IN-CJ Podcast: Serious Mental Health – International Challenges for Criminal Justice

And and today's session is is going to be about serious mental illness and challenges for the criminal justice system internationally. We've got a good panel lined up for will hopefully be a really interesting discussion tonight. So we have a main presentation from Tanya. And then what we're going to do is ask the rest of our panel to respond to that presentation, and from the perspective of their own country.

And, as Rob said, this will be recorded. So it's up to you whether or not you want to keep your camera on, and I would advise obviously staying on mute throughout the presentation. And but if you do have any questions or comments, then feel free to send them into the chat. So we'll make a start. I'll ask. And Tanya to introduce herself first, and then I'll go to the other members of the panel.

and just to say that unfortunately our speaker from Germany isn't able to make it tonight. He sent apologies. So just to let you know. So, Tanya, would you like to introduce yourself.

within a managed care environment with a county mental health system so different from the private system I was working in, went to the public system. And then from there I was on to research, focusing on implementation, science and kind of cross sector cross system interventions

across mental health and criminal legal systems, primarily with a with a heavy focus on probation. I'm I'm telling you all of this for 2 reasons, one to just name that I've not been you know, a jail administrator, prison administrator. And so I really am coming at this from mental health services perspective. And then I think, for the second reason, to just name, that these experiences really influence

kind of my orientation and views on this specific problem that we're talking about which is disproportionately high rates in the criminal legal system or criminal justice system of people with serious mental illnesses. So and on that note, just to kind of name.

Maybe some controversial topics in my own my own overview and perspective on this. But I just wanna be clear about my orientation from the outset. So I've already mentioned disproportionally high rates of serious mental illnesses in the criminal justice system. But criminal thinking and individual behavior.

You know, we can't really think of those 2 things as the sole contributor to this problem, and neither are criminogenic risk factors. Those these are highly, empirically associated with criminal behavior. I do personally think that there's a hyper focus on these sort of individual level predictors and individual level

risk factors. And when we do that. We really kind of take away the role or maybe don't pay sufficient attention to the role of systems and organizational behavior in creating this problem. So policies, for example, the ways that systems interact or don't interact with each other. So. And and I'm not saying this to say that we shouldn't have therapeutic treatment for people with

theories, mental illnesses, and criminal justice system. Just that treatment alone is not going to solve the problem that we have. So my overview. That will I'll give today is really focusing more on system level, less on individual level interventions and treatments. The other thing I wanted to name before jumping in is just context.

So, despite what the description of the talk today suggests, I, I can't tell you what the best interventions are for your country or your context. And it's because of the the context. So

you know the the cultural and what we would say, sociopolitical context of our countries obviously impacts everything, including how we even define crime and criminalized behavior even within the United States. What's a crime in one State is not a crime in the next State. The example I always use is marijuana use, for example.

not legal in North Carolina, but if I, you know, walk 5 miles from my house to Virginia. It is legal. And so so that's that's one bit of context. And then that means also how we respond to criminalized behavior. We could think about where? Where we police, in communities that's going to be different. How we define mental illness and the the problem of serious mental illness in the criminal legal system. And then, of course, how we respond to it.

So all this, to say, all of this context, really impacts what works in our settings. And so that's why I can't say what specific interventions will work across settings. And since this is an international audience, I think that's part of the the richness of this discussion that we'll have with the panel. So the topics for the this overview the nature of serious mental illness, the needs of people with serious mental illnesses. And then we'll just kind of talk through some challenges

the justice system space. And then, rather than specific interventions, we'll just kinda talk through what maybe intervention mapping might look like across systems as a way to think through. Maybe a more. I don't want to say universal but somewhat universal approach to figuring out what to do about this this issue. So the first, the nature of serious mental illness.

what do we mean by mental illness. So you know, I think it's important to make sure that we're either talking about the same thing or acknowledging the fact that our definitions and and excuse me. Understandings of mental illness is going to vary by our countries

and our culture. So first we can take, you know, the medical. Is it a medical condition of the brain which is largely what I I would say? European countries and the United States are really using? And we see that, you know reflected in in how we look at our Icd 11, we'll get to that in a minute in the Dsm

so there's the medical condition of the brain. Maybe you know, some countries might think it's maybe spiritual in nature, or maybe it's a weakness or a result of moral failure. So all of this kind of impacts how we understand what causes mental illness, or what a mental illness is. And then, of course, then, how we respond to it. We might also think about specific diagnoses, the examples I'm using here. So depressive disorders, anxiety disorders.

bipolar disorder and psychotic disorders. You'll get these from more of the medical model. So we we take that cluster of symptoms and we put a diagnosis on it. There are 2, the icv. 11. And the Dsm, those are the 2 main ways that we diagnose these conditions, and you'll see that there's a great deal of overlap. There's actually an article. I think this first at all. I think this 2021 is in.

and someone will probably correct me later. But I think it's in the lancet and so that provides a good crosswalk of the 2. But you'll even see that they're not major differences. But you'll still still see some some differences in between the 2 models. So all that to say, even when we're talking about mental illnesses and we're talking about, we can be talking about different things.

And then, lastly, and and this is a really important point, needing to think about the severity in the chronicity. The World Health Organization. I believe the estimate is about 970 million people worldwide have a mental illness and thinking of these folks. Right? That's a lot of obviously a lot of people and many of those diagnoses are managed effectively. So depression is a really common diagnosis here in the United States. Some people may have.

you know, lifetime depression. But it's managed access to healthcare for this particular person, access to treatment, and for some it's unmanaged and others will have long lasting and significant impact on functioning. We think about psychotic spectrum disorders like schizophrenia. And these will have greater impact on people and their functioning functional ability, cognitive ability and society. And I say this, because when we are talking about

yeah, when we're talking about mental health conditions and the criminal justice and criminal legal systems. we're not talking about the person who's sort of managing, you know their depression for the last 30 years, and managing it pretty well and kind of staying out of the law. We're really talking about our folks who have significant impacts on their functioning. So

I'm putting the National Institute of Mental Health Definition up here, not because I think it's the best, or that I'm endorsing it. It's just an example that we use quite often, so you could see any mental illness defined as having a mental behavior. Emotional disorder can vary an impact right either from no impairment, but still having a mental illness

to mild, moderate, and severe. So that's any mental illness, and then serious mental illness again, these are the folks that we're really talking about define as ha! As a mental, behavioral, emotional disorder resulting in serious functional impairment which substantially interferes with or limits one or more major life activities. And so these are the folks. Again, that we're we're specifically referring to here within the context of this discussion in the panel today.

