narrative method to review the nature and extent of evidence streams supporting health

care delivery within interagency pathway developments since 2000.

The available literature was reviewed using three databases—PubMed, Medline, and Google Scholar—and we

used a keyword approach to search for relevant material, with the following keywords:

• Pathways (or healthcare pathways or health in justice pathways),

• AND (police or police custody),

• AND (court),

• AND (prison).

We also accessed relevant government documents in England and Wales from 2009, given that a pathways

approach became national government policy in these jurisdictions following the introduction of the Corston (2007)

and Bradley (2009) reports.

As a main goal behind this paper was to identify key areas for new research in the United Kingdom, and there

are jurisdictional differences in both criminal justice and health care delivery systems, there is a bias towards

reporting U.K.-based studies.

We focused on reports and articles that considered a pathways approach to service design and delivery and

excluded non-English language publications.

3 | FINDINGS

3.1 | Mental health in police custody

Police contact is the first step for any potential progress through the criminal justice system. Studies of any interac-

tion between police and mental health services are confounded by the fact that the police are increasingly having to

respond in the community to distressed people with mental disorders; indeed, police powers for removing a person

from a public place to a place of safety are written into mental health legislation, at least in the United Kingdom.

Since the publication of the Corston report in 2007, the literature on health care provision for people presenting

with mental disorders in police custody has moved towards a greater focus on providing care for people likely to be

charged with a criminal offence. Published data have been in three main areas—observational studies of need among

the people who are detained, simple, but effective methods of identifying mental disorder among such people and

evaluation of health care delivery models.

Observational studies have demonstrated high rates of mental disorder and substance misuse problems among

police detainees (Forrester, Samele, Slade, Craig, & Valmaggia, 2017; McKinnon & Grubin, 2010; Payne-James et al.,

2010). Large numbers of these detainees have histories of contact with psychiatric services or present with active

psychiatric symptoms when they are clinically reviewed. These findings are broadly consistent with samples from

other parts of the criminal justice system, in the United Kingdom, and overseas (Baksheev, Thomas, & Ogloff,

2010; Dorn et al., 2014; Ogloff, Warren, Tye, Blaher, & Thomas, 2011). There is also an overrepresentation of

FORRESTER AND HOPKIN 209

neurodevelopmental problems, including intellectual disabilities and attention deficit hyperactivity disorder, among

police detainees (Young, Goodwin, Sedgwick, & Gudjonsson, 2013).

There is evidence that detainees who exhibit mental health and substance misuse problems can be identified

with acceptable reliability and validity in police custody by clinical staff using research-validated screening tools

(McKinnon & Grubin, 2012; Noga, Walsh, Shaw, & Senior, 2015). The application of screening processes in opera-

tional reality has not, however, kept pace with these research findings, and in England and Wales, this area presently

requires review and improvement (Forrester, Taylor, & Valmaggia, 2016). The Health Screening of People in Police

Custody (HELP-PC) project, for example, has produced an evidence-based screen that can be simply applied; how-

ever, in most areas, appropriate screening is simply not being done (McKinnon & Grubin, 2012). Meanwhile, attempts

to help police by flagging risk may be disadvantaging the people with mental disorder who come into contact with

them (Kane, Evans, & Shokraneh, 2018).

Mental health intervention models designed for police custody suites have been evaluated, including consider-

ation of crisis intervention teams, liaison and diversion services, and street triage schemes. There is some limited evi-

dence in the literature for the effectiveness of both liaison and diversion and street triage interventions (Reveruzzi &

Pilling, 2016; Scott, McGilloway, Dempster, Browne, & Donnelly, 2013). The developing literature favours an inte-

grated multiagency approach to service delivery, but the literature remains sparse, includes no randomised controlled

trials, and does not clearly favour a particular model (Kane et al., 2018), indicating that those who are involved in

making policy and designing services should review the national approach that is currently being taken within

England and Wales.

It is now 10 years since the publication of Lord Bradley's (2009) review of people with mental health problems or

learning disabilities in the criminal justice system in England and Wales, and mental health services and multiagency

approaches have developed substantially in this area since then. These services—known as liaison and diversion ser-

vices—have been rolled out across the criminal justice system and explicitly include the possibility of diverting people

into mental health services before formal criminal charges are made. They have continued to receive political support

and treasury backing and, as a consequence, now cover almost three quarters of the population of England,

representing considerable change since they were first started as single-site pilots in the late 1980s (NHS England,

2019; Srivastava, Forrester, Davies, & Nadkarni, 2013).

