This article was written by Mark and was published in a recent issue of The Big Issue magazine in the UK:
G is a former medical student whose wealthy and generally happy childhood had a dark side: sexual abuse. In adulthood he suffered from depression. Smoking weed progressed to smoking crack and soon his medical career was over. Occasional drug-induced psychosis became a permanent state. Whenever he was admitted to hospital, despite self-harming, he was released after one night because his illness was drug-induced – although you could argue that the drugs were illness-induced. Before long, G was taken into custody instead of hospital.
“I was really acting crazy, walking down the street naked, hearing voices, including the Queen’s. I was put in a cell shouting and barking like a dog. The officer came in and said keep quiet but that incarceration was terrible. I walked around and around and I banged on the door until I got myself taken down. I mean 5 or 6 officers jumped on me and tied me down and took me to a cell where there was just a mattress on the floor and a blanket. I was given medication to sedate me throughout my incarceration.
“Actually, I was never convicted of any crime but those months I spent in jail on remand I regard as wasted time. I could have been treated for my problems there instead of just being sedated then put back on the streets.
“G eventually found his way, on his own, into rehab. In his early 40s, clean five years and now working for the NHS as a mental health support worker, he frequently encounters people with undiagnosed mental illness and consequent drug use, as well as drug users who are living with induced mental illness. Either way, they’ve generally, like G, had some horrible experiences in jail.
It will come as no surprise to G or the many thousands like him, that a huge new report into mental health and the criminal justice system has found a dog’s dinner of piecemeal policies, failure to diagnose, intervene or support at any stage and a flaunting of human rights which shames us all.
Unfortunately Lord Bradley’s report offers few solutions. The recommendations tend to demand more studies, reviews or reports, more awareness programmes for already overworked service providers like the police, more leaning on the unmonitored, un evaluated and usually unprofessional third sector. Despite the time and money spent on this report, it only proposes building further on our existing chaos.
Here are my own proposals. I can offer them at a fraction of the time and money the Bradley report cost because, unlike anyone involved in that report, I have first-hand experience of the ugly interface of mental illness and criminal justice .
1. Tear up the existing hotchpotch of ill thought-out provision and start again. Build a new policy from the ground up by talking to people like G and me with experience of mental ill-health inside the criminal justice system. The answers to the problem lie in the cells and on the wards but Lord Bradley has done no more than nod towards service users. He should have listened to their anguish and witnessed their anger, and, yes, shared it.
That would have led to change. By consulting people far away from the point of delivery, he has simply shared their delusions and re-enforced their failing systems.
2. There’s a big review of drugs in prisons going on right now: work together for a new system, recognising that mental health and drug abuse are often interlinked. At the moment, as Lord Bradley points out, dual diagnosis means offenders are generally treated for neither problem.
3. Accept that the key is early intervention. I defy you to find a service user who is or has been mentally ill who claims that all the signs were not evident in childhood. Children leave their troubled families to go to schools, churches, clubs and classes and that’s where we need awareness training. I’m not talking about well-meaning volunteers. I’m talking about a teacher who is trained to spot certain indicators. And an available professional who can deal directly with the child when a teacher is concerned.
4. Forget systems and think individuals. Just as Lord Bradley preferred data to people, most service providers find it easier to hide behind a computer than interact with the misery on the front line. But in drug courts something strange has been noted: when an offender progresses through the system under the care of only one judge, he has significantly less chance of re-offending. Continuity of care, where service users actually develop personal relationships with one service provider, is the human face of the system. Before we condemn them as offenders, let’s remember that the mentally-ill are vulnerable humans and patients first.