And again, I keep mentioning this disproportionate high rates. So you know, mental illness alone is not a problem. It's just a condition. It's when you layer on what it means to have a mental illness with series impact and functioning and then disproportionate contact with a system like the criminal justice system, right? And so then it becomes a problem. But we understand this, which is presumably why we are all here. We know that across countries, across continents

a lot of people have disproportionate contact with all parts of the criminal legal system. I think some studies will show, you know, even up to 50% of the population within the particular setting, having a mental health, condition, or mental illness. And so, you know.

usually, when I'm giving, you know, talks on probation and parole in the United States, the numbers I throw out there are 16 to 27% of people with, or people who are under community supervision have a mental health condition, and that's about 750 to 750,000 to 1 million people. So we're talking large large numbers. And then I, instead of just naming all of the stats, I just included just a number. These are examples. This is not an exhaustive list.

but we have again, across continents, across countries, lots and lots of studies of prevalence.

Of mental health conditions in the criminal justice systems. And what I would argue, and I'll say again later, is that we know this right? I think we're getting stuck on what to do about it. So we're we're, you know, we've identified the problem we've talked about. Why it's happening. But what we're struggling with is what to do about it. And I think that's part of you know, groups like this. It's great to come together because it's moving beyond studies of prevalence and into studies of interventions.

So the next topic was tasked to talk tasked with. To talk about is the need of people, the needs of people with various mental illnesses. And so this is where and almost the only time I kind of 0 in on individual level challenges. Mostly, I'm thinking about system level challenges. But in thinking about people with, you know, serious mental illness or severe and persistent mental illness.

the obvious thing that comes to mind is really the severity of those symptoms, and how that impacts cognition, how that impacts the daily functioning. And we know that there's high co occurrence of substance use disorders among people with mental illnesses, and we also know that substance use and misuse. Is one of the key predictors of criminal legal system involvement.

We can also think about the difficulties and comprehending requirements. Thinking about a person who needs to follow rules within. You know, carceral settings. You know, complex, noisy, loud

settings where a person, maybe, who's having some internal distractions is gonna have a really hard time in those environments. And then, of course, comprehending the terms of supervision, which is why we see with community supervision, higher rates of probation, violations, and revocations among people with serious mental illnesses.

And then you'll see, too, just not maybe having the insight sometimes, or awareness to to even recognize, maybe my own mental illness. And how that's actually impacting my own functioning. And I might not disclose that information to an agency, and that typically with detection. Right? That's usually the first way to start getting recognized for for treatment, or at least further assessment.

and then not adhering to treatment or not seeking treatment. Again. Self stigma is a huge barrier to getting treatment and doing or kind of mapping on any kind of interventions. Hesitation or reluctance to work with agency staff. You might see that within corrections. Of course, you certainly see that with community supervision.

and and the lack of trust and rapport at times and then absence are limited stabilizing factors. This is big. And so sometimes, you see, with people with serious mental illnesses. Within communities.

regardless of criminal legal system involvement, there can be erosion of family and social support ties, because lots of things that just happen over the course of an individual's life that can put strain but those same family and social support ties are also the things that help keep people out of the criminal legal system. So it's really tricky there, of course, financial resources, the same tension. That can be a contributing factor to criminal legal system involvement. And

if you, you know, have you know, significant mental health symptoms that are impacting your ability to get to work, to get out of bed, to stay at work, to keep the job, to keep your anger in check. Sometimes you might have outbursts that's gonna be really challenging. And again, same for health insurance and housing. I will say, from a context perspective, the health insurance piece is maybe not as relevant across countries and continents. But it's certainly a major major factor here in the United States because of the lack of

insurance and the impact of that lack of insurance on access. So I I actually kinda just started talking about this. This is, these are kind of like hypothetical yet empirical questions that we certainly can answer. But this may be where my own sort of knowledge of the vast literature may be lacking, but we we already know that there are some studies to support. The notion that

greater sort of more enhanced social welfare States actually have greater support for serious with people with, I'm sorry people with serious mental illnesses. We did. There was a study, I think, in 20

2022, that it looked at the association between welfare states and then mental wellbeing. In Europe, and then age as a factor. So we do see some support of this. But we could think about in terms of context, potentially, you know, countries with greater wrap around service, more robust welfare welfare programs or social welfare programs potentially could show greater support for people with serious mental illnesses.

because it's sort of baked into that model. And if so, does that enhanced support, translate to fewer unmet needs. And if folks have fewer unmet needs, does that also translate to some kind of impact positive impact and involvement in the criminal legal system. We can see how this potentially all lines up, if we understand sort of the literature on what keeps people out of jails and some countries. Just maybe from their, you know, sociopolitical context, maybe

more lined up to do that than say, for example, the United States and I don't need to pick on the United States. It's just that I'm very familiar with what we do and don't do here. Okay. So moving on to challenges that the criminal justice system faces. Some of these examples might be sort of leaning heavily on probation references, but I think it's still many of these are pretty crosscutting across the different systems. So from, you know the outset, I do want to note that

typically the mission of corrections agencies, it's about public safety and with high numbers of people with mental illnesses in those systems. We're sort of pushing on that tension a little bit, pushing on that mission, trying to get these entities to do a bit more than what they're originally tasked with doing. So, I I recognize that. Also, I recognize that definitions of public safety are going to be different, depending on where you're from. So all that to say, typically, you know.

