1. Do Services work? Critically assess the effectiveness of modern psychiatric services for the
treatment of mental illness and mentally disordered offenders.
Psychiatryhas undergone aprocessof modernisation,yet the effectivenessof modernpsychiatric
servicesneedtobe assessedinrelationto the treatmentof the mentallyillandthe mentally
disorderedoffenders.Inthissense, the assignmentwill followthe structure of foursections:
legislationssurroundingmental illnessandmentallydisorderedoffenders;the service provisionfor
mentallydisorderedoffenders; debatesaround service provisionformentallydisorderedoffenders,
specificallyfocusingonthe vulnerable groupyoungerpeople,andthe argumentthatthese services
are effective will be analysed. The mainargumentwill be thatindividualswhoare mentallyill should
be treated ratherthan in prison. These fourareas will thenbe analysedbasedonresearchand
evidence thatevaluates the effectivenessof service provisionsformentallydisorderedoffenders.
Legalisationssurroundingmental illnessandmentallydisordered offender’s objectivesare toprotect
and safeguardthe individual andthe widerpublic. (Moon,2000). The legislationsare basedupon
the medical model.Mental healthlegalisationsandservices thatare builtuponthese objectivesand
model thencreate the notion thatthe individualormentallydisorderedoffenders needtobe
treatedratherthan punished. (Lamb&Weinberger, 2005) In the contextof forensicservice,an
offenderisreviewedtosee if theyhave enoughinsight tobe heldresponsible.(Crocker&Côté,
2009) Thusprisonshouldbe the last resortas treatingan individualwithmentalhealthisthe
priority. Oftenthisisnotthe case as statisticssuggest. Researchcarriedoutby The OffenderHealth
ResearchNetwork (2010) statesthat 84% of female offenderssufferfrommental health disorders
comparedto 69% of males.Itis difficulttogetan exact numberof mentallyill offenders due tothe
highturnoverof inmatesandthe subjectivityof mentalhealth. Thisstatistichoweverismore likely
to be lowerthanthe true figure due the large amountof inmatesandlimitedtime allocatedtoeach
offenderwhenbeingassessed. The rate of mental illnessinprisonistoohighandthiswhyit is
importantto criticallyassessthe effectivenessof modernpsychiatricservicesforthe treatmentof
mental illnessandmentallydisorderedoffenders.
In 2007 a Mental HealthAct was established (Departmentof Health,2007) and became the
backbone formodern mental healthprovision.The actmade serval recommendationsincluding
advocatingthatamount of mental healthprofessionalsshouldincrease andvariousotheradvocacy
schemes.Thisactdid notignore previousactsas itincludedthe Mental CapacityAct(2005).
(Williamson,2007).Thisact acknowledged the rightsof vulnerable as the EuropeanCourtstatedthat
justbecause vulnerable individualsdonot have the capacityto vocalise doesnotmeantheydonot
have opinions.Thisacthad the strengththatit focused onsafeguardingliberty.Onthe other hand, it
has beenquestionedthatnot muchhas changedinthe service provisionsince these actswere. A
reviewfive yearslaterfound thatthe acts were achievingthe majorityof theirgoalsbutthe review
alsofoundthat the numberof BME was disproportionate tothe coercion of treatmentand
discriminationwithinthe mental healthservice. (‘Themental healthact2007: A review of its
implementation’,2012) ThissuggeststhatMental Health legalisations were largelysuccessful,
howeverwhetheritisdoingthe mosteffectivejobisstill debatableasmental healthisnota one size
fitsall situationandthiswill be discussedinthe comingsections.
