SAMH JDSG Involvement Event
Justice Disability Steering Group
SAMH Involvement Event
Friday 18 September 2009
- Background to the event
- Results of discussions
2.1.Attitudinal barriers / 7
2.2.Communication barriers / 12
2.3.Physical barriers / 15
2.4.Legal assistance / 16
- Summary of ideas for action
- Continuing involvement
The Justice Disability Steering Group (JDSG) was set up in 2007 by the organisations representing the justice sector in Scotland. It is comprised of the Scottish Government, the Association of Chief Police Officers in Scotland, the Crown Office and Procurator Fiscal Service, the Scottish Court Service, the Law Society of Scotland, the Scottish Legal Aid Board and the Scottish Prison Service.
The aim of the JDSG is to develop ways in which disabled people can be involved in helping to improve access to services across the justice system in Scotland and to draw on their skills and experience to improve the Scottish justice sector for all. The JDSG contracted Capability Scotland to manage a project of involvement events to find out from disabled people the barriers they encounter in accessing justice. Capability organised seven public involvement events across Scotland in Autumn 2009 in partnership with other disability and race organisations.
Capability Scotland worked in partnership with the Scottish Association for Mental Health (SAMH) to arrange an event involving 14 adults with experience of mental health problems on Friday 18th September 2009at Touchbase, a fully accessible resource centre run by Sense Scotland inKinningPark in Glasgow.
SAMH, Scotland’s leading mental health charity, works to support people who experience mental health issues, homelessness, addictions and other forms of social exclusion.
Experiences of the justice system discussed at the group were wide ranging and included being a witness in a criminal trial, a victim of a crime, being wrongfully accused of a crime, involvement with the police after experiencing a hate crime, seeking advice of solicitors in civil and criminal cases, attending a mental health tribunal, being arrested, going to court on a criminal charge, going to prison on a number of occasions, supporting war veterans with post traumatic stress disorder who are arrested by the police, having a close relative sectioned under the Mental Health Act, attending a children’s hearing, and providing peer support or advocacy to others with mental health problems when they are involved with the justice system.
The involvement day was designed around four key discussion areas:
- Attitudinal barriers
- Communication Barriers
- Physical barriers
- Legal assistance
Scenarios were used for each area and adapted so as to capture barriers unique to mental health issues in order to prompt discussion and bring the issues to life. Participants talked in three discussion groups about their experiences and perceptions in each area and then reported back on their main areas of discussion and key ideas for action. The key areas of concern and suggested action points are detailed below.
2.1.Attitudinal Barriers
Attitudinal Barriers were considered the most problematic in terms of people experiencing mental ill health accessing Justice
“Courts are scary places... and the staff look right though you. They need training in how to talk to people with mental health problems, mental health awareness, how to talk to everybody really, just to make the experience more bearable’
People with mental health problems and other impairments find attitudinal barriers, and institutional failure to recognise signs of mental distress, PTSD, crisis, mania, psychosis, catatonia, depression or other mental health conditions highly problematic when interacting with the Police, the Courts, Solicitors and Prison staff. One delegate described being locked up over the weekend in a police cell whilst having PTSD caused by his involvement as a serviceman with the war in Iraq.
He was ignored by Police and not given food or water because he would not bang or shout like other people in the cells as he was in crisis and experiencing flashbacks and the noise was exacerbating his distress. He now works as a PTSD counsellor with veterans and supports clients who are arrested or imprisoned. He spoke very eloquently and realistically about the everyday pressures that desk sergeants may be under when booking people in who may be drunk and/or violent and suggested that it might be naive to expect police to be able to spot the signs of PTSD themselves. The whole group suggested that people need to be asked clearly and sensitively and/ or supported to identify or disclose these conditions themselves to staff within the Justice Sector.
Another delegate talked about being a witness in court and not being able to speak because of difficulty ordering his thoughts, he wasn’t given any support by staff and wasn’t taken seriously when he asked for support. He wasn’t aware of vulnerable witness provisions.
The group gave positive feedback about the witness service in court but were less aware about the vulnerable witness provisions. They felt that this service is not being used to support those with mental health problems when it could be.