Despite this developing evidence base and successes in service provision in the early stages of the criminal jus-

tice system, there are several issues that require more focus. There is currently an increasing recognition that people

from Black, Asian, and some minority ethnic groups have much higher arrest rates than White groups, leading to a

national review and a series of recommendations (Lammy, 2017). The extent to which these are being followed is

unclear, as is the impact this could have on the mental health of criminal justice-involved individuals from these

groups. Meanwhile, although there is evidence of a reduction in recorded crime, demand upon the police has risen

OR increased - not both in a number of areas, and at the same time, there has been a drop in overall police numbers.

In particular, there appears to have been an increase in the number of incidents in which mental health is a factor

(College of Policing, 2015). There has also been a renewed focus on deaths in police custody, of which there were

14 in 2015/2016, although 60 people died by suicide after being released from police custody during that same year.

In the 10-year period between 2005 and 2015, 51% of people who died in police custody did so from natural causes,

whereas drugs and/or alcohol were involved in 49% of cases (Angiolini, 2017). It is clear that much more needs to be

done in each of these areas to ensure the delivery of appropriate services and prevent adverse and harmful

outcomes.

3.2 | Mental health in courts

In 2017, the Magistrates' Courts managed 1.5 million cases in England and Wales, of which 114,000 (7.6%) were

subsequently committed to Crown Courts (upper courts) for further action, including trial and sentencing (House of

Commons, 2018). Magistrates' Courts (lower courts) in England and Wales are now mostly served by liaison and

210 FORRESTER AND HOPKIN

diversion services that often work across several parts of the criminal justice system—mainly police custody and

courts, although they also sometimes provide liaison input into prisons and probation services—offering a pathways-

type service within geographical areas (NHS England, 2019). In the main, these teams are staffed by nurses, although

other staff, including psychiatrists, social workers, and psychologists, can also be provided (Forrester et al., 2018).

The aim of such services is to provide assessment of a range of mental disorders and clinical liaison across a number

of agencies and to promote the diversion of people from the criminal justice system to safe alternatives, such as hos-

pital or community pathways, where this is appropriate. Although there is a commitment to the provision of mental

health services in the lower courts, they are not routinely provided in Crown Courts. Apart from a handful of small

schemes offering a liaison function involving local secure psychiatric services, mental health input into these courts

is mainly provided by expert witnesses.

Published literature indicates a high prevalence of mental disorder among court attendees (James, 2009; Shaw,

Creed, Price, Huxley, & Tomenson, 1999), for whom a range of special measures can be made available. These mea-

sures are meant to provide protection to vulnerable witnesses and they can include the use of screens, live links, giv-

ing evidence in private, the removal of official clothing such as wigs and gowns, using video-recorded interviews, or

the assistance of an intermediary (Crown Prosecution Service, 2019).

A range of diversion outcomes are available at various stages within the court process, and the available legisla-

tion can enable them to be tailored to the specific circumstances. For example, defendants can be diverted to hospi-

tal under civil sections of the Mental Health Act 1983 while they are unconvicted, or convicted but unsentenced, or

following a conviction, to community orders or suspended prison sentences provided under the Criminal Justice Act

2003, or mental health disposals provided under the Mental Health Act 1983. In cases where either fitness to plead

or insanity is an issue, there are three possible disposals: a hospital order, a supervision order, or absolute discharge.

