Interagency training between the mental health and criminal

justice systems: the need, the now and the next

Sarah Hean Bournemouth University, UK

ContentTHE NEED• Context Offender Mental Health

– need for collaborative practice and interagency training.

THE NOW• Crossing boundary workshop• MHS and CJS professionals’ attitudes towards interagency training

– content and constraints.

THE NEXT• Exploring future development of pedagogical framework in this field• Development of a EU collaboration to develop a Community of Practice

supporting research and education in collaborative working– COST

Problem: the need• In Europe, 9 out of 10 prisoners demonstrate

signs of at least one mental disorder[1].

• Represents severe health inequality within the Europe.

• Neglecting this area leads to:– Non adjustment to life on outside: social

exclusion and reoffending/recidivism.– Compromised wellbeing of offenders’

family, fellow prisoners, frontline staff and public safety.

– economic strain on the public purse and prison and mental health hospital places [2].

Solution• Effective partnership working between MHS and CJS needed for early

diagnosis of the offender, treatment, appropriate sentencing or diversion into the MHS [5].

• Collaborative practice at the interface of the MHS and CJS particularly challenging [3].– lack shared protocols, agreed timeframes, information sharing, clarity

on lines of responsibility. • Range of collaborative models:

– diversion and liaison schemes, – specialist mental health courts, – care coordination– service level agreements [4].

No Interprofessional training• UK Bradley report [4] called for joint training: but what

format?

• Mental health awareness for CJS front line professionals [10]

• Interorganisational and interprofessional training required. [11]

The now: crossing boundaries workshop

• A crossing boundary workshop [25] delivered to 52 professionals:– criminal justice system (probation, police and courts)

– mental health system (learning disability, substance misuse and mental health services)

• Individuals within each activity system brought together in facilitated environment.

• Together presented with stimulus mirroring dimensions of their collaborative practice.

• A case study “Kevin” with mental health issues, in contact with the CJS. Written by practice partners served as this mirror.

• Co-observe case study:– identify challenges and contradictions of working together, – discuss a potential solution to this problem– Develop models whereby cross agency partnerships might be able to address this.

Theoretical perspective to interagency training

Engestrom, 2002

Outcome:

Different expectations, priorities, culture.

• Delays,• Report

content• Low

efficacy (Hean et al. 2008)

Mediating toolsAssessment tools

Rules

Con-fidentiality

Subject

Psychiatrist

Community

Patient, liaison workers, other health & social care professionals in MHS

Division of labour

Psychiatrist, Community psychiatric nurses, liaison workers, probation

Object/Activity:

Assessment/report writing; Defendants referred to MHS by CJS; Make requests of CJS for information on patient

Subject

Magistrate

Object/Activity

Request for info on mental illness of defendant & relationship with crime for disposal and support of defendant

Rules

Cost effectiveness; Disposal time targets

Mediating tools

Liaison workers, assessment requests

Community

Legal advisors, liaison workers, lawyers, probation, judges, magistrates, Reliance (police)

Division of labour

Probation, Lawyers, liaisonLegal advisors, Magistrate

CJS

MHS

Perceptions of participants• The receptiveness of criminal justice system and mental health service

professionals to interagency training:

• Readiness for Interprofessional Learning Scale (Reid et al., 2005)(Q). (n=51).

• Perceptions of the challenges facing interagency working and the expectations of the workshop • interactive exercises (E).

• What needed to prepare the workforce to respond effectively to the liaison/diversion agenda and constraints in current climate.• 6 parallel focus (F)

Taster of some themes

Person centredness• High person centredness (Q)• Interagency training would help offenders with mental health

issues (F). • MHS and CJS share similar patient centredness (Q)

Positive attitude to interagency training and its benefits • Interagency training (F, E) builds relationships to enhance

interagency working (E), improve and share good practice (E) and implement liaison agenda (F).

• Be included in preregistration and mandatory basic training for professionals from both the CJS and MHS (F).

Increasing knowledge of other agency• Knowledge of other agencies (E):• Roles and responsibilities of professionals in other agencies

(F,E)• How systems fit together (F). Building empathic relationships• Legal and political environment others practice within (F). • Different priorities and values (F) and alternative perspectives

(E), targets and priorities (E, F) • Interagency empathy reduces prejudice, builds communication

channels and information sharing (E, F) and clarity on lines of accountability (E)

• Important horizontally between senior managers across agency boundaries (F).