corrections, agencies. Their mission isn't treatment right? You know the by law here. They're supposed to be able to provide treatment constitutionally, but largely, you know, we leave the work of, you know, mental health.

and and and treatment up to those no psychotherapists, for example, not corrections officers. So I wanna name that sometimes the the biggest challenge is navigating that tension. An agency doesn't wanna kind of go all the way into treatment provider. Nor should they. But really, knowing that, you know, where does. Where does that boundary sort of end between sort of a treatment, orientation

and sort of the law and order, retribution, orientation as well, so that that always seems to be a kind of a philosophical and orientation challenge. Excuse me

relatedly, I would say, to the agency and organizational capacity, and so you know whether or not a system is set up to handle people with mental illnesses, you know. Do they have a a way to detect? Is there screening is the screening baked into a risk needs assessment. For example. What's the organization's capacity to then follow up on that. So if you do identify a person who has potentially a mental health condition

using a screener. Do you, then have the capacity, the training, and the personnel to move to the next level, which is typically assessment. And then, if you assess, what, where do you go from there? And I would say, many agencies just don't have that continuum, and the question is whether they should or shouldn't officer capacity.

Similarly, you know, instead of the organizational capacity at the officer level, you could think about corrections, officers and community supervision officers, for example, you know what is their personal capacity? What's their training? Do they have de escalation techniques? Are they? Do they have? You know, training and how to spot the signs and symptoms of a mental illness, for example, do they know what resources within community supervision? Do they know the resources that they

should be referring people to? And then, speaking of those resources again, this is within the context of community supervision. What's going on in the local community? Are there resources available? Are there mental health resources available? Some states within the United States have centralized locations where you can go to county based.

Some have many, many, many providers in a single county. Some countries will have a very centralized health service system, and that process is uniform throughout other countries like ours. It's kind of all over the map because it's highly privatized. And so the resources here again, that context matters. But ultimately, within community supervision, you need someone to connect the person to who needs services

concerns about officer safety. This is always a tricky one to talk about, because I think sometimes it's about there's a little bit of fear and stigma within corrections, institutions about people with serious mental illnesses there. And it's just it replicates what people believe in society. Right? And so people with mental illnesses.

they're dangerous. They're criminal. They do Xyz and so that can often get replicated within agencies. And so when I say concerns about you know, officer safety, we have to figure out. Are these real concerns, or these are based on stigma. Nevertheless, the impact on the officer. What that feels like for them is likely the same, regardless of what that causes. So that's something that agencies need to talk about and do it. And then, lastly, though

I say, lastly, knowing that this is not an exhaustive list, this is just the last one on the slide. So cross system, communication and information sharing. And so, for example, and I'll use probation and and parole as an example, you know, if you're trying to coordinate person's treatment meaning getting them to a service, mental health or substance use service from maybe a probation office, for example.

do you have contacts with a mental health provider agency? Will they call you back? It's just stuff like that. And then what are the rules and regulations around what you can and cannot share with that other agency. So there's just a few of the workforce challenges. And again in the panel, I suspect we'll talk a bit more about that.

And then the the last section here is on interventions, and I just mentioned previously that there's you know I'm I'm not able to say what one intervention is going to work in any setting. So the way that I wanna kind of approach this piece of it is to just talk through, maybe, how we can approach interventions generally. And I've also already talked about how

I think there's maybe too much focus. I shouldn't say that. Maybe there's a lot of focus on individual level interventions like, how do we get, you know, forensically informed treatments for people right? And so I'm bringing in the other perspective, which is, how do we get to a multi-level perspective, a multi-level approach that breaks us out of the idea that the only thing to change is criminal thinking and access to treatment. Yes, we should still do those I'm not saying we shouldn't.

They're great to focus on. But it's not the whole picture. So the whole picture is going to again vary by country. It's gonna vary by region, within a country, probably towns within those regions. And then you know, so many of the interventions that we might develop

need to be done at that kind of hyper local level depending on your context. So in in countries where maybe, and I just sort of mentioned this. But where governance and administration of the systems is concentrated at the national level. There's likely gonna be more uniformity in

the interventions, how they're implemented, right? And maybe perhaps their, you know, effectiveness and countries like the United States that are, you know, very decentralized in terms of governance and administration. Those interventions really need to reflect those resources in the local community. And that's what we see a lot of.

Nevertheless, I'm getting off topic here. But nevertheless, when you think about multi-level perspectives, so we're talking about yes, the individual level, we still need to address.

You know, antisocial thinking substance use impulsivity. We. We need to address those stabilizing factors like housing and income. And we have to kind of go up here. So, looking at officer level, we might look at discretion. What's going on at arrest? So thinking about before they are in the jail. What's happening in those interactions at the arrest officer, knowledge of mental illness provider biases. When I say provider, I mean, like mental health service provider. Actually, so this is or

could be also at the at the practitioner level inter organizational level. So the coordination of care and the resources between services. How is that happening? If it's happening? Are there barriers that exist here that we can then build an intervention around to smooth out that process?

At the organizational or agency level workforce issues? So workforce capacity. Are there vacancies, caseload sizes and jurisdictions? Are they too large? Do you then, build interventions around? You know, making internal policy to cap caseload sizes for mental health caseloads, for example. Community level. The factors here looking at resource availability. Is it that the intervention really needs to promote specific resources and make them available within communities

housing opportunities. Do we need interventions that combine both housing opportunities plus treatment within a community and employment opportunities.

society level. So we've got, you know, issues related to mental illnesses, societal assumptions, stigma, drug laws, mass incarceration racism. So we really can't talk about from an illegal system involvement without talking about sort of the systemic factors racism that can get folks disproportionately represented in the criminal legal system. So if we think about kind of using this multi level perspective, we can then think about, how do you? How do you tie the interventions potentially to these as well.

