CORDIS - EU research results

Reducing the burden of offender mental illness in Europe: improving interorganisational collaboration between the mental health and criminal justice systems

Final Report Summary - COLLABORATION (Reducing the burden of offender mental illness in Europe: improving interorganisational collaboration between the mental health and criminal justice systems)

Offender rehabilitation is a key strategy employed by Correctional Services internationally to support offenders’ effective reintegration into society. The offender’s mental health mediates the success with which they engage in these interventions and eventually desist from further criminal behaviour. Mental health (MHS) and Correctional service (CS) professionals therefore work together with the offenders to improve mental health and the chances of remaining crime free. There is little is known about what characterizes collaborative practice between the MHS and CS and how this can be improved. With this shortfall in mind, this Marie Curie study aimed to explore the characteristics and levels of integration and collaborative practices in a Norwegian context and use this knowledge to build a pedagogical framework to underpin training that prepares mental health services (MHS) and criminal justice service (CJS) professionals to deliver better collaborative practice.

The first objective of the study was to identify and describe factors underpinning collaborative practices between MHS and CJS in Norway. Semi structured interviews with key Norwegian MHS and CS leaders (n=12) explored perspectives on collaboration. Interviews showed collaborative practice between the MHS and CS to revolve largely around their common work goals of rehabilitating and reintegrating the offender back into society. Communications between the two systems are mediated by a range of tools, norms and rules that include multi agency meetings and coordination tools. Key contradictions occur within this boundary space between systems, that limits collaboration between the MHS and CS, and include conflicts related to different interpretations of patient confidentiality and threshold levels for transfer of prisoners from prison into specialist mental health facilities. Leaders are particularly exercised by the distribution of responsibility for the care of the offender across systems. Professionals and organisations are perceived as often failing to take responsibility for the offender as expected and this is attributed to resource limitations, logistical issues and poor attitudes towards the offender population. Based on these findings, it was suggested that the MHS and CS workforce would benefit from a great knowledgeability of the roles and responsibility domains of collaborative practice. It is also important that trainee professionals be encouraged also to consider the cost for other professionals taking up particular responsibility. They should be given the opportunity to explore the tensions and limitations of the other professional, as well as the position of the professional relative to the offender, when negotiating with other professionals and organisations as to who has responsibility to alleviate the suffering of this target population group.

The second aim of the study was to evaluate levels of interorganisational integration and collaborative practice between the mental health and criminal justice systems. This work package focused relational coordination between prison officers and mental health professionals when they work with mentally ill offenders in prison and the impact of internal and external structures upon this. A validated questionnaire was administered to prison officers (n=160) across 4 regions in Norway. Levels of relational coordination were particularly low between prison officers and psychologists and psychiatrists in specialized mental health services. By way of contrast, prison officers demonstrated the highest level of relational coordination with nurses, social workers and other prison officers working in the same prison. Relational coordination between mental health professionals and prison officers was higher in prisons perceived to support collaboration actively but on average, prisons generally are perceived as doing nothing actively either to promote or discourage a culture of collaboration with specialized services. Participation in formal meetings with mental health services also promoted relational coordination. Those prison officers in a leadership position were more likely to report better relational coordination than others and they participated in meetings with specialised services more frequently. A positive orientation to rehabilitation adds to relational coordination over and above participation in meetings and a positive organisational culture of collaboration. The study recommended to prison leaders that they schedule more formal meetings with specialist mental health services and that these meetings should include front line prison officers, as well as leaders in their membership. It was also stressed that an emphasis be put on the importance of the rehabilitation process in these meetings, as attitudes to rehabilitation were positively linked to levels of relational coordination reported. Leaders are encouraged to actively promote a culture of collaboration in their organisations.

A third aim of the project was to develop an evidence based, theoretically informed and practice relevant pedagogical framework aimed at preparing professionals and service leaders from the MHS and CJS for collaborative practice. The study explored the collaborative competencies required in the workforce to address current and future population health and welfare needs. Whilst collaborative competence is important in professionals, it was concluded that this should be viewed as connected to other competency frameworks, such as social innovation and integration competence frameworks in which collaboration is a key component. The study supported an integrated approach to competency development in which both the outcomes and processes of learning are both articulated. Further, competence cannot be viewed at an individual level alone and group and the organizational competence need all be considered if training is to have an impact on practice.

The study identified the Change Laboratory Model (CLM) of workplace transformation as an effective means of supporting interagency collaborative practice, judged to be potentially more effective at promoting collaborative practice than current integration tools. It provides a way to optimise the effectiveness of mental healthcare provision to offenders through a model that fosters innovation and collaborative processes. However, the change laboratory, highly successful internationally and in other clinical contexts, is a new idea in prison development, none as yet being applied to the challenges facing the MHS and CS.

A fourth aim of the project was the development of a community of practice to support and develop research, education and practice at the interface of the MHS/CJS and in related fields. A consortium of 6 University partners in the UK, Denmark, Finland and Norway and 2 Industry partners in Norway and the UK with a common interest in collaboration and offender rehabilitation was formed as part of this project. Together this consortium submitted a proposal to the MCA –RISE stream of funding stream (May 2016). The aim of the submitted study is to develop and validate the change laboratory model ready for implementation in practice. This validated change laboratory model, offers the ERA a clear strategy with which to promote integrated care for mentally ill offenders.
For further information on the project please contact:

Dr Sarah Hean
Marie Curie-Sklodowska Fellow
University of Stavanger
+47 954 933 13
+47 518 341 37