Psychiatric liaison service

Sir: We read with interest the description by Nadkarni et al (2000) of their experience of running a psychiatric liaison service in a probation hostel. They note that “there is only one bail hostel (in Birmingham) within the criminal justice system specifically for mentally disordered offenders”. They also note that they “are not aware of any established services providing psychiatric input to probation hostels”.

In fact, there are now three approved bail and probation hostels specifically for mentally disordered offenders — in Birmingham, London and Manchester. The first of these, Elliott House in Birmingham, was established in 1993 through partnership between the West Midlands Probation Service and the Regional Forensic Psychiatric Service at Reaside Clinic. Since that time, multi-disciplinary psychiatric input has been provided to the hostel, including twice weekly out-patient reviews by psychiatrists, a community psychiatric nurse clinic and occupational therapy group and individual work. In addition, there is a weekly inter-agency multi-disciplinary review meeting at which all residents are discussed by mental health and probation staff. The joint aims of the probation and mental health staff providing input into Elliott House are to prevent unnecessary remands of mentally disordered offenders in custody, provide assessment and appropriate treatment where necessary, facilitate connection with local mental health and social services, attempt to reduce the risk of future reoffending and assist courts in making appropriate sentences. Over the years there has been an increasing emphasis on providing a stable environment for a number of mentally disordered offenders made subject to a probation order, often with a condition of residence and treatment.

Most of the residents at Elliott House suffer from a severe mental illness (Geelan et al, 1998/99). It is common for individuals to be diverted from custody because of the availability of a specialised facility. Often individuals have been declined accommodation by other probation hostels precisely because of their mental illness. In addition, the presence of a mental illness is associated with a greater likelihood of being remanded in custody (Birmingham, 1999). Therefore it is not safe to assume, as Nadkarni et al (2000) suggest, that the high rate of mental disorder in the prison population predicts a high rate in the probation population. In fact, only 12 referrals were received by the service described, of which four were diagnosed with a primary mental illness. Only one was diagnosed as suffering from a severe mental illness. The other three may have been appropriately managed by a general practitioner. The assertion that resource implications were ‘minimal’ may need to be re-evaluated in light of such a low yield of mental illness.

Nonetheless, it is encouraging to see others advocating increased partnership between mental health services and the probation service. The development of such links requires careful thought and planning in order to target those at high risk of severe mental illness and to overcome the pitfalls to such inter-agency working that have been previously noted by the Probation Service (HM Inspectorate of Probation, 1993).