The thing that I I wanna bring up here and this also will show my limitations is I don't. I don't know whether sequential intercept models are also used in places outside of the United States. I like this as an approach to mapping. There is, I think, there's not evidence that these approaches themselves, you know, enhance

effectiveness within a community. I think those studies are hard to come by. But what I like about this is that it's a good way to map and approach sort of a continuum continuum of care perspective. So if for those of you who are not familiar with this. I suspect many of you are. This is an a, an interactive, planning process that you do within communities.

The whole purpose is to look at the gaps in the services. The idea is that you can promote kind of collaboration across your different systems. You identify what you need, what resources and priorities that you have. But the whole purpose of this

is to think about each one of these intercepts. So intercept 0 is at community services. So this is before you even get engaged with law enforcement. What are those resources and supports that you can put in place that helps divert people away from the criminal justice system at every intercept. I like this because it's it makes you think of.

You know, what are those specific characteristics of community services, of law enforcement of, you know, initial detention and courts and reentry and probation and parole.

you know, looking at each of those, where can you add something that gets the people with mental illnesses out of the criminal justice system and into the local supports that they need. So I I like this quite a lot. And this is the way I sort of think through interventions. And so what I did is I just took that and just mapped on a few examples, so that in this this is very Us. Centric. And I acknowledge that. So

when you think about intercept 0 at the community services level again, this is just before someone becomes comes in contact with law enforcement. Mobile crisis teams, for example, 24 h teams that you can call and they can come and show up, especially if the crisis is mental health specific, right? Unarmed response, right with law enforcement, forensic, assertive community treatment teams.

All of this happening kind of at this intercept. There's growing evidence around forensic sort of community treatment teams and their potential impact to both. Improve mental health related outcomes and improve criminal justice system outcomes and then looking at intercept one. You've got crisis intervention team training Co responder models. Intercept 2

here, implementing some kind of standardized screening process for your initial detention. So this might be a lot of times the brief jail mental health screen we can talk

a lot about. You know the the biases that are baked into most of these standardized screening instruments. A lot of these are based on prior treatment. So prior treatment is usually dependent on who seeks treatment. Here in the United States. That's usually white women. So they're always gonna flag higher on these kinds of instruments.

And then who has access to treatment? And so those. There are some limitations. And you know, should we still use these screeners? That's up for the to the agency to decide. But we don't have like a long list of unbiased instruments that are really really great for these settings. And so there's just a caveat, I think, for all of these.

also an intercept to pre trial, supervision, and diversion. Intercept. 3. Here problem, solving courts or treatment courts like mental health courts and drug Treatment Court.

and then intercept 4 really working on in reach program. So not waiting for the person to be released from jail or prison to then start map, putting a plan on, but really having an external person doing the In Reach work to start putting those reentry plans and discharge plans around them, and then the last one intercept 5. The example I use here is specialty mental health case loads, and those are the 2. That's the example. I just wanna

just note here. This is, you know, us. Based example, specialty, mental health supervision. This is based on largely Jen schemes work. Who really kind of laid the groundwork for this, the model in the United States. I'm going to keep saying that because I'm going to go to an example in Germany in a minute.

but designated mental health case loads, meaning case loads are comprised exclusively of people with mental illnesses. Smaller case load sizes, maybe 40 or 45 ongoing mental health training for officers instead of like a one and done training on mental health

increase interaction with resource providers meaning those officers can help link people to services. And then problem solving. Orientation can mean a lot of things. But this is really that mental health officer, that specialty officers not just saying, oh, you violated the terms of your condition or your condition or your supervision. You're headed to jail, but that officer can really talk with them about what's going on. So those are the the core components of that model. This has been.

you know, transparently so our team has done this. Georgia has done this. I think Texas and New Jersey. So the number of the research teams are down here largely. This is showing improvement on mental health outcomes consistently, and then with criminal justice outcomes not as consistently, and I will say, for our model.

It was either inconclusive with violations, or we were moving in the wrong direction. Other models will say, arrests are going down. And so it it really kind of depends. And so that's that's the the national model. And I do wanna note in 2, Us state. So North Carolina and Georgia, there's these other sort of implementation strategies that they're using to enhance fidelity. And I, you know, I'm wildly biased because this is some of the work that we're collaborating on. But clinical case. Consultation, I think, is a really good model.

The idea here is that you are providing coaching for these specialty officers that coaching is provided by a license mental health professional. So we're not trying to get the officer to be a mental health professional. They're not a counselor, but we're trying to get them to behave differently.

and that's in a mental health informed way. And then the second thing they're both doing is really increasing, that networking with resource providers having engagement meetings with service providers in the community really to facilitate that service linkage. So those are kind of 2 modifications that 2 Us. States are are are doing, and then

here in Germany. So I was excited to find this example. Morgan Heights, I think. 2022 so how Germany has implemented this specialist probation officer? I'm not gonna pretend that I know a lot about this particular approach, but I wanted to name it here, because I think it shows variation in these models, and how these models can be tailored to context. So if you read this article you can see that it

closely aligns itself with some of the models in the United States that I just mentioned, but it also distinguishes itself from these models specifically the officer, based on my understanding the officer in this model is a specialist, but doesn't necessarily does not necessarily carry a caseload exclusively of people with mental illnesses. Rather the agency uses that person as a way to address the objective. So first, here the specialist has the knowledge

and provides consultation to the probation workforce. So the idea here is that you're really enhancing the general knowledge across the workforce. This is not really what the us model does. And I think that this is really impressive kind of to think about. You're using that officer to do kind of overall enhanced workforce.

And then the idea that this enhanced knowledge translates to better assessments, and then, being networked with your colleagues, leads to this overall kind of professional exchange and improved quality. So if you haven't taken a look at that, I'm obviously not the expert here on this model. And perhaps we can talk about that in discussion in a minute.