One option that can be particularly effective for some offenders with mental disorder who do not require

hospitalisation is the personal tailoring of the community order or suspended prison sentence. It is possible to add a

number of specific requirements, with supervision by a probation officer, the most commonly used of the 13 possi-

bilities. Of the three community health treatment requirements, which include alcohol and drug treatment require-

ments, the mental health treatment requirement has not only been underused, but its use was falling; the court, in

essence, makes a form of contract between the probation officer, the clinician, and the prospective patient, who

must agree to the order (Scott & Moffatt, 2017). It is reassuring that the offender patients involved appear to under-

stand these orders (Manjunath, Gillham, Samele, & Taylor, 2018), but empirical research on their effectiveness is

lacking. A similar kind of community order in New York, to which patients must also give consent, has proved highly

effective in reducing rearrest and incarceration (Steadman, Redlich, Callahan, Robbins, & Vesselinov, 2011) as well as

inpatient hospitalisation, among other benefits (Swartz, Swanson, Steadman, Robbins, & Monahan, 2009). A

government-funded programme to improve availability of relevant services has proved effective in terms of both

increasing overall numbers of people being given a mental health treatment requirement and in being given com-

bined health requirements where the contribution of substance misuse has been recognised (Her Majesty's Prison

and Probation Service, 2014). Now, there should be research evaluation of the health and criminal justice outcomes

that follow from such orders. These must include reporting outcomes for the individual offenders and also test the

impact on the ever growing prison population. As yet, notwithstanding government policy since the publication of

the Bradley (2009) report to reduce the prison population in England and Wales, this has not happened in practice

(National Audit Office, 2017).

3.3 | Mental health in prisons

To date, the main approaches to the management of mental disorders in prisons have also fallen onto three main

categories: observations on the prevalence of mental disorders among prisoners, the development of screening

tools, and evaluation of services and interventions delivered—considering both treatment offered within the prison

environment and transfer to health service facility options.

FORRESTER AND HOPKIN 211

A high prevalence of mental disorder among prisoners has been reported across the world and is well established

in the international literature (Fazel & Baillargeon, 2011). Specific concerns have also been investigated, including

alcohol and substance misuse (Kissell et al., 2014; Singleton, Farrell, & Meltzer, 2003), self-harm and self-inflicted

death among prisoners (Hawton, Linsell, Adeniji, Sariaslan, & Fazel, 2014), traumatic brain injury (Williams, Cordan,

Mewse, Tonks, & Burgess, 2010), attention deficit hyperactivity disorder (Young et al., 2018), and ultra-high psycho-

sis risk (Evans et al., 2017). Meanwhile, the idea that health care screening must take place at prison reception has

gained international approval (United Nations General Assembly, 2016). A number of tools are available to screen for

mental disorders, six of which are supported by studies demonstrating replication—including the England Mental

Health Screen, the Jail Screening Assessment Tool, the Brief Jail Mental Health Screen, the Referral Decision Scale,

the Correctional Mental Health Screen for Men, and the Correctional Mental Health Screen for Women (Martin,

Colman, Simpson, & McKenzie, 2013).

The management and treatment of people in prisons in situ has been considered broadly in terms of mental state

change during imprisonment. A systematic review of longitudinal studies internationally confirmed, perhaps surpris-

ingly, a tendency towards improvement in mental state, perhaps especially during the early weeks of stay (see

Walker et al., 2014, for a systematic review). In England and Wales, it is estimated that over a third of prisoners have

diagnosable mental health conditions and mental health in-reach teams have been developed to provide care and

treatment using a model that is meant to be equivalent to the services prisoners would receive if they were resident

in the community. Although these teams are now providing care to many people who would not otherwise have

received it, variations in their coverage and content, and persisting issues with the identification of mentally ill

prisoners, have remained problematic (Forrester et al., 2013; Senior et al., 2013).

If a prisoner has a disorder of health, including mental health, of sufficient severity to require inpatient treatment,

then, in the United Kingdom, that individual must be transferred to a health service hospital (under mental health leg-

islation in the case of mental disorder). In England and Wales, there were 1,081 such transfers during the year

2016/2017. Most of these people waited much longer for hospital admission than the recommended 14-day period

(National Audit Office, 2017). Although this group only represents around 3.5% of the 31,328 in prison thought to

have mental health problems (National Audit Office, 2017), they are acutely unwell, and delays to transfer generally

prevent effective treatment delivery. Continued commitment to both management in situ and reduced delays to

transfer is needed to ensure that transfer to hospital is completed promptly for the small number of acute cases and

that high-quality mental health care is available in prison for the larger group of prisoners with mental health prob-

lems that can be managed by teams working within prisons.

