INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024

 
INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024
INTEGRATED
HEALTH AND
JUSTICE
STRATEGY
2020-2024
INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024
2                                                          3

    CONTENTS
    Health and justice in Greater Manchester           6

    Executive summary                                  8
    Our priorities                                    10

    1. Why focus on health and justice?               12
    Our opportunity in Greater Manchester             12
    Defining the case for change                      13
     isk factors associated with contact with the
    R
    criminal justice system                           17
    National and international policy and evidence   19
    Greater Manchester evidence and insight           24
     enefits of violence reduction in human and
    B
    system costs                                      26

    2.	Whole-system leadership for health
        and justice                                   27
    A whole-system approach to Family Justice         28

    3. O
        verview of specialist health and justice
       provision in Greater Manchester                30

    4.	Rationale for strategic focus
        on particular groups                          33

    5.	Health and justice strategic framework
        and priorities                                36
    Existing health and justice work programmes       36
    New strategic priorities                          37

    6. Delivery and resource planning                 38
    Delivery                                          38
    Resource planning                                 38
INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024
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    In Greater Manchester, justice devolution has provided us with a unique opportunity to address                          The development of this integrated health and justice strategy is a first for Greater Manchester
    the typically very poor physical and mental health of people, both victims and offenders,                               and potentially also the first placed-based strategy in England developed specifically to
    who come through our criminal justice system. This includes a focus on earlier identification                           address the health and social inequalities experienced by vulnerable children, young people
    of health and support needs, more responsive interventions, and providing health and care                               and adults seen across our criminal justice systems. Like justice devolution, health and social
    services, which are equal to those available to people living in the wider community.                                   care devolution in Greater Manchester creates new opportunities to address the ongoing social
    This strategy describes in detail the broad range of risk   The values and priorities represented in this strategy      challenge of health inequalities. This strategy is a significant part of that effort, focusing on
    factors and the complexity of individual, family and        closely reflect our public service reform principles        perhaps the most vulnerable members of our communities.
    social circumstances that contribute to victimhood          for the city-region and our model of public service         The health inequalities experienced by children and           One of these risk factors is mental health. The strong
    and offending behaviour. These complexities only            delivery – preventative, proactive and person-centred.      adults seen in the criminal justice system are broad          association of poor mental wellbeing, low to moderate
    serve to emphasise the value of closer integration          We believe that this approach will support the most         and deep, and in some cases, contact with the criminal        mental health issues and clinical mental health
    and collaboration between our public services. From         vulnerable members of our community, including              justice system will be the first time that they have had      conditions, with health and justice has been widely
    services providing health and social care, education        victims and offenders, to recover from their experiences,   their health needs assessed or have had any consistent        referenced by colleagues, partners and the public
    and accommodation to the police, Crown Prosecution          build their physical and emotional resilience, and          contact with a health or social care professional. This       during the development of and consultation for the
    Service, courts, prisons and probation services – each      eventually enable them to succeed and thrive.               is why the strategy places high value on the early            strategy. For the purposes of this health and justice
    has collective responsibility to address the issues                                                                     identification of health care and support needs, to           strategy, a broad definition of ‘mental health’ has been
                                                                Whilst individuals and families benefit most directly
    outlined in this strategy. Justice devolution will help                                                                 ensure that they are recognised on first contact with         adopted, which crucially recognises the psychological
                                                                from this approach, there is also a ‘community
    to consolidate and strengthen the way services work                                                                     the criminal justice system and that effective action is      and emotional impact of adverse childhood
                                                                dividend’ for society as a whole, including safer
    together around the needs of people seen in the                                                                         taken to prevent issues from getting worse.                   experiences on lifetime mental health and wellbeing.
                                                                communities, less children in care, fewer people at risk
    criminal justice system in Greater Manchester.                                                                                                                                        This is why the strategy recommends a trauma-based
                                                                of homelessness, lower rates of violent crime, more         The strategy also adds to our appreciation that being
                                                                vulnerable children and young people participating in                                                                     model of intervention and support, which is also more
                                                                                                                            either a victim of serious violent crime, or an offender,
                                                                                                                                                                                          likely to prevent youth offending and effectively support
    "We believe this approach will                              education, and better health for all.                       is often an indicator of past or current vulnerability. The
                                                                                                                                                                                          victims of sexual violence and abuse. This signifies an
                                                                                                                            priority groups that are a focus for our early strategic
    support the most vulnerable                                                                                             work reflect this understanding – children and young
                                                                                                                                                                                          important change in the way public services will work
    people to recover from their                                                                                            people; vulnerable and marginalised women; people
                                                                                                                                                                                          with victims and offenders in Greater Manchester.
                                                                                                                            with learning disabilities, autism or communication
    experiences, build their physical                                                                                       disorders; and people who are rough-sleeping. However,
    and emotional resilience, and                               Beverley Hughes
                                                                Deputy Mayor for Policing, Crime, Criminal Justice
                                                                                                                            the choice of these priority groups has been made
    eventually enable to them thrive."                          and Fire
                                                                                                                            with an awareness that the risk factors that lead to
                                                                                                                            victimhood and offending are broad, complex and               Lord Peter Smith
                                                                                                                            overlap with each other and this is highlighted in            Chair Greater Manchester Health and Social Care
                                                                                                                            the strategy.                                                 Partnership Board
INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024
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    Health and justice in Greater Manchester
    These Greater Manchester specific research and insight exercises tell us that:

                                                                                                                                                                             Physical Health                                        55%

                                                                                                                                                                             Mental Health                                  48%

                                              23–51%                                                   76–83%
                                                                                                                                                                             Self-harm or suicide risk                41%

                                             28–25%                                                        25%
                                                                                                                    More than one in four victims of crime will
                                                                                                                                                                        0%          10%           20%          30%      40%         50%   60%
                                                                                                                    develop symptoms of post-traumatic stress
                                                                                                                    disorder as a result. People who have experienced
       One third of young people in the Greater                   Between 76-83% of women who have been             crime can often be surprised by how much             Screening of individuals in police custody shows
       Manchester youth justice system have                       assessed by a Greater Manchester Women’s          distress they experience. Experiencing crime can     that members of the public who are arrested
       substance misuse issues. 28-35% of young                   Centre have mental health issues, often linked    lead to the development of long-term problems        on suspicion of committing a crime are far
       people on the youth justice caseload have                  to their experiences of domestic abuse. 25% of    such as depression or anxiety, which in turn can     more likely to have a health problem. 55% of
       special educational needs, whilst 23-51%                   women who have accessed Greater Manchester        manifest as physical problems. Many victims of       individuals in police custody had a physical
       have recognised speech, language and                       Women’s Alliance Partnership services have a      crime experienced harm – often severe – as a         health issue, while 48% had an underlying
       communication needs.                                       physical health issue. 55% of women who use       direct result of the crime that was committed.       mental health issue. 41% of these individuals
                                                                  these centres have a child under the age of 18.   The experience of each victim will vary.             were at risk of suicide or deliberate self-harm.

                                                                                                  33%
                                                                                                                                                                         Cardiovascular Disease                                   34%

                                                                                                                                                            16%          Muskuloskeletal Problems               24%
                                                                                                                                                            MEN

                                                                                                                                                                         Asthma/respiratory conditions   20%
                                                                           16%
                            50%                                                                                                 44%                                      Epilepsy 5%

                                                                                                                                                                         Diabetes 5%

                                                                                                                                                            34%
                                                                                                                                                           WOMEN
                                                                                                                                                                        0%                10%              20%                30%         40%