There were numerous commentsfrom participants about poor communication from lawyers representing those in mental distress. One delegate spoke about going to see a lawyer about representation at a children’s hearing as a relevant person when he was feeling very depressed after a divorce and recent bereavement, the lawyer wouldn’t wait for him to answer questions and looked at him as though he were stupid, he felt suicidal on the way home, and decided not to attend the hearing about contact with his children. The decision made about contact without him being there caused his mental health condition to worsen.
If professionals cannot be expected to identify particular mental health conditions they need to be aware of what they might consider ‘unusual’ or ‘uncooperative’ behavioural responses caused by underlying mental health problems. When professionals within the Justice Sector are making judgements about a person’s behaviour to determine credibility, guilt, eligibility for support for example, delegates stressed the importance of these professionals being trained to spot when a behavioural response from someone, excessive anger, tears, failure to express themselves clearly, silence, a lack of emotion, poor concentration, incongruity of affect for example may be as a result of an underlying mental health condition.
The groups recognised that there are no easy solutions to this, particularly in punitive situations, or where a person with current or past experience of mental ill health does not want information shared by professionals, or contact made with GPs, psychiatrists, or CPNs. They may have chosen to stop medication or are worried that their evidence will not be considered credible by police or courts.
The issue of disclosure and identification were discussed at length by the wider group. Some participants felt that staff within the justice sector may be more likely to discriminate against someone once theirmental health status is disclosed, others thought that supported self-disclosure was necessary to signpost people effectively to services.
It was recognised by the wider group that many people with undiagnosed or untreated mental health problems consider self-harm or committing a crime to get the help required. One participant described how he had been out on the street deciding what crime to commit so as to get the attention from services that he needed, if he hadn’t got help from SAMH he would have committed an offence, just to get arrested and feel safe.
Another participant said that she had after a family bereavement and subsequent mental health problemsshe started shoplifting. It was only after being arrested and charged that a court appointed lawyer and judiciary involvement led to the referral to social work and the provision of mental health services that she desperately needed.
There was a feeling in the room that interaction with the Justice Sector for people with mental health problems can be a double-edged sword in many ways, exacerbating mental health problems when barriers were present, but also acting as a catalyst for recovery in other situations when supports were put in place by Justice professionals.
Issues faced by disabled prisoners experiencing mental health problems and symptoms of addiction and withdrawal were discussed by the wider group. The general consensus was that treatment in the area of addictions and withdrawal within prison had once been very poor because of attitudinal barriers, and the widely-held belief that prison staff once believed addicts should just have to ‘put up’ with withdrawal symptoms in prison despite the implications for their mental health. The wider group thought that treatment of addicts in prison has improved a lot in the last 5 years.
All agreed that Mental Health Awareness Training for staff across the sector would be extremely valuable and might also break down the barriers that professionals in the sector face themselves when disclosing personal experience of mental ill health. The key is openness, active listening, and innovative methods of identifying a mental health problem alongside provision of mental health support workers (including peer support) and advocacy.
Ideas for action:
- Justice staff valuing the support provided to those with mental health problems by families, peer supporters, advocates, social workers and CPNs is fundamental to breaking down attitudinal barriers. Professionals, particularly Solicitors and Police need to be trained to work effectively with these supports and to feel confident with signposting clients to these services.
- Justice sector organisations should work with others (NHS and Scottish Government) to develop inventive and sensitive ways of people self-identifying as having a mental health problem. A card, dog-tag or armband system was suggested but participants did acknowledge that social stigma and the reaction by staff to this might make these methods inappropriate. All were agreed that staff within the sector need to be able to ask sensitive questions that might allow someone to disclose information about their mental health.
- Better use needs to be made of vulnerable witness provisions for people with mental health problems.
- Justice sector organisations need to provide mental health awareness training to staff. As attitudinal barriers in this area exacerbate disability for people with mental health problems in ways that are unique to mental health, this area needs particular attention that is entirely separate from general disability equality training.
- Justice sector organisations need to support staff to disclose personal experience of mental ill health without fear that their jobs will be affected. This was identified in group feedback as very important in breaking down the barriers and secrecy surrounding mental health in Scotland. When empathy is so crucial to successful communication this may be as powerful in terms of removing attitudinal barriers as provision of external training.
