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• Review of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System, Paper Four: The Corrections Setting
• Review of the Interface between Mental Health and Alcohol and Other Drug Services and the Criminal Justice System Paper Five: Population Groups: Maori, Pacific Peoples, Women and Youth
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Paper 13: A Systematic Review of the Interface between Mental Health/Addiction Treatment and the Criminal Justice Systems

Proposal

1. This paper proposes Terms of Reference for a systematic review of the interface between the mental health/addiction treatment and criminal justice systems, including implications for Māori and Pacific peoples, for women and for young people in the criminal justice system.

Executive Summary

2. This paper responds to Cabinet's direction to officials to develop:

3. Terms of Reference for the review are attached as Appendix 1.

4. The objective of the review is to develop options to improve the way in which the mental health/addiction treatment needs of offenders in the criminal justice system are met, in order to: enhance the social functioning and mental health of this population; assist in reducing their rate of addiction and addiction related harm; and assist in reducing their re-offending. In the context of this review, addiction refers to the areas of alcohol and drugs.

5. The project deliverables are:

6. The project will be funded from the Ministries of Justice and Health baselines, and will be completed by 30 August 2007, with specific components completed by 28 February 2007.

7. NZ Police and the Department of Corrections will provide data, policy advice and operational support throughout this project. The costs of this will be met from within their baselines.

Background

Cabinet Direction

8. This paper responds to Cabinet's direction to:

What we know

9. Cabinet Policy Committee, Paper 9 - Preventing Re-offending paragraph 33 noted that "There are complex links between addiction and crime and there is no single causal connection between them. Nevertheless timely, well-targeted and effective treatments can reduce re-offending and imprisonment rates."

10. Statistics support the thesis that there may be a link between mental health, addiction and crime. For example, approximately 80 percent of prisoners in New Zealand have had a substance misuse disorder at some time in their lives, compared to 13 percent of the general population. The impact of this on offending is not known, but international evidence suggests it may be significant.

11. Fifty percent of prisoners also have a diagnosable axis 1 mental disorder as defined in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), such as a psychotic, mood or anxiety disorder. Of these, 90 percent also have a substance misuse disorder.

12. In addition, offenders may develop, or experience an exacerbation of a range of mental disorders as a consequence of their interaction with the criminal justice system.

13. Māori represent approximately 50 percent of the total prison population. Pacific peoples represent approximately 8 percent. The rates of mental health and substance misuse disorders among Māori and Pacific prisoners are comparable with those for other imprisoned population groups. However, the over-representation of Māori and Pacific peoples in prison means that it is vital for mental health/addiction treatment and criminal justice systems to better address their needs.

14. In addition, treatment for mental disorders is less common among Māori and Pacific offenders than for other ethnic groups, both in prison and prior to entering prison. This suggests that their needs are not being met as well as those of other ethnic groups.

15. Although females make up only 5 percent of convicted offenders, the number of females sentenced to prison increased by 61 percent between 1999 and 2005; a far larger rate of increase than for males. Moreover, female prisoners present with different mental and substance misuse disorders, have greater rates of pathological gambling, and may have different treatment needs.

16. There is an absence of epidemiological data on the mental health/addiction needs of people within the criminal justice system who are not in prison.

17. In summary, Cabinet has directed a systematic review of the interface between the mental health/addiction treatment and criminal justice systems as it is possible that if the mental health/addiction needs of offenders in prison or in the community were more adequately addressed, it would lead to reduced offending and the need for imprisonment.

18. The addiction/mental health needs of different population groups frequently require different approaches. The review needs to consider the specific needs of Māori and Pacific peoples and women, in this context. For reasons outlined later in this paper, we believe the review should also consider the mental health/addiction needs of young persons in the criminal justice system.

19. Finally, we note that the general community (including offenders in the community), does not, as yet, have full access to the range of mental health/addiction treatment predicated by the Mental Health Commission's Blueprint for Mental Health Services in New Zealand (1998)

The Interface between the Mental Health/Addiction Treatment and the Criminal Justice Systems

20. The health and criminal justice systems have different philosophies, objectives and priorities that underpin different policies around the design, targeting and access to services at the interface between the two systems. For example, the treatment system focuses on improved social functioning and physical and mental health. The criminal justice system focuses on reducing offending.

21. The Department of Corrections funds the provision of primary health services, including primary mental health/addiction services, for prisoners. The Ministry of Health funds all specialist health services (except those funded though ACC or privately) including forensic mental health services. Health also funds a range of public health services in prison for communicable diseases. Offenders in the community can access any health service, including mental health/addiction services, on the same basis as other members of the community. However, potential barriers to access will need to be identified in the course of this project. Courts can order health assessments, including mental health/addiction assessments, and are responsible for funding these assessments.