                                                                  In HM Prison Manchester, 16% of prisoners                                                              Mental and physical health needs are highly
                                                                  were reported as being homeless during the        Mental and physical health problems are often        common in prisons. High levels of severe and
                                                                  year before imprisonment. A review of the         enduring and can be a cause of re-offending.         enduring mental health problems are matched
       Over 50% of the women who go to the Greater                Cheshire and Greater Manchester Community         16% of men and 24% of women who are on               by very high instances of physical illness,
       Manchester Sexual Assault and Referral Centre              Rehabilitation Company (CRC) caseload in 2018     probation self-identify as having a mental health    including 34% with cardiovascular disease (like
       (SARC) have a history of domestic abuse. Repeat            found that 33.1% of people had an issue with      problem. Suicide is the most common cause of         angina), 24% with musculoskeletal problems
       attenders at the SARC are typically female and             accommodation. This proportion was higher for     death among offenders. It is the cause of 44%        (like arthritis), and 20% with respiratory problems
       have a background mental health problem, a                 those who had an identified mental health or      of deaths for those open to the National             (like asthma). Many of these conditions go
       learning disability, or are a child.                       suicide/self-harm need.                           Probation Service.                                   unidentified and untreated.
INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024
8                                                                                                                              Integrated Health and Justice Strategy                       9

    Executive summary                                                                                                          However, there is broad acknowledgement that
                                                                                                                               the application of trauma-led practice is especially
    The purpose of this first Integrated Health and Justice Strategy for Greater Manchester                                    important in supporting this population of children,
    is to inform and enhance the way in which we understand and address the health, social                                     young people and adults, as many victims and
    care and criminal justice factors that can lead to life-long poor physical and emotional                                   offenders have a history of challenging life experiences
                                                                                                                               including abuse, which can in some cases lead to poor,
    health, and reduced life-expectancy, for people who are seen in the criminal justice system,
                                                                                                                               ongoing psychological and emotional health.
    as offenders or victims.
                                                                                                                               Building on our assets
    The devolution opportunity                                   Targeting our efforts
                                                                                                                               It is important to recognise that there are already a
    The benefits of focusing on addressing the social and        The engagement work that has fed into the                     number of well-established public and VCSE sector
    health inequalities experienced by this group of often       development of the strategy has pointed towards an            services across Greater Manchester whose purpose it
    vulnerable people will be seen at an individual level – in   initial strategic focus on four particularly vulnerable       is to improve the health and wellbeing of people seen in
    the form of improved physical and mental resilience,         groups;                                                       the criminal justice system, such as the Sexual Assault
    healthy relationships, reintegration in community                                                                          and Referral Centre (SARC), the Women’s Support
                                                                 • c
                                                                    hildren and young people
    life and the avoidance of first or repeat offending or                                                                     Alliance services and wider victim support services.
    victimisation – and at a community level, reduced            • v ulnerable and marginalised female victims of
                                                                   domestic abuse or sexual violence                           Whilst Greater Manchester is leading the way nationally
    health inequalities, lower crime rates, and safer and                                                                      with new, jointly commissioned service models, i.e.
    more cohesive communities.                                   • p
                                                                    eople with a learning disability, autism or
                                                                                                                               Integrated Healthcare in Custody and wider Liaison
                                                                   communication disorder
    Increasing national focus on effective healthcare for                                                                      and Diversion, there is scope for greater alignment and
    the victims of abuse and sexual violence, and offenders      • and people who are rough sleeping.                          collaboration across Greater Manchester around the
    in the prison estate, provides a backdrop for the                                                                          needs of this population group, not only across health
                                                                 Doing things differently                                      and justice provision, but across mainstream services
    development of this Greater Manchester city-region
    approach, alongside local needs assessments and              The strategy introduces two key concepts that offer           and professional domains.
    strategic review work.                                       the potential to transform the way that public services       This strategy and the delivery plan in particular reflects
                                                                 across all sectors in Greater Manchester identify,            this combination of existing development work and
    Greater Manchester’s long-standing ambition as a
                                                                 engage with and support some of the most vulnerable           new health and justice ambitions and priorities, with
    city-region has been to take greater control of its own
                                                                 people living in our communities.                             a view to bringing greater strategic coherence to both
    destiny. Our devolution deals, including health and
    social care and now justice devolution, are enablers         The first is the idea of adopting a public health             programmes of work, and eventually bringing them
    to achieving that. Integrating and reforming public          informed approach to health and justice strategy,             together as one. As well as seeing the emergence of a
    services is the key to breaking down service silos           policy and delivery. This is intended to stimulate a          more consistent, whole system approach to health and
    and moving towards a preventative approach which             more preventative model of identification and support         justice in Greater Manchester within the first 5 years of
    serves residents and communities better. This strategy       for victims and offenders, with an explicit aim of            the strategy, a further success factor will be tangible
    emphasises and embraces this vision of public                intervening earlier to reduce the likelihood of offending     evidence of health, social care, Voluntary, Community
    service reform.                                              or being victimised. In practice, this means using data       and Social Enterprise (VCSE) sector and criminal
                                                                 and intelligence to understand this typically vulnerable      justice services providing more trauma-informed,
                                                                 population of children, young people and adults and           collaborative care and support to this population group,
                                                                 the complex often interdependent factors that have led        with a stronger emphasis on prevention and earlier
                                                                 them to be in contact with the criminal justice system.       intervention. In due course, this should manifest in
                                                                 The second concept introduced through the strategy            better health and wellbeing and reduced offending
                                                                 is the development of trauma-informed approaches              and reoffending.
                                                                 that involve moving to a position where public                This first Integrated Health and Justice Strategy
                                                                 services in Greater Manchester regularly and                  for Greater Manchester therefore provides both a
                                                                 consistently use more therapeutic practices, which            case for change and a platform for improvement
                                                                 recognise the impact of previous trauma or difficult          and development in health and justice intelligence,
                                                                 life experiences. What works to support and address           commissioning and service provision through
                                                                 the health, care and wider social needs of people in          its delivery plan.
                                                                 contact with the criminal justice system is currently an
                                                                 evolving field, and the delivery programmes identified
                                                                 in the strategy will no doubt add to this relatively narrow
                                                                 evidence base.
INTEGRATED HEALTH AND JUSTICE STRATEGY 2020-2024
10                                                                                                            Integrated Health and Justice Strategy   11