Developments in prison models of care using specific screening, referral, and stratification processes have been

implemented within large prison systems and described in the literature (O'Neill et al., 2016; Pillai et al., 2016). The

organisation of these processes into a particular model—the STAIR model—is one easily understandable way of signi-

fying what should happen within the prison health care pathway and when. It includes five key elements—screening,

triage, assessment, intervention, and reintegration (STAIR) (Forrester et al., 2018; McKenna et al., 2018; Pillai et al.,

2016). Although this model is broadly in keeping with guidelines for the management of adults who are in contact

with the criminal justice system, which particularly emphasise screening processes, further research is needed to

refine existing models to ensure they are sensitive to the wide range of mental disorders seen (National Institute for

Health and Care Excellence, 2017). Service developments are also needed to ensure that resources provided on the

ground are both adequate and appropriate (Patel, Harvey, & Forrester, 2018).

3.4 | Mental health following release

Literature on the postrelease period for prisoners with mental health problems is limited, but available evidence indi-

cates that outcomes in this period are poor. Continuity of care between prison and community-based services is

difficult to provide, and prisoners often lose contact with services after release, even where management in prison is

in place (Lennox et al., 2012). Mortality after release from prison is high, with elevated risk of both drug-related

212 FORRESTER AND HOPKIN

mortality (Farrell & Marsden, 2008) and suicide (Pratt, Piper, Appleby, Webb, & Shaw, 2006). It has also been

suggested that prisoners with mental illness have higher rates of reoffending than those without mental disorder and

are more likely to return to prison due to lack of support (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009).

Despite these outcomes, care targeted at the transition from prison to the community is seldom present. Services

based in prison have limited ability to provide care after release, and due to the chaotic nature of release, community

services have limited ability to respond to referrals. Targeted interventions are therefore needed to attempt to

improve outcomes in this area. A number of evidence-based interventions are available, and studies suggest that

interventions focused on the transition from prison to the community can improve outcomes with prisoners with

mental health problems (Hopkin, Evans-Lacko, Forrester, Shaw, & Thornicroft, 2018). In the United Kingdom, com-

munity mental health care services are well established, and short-term bridging interventions may be sufficient to

improve care by ensuring that continuity of care between existing services is achieved. Randomised controlled trials

are, however, feasible in this area (Lennox et al., 2018); one such trial having shown that providing additional care in

4 weeks before and 6 weeks after release, and planning more proactively for transition to the community, can

improve engagement with mental health services (Shaw et al., 2014).

Further research is now needed in this area to consider what initiatives work best to facilitate engagement with

services and improve outcomes in the postrelease period. In addition, we need to understand how these services can

best ensure that continuity of care is optimised. It will also be important to understand how these services can best

work alongside probation services by testing appropriate models.

It is not possible to conclude without referring to the offender personality disorder pathway programme, a large-

scale national initiative in England and Wales that provides a range of therapeutic services for people with severe

personality disorders and associated risk to others, across the criminal justice system (National Offender Manage-

ment Service and NHS England, 2015). Key components of this model include the use of case identification and

pathways planning, psychologically informed planned environments, and case management in the community, both

following release and through probation services (Benefield, Turner, Bolger, & Bainbridge, 2017). This model is pres-

ently being evaluated, and a review of its advantages and limitations will soon be possible.

4 | CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH

It is clear that there have been many welcome research developments in this field and that these research develop-

ments have led to an improved understanding of service design and application. It is also apparent, however, that

research has not always been done either preparatory to service development or after a service has been put in

place. There has too often been a reliance on lower quality evidence, rather than introducing higher quality studies

including quasi-experimental and randomised controlled trial work. The many service developments in the field tend

to be driven centrally by political declarations and policy statements rather than being underpinned by robust

research evidence. This would not be acceptable in most, if any, other areas of health care provision.

Moving forward, it will now be important for us to develop our understanding in a number of key areas. When,

where, and how often should screening be applied, and what tools offer the best results? What qualities in liaison

and diversion services improve the uptake of community alternatives to prison custody and have a beneficial effect

on rates of recidivism? Can integrated service delivery work across sectors and achieve its theoretical potential by

improving the accessibility to and overall quality of services? How do we best resolve serious and persisting prob-

lems in respect of clinical complexity and mortality, and what interventions should now be targeted through research

to ensure better outcomes? How can environmental effects, such as the impact of overcrowding or segregation, best

be understood, and what environmental improvements are required?