Policies coveringmental healthandmentally disorderedoffendershave beendiscussedandthe
service provisionforoffendersmentallyill. The infrastructure of mental healthservice provision
reliesheavilyonpsychiatricnurses. (Hean,Walsh,Hammick, 2015) Thisis because the professionals
involvedshouldinclude healthcare assistants,psychologistsandpsychiatrists.However,due totime

2. and practicality, psychiatricnursesendupwiththe bulkof the work.Communicationthereforeis
essential tomake sure mental healthprovision doesnotfail the oppressedgroup.Thiswas
demonstratedinthe case of ZahidMubarek. An inquestconcludedthatif communicationwas
sharedaboutMubarek’skillerhe wouldnothave died.(HMInspectorate of Prisons,2014) An
example of thisisif everyonewasaware of RobertStewart’sracistattitudeshe wouldnothave been
put ina cell to share withZahid Mubarekaccording to the inquest.Animplicationof the Zahid
Mubarek case made it that documents,includingthose onmental health, needtobe sharedmore
efficientlytopreventaneventlike thishappen again.The review in2014 foundthatthiswas made
easywithtechnology,yetmental healthfileswere notalwaysbeingread.Thisisa bigconcernwith
mental healthprovisioninprisons,asmanyprisonershave mentalhealthissuessothisshould
alwaysbe made clearon arrival at the prison.
Mental healthandprisonsare intertwined,due tothe highlevel of prisonerssuffering fromamental
healthdisorder.The debate whetherprisons helpoffenderswhoare mentallyillortriggermental
issuesneedstobe explored. There isnoclearcutanswerto this,howeveritiswidelyacceptedthat
prisonsare damagingfor mental health. (Maschi,Viola,&Koskinen,2015) This iswhycourt diversion
isextremelyimportant,notonlytopreventanoffender’smentalhealthfromdeterioratingbutalso
to aidthe offender’s treatment. The majorityof offenderswhoare mentallyill havenotreceived
any treatmentanda diagnosisbefore theirarrest.Variousreasonsare behindthis,offendersare
oftenmarginalisedfromsocietyanddonotalwaysknow whatservicesare outthere forthem.
Before the modernisationof the prisonservicesmentallydisorderedoffendersdidnotreceive
treatment,thisisnolongerthe case.It was decidedthatprisonwasthe punishmentandnotlosing
out onthe national healthservice. (HMGovernment,1999) It is highlyeffective havingthe national
healthservice inpartnershipswithprisonstomake sure offenderscanhave treatmentthey
otherwise mightnothave received.
The problemwithhavingmental healthserviceswithinthe criminal justice systemisthe publiccan
be verysceptical.(Council of State Governments,2002) Firstly,whenanoffendergetsdivertedat
courts to seektreatmentratherthana prisonsentence,public out-roarcanoccur.This can be
demonstratedinthe media,asthere seemstobe afascinationwithcriminalsgoingtoapsychiatric
hospital ratherthan a prisonand LouisTheroux’sdocumentaryisanexample.(BBC&Theroux,2015)
Reasonswhythismightbe unsettlingtomanycouldbe due to individualsnotunderstandingthe
service provision available formentallydisorderedoffenders.Insteadof encouragingthisstigma
educationormore awarenessforthe publicshouldbe given.Secondlysome believe offendersfake
mental health,withthe famouscase of PeterSutcliffe,togetoutof a prisonsentence. (Cross,2014)
Thisis a difficult issuebutitisone that mustbe tackledtoensure mentallyill offendersdogetthe
appropriate care. It isdifficulttoevertell if anoffenderisfakingmental healthdisordersdue tothe
nature of a prisonenvironment,howeverall possibilitiesmustbe takenseriouslyandneverignored.
Reasons include the potential detrimentof dismissingthe offender’shealthwhenitcouldbe acry
for help. Modernpsychiatricserviceshave come alongway,but there isstill more thatcan be done.
Modernpsychiatricservicesforthe treatmentof mental illnessandmentallydisorderedhave been
criticallyexamined.Thisisnowgoingtobe appliedtothe debate aroundyoungerpeople, prisonand
mental health. The perspective thatyoungchildrenshouldnotbe lockedup inprison isthe
viewpointthisdiscussionwill include.Beforeassessingthe impactof prisonona youngerperson’s
mental health,itisimportanttoconsider thatyoungerpeople are one of the mostvulnerablegroups
for mental health. Toillustrate,one intenbetweenthe age of 5-16 sufferfroma diagnosable mental
healthdisorder.(YoungMinds,2016) If mental healthisthishighamongstchildrenthenservices
shouldaimto help. Greatermodern psychiatricservices needtobe available tosupportchildrenand

3. to helpreduce offendingbehaviourinthe young,particularly if the helpwasgiventothempriorto
the offence.