     Our priorities
     Prevention

      1.                                  2.                               3.   
      I ntroduce a public health         Work with schools, youth          Building on the work with
       approach to violence reduction     justice and children and          the Women’s Alliance
       across public service              young people’s services to        Partnership, extend provision
       provision, with a focus on         develop upstream, targeted        to reach a wider cohort of
       children and young people at       interventions that reduce the     vulnerable women who are
       increased risk of committing       risk of first-time entry to the   at risk of victimisation or
       anti-social or criminal activity   criminal justice system           committing criminal activity,
                                                                            and, strengthen health care
                                                                            pathways between existing
                                                                            services

     Intervention

      4.                                  5.                                6.
      Develop best practice               Agree a standardised health       Work with partner
      approaches and pathways             improvement model with the        organisations to promote
      that appropriately identify and     NHS and youth justice teams       and embed the principles
      support offenders and victims       that targets and addresses        of Family Justice within
      of violence or exploitation         health vulnerability in this      the strategic direction and
      who have a learning, autistic       group of young adults             operational delivery of unified
      spectrum or communication/                                            public services in Greater
      speech and language issue                                             Manchester

     Enablers/Systems

      7.                                  8.                                9.
      Develop a long-term,                Collaboratively develop           Establish more consistent
      sustainable approach to             workforce training and            approaches to service user
      commissioning services that         development programmes            engagement in the design and
      deliver specialist healthcare       that promote insight into         delivery of specialist health
      and therapeutic support to          trauma, abuse, learning           and justice services
      offenders and the victims           disability and communication
      of crime, agreeing common           disorder presentation and how
      quality standards for Greater       to identify and support these
      Manchester                          issues effectively
12                                                                                                                              Integrated Health and Justice Strategy                                                                                                                               13