Working together in an imperfect world: sharing resources, economies of scale• Budget cuts: Sharing training resources across agencies, piggy

backing interagency training onto existing training programmes and joint commissioning of services including training (F).

• Economies of scale and learning from good practice: bring together a wider range of regions versus localised events for local interagency partnerships to develop (F).

• Targeting staff involved in cross agency working only (F).

A valid interagency learning experience• Interagency placements, shadowing opportunities or formal

visits between agencies, case conferences, service development projects (F)

• Use of real life issues (F)(Kevin the case study).

• Well established adult learning approaches including practice based, situated and experiential learning principles.

• Interagency training champion within practice and train the trainer.

Role of the university

• Role of university:• Evidence base• Conceptual or pedagogical framework. • University evaluating this work.

• The interagency champion monitors the roll-out of the training/train the trainer.

The next: pedagogical framework• A valid interagency learning

experience.• Explore new methods of

linking interprofessional education (IPE) and interprofessional collaborative practice (IPP).

• Substantive content, based in practice reality and with obvious value for practitioners.

The pedagogical frameworkIPE IPP partnership • UK/Norway/ Sweden (Bournemouth

University, University of Stavanger, University College Molde, Nordic School of Public Health)

• national drivers and context (Norway)• assessment tools and measures of service

integration and collaborative practice.• Prototype for piloting in the MHS and CJS

in the EU• Transferability to other national contexts

and clinical contexts

Some of the substantive content being explored

Interorganisational integration• Quality of joint effort put in by two or more organizations and their

constituent professionals to collaborate with one another • On a continuum: full segregation to no contact between service providers• Optimum level of integration depends on context and service user need. • The Scale of Organisational Integration (SOI) measures both actual and

then optimal levels of interorganisational integration required for optimal collaboration [5].

• Utility: service development, evaluation

Collaborative Practice• individual behaviour of different professions and organisations working

together • Perception of Interprofessional Collaboration Model (PINCOM). Quantifies

collaborative practice at individual, group and organisational levels[6]. • Utility: Link to service integration, staff appraisal

Collaborative leadership and other interprofessional competencies• Lancet Commission on Education of Health Professionals [7]:

– generation of core competencies drawn from global knowledge but adapted to local contexts.

– include interprofessional team working competencies of interprofessional communication, role clarification, conflict resolution, 2nd order reflection and collaborative leadership.

Collaboration for social innovation• Social innovation: using new knowledge or combining existing knowledge

in new ways or applying it to new contexts. • Being collaborative enables professionals be innovative to adapt to the

ever complex and changing needs of service users within an interorganisational environment. Innovation is required to fill the grey spaces that lie between services[9]

Cost effectiveness of Collaboration• Further in the current economic climate, and cuts to public sector

resources, different organisations must collaborate more effectively to achieve financial savings.

• Professionals must collaborate to find innovative ways of working to be cost effective and deploy resources differently.

Remaining Challenge: despite focus groups remains top down approach.

Seeking COST partners

• Transferability to other clinical contexts

• Propose a COST Action that enriches international research cooperation between EU and international partners with the long-term improving innovative collaborative practice for health and welfare in Europe.

INNOVATIVE COLLABORTIVE PRACTICE FOR HEALTH AND WELFARE IN

EUROPE

Interprofessional and Interagency

training

Inter-professional collaborative

practice

UK Norway

Sweden ?

? ?

USA

Australia

Canada

Inter-organisational

practice

COST ObjectivesFor each Work package: • Development of early career researchers.

• Development of approaches to interdisciplinary knowledge exchange.

• Identification of research priorities in line with changing practice needs.

• Development of pedagogical frameworks that keep pace with changing practice needs

• Identification of strategies for achieving and evaluating impact– Seeking COST partners 27th Sept Phase 1– At least 5 practice partners– To lead in work packages in the different clinical, objective and national

contexts

TAKE HOME MESSSAGES• Need for valid learning experience that

has obvious utility for practitioners.– Interorganisational integration and

collaborative practice– Interprofessional competencies

including collaborative leadership– Collaboration for social innovation

including cost effectiveness.

• Pedagogical framework with transferability to other clinical contexts and national contexts.

• Seeking COST partners to develop a Community of Practice supporting research and education in collaborative working and education

Sarah Heanshean@bournemouth.ac.uk

Bournemouth University, United Kingdomhttps://www.facebook.com/groups/IN2THEORY/)

THANK YOU

QUESTIONS

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