Such questions cannot be easily answered without a considered and strategic approach to research planning

within this field, recognising the difficulties in ensuring research funding in an area where the acquisition of such

funding has always been difficult. In order to take this forward, we recommend that a suitable expert group is

FORRESTER AND HOPKIN 213

brought together to identify the most important research questions and develop responses. What are the research

priorities for the next decade?

ACKNOWLEDGEMENTS

None.

CONFLICT OF INTERESTS

The authors declare no conflict of interests.

FUNDING INFORMATION

There are no funding sources to declare.

ORCID

Andrew Forrester https://orcid.org/0000-0003-2510-1249

REFERENCES

Allen, D., Gillen, E., & Rixson, L. (2009). Systematic review of the effectiveness of integrated care pathways: What works, for

whom, in what circumstances? International Journal of Evidence-Based Healthcare, 7(2), 61–74. https://doi.org/10.1111/

j.1744-1609.2009.00127.x

Angiolini, E. (2017). Report of the independent review of deaths and serious incidents in police custody. London: HM

Government.

Baillargeon, J., Binswanger, I. A., Penn, J. V., Williams, B. A., & Murray, O. J. (2009). Psychiatric disorders and repeat incarcer-

ations: The revolving prison door. The American Journal of Psychiatry, 166(1), 103–109. https://doi.org/10.1176/appi.

ajp.2008.08030416

Baksheev, G. N., Thomas, S. D., & Ogloff, J. R. (2010). Psychiatric disorders and unmet needs in Australian police cells.

Australian and New Zealand Journal of Psychiatry, 44(11), 1043–1051. https://doi.org/10.1080/00048674.2010.503650 Benefield, N., Turner, K., Bolger, L., & Bainbridge, C. (2017). Psychologically informed planned environments: A new opti-

mism for criminal justice provision? Transforming environments and rehabilitation, 179–197. Routledge. Bradley, K. J. C. B. (2009). The Bradley report: Lord Bradley's review of people with mental health problems or learning dis-

abilities in the criminal justice system (vol. 7). London: Department of Health.

Cheah, R. S. (1998). Clinical pathways—The new paradigm in healthcare? Medical Journal of Malaysia, 53(1), 87–96. College of Policing. (2015). Estimating demand on the police service. Available at: https://www.college.police.uk/News/

College-news/Pages/COP-response-HASC.aspx [Accessed 17 Mar. 2019].

Corston, J. (2007). The Corston report: The need for a distinct, radically different, visibly-led, strategic, proportionate, holistic,

woman-centred, integrated approach. Home Office.

Crown Prosecution Service. (2019). Special measures. Available at: https://www.cps.gov.uk/legal-guidance/special-

measures [Accessed 17 Mar. 2019].

Dorn, T., Ceelen, M., Buster, M., Stirbu, I., Donker, G., & Das, K. (2014). Mental health and health-care use of detainees in

police custody. Journal of Forensic and Legal Medicine, 26, 24–28. https://doi.org/10.1016/j.jflm.2014.06.005

European Pathway Association. (2019). Care pathways. [online] Available at: http://e-p-a.org/care-pathways/ [Accessed 16

Mar. 2019].

Evans, C., Forrester, A., Jarrett, M., Huddy, V., Campbell, C. A., Byrne, M., … Valmaggia, L. (2017). Early detection and early

intervention in prison: Improving outcomes and reducing prison returns. The Journal of Forensic Psychiatry & Psychology,

28(1), 91–107. https://doi.org/10.1080/14789949.2016.1261174 Farrell, M., & Marsden, J. (2008). Acute risk of drug-related death among newly released prisoners in England and Wales.

Addiction, 103(2), 251–255. https://doi.org/10.1111/j.1360-0443.2007.02081.x Fazel, S., & Baillargeon, J. (2011). The health of prisoners. The Lancet, 377, 56–65.