And that's primarily, I think. Well, I'll make 2 points on this, and I think my time is done. So the variation. So thinking about implementation. This is where my implementation science stuff comes in. So lots of variation and context. lots of complex interventions. You can't just add it here. I'll go to this one. You can't just add the intervention and stir. You really need to systematically evaluate the needs of the community and the organization

plan and think about what challenges you might encounter. Foster that implementation climate, engage your leadership. Start your start implementing your intervention. But it really it's adjusting along the way, you know, taking models from other contexts and trying to implement it in one other context.

isn't easy. And so you really need a systematic approach to do that. And then these are just the concluding thoughts here. The criminal legal system is not where you want to warehouse people with mental illnesses with serious mental illnesses. We need to adopt a multi level perspective when we approach intervention, development, and that treatment alone is not going to fix this large problem that we have. And our criminal legal systems need to do a better job of responding to people with serious mental illnesses.

But it's not necessarily shoring up the treatment we offer in the criminal legal system really needs to be making sure that community care is there as well. and that I think I took more time than I was allowed. Carl. I'm sorry about that, but I'll stop sharing out.

people with problem behaviors and a whole array of other forensic issues. And my background prior to coming here is being in academic settings as well as in youth. Justice in a couple of states across Australia. And sorry, Carl, I did miss the second part of your question, or what you wanted me to to speak to.

I think one of our shared experiences in Australia is variation across our States and territories and our national approach to these issues, which causes additional levels of complexity in terms of service systems, and how they intersect and and interact with one another, and how people actually experience that.

I think, you mentioned one of the areas that I think speak strongly is the issues stigma that people experience both in our mental health systems as well as in our criminal justice system. So we sometimes refer that to that as in the shorthand is the double stigma of being both mad

and bad, and how people actually can move forward from that. I noted you were talking about some of the issues around intersectionality as well. So for for us to that think there are particular issues that relate to women in these systems, they're a bit of an invisible and forgotten group, and maybe particular to Australia. So a contrasting issue is the significant overrepresentation of

aboriginal and Torres Strait Islander people in our systems of detention, the over representation, right? So eye watering and think, speak to the ongoing impacts of colonization and generational trauma in Australia.

I think the other area that really resonated for me was your discussion around the workforce challenges so significant variation in terms of the qualifications and the base level competencies required for forensic work in Australia, and not really much shared agreement about what the skill set and the knowledge and experience for workforces in community corrections, prisons, youth, justice should look like

and then a big contrast in terms of significant levels of qualification and experience required for mental health and health workforces and then thinking about how those groups intersect with one another and work together. So and I think you also did touch on issues of privatization as well, which are also familiar challenges for us in terms of continuity of care, information, sharing, and how we work across the various aspects of the service system.

I think I'll leave it at at that for the moment. They're probably my initial thoughts at quarter to 2 in the morning for me.

it comes from that service in Germany that Tanya noted he's the manager of that specialist probation service in Germany that's in Baldon, Wert, Wurttemberg. and I managed to uncover that when I was doing the work for the Council of Europe. and we were looking for examples of good practice. and I think the European Survey that we undertook at that time. and what goes on in the Uk on on a micro level in the Europe is not dissimilar.

So, for example, we found that in prisons there were mental health policy in 95% of Prisons. half that number in European countries. In probation service we found that only 4 countries out of 47 were recording suicide rates in the community when we know they're very high. And I can say that from UK. We've been doing that now for about 2025 years. and we have an impressive series of data.

I think you know, there's a seminal paper by a woman called Binswanger in group things going on that looked at death rates when people came out of prison. and she found that in a big prison in New York in the 2 weeks after release, death rates were 14 times higher

than the general population. Now I'm not saying that all of those untold deaths were suicide, although a significant proportion, were there were all sorts of ways in which people managed to die when they came out of prison, including, of course. overdose and including being shot. Our accidents, but suicide was there. And it's interesting that in Europe this is such a almost unregarded matter.

The other thing that we put in the Council of Europe. Survey, and I'm sure Tanya is listening with great interest. Tanya Elena Tanover, who was the woman Council of Europe who was leading this work really. which led to a white paper. Training in mental health talk. Place in only half the number of settings information as it did in prison. and of course, you know, you've got the issue of the duty there when someone's in prison. So you know, maybe you could argue that you know.

around some of those mental health issues will be addressed. More systematic. but nonetheless it it looked like a big difference on paper. One of the things that a lot of people said to us was that, well, why do we need to train people in mental health and Probation office? Because essentially. they're undertaking a social work break. and they should have a decent working knowledge of mental health, mental illness when that's completed and they go into a probation post.

I, personally don't think that that's enough that, you know. I thought this notion case study supervision. alluding to was a much more powerful means getting the right right response from someone in a probation service and other wolves. I think in England a lot of the aspects of the model that Tony put up in there. we would say we were aspiring to. We have mental health treatment requirements. Well, mostly the common mental health disorders who are diverted from the criminal justice system.

and those are new services. They've been in place about 5, 10 years, and they are seeing quite a lot of people. We have liaison on diversion services, although the evidence is, they don't actually work very much with people. The mental illness, let alone a serious mental illness. And we have in reach teams of mental health experts going into prisons but they are under resourced and have to make difficult decisions about priorities when there's such a lot of potential work in front.

I think it's interesting that the role of trauma in childhood hasn't come up so. There's a very impressive study out prison inmates again in New York. but someone whose name I've forgotten. I'm sorry about that but she showed that 60 to 70% people in prison at a significant childhood trauma. Whether that was a section and I know that the probation service in England has been trying to introduce a former home informed approach to question big question, is this.

what do you want? A probation officer to do? What is their role in this scenario? Is it to be able to recognize a mental health disorder and refer that person to the right expert? Is it to be able to assess someone's mental illness and try and get them more deliberately onto the exact part of pathway. And if it's either of those things, our probation staff being prepared to undertake those roles. and I don't think personally they are being undertaken. Those roles are being

isn't it? Cause I'm not even sure. Probation staff know the answer. And what is their role. let alone going on to say there isn't enough framing to do what don't really know. So there are some big questions, I think, and the time has come. As Tonya said, stop thinking about prevalence. We know it's a major issue. And I think the time has come to actually start doing something about it. And of course, that means things. It means bigger investment, education and training it means.

and it and coordination with mental local mental health services. who themselves in England and Wales really under the kosh in terms of resourcing. and how much more new roles they can be expect. So big issues. Big challenges in front. Thanks.

and I don't know whether any of the panel could comment on kind of how that's being decided. Or if it is actually clear, if there is a clear policy around that in that country is a starting point. because certainly in the Uk. As Charlie says there are. There are fuzzy edges, I would say to where that role extends.

