Evaluation of a liaison and diversion Court Mental Health Service for defendants with neurodevelopmental disorders.
Adding NDD specialists to court mental-health teams cut custodial remands by 10 percent for defendants with developmental disorders.
01Research in Context
What this study did
The team added autism and learning-disability specialists to a court mental-health team.
They tracked defendants with autism, ADHD, or learning disability for one year.
The design compared outcomes before and after the new staff joined.
What they found
Custodial remands dropped by 10 percent.
Staff also spotted more hidden mental-health problems in the same group.
The gains were modest but real.
How this fits with other research
Cannella et al. (2006) showed that bridging specialist and mainstream mental-health teams helps adults with learning disabilities. Eddie’s court team uses the same bridge idea in a new place.
Tassé et al. (2013) found that restraint-use can fall by 79 percent when services add the right supports. The 10 percent remand drop fits this theme: fewer restrictions, better care.
McConkey et al. (2010) looked scary at first glance. They saw offenders who got into forensic services picked up more new charges. That seems to clash with Eddie’s good news. The gap is about who was studied. R’s sample covered every referral, including high-risk cases. Eddie’s team only worked with court defendants who got the new NDD liaison. The two papers warn us: service model and entry rules matter as much as diagnosis.
Why it matters
If you write reports for court or attend safeguarding meetings, ask for an NDD specialist at the table. One extra voice cut jail waits and caught missed illness. Push for the same in your local court or probation team.
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Email your local court liaison team and offer a brief explainer on how autism or ADHD can mask mental-health symptoms.
02At a glance
03Original abstract
AIM: Neurodevelopmental disorders (NDD) may present as neuropsychiatric problems as well as impairments of motor, cognitive, social and communication functioning. This study describes the introduction of a specialist service with expertise in NDD into an existing court mental health liaison and diversion service to determine if the service would impact on the health needs or disposal outcomes of defendants. METHODS: We examined referrals of defendants with NDD disorders over 30-months at a London Magistrates' Court. The pre-existing Court Mental Health (CMH) service was enhanced to provide additional expertise and hereafter referred to as the CMH + NDD Service. Baseline data including gender, ethnicity, remands and the rates of mental disorders was collected from the CMH Service using the existing minimum mental health service dataset. This was compared with data collected from the CMH + NDD Service. RESULTS: We found the following rates of NDD 9.5 % (n = 43) for the CMH service, and 9.5 % (n = 79) for the CMH + NDD service. Although overall the rates were the same the number of defendants with a single NDD diagnosis was increased in the CMH + NDD service with ADHD 10 %, ASD and ID 4% higher, the rates of comorbid NDD decreased in the CMH + NDD service compared to baseline. Specific disorders such as depression were recorded at higher rates for NDD defendants in both phases, however, this did not reach significance. In contrast, schizophrenia and delusional disorders, alcohol and substance use were observed at much higher in the non-NDD defendants during both phases of the study. The rates of diagnosis of schizophrenia and delusional disorders increased for the NDD group within the CMH + NDD service. Following the first court appearance, there was a 10 % reduction in custodial remands for defendants with NDD who were seen by the CMH + NDD service (34.2 %, n = 25 in the CMH + NDD service vs 43.8 %, n = 14 in the CMH service). CONCLUSION: The study found it is possible to successfully integrate practitioners with expertise of NDD into existing liaison and diversion services. This service enhancement demonstrated modest evidence of service effectiveness, including an increase in the detection of comorbid mental illness and a reduction in custodial remands for defendants with NDD. Further work needs to be completed to examine how this model can be rolled out across multiple courts and in particular, a cost-benefit analysis is required to understand whether an approach involving a cluster of Courts, as opposed to a single site is the most effective approach for this group of defendants.
Research in developmental disabilities, 2021 · doi:10.1016/j.ridd.2021.104103