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The purpose of this paper is to improve the health and criminal justice outcomes for people who come into contact with the criminal justice system. People with learning disabilities (LD) are particularly vulnerable to health and social inequalities within the criminal justice system.

Using examples from practice, this paper discusses some of the challenges and achievements experienced by a LD nurse employed within a liaison and diversion service within the North-West of England.

Whilst the specific functions of liaison and diversion practitioners are detailed by National Health Service (NHS) England (2014), complexities in communication, multi-disciplinary working and role recognition affect the embedment of the role in practice.

The implications for practice are identified and recommendations for further research made. These seek to evaluate the impact of liaison and diversion services from the perspectives of LD nurses within liaison and diversion services, people with LD, their families and the wider multi-disciplinary team.

NHS England (2015) are in the process of evaluating of liaison and diversion services. This paper adds to the evaluation by discussing the experiences of a LD nurse within a liaison and diversion service through the inclusion of activity data and illustrative examples.

At present, there are significant limitations to the criminal justice system’s (CJS) ability to respond appropriately to detainees or defendant with learning disabilities (LD). The development of Liaison and Diversion Services has provided the opportunity to more easily identify people with LD in the CJS through the use of screening assessments. Therefore, the purpose of this paper is to consider why there is a need for screening assessments and review the literature on existing measures, in order to consider the next steps to develop a more effective pathway from the CJS to LD services.

This paper takes the form of a literature review.

The review found that there is a significant body of research defending the need for LD screening in the CJS across the UK. The aim of a screening process would be to identify individuals who possibly have LD and ensure that the correct measures are in place to assess and manage these individuals, including appropriate diversion to specialist LD services. The learning disability screening questionnaire (LDSQ) is an instrument that could be utilised in these instances and could be carried out by Liaison and Diversion Services.

Neither of the tools reviewed in this paper have been vigorously field tested within forensic settings in the UK. It is recommended that there should be trials of the LDSQ as a screening tool within Liaison and Diversion Services with comparison against outcomes of full diagnostic assessments for LD.

Screening for LD is being discussed across the UK as part of Liaison and Diversion Services. This paper highlights the need for a reliable and valid screening tool and provides support for the use of the LDSQ.

The purpose of this study was to describe programs that aim at programs to divert people with a mental condition from the criminal justice system to mental health services are being initiated, but reporting is limited and fragmented. This study described programs that aim at diverting persons with mental health conditions out of criminal justice systems to community mental health services, with the intention to inform research and practice.

A scoping review was used to map and synthesise diversion programs. Ten online data bases were searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used to direct the selection of sources. Research and evaluation publications and grey literature published from 2010 to 2021 in English language were included.

Eight distinct diversion programs were identified across 24 countries or territories covering five phases of the criminal justice process. Diversion programs included crisis intervention teams, the electronic linkage system, mobile crisis units, the criminal justice liaison program, problem-solving courts, the abstinence-based program, the community equivalence program and the forensic assertive community treatment program. Although distinct programs have the potential to form a system of diversion across the continuum of the criminal justice process, only two territories moved in that direction. Diversion programs reported overwhelmingly originated from high-income countries.

Stigma that labels people with mental health conditions as violent and dangerous need to be addressed. It is important to place diversion systems on national policy agendas and advocate for evidence-based interventions.

The study provides a blueprint on diversion systems to set a research agenda and develop a road map, tailored towards local contexts.

The purpose of this paper is to examine the role of liaison and diversion services working in the lower courts (also known as Magistrates’ courts) with regard to autism spectrum disorders (ASDs) and their assessment, in particular, the role of pre-sentence and psychiatric reports and interviews.

Current practice is described in the lower courts in the context of current legislation and procedures.

When writing reports, there is a need for expertise to offer an opinion on future risk, disposal and what needs to be in place to support people with ASDs. No assumptions should be made when reporting on the basis of an ASD diagnosis alone and each case must be assessed on its individual merits while ensuring that individual human rights are protected.

There is currently a sparse literature examining ASD in court settings. This paper seeks to clarify the current practice.

People with learning disabilities (LD) often lack necessary support in navigating and coping within the Criminal Justice System (CJS). The purpose of this paper is to explore their experiences, from their own perspective, and identify the supports which need to be implemented.

Focus groups were held with nine patients in a forensic LD service, discussing their experiences and support needs within the CJS. Template analysis was undertaken on the transcripts.

Four themes were identified: negative feelings, professional attitudes, suitability of the CJS, and supports needed.

This research demonstrates the valuable opinions to be obtained from offenders with LD on their experiences and needs. Implications for the CJS include a need for further awareness, training, and expertise to work effectively with people with LD. Participant perspectives also highlight the importance of consistent liaison and diversion schemes, and indicate that CJS services may have something to learn from healthcare settings.

Previous knowledge of offenders with LD overlooked the perspective of the service user. This research has given this group a voice, and has benefited from their insight. This is a timely piece of research in the current landscape of the CJS, and so these findings may be of practical value to the implementation of supports, particularly the liaison and diversion schemes.