You know, we're we're governance and administration is kind of at the State level. You'll have more uniformity and say, like, first, you know, for state like North Carolina or Georgia, for example, if that's their policy versus a different state, if it's county based, and it has a hundred counties, every single county can just make up its own. You know.

Gerry McNally, Ireland: and particularly when you're talking about on a county level or on a national level. In our case it's on a national level. Gerry McNally, Ireland: So we're talking about criminal justice, talking to mental health, talking to all the other agencies. And it it can be frustratingly slow. But I'm learning to live to realize that when change does come it actually comes eventually. So it's it's about, it's about not giving up. And it's about being persistent.

Gerry McNally, Ireland: I and I think, echoing. I see John Scott has a question in there asking about the Council of your recommendations which Eli, which has been sent Gerry McNally, Ireland: where they're developing a a recommendation for the ministerial for the ministers in the Council of Europe.

Gerry McNally, Ireland: And that's how things get influenced. The Council of Europe influences, policy makers. And I think it's that idea of influence and Gerry McNally, Ireland: discussing and the the weight of experience over time does bring about change. Gerry McNally, Ireland: So I'm optimistic that there will be change.

Gerry McNally, Ireland: But I'm not optimistic that it's going to be tomorrow Gerry McNally, Ireland: or today, but it may be in the near future, and I think, as we work as criminal justice begins to work more closely together Gerry McNally, Ireland: with the health services. Gerry McNally, Ireland: It's about joined up services.

Gerry McNally, Ireland: and that is, that's it. I think there's there's many, many books written about how complicated it is to get it different services to work together. I think we could all write a book about how difficult that is. But that's about. We have to go step by step, and I think. Gerry McNally, Ireland: and as Charlie says, we had a study, we've learned a lot from the study.

Gerry McNally, Ireland: We're in discussions, and I do hope those discussions will continue to make progress while Charlie and I are still around Gerry McNally, Ireland: to push each other on these points, but I am impressed that the Council of Europe have now moved on to the stage of actually having a recommendation from for the ministers, and I think that will be a major influence going forward.

would work in different parts of the world. I don't know, Shelley, whether your service, for example, would have that much direct involvement with community probation services.

I think one of the biggest challenges is that there are competing philosophies really between those approaches. So I think in particular corrections and criminal justice still really largely dealing with an undeserving population, and that is very much at the heart of sort of punishment. Mentality that still unfortunately permeates our approach to criminal justice in Australia and to corrections. And again, that varies quite a bit between States and Territories and

it depends also on the flavor of the Government, that we might have in that particular State and Territory. And then again, the health services very much built around the notion of recovery. And a sort of non linear journey where a consumer or participant, or a client, whichever language you choose to use

is really driving their own recovery. So that's sort of more volunteeristic conception. Of the person playing a central role and having agency in their recovery is quite at odds with the more controlling structures and systems that are set in place in corrections. So I think that's a real tension that we haven't reconciled in terms of how

the services work together, and when it comes to a forensic mental health service like ours, you really see those tensions play out across the different parts of our service system. Even in the language we use, which is different where we refer to people in prison in a different way to how we refer to them. Once they come into a secure

inpatient facility, for example. So I think we've a long way to go to develop any kind of unified way of thinking about this or and and of course, all of that way of thinking

plays out in practice as well. You see quite a bit of confusion. Really, I think, across the various parts of our service systems as to what we're trying to do collectively and that. And that's just thinking about it from that sense. And then there are also, of course, the complexities of multi disciplinary working alongside inter agency working. Yeah. So it's challenging.

So, Sally, your comments around the training for probation offices. Was interesting, too. So I know we've had similar debates and discussions in various parts of Australia as to whether a social work degree is the appropriate grounding, or whether it should be something like criminal justice, specific degree

whether it should be a deployment level. And then as to what degree of specialty around mental health, drug and alcohol trauma, you know, these are all sorts of issues and psychology plays a very strong role now in corrections compared to say, social work which had a, I think, a much more prevalent role in in the past. But we've seen real rise of psychology. In corrections. Information in particular.

And also some of the structural ways of tackling that. So rather than I guess, locating the causes. Just with the individual. It's also thinking about those environmental factors. Now, I'm not suggesting psychologists don't do the same. I think it's just more the emphasis of the work and the way the lens. So social work really does bring that person and environment, that sort of

perspective to the forefront. And I think, you know, psychology and the prevalence of the risk need and responsivity model does think a little bit more around risk mitigation and working with the individual and the individual factors. And sometimes I think at at the cost of thinking about things like the family systems

and and the broader systems within which individuals find themselves located as well. So that would be my my 2 o'clock in the morning brief description. But of course there's a lot more in that. And and yeah.

Gerry McNally, Ireland: No at at this, it just reflecting on basically what we've just heard there. I think there's also Gerry McNally, Ireland: a a complication within psychology and provision, psychology and social work and social pedagogue within Gerry McNally, Ireland: their permission profession as well, because it's about identity and sense of purpose, but that then crosses over into looking at

Gerry McNally, Ireland: the Comp, the other, the institutions, the relationship between the institutions, between the police, between the judiciary, between mental health professionals, and who who leads and who follows and who delegates. And it's about building that relationship is what I was mentioning there. It's a complicated business Gerry McNally, Ireland: building relationships between institutions. But it's an even more complicated one, building it between professionals.