Thisis notto say there are notmodernpsychiatricservicesavailable forchildrenas there ismore
nowthan ever.An example of this isChildandAdolescentMental HealthServices (CAMHS). This
service wascreatedinthe early21st
century and createda mental healthservicethatfocused on
youngerpeople. (YoungMinds,2016) Thisservice provisionexcelled atbeingaccessible toyounger
childrenasGP’sand schoolscoulddo referrals.CAMHSoperatesonafour tierstructure allowing
coverage of a range of mental healthdisorders.Thisallowedforcontinuouscare forchildren asif a
youngerpersongotarrestedCAMHS wouldstill be involved.There doeshoweverneedtobe more
trainingandregularreviewsonCAMHSto increase the effectivenessof thisparticularpsychiatric
service.
Youngerpeople are extremelyvulnerable tomental health disordersandexcludingthemfrom
societyonlyworsenstheirconditions.Manyyoungoffendersbelieve theyhave lettheirfriendsand
family downbygoingtoprison,inturn creatingmore stress for the individual. (PrisonReformTrust,
2014) Theyalsoare surroundedbyastigmaof mental healthdisorders; negativelycausingthemto
hide theirmental healthdisorder. (Flett&Hewitt,2013) Thiscouldbe because theycare a greatdeal
abouttheirappearance to othersandalsoperhaps because theydonot understandthe situation.
Thisis veryproblematicforyoungerpeople whentheytrytohide theirmental healthdisordersasit
will onlyprogress. Anotherstigmasurroundingyoungpeople isthat some olderindividuals donot
believetheyhave reasonstobe stressedorhave mental healthproblems. (Niederkrotenthaler,
Reidenberg,Till,&Gould,2014) Before mental healthdisordersgettothe stage of treatmentin
prison,the cause for theirhealthshouldbe examinedtohelp preventthe same problemsrepeating
themselves.Although, itisextremelydifficulttofindacause and effectformultiple reasons.Itisa
sensitivetopicforsocietyaswell asethical issueswhentoresearchonchildren.Inaddition,itis
extremelydifficulttofindacausal factoras there are more oftenvariousvariables. Suchasa parent
beingabsentgrowingup,asPrisonReformTrust(2014) found76% of youngoffendershadan
absentfather.Althoughthisisafact, a causal link cannotbe established.
Withinthe debate thatyoungchildrenshouldnotbe lockedupinprison,the age of legal
responsibility needstobe explored.Inthe UKthe age of criminal responsibilityis10.(HM
Government,2015) Overhalf the populationagree withthisstatementsuggestingthatcouldbe
done. (PrisonReformTrust,2014) Thisage of legal responsibility istooyoung,notonlybecause a
personas youngas 10 doesnot understandthe consequencesof theiractions,especiallywhen
offendingbutthe damage itcan cause to a child’smental healthandcanreduce life opportunities.
The reviewonthe Bradleyreportexplainsmore trainingneedstobe done onstaff to combat this.
(Durcan,Saunders,Gadsby,& Hazard,2014). Howardleague agree withthe argumentthatthe legal
age of criminal responsibilityshouldbe increased to16 and have carriedout extensiveresearchon
thistopic. (HowardLeague,2011) Thissupportsthe pointthat the legal age of responsibilityneeds
to be increasedanduse alternativestoprisonsbutstill offer modernpsychiatricservice provision.
Insteadof usinga setage, eachcase shouldbe assessedseparatelyandtake mental healthof the
offenderintoconsideration.Thisrecommendationof discretion isextremelydifficulttoimplement
due to the Thompsonand Venablescase. (Haydon&Scraton,2000). This controversial case tested
the rule of rightand wrong to the max andfuelledamedia-ledmoral panic, generalisingarare case.