- Peer support provision should be formalised, and legal advice offered to peer supporters when they are interacting with solicitors and police.
2.2.Communication Barriers
Communication Barriers are still present for people with mental health problems ‘when travelling through’ the justice system.
‘We need to build confidence, lose the formality and address issues that people have without jargon’
People with mental health problems and other impairments reported that being talked to by Justice Sector Staff, particularly police, prison staff and lawyers with a lack of respect or in confusing language led to them feeling angry and frustrated, which really affected their mood and self-perception at times. This was said to be a particular problem in prison as ‘you can’t get away from it’. They also said that repeating information, particularly about distressing events to different staff within the sector could be very detrimental to their mental health and said that there is a need for better information sharing.
Participants found the language used by professionalsvery difficult to understand, particularly communications from solicitors and the courts and said that too few professionals asked them about their communication needs and how to get help with this. One participant said that accessing communication support in prison meant going through ‘the chain of command’ and that this just wasn’t quick enough to provide the support he needed when he was in crisis.
The whole group said that information needs to be dispensed in ways that are right for the individual. They discussed how letters and leaflets could be made more helpful when people with mental health problems are having difficulty processing information. Participants acknowledged that when people are very depressed or experiencing a break-down or crisis, they stay away from written materials and letters and leaflets may very well not be read by the individual in most cases, so the key is to take the time to verbally communicate well with people’s supporters and advocates and always provide an accessible written record.
Participants said that professionals within the Justice Sector ‘only seemed interested in collecting the minimum amount of information required for form filling and ticking boxes’, they explained that active listening skills, and staff finding out what information someone can retain themselves and what must be told to others, family or supporters, was really important.
Participants reported very positive experiences of being helped by law centres across Scotland to understand forms and procedures, this ranged from assistance with benefit appeals, to taking a legal case against a utility company.
People explained that they have seen posters in police stations, courts or in prison telling them their rights but that the gap between that information and people with mental health problems actually enforcing their rights can be massive.
All spoke of the need for plain English and clear follow-up after interviews with Police and Lawyers. People with mental health problems can leave lawyer’s offices with no recollection of what has been said or decided.
One delegate talked about a family lawyer speaking to her in latin when she was experiencing extreme depression after the death of her child, she couldn’t bear going back to see him, another described how letters about court dates felt so impersonal and were often inaccurate, she found this very distressing as she was finding it very hard to plan future time anyway. A participant with communication impairment and autism spectrum disorder spoke very highly of the support provided to him by the police when he reported a hate crime but suggested that written follow-up would have been useful dates to share with his supporters.
A participant who had a hearing impairment said that he was involved as a witness, and at other times as the accused in a number of criminal incidents between 1970 and 1980. He did not use a hearing aid and said that the police knew he was deaf but wouldn’t write things down for him, and insulted him when they thought he couldn’t hear them. He said that other staff at the station would say he was using deafness‘as an excuse’.
The whole group said that human decency and respect should be central to communication with participants throughout the justice system but that this went against how the police, the courts and prisons operated at times.
The wider group said that there were plenty of voluntary sector organisations that can offer support to Justice agencies with the communication needs of clients but a lack of money or knowledge stops this occurring when it should.
The wider group reported that instead of asking some people what their additional support needs were in relation to communication they should just start asking everybody what their communication needs are, this might lead them into better communication habits.
Ideas for action:
- Communications by Justice Professionals with those with mental health problems must be respectful, active and inclusive and should seek to include families, peer supporters, advocates, social workers and CPNs where possible. When working with supporters Justice Staff should talk to the supported individual rather than ‘about them’.
- Letters should be as informally or inofficiously written as possible whilst remaining legally valid. It is good practice to provide copies to supporters, particularly when dates and times are critical and their help will be needed to get the individual to attend court and tribunal appearances for example.
- When those with mental health problems are unsupported police, court staff and lawyers should spend time at the end of any meeting making sure that an individual has packed away all the information they will need and that it will not get lost. They might agree to post it out in a pack to a supporter.
- Peer support mechanisms should be formalised and sufficiently resourced. In terms of effective communication when peer supporters are interacting with lawyers, court staff or prison staff on behalf of someone it should be clear that they themselves understand rights entitlement and legal issues.
2.3.Physical Barriers