     1. Why focus on health and justice?
     Our opportunity in Greater Manchester
     The 2016 devolution of responsibilities for health and        Focusing our collective efforts specifically on the
     social care brought to life through ‘Taking Charge’ Plan,     health needs of people in contact with the criminal
     and the 2019-2021 justice devolution agreement, create        justice system, or at risk of entering it, is a relatively
     an opportunity for Greater Manchester to innovate and         new approach for the city region, and it presents a
     integrate public policy and services in the field of health   chance to deliver high-impact change in the medium
     and justice.                                                  to long-term for some of our most marginalised and
                                                                   vulnerable children, young people and adults.
     Devolution has created a framework to do this,
     enhanced by a new Greater Manchester integrated               The emphasis throughout this strategy is to integrate
     public services model and reform principles which             policy and services relating to health and justice,
     emphasise prevention, people and place. Together              including the development of innovative approaches
     these act as enablers for change, but they are also           to support people who can often become stuck in a
     helping to stimulate a shared understanding of the            cycle of exclusion, vulnerability, offending, victimhood     Defining the case for change
     health needs and health inequalities of a population          or exploitation. In line with a shared ambition in Greater
                                                                                                                                The founding premise of this strategy is that health                                  However, poor physical and mental health amongst
     group who have traditionally been ‘seen’ separately by        Manchester to invest in preventative approaches, the
                                                                                                                                and wellbeing of people in contact with the criminal                                  victims and offenders is also attributed in part to the
     public services.                                              strategy focuses on the need for earlier identification of
                                                                                                                                justice system, as a victim or an offender, is a                                      priority and value that individuals place on their own
                                                                   risk factors and health and social care needs, as well as
                                                                                                                                shared responsibility of local authorities, CCGs, NHS                                 health, with vulnerable people often not accessing
                                                                   appropriate interventions and support.
                                                                                                                                healthcare providers, the Greater Manchester Health                                   health and care support in proportion with their needs,
                                                                                                                                and Social Care Partnership (GMHSC), the Greater                                      leading to pronounced differences in life course health
                                                                                                                                Manchester Combined Authority (GMCA), the Voluntary                                   and life expectancy. Whilst health inequalities are often
     A Focus on Prevention and Intervention                                                                                     Community and Social Enterprise (VCSE) sector and                                     driven by socio-economic disadvantage and poorer
                                                                                                                                criminal justice services.                                                            opportunities and life chances, amongst children,
                                                                                                                                                                                                                      young people and adults who come into contact with
                                                                                                                                This is because the majority of people that have been
                                                                                                                                                                                                                      the criminal justice system, it is common to see a
                                                                                                                                a victim of crime, or a perpetrator, live in and are part
                                                                                                                                                                                                                      further layer of complexity which increases the risk
                                                                                                                                of our local communities and it is in a community
                                                                                                                                                                                                                      of exposure to criminality or victimhood. These risk
                                                                                                                                setting that health, wellbeing and resilience can be
                                                                                                                                                                                                                      factors include:
                                                                                                                                best supported and improved.
                                                                                                                                                                                                                      • c
                                                                                                                                                                                                                         omplex and traumatic personal histories and
                                                                                                                                In fact, many more offenders are supervised in the
                                                                                                                                                                                                                        relationships, which may also include abuse and
                                                                                                                                community than in secure custody, and the majority of
                                                                                                                                                                                                                        exploitation;
                                                                                                                                custodial sentences are relatively short at 12 months
                   Address ‘upstream’ determinants                                                                                                                                                                    • e
                                                                                                                                                                                                                         nduring mental health and/or substance misuse
                                                                                                                                or less.1 This means most custodial sentences allow
                       e.g. ACE, Troubled Families                                                                                                                                                                      issues;
                                                                                                                                for a relatively limited opportunity for the health and
                      Programme, Truancy, Youth
                                                                                                                                wider care and support needs of offenders to be                                       • learning disabilities, autistic spectrum disorders and
                     Offending, Liaison & Diversion,
                                                                                                                                identified and addressed, before they return to their                                   communication disorders;
                      Drug & Alcohol dependence,                     Address ‘downstream’ determinants
                                                                                                                                communities.                                                                          • g
                                                                                                                                                                                                                         ender, in particular women and girls; and
                           unemployment etc.                        e.g. support recovery from drug/alcohol
                                                               dependence, address mental health problems,                      In addition, the transitional period of returning to the                              • r ace, particularly Black and mixed ethnic minority
                         REDUCE OFFENDING /
                                                               ensure access to primary care, support through                   community after a prison sentence is known to carry                                     men in terms of offending.3
                            VICTIMHOOD
                                                                training, education, employment, housing etc.                   significantly increased risks to physical and mental
                                                                                                                                                                                                                      This combination of risk factors can lead to entrenched
                                                                                                                                health, including premature death – suicide, accidental
                                                                   SUPPORT REHABILITATION, RECOVERY                                                                                                                   health inequalities, which then negatively impact
                                                                                                                                death and homicide – and reoffending.2 Identifying and
                                                                        & REDUCE REOFFENDING                                                                                                                          upon personal resilience and reinforce vulnerability,
                                                                                                                                supporting the health, care and wider social needs of
                                                                                                                                                                                                                      meaning that people in contact with the criminal
                                                                                                                                offenders, as well as victims of crime, whose multiple
                                                                                                                                                                                                                      justice system are some of the most marginalised,
                                                                                                                                and complex needs may not always be recognised, is
                                                                                                                                                                                                                      vulnerable and health-deprived population groups in
                                                                                                                                regarded to be a major factor in rehabilitation
                                                                                                                                                                                                                      any community.
                                                                                                                                and recovery.
                                                                                                                                1
                                                                                                                                    Balancing Act, published by Revolving Doors Agency 2013
                                                                                                                                2
                                                                                                                                    As 1
                                                                                                                                3
                                                                                                                                     he Lammy Review: An independent review into the treatment of, and outcomes for, Black, Asian and Minority Ethnic individuals in the Criminal Justice System,
                                                                                                                                    T
                                                                                                                                    September 2017
14                                                                                                                                                                                              Integrated Health and Justice Strategy                                                                             15