214 FORRESTER AND HOPKIN

Forrester, A., Exworthy, T., Olumoroti, O., Sessay, M., Parrott, J., Spencer, S. J., & Whyte, S. (2013). Variations in prison men-

tal health services in England and Wales. International Journal of Law and Psychiatry, 36(3-4), 326–332. https://doi.org/

10.1016/j.ijlp.2013.04.007

Forrester, A., Samele, C., Slade, K., Craig, T., & Valmaggia, L. (2017). Demographic and clinical characteristics of 1092 consec-

utive police custody mental health referrals. The Journal of Forensic Psychiatry & Psychology, 28(3), 295–312. https://doi.

org/10.1080/14789949.2016.1269357

Forrester, A., Taylor, P., & Valmaggia, L. (2016). Healthcare services in police custody in England and Wales. British Medical

Journal, 353, i1994.

Forrester, A., Till, A., Simpson, S., & Shaw, J. (2018). Mental illness and the provision of mental health services in prisons.

British Medical Bulletin, 127(1), 101–109. https://doi.org/10.1093/bmb/ldy027

Hawton, K., Linsell, L., Adeniji, T., Sariaslan, A., & Fazel, S. (2014). Self-harm in prisons in England and Wales: An epidemio-

logical study of prevalence, risk factors, clustering, and subsequent suicide. The Lancet, 383(9923), 1147–1154. https://

doi.org/10.1016/S0140-6736(13)62118-2

Her Majesty's Prison and Probation Service. (2014). Guidance: Healthcare for Offenders. Available at: https://www.gov.uk/

guidance/healthcare-for-offenders [Accessed 11 Aug. 2019]

Hopkin, G., Evans-Lacko, S., Forrester, A., Shaw, J., & Thornicroft, G. (2018). Interventions at the transition from prison to

the community for prisoners with mental illness: A systematic review. Administration and Policy in Mental Health and

Mental Health Services Research., 45, 623–634. https://doi.org/10.1007/s10488-018-0848-z House of Commons. (2018). Court statistics for England and Wales. Briefing Paper Number CBP 8372

Williams, W., Cordan, G., Mewse, A. J., Tonks, J., & Burgess, C. N. (2010). Self-reported traumatic brain injury in male young

offenders: A risk factor for re-offending, poor mental health and violence? Neuropsychological Rehabilitation, 20(6),

801–812. https://doi.org/10.1080/09602011.2010.519613 James, D. (2009). Court diversion in perspective. Australian and New Zealand Journal of Psychiatry, 40(6-7), 529–538. Kane, E., Evans, E., & Shokraneh, F. (2018). Effectiveness of current policing-related mental health interventions: A system-

atic review. Criminal Behaviour and Mental Health, 28(2), 108–119. https://doi.org/10.1002/cbm.2058

Kinsman, L., Rotter, T., James, E., Snow, P., & Willis, J. (2010). What is a clinical pathway? Development of a definition to

inform the debate. BMC Medicine, 8, 31. https://doi.org/10.1186/1741-7015-8-31

Kissell, A., Taylor, P. J., Walker, J., Lewis, E., Hammond, A., & Amos, T. (2014). Disentangling alcohol-related needs among

pre-trial prisoners: A longitudinal study. Alcohol and Alcoholism, 49(6), 639–644. https://doi.org/10.1093/alcalc/agu056 Lammy, D. (2017). The Lammy review: An independent review into the treatment of, and outcomes for, Black, Asian and

minority ethnic individuals in the criminal justice system. HM Government.

Lennox, C., Kirkpatrick, T., Taylor, R. S., Todd, R., Greenwood, C., Haddad, M., … Brand, S. L. (2018). Pilot randomised con-

trolled trial of the ENGAGER collaborative care intervention for prisoners with common mental health problems, near to

and after release. Pilot and Feasibility Studies, 4(1), 15. https://doi.org/10.1186/s40814-017-0163-6

Lennox, C., Senior, J., King, C., Hassan, L., Clayton, R., & Shaw, J. (2012). The management of released prisoners with severe

and enduring mental illness, The Journal of Forensic Psychiatry & Psychology 23(1), 67–75. Manjunath, A., Gillham, R., Samele, C., & Taylor, P. J. (2018). Serving a community sentence with a mental health treatment

requirement: Offenders' perspectives. Criminal Behaviour and Mental Health, 28(6), 492–502. https://doi.org/10.1002/

cbm.2096

Martin, M. S., Colman, I., Simpson, A. I., & McKenzie, K. (2013). Mental health screening tools in correctional institutions: A

systematic review. BMC Psychiatry, 13(1), 275. https://doi.org/10.1186/1471-244X-13-275