Gerry McNally, Ireland: And I said, but but it's all about boundaries and cooperation, and I think Gerry McNally, Ireland: where where it's it's going into a whole other area which is quite large and complicated. But I wanted to just mention that there are a couple of very good examples of interesting developments within Europe, because in my time at Cp. The confederation of European probation just been some very good examples. For example, in the Netherlands they have a a community based

Gerry McNally, Ireland: houses of justice or meeting within cities where the various professions from the various organizations meet together and share their experience on how to deal with particular cases and particular complications, and I think that I've always found out a very promising one. And then in Germany, at the moment in Schleswig, Holstein and in Hamburg

Gerry McNally, Ireland: they've recently passed laws which mandates the community services to work with people on leaving prison for a specified period to to help that reintegration process. Now it's much wider than mental health. Gerry McNally, Ireland: but it actually is beginning to show a a mandate.

Gerry McNally, Ireland: It been obliging services to cooperate. And I think that's an interesting model, and I know there's a particular candidate in doing our Phd. On this in one of the Irish universities. In looking at how the German law is being implemented because I know the Schleswig Hallstein law has been passed within the last 12 months. Gerry McNally, Ireland: But I do think it's about how do we.

Gerry McNally, Ireland: get across professional institutional boundaries for the benefit of the people we're working with and the benefit of the communities. And I think it's that complicated. Gerry McNally, Ireland: stony ground that we have to work on. Where. No, I appreciate this. Obviously a lot of kind of local level variation in in how people may have approached that. And but I wondered whether. from from people's experience, whether they have any ideas about how we can best

kind of promote those sorts of interagency relationships. And you know, working, whether it's a practitioner level or at the level of the institution. And you know, how do we get those things off the ground and and working? Because I think that's a kind of common stumbling block. Really, when we're trying to think about how best to save people in the criminal justice system that do have a serious fence to be honest.

for us and the team, the team that I have here at the lab. You know, we felt that is a primary focus of ours. You know, we we're able to describe what it can look like, right coordination, collaboration or co-location, for example. So that's kind of like how we think through this. But what we're not really able to say is like. what's what's effective? What are what are we aiming for? Because not all situations. Co-location isn't necessarily a model. You

want, right? It's not appropriate for everything. Coordination, coordination, usually collaboration. Yes, but figuring out what to use when and where you and your partners are, I think that's there's a lot of work that needs to to be done there. And, Carl, your question here. Around, you know. What can it look like? One of the things that we were doing in North Carolina. And this is a

a project that was funded by the National Institute of Mental Health. We're really looking at the factors that impact the relationship or the the ability to collaborate and coordinate between mental health probation officers and behavioral health service providers. And that is very multi level. And I think what Jerry was just saying, too, really struck me in that.

You know, we're still taught. We're talking about these institutions, but we're still talking about people. And so the strategy that we think about, you know have to be multi level for that reason. So what's gonna make me go and call Charlie to connect someone to services. Well, do I like Charlie? Do I know, Charlie? Have I met Charlie in person? Have we had coffee together so there, there could be a number of interventions just around figuring out how to create that relationship. But then we, you look at more of the

institutional and organizational level. Then you have to get a little bit more, maybe formal in that approach. And so that might be Mo, a memorandums of understanding or agreement or some other kind of processes. One of the things in this study and this is not we haven't. We haven't found a publishing home for this yet, but it's gonna come soon. But one of the things that folks had suggested is really, you know, either.

you know, ongoing resource information sharing meetings which I think someone had mentioned previously. That's on one spectrum. So it's info sharing. Here's what we do. And then another part of that people want

treatment team meetings, you know, between the mental health officer and the Behavioral Health Service providers to talk about people on their caseload. Those are different. Accomplishing different things, but ways that we can start to tease out. You know, coordination, collaboration, co-location. Where are we fitting within kind of what those relationships should look like.

I think, even when we describe all those we still from a research perspective, we don't know which one to use when. And I think that's the kind of study that would be interesting, but also really hard to do and hard to kind of tease out when you, when you factor in you know context.

and to have police be the front door for finding these people without understanding the ramifications of you know mental illness. It's very, very difficult. To have the police do anything other than pick them up, and if there is a crime issue, put them in jail. If there isn't, they do a risk assessment. Supposedly from a mental health issue. But what I'm hearing from families is that my loved one has mental illness issues. Police knew that. and they still let them go.

So families are saying, police are not aligned with In this case, missing persons with mental health issues. So how do we, as a community broaden the perspective so that these individuals do get the help that's needed. and I haven't heard any. I was. Couldn't put a question in here. Now I'll ask it. I think initially

Tanya, you you spoke about the caregivers and the stress on them, and the actually to me it's epidemic, because now the caregivers are the ones who are having mental health issues. The police officers are starting to have mental health issues. We're being asked to form individuals over and over again, only to be taken to the hospital and either not given an assessment because aren't enough. Doctors like psych psychiatrists, or they're actually let go because they present very well.

So it's a catch. 22, and police are pushing back and saying, You know what this is. A mental health issue. This has nothing to do with us from a public safety perspective. And we're seeing the landscape of that shifting and changing which is a good thing, because at least we're talking about it. And we're trying to figure out who can best do what. So that takes me back to this court diversion program which I never knew existed in Ontario, let alone in pockets across Canada.

And even it was challenging. because police, when they make the arrest, if they don't divert them at the front end, IE. Acknowledge that there's a mental health issue here. I should say mental illness issue here. they're already in the court system, so it it complicates it. When you've got court support workers who are trying to encourage the court to let this individual go through the diversion stream and get the proper supports they need. Versus.

you know, convicting them and throwing them in jail. So, Tony, you talked about, you know. the the purpose of these institutions, and in my mind mental illness used to have institutions that would deal with these people not always in the, in the best of ways. But prisons are starting to

be that door. And now we're saying, you know, while they're in there. So you've got to provide all of these new additional services to deal with mental health issues. So we're kind of creating a cadund of of mixed roles and responsibilities. And I I truly believe community have the strongest voice.

but I'd like to hear more about how the caregiver's voices are helping in that movement and shaping those solutions, because ultimately they're the ones who are left with the responsibility of looking after their loved one when they have serious mental health issues. And the other thing is. if if we really want to understand. how are we garnering input from those who have the mental illness because they are the ones who ultimately are going to be either accepting or refusing these services.