22. The varying points of interface between the two systems from the point of a person being arrested through to being released from custody raise a number of issues about the access, delivery, and consistency of treatment and other services to offenders. It is likely that offenders are not getting optimal access and treatment, despite high levels of need. Better alignment of policies and practices between the two systems may be needed to achieve better outcomes for this population.

23. In light of the aims, the proposed systematic review will need to gather information from key informants about the current situation; review and analyse key documents; review and analyse available quantitative data; draw upon national and international best practice information; and develop preliminary proposals to address the issues identified. The review will need also need to take into account the needs of special population groups.

24. The current availability of alcohol and drug treatment programmes for offenders in the community and options to expand them, are reported in a separate paper to CBC, in response to Cab Min (06) 27/3A.

Terms of Reference

25. Terms of Reference for the systematic review of the interface have been drafted for Cabinet's approval, and are attached at Appendix 1.

26. As this is a systematic review the youth justice system is included within its ambit. Because of their age, the physical and mental capacities of young people within the youth justice system have not matured and they require different services to adults.

27. The objective of the review is to develop options to identify and improve the way in which the mental health/addiction treatment needs of people within the criminal justice system are met, in order to:

28. The project deliverables are:

29. A technical reference group consisting of individuals who have in-depth knowledge and expertise in the mental health/addiction and/or criminal justice systems may be established to provide advice on the review, as and when required.

30. The timing of key milestones in the review is as follows:

Milestone	Date
A report which combines the findings of a literature review, a review and analysis of available documentation and quantitative data, and a review of qualitative data, including discussions with key people in the sectors delivered to Ministers of Justice and Health for approval	28 February 2007
Discussion document delivered to Cabinet for approval	30 April 2007
Discussion Document distributed for stakeholder review	10 May 2007
Submissions Close	29 June 2007
Final Papers delivered to Cabinet	30 August 2007

Financial Implications

31. The budget will be shared equally and be met from the Ministries of Health and Justice current baselines.

Offender Population Implications

32. Offenders have higher levels of addiction and mental health problems than the general population. Addressing these problems may assist in reducing the prison population.

Human Rights Implications

33. Human rights implications of the current interface between the mental health/addiction treatment and criminal justice systems will be addressed in this review, as will the human rights impact of any proposed changes.

Legislative Implications

34. At this stage there are no legislative implications from this review. Legislative proposals may, however, emerge from the information gathering and analysis exercise, literature review and development of options.

Regulatory Impact Statement

35. A regulatory impact statement is not required.

Gender Implications

36. The outcome of the work flowing from the review will be of greater advantage to males as they comprise 95 percent of convicted persons. The scope of the review does, however, include specific consideration of female offenders - a group that is increasing proportionately faster than males.

37. Female offenders present particular issues. For example, female prisoners are more likely than males to be pathological gamblers and be on psychiatric medication. We note there may be some need to distinguish the needs of Māori and Pacific women to those of Māori and Pacific men.

Disability Perspective

38. As the review deals with the mental health problems of offenders, it is relevant to assisting people with psychiatric disability. Offenders with mental illness or addiction may have co-existing disabilities such as intellectual disability or disability arising from head injury.

Consultation

39. The following agencies have been consulted on this paper: Department of Corrections, NZ Police, Treasury, Department of Prime Minister and Cabinet, Ministry of Social Development, Te Puni Kōkiri, Ministry of Pacific Island Affairs, Ministry of Women's Affairs and the Law Commission. In addition, DHBs representatives have been consulted in the preparation of the paper

Publicity

40. The discussion document will be the primary vehicle for consulting on the range of options with the stakeholders and the public. A communications strategy will be developed to manage this.

Recommendations

41. We recommend that the Committee:

1. Note the requirement by Cabinet to report to POL by 30 September 2006 on terms of reference, scope, timing and resources for a systematic review of the interface between addiction and mental health treatment, and criminal justice systems, including implications for Māori and Pacific peoples, and for women offenders

2. Note that the Ministries of Health and Justice will jointly lead the project, and that NZ Police and the Department of Corrections will provide data, policy advice and operational support throughout this project.

3. Approve the attached Terms of Reference which map the process for a systematic review of the interface between the addiction and mental health and criminal justice systems, including implications for Māori and Pacific peoples, women offenders, and for young people within the criminal justice system

4. Note that a technical reference group may be established to provide advice to officials throughout the review

5. Approve the following milestones for reporting back to Ministers and/or Cabinet on the review:

Hon Mark Burton Minister of Justice

Hon Damien O’Connor Associate Minister of Health

Terms of Reference
for a Systematic Review of the Interface between Addiction/Mental Health Treatment, and Criminal Justice Systems, including Implications for Māori and Pacific Peoples, Women, and Young People within the Criminal Justice System

Key driver

1. This review is part of Government's Effective Interventions package to relieve pressures on prisons, make better use of prisons, address the precursors of crime, and reduce the over-representation of Māori and Pacific peoples in the criminal justice system, announced on 15 August 2006.