McKenna, B., Skipworth, J., Tapsell, R., Pillai, K., Madell, D., Simpson, A., … Rouse, P. (2018). Impact of an assertive commu-

nity treatment model of care on the treatment of prisoners with a serious mental illness. Australasian Psychiatry, 26(3),

285–289. https://doi.org/10.1177/1039856217748247 McKinnon, I., & Grubin, D. (2010). Health screening in police custody. Journal of Forensic and Legal Medicine, 17(4), 209–212.

https://doi.org/10.1016/j.jflm.2010.02.004

McKinnon, I. G., & Grubin, D. (2012). Health screening of people in police custody-evaluation of current police screening

procedures in London, UK. The European Journal of Public Health, 23(3), 399–405. cks027 National Audit Office. (2017). Mental health in prisons. London: National Audit Office.

National Institute for Health and Care Excellence. (2017). Mental health of adults in contact with the criminal justice system.

London: National Institute for Health and Care Excellence.

National Institute for Health and Care Excellence. (2019). Health of people in the criminal justice system—NICE pathways.

[online] Available at: https://pathways.nice.org.uk/pathways/health-of-people-in-the-criminal-justice-system [Accessed

16 Mar. 2019].

National Offender Management Service and NHS England. (2015). The offender personality disorder pathway strategy.

London: National Offender Management Service and NHS England.

FORRESTER AND HOPKIN 215

NHS England (2019). About liaison and diversion. Available at: https://www.england.nhs.uk/commissioning/health-just/

liaison-and-diversion/about/ [Accessed 16 Mar. 2019].

Noga, H., Walsh, E., Shaw, J., & Senior, J. (2015). The development of a mental health screening tool and referral pathway

for police custody. The European Journal of Public Health, 25(2), 237–242. https://doi.org/10.1093/eurpub/cku160 Ogloff, J., Warren, L., Tye, C., Blaher, F., & Thomas, S. (2011). Psychiatric symptoms and histories among people detained in

police cells. Social Psychiatry and Psychiatric Epidemiology, 46(9), 871–880. https://doi.org/10.1007/s00127-010-

0256-5

O'Neill, C., Smith, D., Caddow, M., Duffy, F., Hickey, P., Fitzpatrick, M., … Gallagher, B. (2016). STRESS-testing clinical activ-

ity and outcomes for a combined prison in-reach and court liaison service: A 3-year observational study of 6177 consec-

utive male remands. International Journal of Mental Health Systems, 10(1), 67. https://doi.org/10.1186/s13033-016-

0097-z

Patel, R., Harvey, J., & Forrester, A. (2018). Systemic limitations in the delivery of mental health care in prisons in England.

International Journal of Law and Psychiatry, 60, 17–25. https://doi.org/10.1016/j.ijlp.2018.06.003 Payne-James, J. J., Green, P., Green, N., McLachlan, G., Munro, M., & Moore, T. (2010). Healthcare issues of detainees in

police custody in London, UK. Journal of Forensic and Legal Medicine, 17(1), 11–17. https://doi.org/10.1016/j.jflm.2007.

10.011

Pillai, K., Rouse, P., McKenna, B., Skipworth, J., Cavney, J., Tapsell, R., … Madell, D. (2016). From positive screen to engage-

ment in treatment: A preliminary study of the impact of a new model of care for prisoners with serious mental illness.

BMC Psychiatry, 16(1), 9. https://doi.org/10.1186/s12888-016-0711-2

Pratt, D., Piper, M., Appleby, L., Webb, R., & Shaw, J. (2006). Suicide in recently released prisoners: A population-based

cohort study. The Lancet, 368(9530), 119–123. https://doi.org/10.1016/s0140-6736(06)69002-8 Reveruzzi, B., & Pilling, S. (2016). Street triage. Report on the Evaluation of Nine Pilot Schemes in England. University College

London.