Legal age of responsibilityshouldnotbe keptatthis low age because of a one of case. The
ThompsonandVenablescase supportsthe argumentthatthe age moralityisunderstoodtobe a
social construction.Before thishighprofile example doli incapax wasusedinthe UK,as a resultof
the Thompsonand Venablescase thiswasabolished.(The CommitteeOffice,House of Lords,&

4. Commons,2009). Doli incapax allowedforchildrenbetweenthe age of ten-13to be triedcase by
case as the case wasextremelyshockingtothe widerpublicthiswasproblematicforthe justice
system.Asthe age of legal responsibilityhaschangedwithinthe last20 yearsinthe UK, andvaries
worldwide,there isnotaset age of legal responsibility.Therefore,thisiscausingchildren whoare
not mature enough togo to prison.If a childisnot mature enough to be inprison,the consequence
will be damagingtotheirgrowthand is detrimental ontheirmental health.Modernpsychiatric
servicesare noteffectiveonyoungerpeople asputtingtheminprisonatagesas youngas ten,
damagestheirdevelopment.
The counterargumentto childrenbeingsenttoprisoncanhelptheirmental health.Thisargument
wouldsuggestthat modernpsychiatricservicesforthe treatmentof mental illnessandmentally
disorderedoffendersare effective. Forthis tobe validthe mental disorderneedstobe identified
and treatedto gain improvements.If the mental healthdisorderhasbeenacknowledgedpriorto
prison,the offendershouldhave had acourt divisionforhelpprior.(PrisonReformTrust,2009)
Prisonisan isolatedplace andcan create lonelinessanddepressionsothis mighthelptreatcertain
mental healthdisordersbutitcan create themtoo due to atmosphere. Beingisolatedisextremely
stressful forayoungerpersonas mostnon-offendersspendeverydaysocialisingwithpeers.If thisis
not available,itcanbe worse onmental health.Youngpeople inprisonmental healthdoesgets
treatedhoweverthe prisonenvironmentcouldbe acause formental healthdisorder.Ittherefore
difficulttodistinguishbetweenprisoncreatingthe mental healthandimprovingit,asitis only
treatingwhatit caused.
In the Bradleyreportfivryearson,it isexplainedthatpreviouslymental healthforyoungoffenders
has had limitedfocus.(Durcan,Saunders,Gadsby,&Hazard,2014) This isconcerningas 95% of
youngoffendershave one ormore mental healthissues,demonstratingthe importance of mental
healthservicesinprisons. (YoungMinds, 2016) For the mental healthservicestobe affectedthey
needtobe acknowledgingthose offenderswhohave a mental healthdisorder.Withthis statisticso
high,itsuggestsyoungeroffendersthatare mentallydisorderedare beingdiagnosed,therefore
people are notslippingthroughthe net. Onthe otherhand,there was65 youngoffenderdeathsin
prisonswithinfouryears. (Townsend,2015) The statisticssuggestthatcurrent psychiatricservices
for the treatmentof mental illnessandmentallydisordered youngeroffenders are notbeingfully
effective.
To conclude modernpsychiatricservicesforthe treatmentof mental illness are ingeneral effective.
Whenrelatingthistomentallydisorderedoffenderthe diagnosisof the mental illnessneedsalready
be done earlierforthe modernpsychiatricservicestobe attheirmosteffective.The downfall of the
effectivenessof modernpsychiatricservicesis onyoungeroffenders.Thisisbecause youngerpeople
are still developingyettheyare treatedasfullydevelopedadults.Indoingthisthe psychiatric
servicesare notdoingtheirjob,as insteadof helpingthe individual servicesare potential damaging
theirmental healthforlife.Thisisadifficulttopic,howeverpsychiatricserviceshave progressed
alongway as demonstratedthroughlegislations andare at theirmosteffective.Thisdoesnotmean
theycan stop progressingasmore still needstobe done if theywanttobe at theirmosteffective.

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