     The Public Health Engand CAPRICORN framework, showing the interaction between risk and protective
     factors for children and young people

                                                                                       Addressing the root causes

                                                                                                           Strengthen
                                                                                   Promote good           communities
                                                                                   mental health          – building on
                                                                                                           community
              Upstream Prevention                           Prevent drug                                     assets           Prioritise looked
            to prevent youth violence                       and alcohol                                                        after children
                  and offending                              problems

                                                                                            unities and soci
                                                                                 mm                                     ety
                                        Prevent violence
                                                                               Co                                                          Early indentification
                                        and exploritation                                                                                    and support for
                                                                                                                                             neurodisability
                                                                                          • Give the best start in life
                                                                                      • Promote stable environments
                                                                                    • Support nurturing and responsive
                                                                                          attachment relationships
                               Promote inclusive                                         • Reduce sources of stress                                    Reduce povety,
                                  schools and                                      • Strengthen core life skills and build                             deprivation and

                                                                                                                                                                         System wide approach
                               ensure exclusion                                           aspiration and resillience                                    address wider
                                is used as a last                                                                                                      determinants of
                                     resort                                                                                                                health

                                                                                         Individuals and families

                                     Trauma
                                                                                                                                                         Access to
                                    informed
                                                                                             • Peer mentoring                                             housing
                                     services
                                                                                        • Family level interventions
                                                                                            • Building life skills

