Dr Jo Wells (Lecturer in Criminology, Bournemouth University)
Introduction
National Health Service England (NHSE) oversees a national network of CJLD schemes who adapt a generic service specification to identify justice-involved individuals meeting the threshold for intervention under their all-vulnerability criteria(NHS England 2019) . The model of delivery embeds CJLD teams in county police force custody suites, achieved by the creation of local CJLD/police partnerships across England, working to local arrangements drawn from NHSE guidance. Roll-out of the schemes was completed in 2020, without exploring how custody-based police staff would collaborate in practice with teams of Liaison and Diversion (L&D) practitioners. An outcome evaluation of the scheme conducted by the RAND corporation (Disley et al. 2021) ten years after they were first launched was unable to demonstrate that the schemes had significantly diverted vulnerable offenders away from a criminal justice pathway, as recommended by Lord Bradley in 2009 following his landmark review (Bradley 2009)
My Research
Research for my PhD responded to the quest of one CJLD team to understand how the partnership operated at practice level (and if L&D practitioners collaborated with police custody staff to deliver CJLD outcomes).Preliminary scoping of custody practice and review of the literature revealed a shared language, where talk of ‘vulnerability’ intermingled with that of ‘risk’. Yet a 2019 scoping review (Enang et al. 2019) found contested understandings of vulnerability between law enforcement agencies and other organisations.
My research has focused on the analysis of discourse; specifically, to investigate how the language of vulnerability is used and understood between partnership custody practitioners and if this affects L&D intervention and outcomes.
Taking an ethnographic approach, I used mixed methods in this research project to explore how vulnerability was constructed and negotiated by the L&D and police practitioners in the identification of detainees as shared objects of practice across the partnership’s three custody suites. The study gathered primary data from observations of custody practice and interviews with partnership participants and secondary data from the CJLDS.
By using Foucauldian Discourse Analysis (Ussher and Perz 2014) to make meaning of the inter-professional/occupational cultures within the partnership, I was able to reveal le dispositif (Foucault 1980)ofthe operational mechanism of the CJLDS model.
Findings
PACE Code C (Home Office 2019)requires police officers screen for risk in detainees when booking them into custody. A key element of the risk screen is for officers to determine whether detainees meet the Vulnerable Adult criteria in line with the requirement to offer the Appropriate Adult safeguard to accompany them throughout police processes in custody. The research found police desk officers identified potential Vulnerable Adults either as detainees they knew, or believed, to be lacking mental capacity or detainees suspected, or claiming to be diagnosed with a mental disorder.
The research also found that police staff tended to construct unknown (i.e., first time) detainees, as ‘risky/vulnerable’, prioritising any individual suspected of sex offences whom they perceived under threat of adverse consequences based on their alleged offences and therefore at high risk of self-harm or suicide.
“What you’re looking at is someone who is, say, a professional person and he’s been arrested for a serious offence. He has child images, something like that. He’s potentially looking at a custodial sentence, basically, his life’s fallen apart, but they’re not actually saying “I’m gonna kill myself” but they become withdrawn and they become quiet, and they’re the people that are more likely to think I’ve got nothing else….” (Reece, Detention officer)
Police staff referred all detainees perceived as vulnerable/risk to the L&D team. They also referred any detainee behaving in manner believed as symptomatic of psychosis. As consummate ‘Street Level Bureaucrats’ (Lipsky 2010), police position L&D practitioners as the ‘mental health team’ and Desk Officers direct them to conduct ‘background checks’ into detainees’ medical history following the risk screen. Having access to online GP and mental health records consolidated the L&D’s function as health practitioners with the expectation that they verify any vulnerability/risk and perform safeguarding interventions to mitigate the risk of self-harm and suicide.
However, L&D practitioners in the custody suite constructed vulnerability in detainees as acute mental crisis, requiring an urgent response. Their priority practice repertoires involved liaising with psychiatric teams to arrange Mental Health Act assessments in custody.
“You know they are vulnerable people because they have the issue of mental illness I’m talking about bipolar or schizophrenia…” (Chris, L&D practitioner).
The L&D custody practitioners effectively perform a nursing function, previously undertaken by Street Triage teams. Custody-based L&D practitioners equated diversion to the act of transferring a detainee from the criminal justice to the health sector, they accepted the diversion as a temporary reprieve from the criminal justice process.
