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This paper seeks to report on a project to estimate the costs and benefits of implementing an Alcohol Treatment Requirement (ATR) in Stockport. The work is designed to support the development of a Payment by Results (PbR) approach to funding.

The paper summarises existing literature on the potential impacts associated with ATRs, broader alcohol treatment, relevant offender interventions and calculates the costs associated with negative outcomes.

A model of the potential cost savings to the Criminal Justice System and the National Health Service is set out which suggests that an ATR would need to achieve a 12 per cent reduction in re‐offending to break even.

The methodology and findings will be of interest to drug and alcohol service providers and commissioners who are considering PbR

The development of policy and delivery of interventions in the connected fields of alcohol and criminal justice is a complex area with implications for the single and joined‐up work of a range of agencies working across health, criminal justice and local government. This paper provides an overview of some of the connected health and criminal justice policy challenges relating to the commissioning and delivery of alcohol services for offenders.

In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a partnership between a probation service, a link worker charity and an independent mental healthcare provider. Short-term structured cognitive behavioural interventions were delivered by psychology graduates with relevant work experience and training. Training for the judiciary on the MHTR and the new service led to a significant increase in the use of MHTR orders. The paper aims to discuss these issues.

A total of 56 (of 76 MHTR offenders) completed treatment in the first 12 months. A single cohort pre-post follow-up design was used to evaluate change in the following domains: mental health and wellbeing; coping skills; social adjustment; and criminal justice outcomes. Mental health treatment interventions were delivered under supervision by two psychology graduates who had relevant work experience and who were trained in short term, structured, cognitive behavioural (CBT) interventions.

Clinically significant changes were obtained on measures of anxiety and depression, and on measures of social problem solving, emotional regulation and self-efficacy. Ratings of work and social adjustment and pre-post ratings of dynamic criminogenic risk factors also improved. This new initiative has addressed the moral argument for equality of access to mental health services for offenders given a community order.

While the current initiative represents one of a number of models designed to increase the collaboration between the criminal justice and the mental health systems, this is the first within the UK to deliver a therapeutic response at the point of sentencing for offenders with mental health problems. The significant increase in the provision of MHTR community orders in the first year of the project has been associated with a decrease in the number of psychiatric reports requested that are time consuming and do not lead to a rapid treatment.

This paper provides a methodological review of a piece of qualitative policy research formulating recommendations for the commissioning and delivery of offender alcohol interventions, for application both within the English region for which it was commissioned, and more widely. It begins by providing some background information on why and how the research was initiated. It then provides a detailed summary of the methods utilised. These were characterised by sustained engagement with diverse stakeholders and the iterative identification of both findings and recommendations. The authors will conclude with a discussion of the validity and possible application of the method adopted to policy research and service development in the field of dual diagnosis and complex needs, particularly in circumstances where impasse at the levels of policy and local strategy is matched with unmet need within a target population.

The aim of the paper is to assess the commissioning systems in place for the commissioning of local dual diagnosis interventions and to make recommendations for the establishment of innovative practice beacon sites. This involves focussing on five areas in the North West: Cumbria, Warrington, Manchester, Lancashire and Bolton.

A diagnostic process was undertaken to determine the characteristics of each area via the filling in of diagnostic tools by local commissioners; interviews; and a consultation event.

The review found that despite the lack of updated policy and guidance around the commissioning of dual diagnosis interventions, there are good examples of innovative practice in the North West. However, it must be noted that these interventions have not been the subject of formal evaluation and this is a recommendation of this review.

This is the first review of its kind into the commissioning of dual diagnosis in this region with the added legacy value of the establishment of the beacon sites, designed to develop and disseminate examples of innovative practice in commissioning dual diagnosis interventions.

The links between substance use and offending are well evidenced in the literature, and increasingly, substance misuse recovery is being seen as a central component of the process of rehabilitation from offending, with substance use identified as a key criminogenic risk factor. In recent years, research has demonstrated the commonalities between recovery and rehabilitation, and the possible merits of providing interventions to substance-involved offenders that address both problematic sets of behaviours. The purpose of this paper is to provide an overview of the links between substance use and offending, and the burgeoning literature around the parallel processes of recovery and rehabilitation.

This is provided as a rationale for a new treatment approach for substance-involved offenders, Breaking Free Online (BFO), which has recently been provided as part of the “Gateways” throughcare pathfinder in a number of prisons in North-West England. The BFO programme contains specific behaviour change techniques that are generic enough to be applied to change a wide range of behaviours, and so is able to support substance-involved offenders to address their substance use and offending simultaneously.

This dual and multi-target intervention approach has the potential to address multiple, associated areas of need simultaneously, streamlining services and providing more holistic support for individuals, such as substance-involved offenders, who may have multiple and complex needs.

Given the links between substance use and offending, it may be beneficial to provide multi-focussed interventions that address both these behaviours simultaneously, in addition to other areas of multiple and complex needs. Specifically, digital technologies may provide an opportunity to widen access to such multi-focussed interventions, through computer-assisted therapy delivery modalities. Additionally, using digital technologies to deliver such interventions can provide opportunities for joined-up care by making interventions available across both prison and community settings, following offenders on their journey through the criminal justice system.

Recommendations are provided to other intervention developers who may wish to further contribute to widening access to such dual- and multi-focus programmes for substance-involved offenders, based on the experiences developing and evidencing the BFO programme.

This study aims to explore service users’ experience of psychological therapy as part of a community sentence with a Mental Health Treatment Requirement (MHTR) in Birmingham Courts between January and December 2018.

All service users that had therapy in this period were telephoned a month after ending and offered a semi-structured telephone interview. Seven service users agreed to be recorded. This data was then transcribed and analysed using thematic analysis to gain a richer understanding of their lived experience.

Themes identified were: Is the MHTR for me? Opening up, enlightening connections and personal change. Service users initially questioned the relevance and burden of the order for them; the experience of therapy allowed them to trust and talk about things unsaid in the past; this helped them to review and reconsider their understanding of themselves and their life choices and what further support they might need.

Interviews were not completed by an independent interviewer. Experience of working with offender manager supervision additionally available throughout the sentence was not explored.

What is included in the MHTR information and support needs to be informed by the service user’s perspective, including this can improve engagement.

Therapy was seen as a “a cog in the machine” and wider social inequalities may need to be addressed within the sentence.

This report focusses on experience of a therapeutic intervention – a key part of a community sentence with an MHTR.

This study aims to investigate the views of commissioners, providers and criminal justice staff on how effective current health-care provision is at meeting the health needs of people on probation. Understanding perceptions of what constitutes effective provision, where barriers are encountered and where improvements could be made is an important step towards improving access to care for this hard-to-reach group.

The research was part of a wider study. This paper focusses on findings from case studies conducted via semi-structured telephone interviews with 24 stakeholders in a purposive sample from six geographical areas of England. Interviews were conducted by researchers from a variety of backgrounds and an individual with lived experience of the criminal justice system. Data were analysed using thematic analysis.

Participants provided examples of effective health-care provision, which largely involved multi-agency partnership working. It was apparent that there are many barriers to providing appropriate health-care provision to people on probation, which are underpinned by the complexity of this population’s health-care needs, the complexity of the health-care landscape and problematic commissioning processes.

Improvements are needed to provide appropriate and accessible health care that meets the needs of people on probation, thereby reducing health inequalities. These include shared targets, improved funding, clearer pathways into care and giving probation a voice in commissioning.

To the best of authors’ knowledge, this is the first study of commissioner, provider and criminal justice staffs’ views on the effectiveness of current health-care provision at meeting the health needs of people on probation.