The role of probation in mental health support – new recommendations in Europe

The prevalence of mental health conditions among individuals in contact with criminal justice systems is disproportionately high, when compared to the general population. Reductions in community mental health services, coupled with limited capacities within prison and probation services make the provision of mental health support to individuals under supervision a major challenge. In this blog Dr. Charlie Brooker discusses recently published research and recommendations in Europe.

Over the past decade there is a growing consensus that mental health support to probation should improve. In Europe, this call has been heeded by the Council for Penological Co-operation (PC-CP) at the Council of Europe (CoE). PC-CP have been working on a White Paper that seeks to improve the mental health support required by not just probation, but prisons as well. The paper has been informed by a Europe-wide survey of probation services which achieved an overall response rate of 66% (See Appendix II in the White Paper).

The key findings from the survey were as follows:

• Only half of European countries had a national policy for the care and treatment of those serving a probation order who experienced a mental illness;
• Just 36% of probation staff in European countries received mental health awareness training;
• A very small number of probation services (4/39 countries) collected data on the prevalence of mental health problems in probation;
• One-third (33%) of countries were able to mandate mental health treatment through the courts (as an alternative to prison);
• Only a handful of countries (13%) collected national probation suicide data.

A number of recommendations were made within the White Paper as a consequence. The main recommendations concerning probation services are laid out below and are directed at each country/jurisdiction in Europe:

• Standards for managing persons with mental health disorders should be agreed in order to evaluate all such services in a given jurisdiction.
• The staff’s role in the recognition and assessment of mental health disorders and in providing interventions and/or facilitating access to mental health care should be defined thereby allowing the design of appropriate training.
• Methods should be developed for collecting data on mental health disorders in line with the relevant data protection rules in Europe. The use of structured assessment tools would facilitate this process.
• Monitoring anonymised data on suicide should be collected routinely by the relevant services over a period of time (3-5 years) so that trends might be examined, and possible preventive actions examined.
• Sufficient research funding should be made available to evaluate the implementation of mental health policies and practices and their impact on health and re-offending outcomes.
• Interventions should be evidence-based, carried out by multidisciplinary teams and have a gender perspective.
• Service users should be involved in the development of these interventions, e.g., trauma-informed care in women’s prisons.
• A standards-based model for interventions with persons with mental health disorders under probation should be developed.
• Continuity of care for mental health disorders should be maintained after release from prison and transfer to probation and after the probation period has ended.
• There should be a dedicated mental health research with experts working in probation settings.
• Every probation service should be aware and be updated on the pathways and access criteria to mental health and other related services (such as drug and alcohol treatment services).

The survey and subsequent report raise a series of important questions. The survey also attempted to identify examples of Good Practice, and it was clear that such examples were thin on the ground.

Perhaps the most basic question of all is ‘what is the role of the probation officer in relation to mental health’?

Should probation staff be able to detect a mental health disorder? If so, how do they do this, when so little preparatory training focuses on mental health (and substance misuse). A recent survey of probation staff across Europe, funded by the Confederation of European Probation (CEP), shows that although their attitudes toward people with mental illness are helpful and non-stigmatising, the knowledge of probation staff about mental illness is no more than that of the general population (Brooker and Tocque, 2023 – in preparation). It thus follows that the initial detection of a mental health illness in a probation service is hard to achieve.  Secondly, referring people on probation onto the most appropriate mental health service becomes a major challenge. This is not just due to probation staff’s lack of knowledge but also the limited responsiveness of mental health services, where referral often entails a wait of over 6 months on a waiting list.

There are solutions to all of these issues but do all European countries have access to them? One response to the lack of knowledge might be to introduce the use of mental health outcome measures for the purpose of assessment, coupled with relevant training on such measures. If assessments were made using the CORE-10, for example, then referrals could be made to appropriate services using simple benchmarks scores. Thus, a score of ‘6-9’ on the CORE-10 would indicate a referral to primary health care for psychological counselling and a score of ‘10’ plus might indicate a more serious mental illness to be assessed by secondary services. A study by Wasserman et al employed exactly this approach in the assessment of suicidal behaviour in justice involved young people. Certainly, .

A main challenge is that a significant number of surveyed countries (50%) lack a national strategy for probation and mental illness that will be needed in order to clearly outline and implement standards and address all the recommendations of the Council of Europe’s White Paper. Such a strategy should, at the least, address:

• probation staff’s lack of knowledge (this might mean large-scale training initiatives are required);
• the role of the probation officer when a mentally ill person presents themselves to a service, and;
• the standards of mental health care that should be expected.

The time has come to pool the significant existing knowledge from practice, lived experience and research on mental health and to offer this as a resource to the governments in Europe that need to develop a national strategy for mental illness and probation. Establishing a central implementation group that draws on all areas of relevant expertise could help  governments develop strategy and policy on a strong evidence-base and help translate knowledge into practice.

Moving from research and reports to concrete and practical action

There are numerous reports about the difficulties and challenges of providing mental health service support to probation. Let’s have no more reports; instead let’s harness the White Paper’s push for improvements and current momentum around this topic to offer governments practical support in providing needed answers and thereby improving the lives of those with a mental illness on probation across Europe. In order to do this, an Implementation Group with the relevant expertise is sorely needed.