This article considers The Bradley Report and specifically its implications for dual diagnosis. This includes implications for dual diagnosis services, drug courts and mental health courts, role of liaison and diversion, and continuity of care on release.

The purpose of this paper is to study the demographic, clinical characteristics and outcomes for those prisoners referred to secondary mental healthcare in a regional Irish prison and the proportion of individuals diverted subsequently from prison to psychiatric settings.

The authors conducted a retrospective review of 130 successive psychiatric assessment case records at a regional mixed gender prison serving six southern Irish counties. The authors analysed demographics, clinical characteristics and outcomes. Where diversion out of prison was undertaken, Dangerousness, Understanding, Recovery and Urgency Manual (DUNDRUM) scores were retrospectively completed to assess security need.

In total, 8.6 per cent of all committals from liberty were referred by a general practitioner and 8.1 per cent subsequently assessed by the visiting psychiatrist. Predominantly, these were young males charged with a violent offence. In all, 42.2 per cent of those assessed by secondary care were diagnosed with a substance misuse disorder and 21.1 per cent with a personality disorder. In total, 20.3 per cent suffered from a psychotic disorder and 10.6 per cent with an affective disorder. Of those seen by psychiatric services, 51.2 per cent required psychotropic medication, 29.2 per cent required psychological input and 59.3 per cent required addiction counselling. In all, 10.6 per cent of those assessed were diverted from prison, the majority to approved centres. Mean DUNDRUM-1 scores suggested that those referred to high and medium secure hospitals were appropriately placed, whereas those diverted to open wards would have benefited from a low secure/intensive care setting.

The multifaceted need set of those referred strengthens the argument for the provision of multidisciplinary mental healthcare into prisons. The analysis of security needs for those diverted from prisons supports the need for Intensive Care Regional Units in Ireland.

Research suggests that individuals with autistic spectrum disorder (ASD) are inconsistently supported throughout the criminal justice system (CJS) in the UK. Bradley (2009) recommended the introduction of criminal justice liaison and diversion (L&D) teams to bridge the gap between the CJS and mental health services and provide a more consistent and improved quality of support for individuals with vulnerabilities, including those with autism. This study aims to explore the experiences of staff working in L&D teams who encounter individuals with ASD.

Interviews were conducted with ten L&D team members. Interpretative phenomenological analysis was used to gain insight into their lived experiences of working with autism in the CJS.

Interpretation of individual transcripts resulted in three super-ordinate themes: “feeling helpless and helpful in the system”, “transition to knowing” and “impact on self”. Each theme encapsulated a number of sub-themes depicting the limitations of services, difficult environments, making a difference, lack of understanding, developing understanding and the impact of these experiences on staff’s confidence, attitudes and well-being.

Criminal justice services are limited for people with autism. There is a lack of autism awareness by staff. Lack of awareness impacts staff attitudes and confidence. Training in autism should be provided to criminal justice staff.

This research highlights the limitations of services available for individuals with autism and the widespread lack of autism awareness. These concerns directly impacted participants’ confidence, attitudes and well-being. Recommendations are proposed to guide future practice and research including increasing availability of access to ASD services, enforcing mandatory autism-specific training for staff and routinely collecting service-user feedback.

Although precise numbers are unknown, it is generally acknowledged that between 5‐10% of the offending population are people with learning disabilities. While there are few provisions that explicitly target defendants with learning disabilities there is a general recognition in law that defendants must be able to understand and participate effectively in the criminal proceedings of which they are a part. The implications of the principle of effective participation are that criminal prosecution may be deemed inappropriate for certain defendants with learning disabilities, in which case they may be diverted away from criminal justice and into health care. There is scope for a variety of measures to be put into place to support defendants with learning disabilities to maximise their chances of participating effectively. However, in terms of statutory provision, there is a lack of parity between vulnerable witnesses and vulnerable defendants. Further, the absence of effective screening procedures to identify defendants' learning disabilities means that their support needs often go unrecognised and unmet.

Increasing research evidence highlights the importance of recognising a person's learning disability early in their journey through the Criminal Justice System (CJS) and highlights the need for liaison and diversion schemes. This practice paper seeks to raise awareness of the importance of mental capacity and its alignment (or lack there of) with the issue of fitness to plead.

The Law Commission's recent consultation has highlighted the disparity of the Pritchard Test and the Mental Capacity Act 2005, and has considered several provisional proposals for consideration. As a learning disability nurse within a Youth Offending Service, the author encounters young people on court Orders who struggle to understand the criminal justice process. To highlight the significance of this, and its relationship to practice, the paper proposes to discuss a young person's case.

Early recognition of a person's needs and mental capacity are crucial to ensure the right pathway is taken through the criminal justice system. Whether this be supporting the person to undertake their Order and delivery of an appropriate and understandable intervention or diversion away from the criminal justice system into services. Information sharing and working together are key factors to success.

This paper seeks to highlight the difficulties and dilemmas facing staff working within the criminal justice system in relation to the identification and support needs of people with learning difficulties. Learning disability nurses and those professionals working within learning disability services have a significant part to play in this area of work and can help to ensure that people with learning disabilities do not face double jeopardy and injustice.