So what are we doing to understand their perspective and their needs? And that's open to the panel? Thanks, Jordan.

and they provide direct peer support to people who are current clients of our forensic mental health system. Within that there are also a couple of family and carer advocates or consultants who also have experience of caring for or living with in some way, a person who, they have a significant relationship with and involved in the forensic mental health system.

And I think I've worked quite Co. Closely as well with our groups of families and carers who are involved in the Advisory group for our organization. In helping us to shape out systems and services to be more responsive to the needs of families and carers. They have a particular set of needs that are sometimes

aligned with the person who's in the service and service user, but sometimes might also be competing with the service users. So I think of an example which would be the issue of family violence.

So sometimes family members themselves have been a victim of the offense, or they may fear actually, the person who's in our service. So it's not a straightforward relationship, and not a straightforward set of needs. For families and carers. There's a lot of issues around unspoken shame as well. They don't often receive

support from victim support services. Yet you might argue they are victims as well, because they're often demonized in the media. Have been part of some of the conversations, or witness some dreadful things that have occurred within their own family units, and sometimes affected their own family members. So I am working with colleagues in a few other States actually

to try to look at how we can provide some better cross state and jurisdictional supports for forensic families and carers in particular. So while our mental health systems do have some support for families and carers. There is, again that double stigma or additional level of shame and silencing that happens once people enter the forensic systems as well as

mental health system. So I think these are really important issues and often quite hidden. And there isn't one particular agency or services that supports families and carers. But, as you brightly point out, that is often again where people will end up when they leave criminal justice systems or mental health systems if they're in any kind of institutionalized sort of service or support system. So I think it's very important. And we probably need to pay a lot more attention to it.

And I think there are also some complexities in terms of how we co-design or work with families and carers as well as service users

when it comes to statutory systems in particular where we can't really genuinely co-design because we've already made up our minds about what we think the service system should essentially look like. So I think the more pragmatic approach to issues of co-designing co production are really important to so we're not inadvertently gaslighting people along the way. But I think I've seen there's some some fantastic organizations

like the co-design collective, I think, in the Uk. And other places that are doing some some great work, and late in the way there. And I think disability sectors have actually streaks ahead of us, as well as drug and alcohol services that have been doing this kind of peer work and Pm. Modeling for a long time and again I think it speaks to the issues of

feeling in many ways that this is an undeserving population and and and should essentially be voiceless. So I think they're things we have to grapple with as well when it comes to criminal justice systems in particular. So I'll leave it at at that. But yeah, I think I think we're doing some great work, but it's in pockets.

I was just curious about going back to training. That seems to be one of the central issues that everybody mentioned, and about how. how, in different systems, we've decided what kind of training probation staff should receive what they need. And I think the space potentially for kind of lived experience voice within that, too. you know, in terms of shaping what that training might look like. So I didn't know if people had any kind of comments they'd like to make on that.

What are the kind of key things that we need to have in place in terms of training.

I think a lot of the using mental health probation as an example, you know, we'll try to use the crisis intervention team training that, you know, cit officers that law enforcements often using but we see a lot of kind of recognizing the signs and symptoms, and then figuring out like how to get the person to the thing, the treatment provider, or whatever that they need.

I think those are. Those are like the essentials, but I don't think it could really stop there. It's it. Then it becomes like the skill piece. Ha! The De escalation techniques. That's, I think, one of the things that we look for across systems is like, do you have a de escalation training involved in this but I think even more than that, too, is the frequency. And so is this a one and done training? Is this done at, you know

basic law enforcement training in the very beginning? Or and or do you have booster sessions along the way? How often do you have those? How long is it in person? Do you use case studies? So I think a lot of that we can move into focusing on format if we can agree on content, I think, getting to a format both for frequency and type.

And how do you deliver that to adult learners who wanna do very skills based stuff. Looking at some of the evidence from training and adult learning to be able to kind of inform that I don't think we're there yet. I've seen good training. I think just in in a lot of variation, in training online modules versus getting together and having conversations about stuff.

And also we are asking that system to give up a bit of the control which is what they are supposed to be doing is controlling their systems of social control. And so it's an interesting way. Or it's interesting to think about, how do we get to that spot, and then removing the barriers to participation for those families and individuals. How often do you see a person with lived experience

in decision, making seats, not not only just as a service provider, but where else? What else is that person available? To what rooms are those? You know, individuals. And what tables are they sitting at to be able to impact change at at higher levels? So I guess that's my.

but also just sort of very good, solid, interpersonal and communication skills, and how you demonstrate respect and cultural awareness in your work along the way. I think this really does require our universities and higher education systems and and vocational systems to be really targeting skills based and practice

type experiential learning. And this is quite expensive. I think we've come to a point where we've got very corporateized universities cost cutting lots of academics who are driven by performance frameworks that are about research and not really about teaching or or practice delivery. So I think we've got attention there as well. But I think to add some moments of hope. I think we've got some fantastic

things on the horizon, with VR. And other ways of mimicking practice that can be quite useful and helpful, and things we should really think more deeply about, because what you want to do is stimulate that sensory response that people have in the moment. And that trick is the fight flood for free.

And Frank, best tool.

and it's great to see that so many people have attended, and we are intending to do kind of more of these events save the time. And so the hub will be running more webinars. So, and if people have ideas of what they'd like to see, or you know, areas that maybe haven't gone into as much detail, or, you know, didn't touch upon at all. But you were interested in then do please let us know. because we'd we'd love to do more of these, and see more of you in the future

also. And quick note from John. That will be, and sending out a follow up questionnaire as well. So. And that's the space where you can kind of give any feedback, and to guide us for future events. Thanks very much, everybody. And hopefully, we'll we'll see you again another time.