Scott, D., McGilloway, S., Dempster, M., Browne, F., & Donnelly, M. (2013). Effectiveness of criminal justice liaison and

diversion services for offenders with mental disorders: A review. Psychiatric Services, 64, 843–849. https://doi.org/10. 1176/appi.ps.201200144

Scott, G., & Moffatt, S. (2012). The mental health treatment requirement. London: Centre for Mental Health. Available at:.

https://www.centreformentalhealth.org.uk/publications/mental-health-treatment-requirement

Senior, J., Birmingham, L., Harty, M. A., Hassan, L., Hayes, A. J., Kendall, K., … Webb, R. (2013). Identification and manage-

ment of prisoners with severe psychiatric illness by specialist mental health services. Psychological Medicine, 43(7),

1511–1520. https://doi.org/10.1017/S0033291712002073 Shaw, J., Conover, S., Herman, D., Jarrett, M., Leese, M., McCrone, P., … Stevenson, C. (2017). Critical time Intervention for

Severely mentally ill Prisoners (CrISP): A randomised controlled trial. Health Services and Delivery Research, 5(8), 1–138. https://doi.org/10.3310/hsdr05080

Shaw, J., Creed, F., Price, J., Huxley, P., & Tomenson, B. (1999). Prevalence and detection of serious psychiatric disorder in

defendants attending court. The Lancet, 353(9158), 1053–1056. https://doi.org/10.1016/S0140-6736(98)08094-5 Singleton, N., Farrell, M., & Meltzer, H. (2003). Substance misuse among prisoners in England and Wales. International Review

of Psychiatry, 15(1-2), 150–152. https://doi.org/10.1080/0954026021000046092 Srivastava, S., Forrester, A., Davies, S., & Nadkarni, R. (2013). Developing criminal justice liaison and diversion services:

Research priorities and international learning. Criminal Behaviour and Mental Health, 23, 315–320. https://doi.org/10. 1002/cbm.1888

Steadman, H. J., Redlich, A., Callahan, L., Robbins, P. C., & Vesselinov, R. (2011). Effect of mental health courts on arrests

and jail days: A multisite study. Archives of General Psychiatry, 68(2), 167–172. https://doi.org/10.1001/

archgenpsychiatry.2010.134

Swartz, M. S., Swanson, J. W., Steadman, H. J., Robbins, P. C., & Monahan, J. (2009). New York State Assisted Outpatient

Program evaluation. https://static.prisonpolicy.org/scans/NYDPH-report.pdf

United Nations General Assembly. (2016). United Nations standard minimum rules for the treatment of prisoners (the Nelson

Mandela Rules). A/RES/70/175 (8 January 2016). http://www. refworld. org/docid/5698a3a44.html

Vanhaecht, K., Bollmann, M., Bower, K., Gallagher, C., Gardini, A., Guezo, J., … Van Zelm, R. (2006). Prevalence and use of

clinical pathways in 23 countries—An international survey by the European Pathway Association. Journal of Integrated

Care Pathways, 10(1), 28–34. Walker, J., Illingworth, C., Canning, A., Garner, E., Woolley, J., Taylor, P. J., & Amos, T. (2014). Changes in mental state associ-

ated with prison environments: A systematic review. Acta Psychiatrica Scandinavica., 129, 236–427. https://doi.org/10. 1111/acps.12221

Williams, W. H., Mewse, A. J., Tonks, J., Mills, S., Burgess, C. N., & Cordan, G. (2010). Traumatic brain injury in a prison popu-

lation: prevalence and risk for re-offending. Brain Injury, 24(10), 1184–1188.

216 FORRESTER AND HOPKIN

Young, S., Goodwin, E., Sedgwick, O., & Gudjonsson, G. (2013). The effectiveness of police custody assessments in identify-

ing suspects with intellectual disabilities and attention deficit hyperactivity disorder. BMC Medicine, 11, 248. https://doi.

org/10.1186/1741-7015-11-248.

Young, S., Gudjonsson, G., Chitsabesan, P., Colley, B., Farrag, E., Forrester, A., … Mason, P. (2018). Identification and

treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: A practical approach based

upon expert consensus. BMC Psychiatry, 18(1), 281. https://doi.org/10.1186/s12888-018-1858-9

How to cite this article: Forrester A, Hopkin G. Mental health in the criminal justice system: A pathways

approach to service and research design. Crim Behav Ment Health. 2019;29:207–217. https://doi.org/10.

1002/cbm.2128

FORRESTER AND HOPKIN 217

Copyright of Criminal Behaviour & Mental Health is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.