Health Director

The Bradley Report: Next Steps

Having delivered his report in April last year and seen his recommendations acted upon not just by the government but by local health and criminal justice organisations, Lord Bradley is a happy man. “I would never have thought that within six months of my report change would start being effected,” he says. “Rather than waiting for central initiatives to be drawn up the service is already working on the recommendations.”

There a number of reasons why Lord Bradley’s report and recommendations might be so popular. First, they appear to be cost neutral. This in itself would perhaps be enough to sell the idea to central government at least, but for diverse organisations across the health and criminal justice service it means Bradley’s ideas can be acted upon without waiting for finance to be made available.

Second, Lord Bradley’s report specifically did not set out to ‘micromanage’ any new structures for dealing with mental health or learning disabilities within the offender population. “When I came to putting this together I wanted to put forward an architectural structure in which local needs could be addressed,” says Lord Bradley, “because the needs of south-west England are very different from the north-west.” This move in itself has empowered regional organisations to adopt Lord Bradley’s vision as their own, realising the practicalities according to their own resources and requirements.

A vision of early intervention

Lord Bradley’s vision is essentially a structure where the barriers between diverse organisations involved in assessing, advising on and managing information on offenders and offender’s health are enabled to work together efficiently, coherently, and perhaps most importantly very early on in an offender’s contact with the criminal justice service. Presently, a typical pathway for a first time offender might consist of serving out their sentence while being held on remand, to be returned to outside society without any intervention on their behaviour or health assessment of their needs being made at all. By introducing early assessment which accounts for diverse issues including mental health, substance abuse and even home background, it is possible to gather crucial information which may be shared across both health and criminal justice sectors to ensure sentencing and subsequent treatment and support for an individual is appropriate and effective.

According to Lord Bradley early intervention not only impacts on improving support for the individual it also paves the way to more efficient provision of mental health services across the criminal justice system. “Currently, because there are a huge number of offenders with mental health issues, the majority of service provision is secondary care,” notes Lord Bradley. “We have to improve primary care for those individuals affected by low level health issues and then make sure the right services are made available for them when they go back into the community.”

Executed correctly this approach means the response to every offender is built around their particular situation. Given that many offenders have dual diagnosis – learning difficulties and substance abuse for example – the action taken to help them is unique and more likely to stop them from re-offending.

Not that Lord Bradley believes his approach will immediately impact on prison numbers: “In the short term I want to see services working more efficiently together and I want more continuity of care for offenders from their first contact with the justice system to their return to the community,” he says. “Over time, I want to see a more clear understanding of who needs to be in which setting – who needs to be in the health sector, who needs to be in prison and who can be dealt with in the community.”

Challenges ahead

Naturally, achieving any of this depends on some more radical action within the sectors. To keep costs neutral Lord Bradley anticipates savings being made from joint commissioning and the sharing of resources between organisations within the system – an assumption which may be flawed given the demands made on finances even when the country is not faced with a recession. Whether organisations are willing to share their budgets or allow their savings to be reinvested in the entire supply chain rather than their particular area will have to be seen.

Lord Bradley recognises there are barriers to achieving a more joined up efficient service - cultural barriers, information sharing needs and so on – but from his experience consequent to writing the report he believes the enthusiasm and impetus for change he’s seen from people within the service far outweighs any of these. Moreover, his report – which takes its place alongside others such as Baroness Corston’s report into women in the criminal justice system who have particular vulnerabilities and which he recognises as playing an equally important role in addressing health issues across the offender and wider population – comes as the government launches its New Horizons programme, which if nothing else should help to take some of the stigma away from mental health and place the issue firmly on the political agenda.

“I think attitudes are already changing,” he says, “There’s a growing recognition of the importance of mental health within the health sector and wider society. New Horizons clearly continues that agenda and it’s been encouraging from my conversations around the country that there is a great desire now to improve mental health services generally.”

In due course, Lord Bradley believes some of his conclusions and models can be transferred to the wider community, but to some extent his recommendations must by their nature affect mental health provision across the board. By engaging in criminal activity, offenders are effectively self-selecting themselves as people who require some form of assessment to understand why they have offended in the first place. Ultimately, Lord Bradley’s report will go further than the police and prison cell walls: “This needs to be addressed in the broader context of mental health provision,” says Lord Bradley. “It’s about the public health agenda, wellbeing, children’s health and the families of those children. This is not about just targeting offenders for offenders’ sake, it’s about having a more coherent community approach to mental health.”

Lord Bradley spoke to Simon Kent, editor