The CJLD practitioners saw secure hospital as a more appropriate ‘place of safety’ than a police cell, which they recognised as triggering for a mentally unwell (vulnerable) detainee, creating risk and potentially leading to self-harm or suicide.
L&D practitioners sought to divert other detainees, mainly those with chronic mental illness, away from further involvement with the criminal justice system, by seeking to (re) engage them with health and community services, mostly through the onward referral and intervention by their community-based colleagues in the CJLD team.
The research found community-based CJLD practitioners to be more aware of NHSE’s all-vulnerability threshold criteria when identifying justice-involved service users (NHS England 2019). Using the criteria, they assess vulnerability as an unmet criminogenic need and practice is focussed on encouraging the engagement of service users with health and other community services. Interestingly, I found that these L&D practitioners avoided the word ‘vulnerable’ in their interactions with service users, claiming it felt uncomfortable. Instead, they insisted their service users ‘help themselves’ by acknowledging their own needs.
Practice in the custody suite responds to (Home Office 2019)legislation and is controlled by police officers. Custody-based partnership practitioners shared a perception that vulnerability could be identified in detainee behaviours which indicate a risk of self-harm or suicide in the custody suite or the period immediately following their release. However, identification of the ‘vulnerable detainee’ in custody was juxtaposed between degrees of mental health between police and CJLDS practitioners. A further disjunction prevailed within the CJLD team and shared understanding between custody and community-based L&D practitioners.
The conflation of risk and ‘vulnerability’ in custody settings begins during the risk screen, which in addition to identifying detainees requiring the Appropriate Adult safeguard, also seeks to expose detainees who feel threatened under arrest and feel psychologically vulnerable in custody. These detainees are of concern to the police who label them as ‘risky’, indicating their potential for self-harm or suicide.
The dispositif of the partnership, and the operational mechanism of the model, is reactive and dominated by apolice-led discourses of risk. The dispositif coheres with Code C and the criminal justice process. Police position the CJLD to identify vulnerability and mitigate the risk of death associated with custody, and potential police liability, should such incidents occur. The dispositif of the custody suite orientates all action within, including the practice repertoires of CJLD practitioners, which is reflected in the outcome indicators monitored.
Further research
The research was limited in having access to one case study only. Findings may not be generalisable across the national network and begs further exploration of this model of interprofessional practice in other English police partnerships.
My study was restricted to the perceptions of vulnerability in professional partnership practitioners as participants. Emic perceptions of vulnerability in detainees and other justice-involved individuals were not analysed and future research should seek to collect their perceptions and understandings of vulnerability, as well as their expressed need as potential service users willing to benefit from liaison and diversion schemes based in custody.
Finally, the findings of this research indicate that CJLD practitioners in partnerships have lost sight of their mission and Lord Bradley’s vision for Liaison and Diversion schemes. A review of the need and purpose of liaison and diversion in the current context for both health and criminal justice services is a must.
References
Bradley, K., 2009. The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. Vol. 7. Department of Health London.
Disley, E., Gkousis, E., Hulme, S., Morley, K. I., Pollard, J., Saunders, C. L., Sussex, J. and Sutherland, A., 2021. Outcome Evaluation of the National Model for Liaison and Diversion. RAND Corporation.
Enang, I., Murray, J., Dougall, N., Wooff, A., Heyman, I. and Aston, E., 2019. Defining and assessing vulnerability within law enforcement and public health organisations: a scoping review. Health & Justice,7 (1), 1.
Foucault, M., 1980. The Confession of the Flesh. In ed. Colin Gordon. In: Gordon, C., ed. Power/Knowledge: Selected Interviews and Other Writings 1972–1977 by Michel Foucault.
Home Office, 2019. CODE C Revised Code of Practice for the detention, treatment and questioning of persons by Police Officers.
Lipsky, M., 2010. Street-level bureaucracy: Dilemmas of the individual in public service. Russell Sage Foundation.
NHS England, 2019. Liaison and Diversion standard service specification.
Ussher, J. M. and Perz, J., 2014. Discourse analysis. Qualitative research in clinical and health psychology, 226-237.
Defending Vulnerability 