Objective

2. The objective of the review is to develop options to improve the way in which the mental health/addiction treatment needs of people within the criminal justice system are met, in order to:

Scope

3. The focus of this review is on those situations where the mental health system and the criminal justice system meet, or where an individual is experiencing both an intervention from the criminal justice system and has a mental health and/or addiction need. For adults these interfaces can occur at the point of arrest, at diversion, when on bail or on remand, at court, while serving a sentence (whether that be in a prison, or on home detention or a community-based sentence), when on parole and finally when released from the custody of the justice system into the community.

4. The mental health/addiction needs of Māori and Pacific peoples and women offenders will be specifically addressed. Experience indicates that meeting the mental health/addiction needs of these population groups frequently requires different approaches.

5. As this is a systematic review the youth justice system is included within its ambit. Because of their age, the physical and mental capacities of young people within the youth justice system have not matured and they require different services to adults. This will be explicitly considered in the review.

6. For the purposes of this paper, and for brevity, the people who fall within the ambit of this review are referred to as 'offenders' whether or not they have been convicted of a criminal offence.

Project Deliverables

A literature review

7. A literature review will be undertaken to draw upon the lessons learnt from international and national experience of this interface, and how the mental health and criminal justice systems can work together to ensure a better delivery of mental health/addiction services to offenders.

8. The Ministries of Health and Justice will deliver a literature review that

9. The review will include material from New Zealand, Australia, Canada, the United States, the United Kingdom and the Republic of Ireland. These countries have been selected as they share a Westminster style of democracy, are English speaking, and have some cultural similarities.

An information gathering and analysis exercise

10. The Ministries of Health and Justice will deliver an information gathering and analysis exercise to investigate the interface between mental health/addiction treatment and criminal justice system and the youth justice system. This will include both interviews with key informants, and a review and analysis of documentation and readily available quantitative data.

11. Quantitative data will be collected and interviews will be undertaken to gain insights into current practices and where the key stakeholders believe there are weaknesses or gaps, and how to best address them. These insights are also important for gauging whether or not some of the international experiences at the interface are relevant to New Zealand. It will also ensure that the key stakeholders actively participate in the review.

12. The interviewees may include: mental health/addiction treatment providers, DHBs, criminal justice sector NGOs, the Judiciary, government agencies, youth justice organisations, Māori agencies, Pacific agencies, women's organisations, service user groups, and other relevant stakeholders.

13. The interviews will cover the key stakeholders' views of the mental health/addiction needs of offenders, whether offenders have particular access problems, the availability of services to offenders, their perceptions of the effectiveness of the available services, whether there are any gaps in the services provided to offenders (particularly in light of their criminogenic needs), and a view as to what barriers exist (including possibly legislative barriers) to the proper delivery of services.

14. The review and analysis of documentation and readily available quantitative data will cover the philosophy and objectives of both systems; the resource allocation models in relationship to mental health/addiction services of both systems; and the nature and extent of addictions exhibited by age, sex and ethnicity for different classes of offenders.

15. The analysis will also consider:

A discussion document

16. The Ministries of Health and Justice will produce a discussion document, identifying offenders' current needs for mental health/addiction treatment; barriers to meeting these needs; and propose future options based on best practice and evidence.

17. The options will be based on the findings of the literature review and information gathering and analysis exercises, and should be capable of being evaluated.

Policy advice to cabinet

18. The Ministries of Health and Justice will develop policy advice to Cabinet based on the feedback from the discussion document. This will be done in consultation with other government agencies such as the Department of Corrections, the NZ Police, Te Puni Kōkiri, the Ministry of Women Affairs, and the Ministry of Social Development.

19. The policy advice will include an assessment of costs and the expected benefits. Implications for existing Health, Justice and Welfare policy settings will be clearly identified and addressed.

Project Management

20. The project will be managed by Ministry of Health and Ministry of Justice officials (joint lead). The Department of Corrections, the NZ Police and DHBs will have extensive input into the project.

Technical reference Group

21. A technical advisory group consisting of individuals who have in-depth knowledge and expertise in the mental health/addiction and/or criminal justice systems may be established to provide advice on the review, as and when required.

Timing

Milestone	Date
A report which combines the findings of a literature review, a review and analysis of available documentation and quantitative data, and a review of qualitative data, including discussions with key people in the sectors delivered to Ministers of Justice and Health for approval by 28 February 2007	28 February 2007
Discussion document delivered to Cabinet for approval	30 April 2007
Discussion Document distributed for stakeholder review	10 May 2007
Submissions Close	29 June 2007
Final Papers delivered to Cabinet	30 August 2007

Budget

22. The budget for this project will be shared between the Ministries of Justice and Health, and be met from current baselines