                                                                                                                                                                                                   CASE STUDY:
                                            Nurturing                                                                                                                                              Support for Victims of Violence
                                          environments                                                                                            Employment
                                                                               y                                 Co                                 support                                        An individual was referred to the Women’s Centre by her Offender Manager after receiving a community
                                                                                                    et             mm
                                                                                   unities and soci                                                                                                sentence for assault. At this point, her children had been taken into care. In addition to managing her
                                                                                                                                                                                                   probation, the Centre identified that she needed support with several areas, including substance misuse,
            Downstream prevention                             Identify and                                                     Liason and                                                          financial problems and relationship issues. Together, these factors had given her the unstable lifestyle that
               to reduce youth                              support children                                                    diversion
                 re-offending                                    at risk                                    Support to
                                                                                                                                                                                                   had led to the assault.
                                                                                       Support
                                                                                                         access the right
                                                                                   identified health
                                                                                                          education and                                                                            The Women’s Centre worked with her to address her most immediate needs. This included:
                                                                                        needs
                                                                                                             training
                                                                                                                                                                                                   • Working to help her maintain her tenancy, avoiding potential homelessness
                                                                                                                                                                                                   • P
                                                                                                                                                                                                      roviding her with advice, support and advocacy regarding how social services were working with
                                                                                            Transforming lives
                                                                                                                                                                                                     her children
                                                                                                                                                                                                   • Supporting her to access donations from a local food bank
                                                                                                                                                                                                   • L
                                                                                                                                                                                                      iaising with probation staff to help her understand how to avoid breaching her Community Order (which
     The following graphic showing the Public Health                                             more likely to be seen in a healthcare or social care                                               may have resulted in prison)
     England CAPRICORN framework4 demonstrates the                                               context, so for many victims the route to accessing                                               • Supporting her into drug and alcohol services to help her stop misusing substances
     interaction between risk and protective factors for                                         help and support is typically outside of the criminal                                             • Providing her with support to stop self-harming.
     offending in children and young people.                                                     justice system. Existing examples of this in Greater
                                                                                                 Manchester include the independent domestic and                                                   It took some time to build a trusting relationship with the woman. After a period of disengagement, she
     In the case of victims of interpersonal violence or                                                                                                                                           returned to the service, disclosing that she was suffering domestic violence, and was traumatised by
                                                                                                 sexual violence advocates and the GP-based IRIS
     harm, there is an opportunity to improve identification                                                                                                                                       an abusive childhood. Her disclosure became possible because her lifestyle had become more settled,
                                                                                                 domestic abuse referral programme. Further details of
     and specialist support, initially through mainstream                                                                                                                                          including having suitable accommodation. She also stopped abusing substances, and her drug and alcohol
                                                                                                 existing health and justice programmes are set out
     health and care provision. Victims of violence, including                                                                                                                                     worker agreed that she seemed to have given up for good. She also became more aware of the coercive
                                                                                                 on p36.
     domestic abuse and sexual abuse or exploitation, are                                                                                                                                          nature of some of her relationships.
                                                                                                                                                                                                   Through ongoing work with health and justice professionals over several months, and in particular with the
                                                                                                                                                                                                   support of her key worker, the woman was able to have more positive discussions with social care regarding
                                                                                                                                                                                                   her children, increasing her access to them with a view to them returning to her full-time care.
     4
         Public Health England (PHE) Collaborative approaches to preventing offending and re-offending in children (CAPRICORN): A resource for local health & justice
         system leaders to support collaborative working for children and young people with complex needs, published July 2019
16                                                                                                                    Integrated Health and Justice Strategy                                                                                                                                 17

     A focus on health and social care needs in a criminal justice context justice therefore has the potential to:    Risk factors associated with contact
                                                                                                                      with the criminal justice system
                                                                                                                      The risk factors associated with offending behaviour
                                                                                                                      and victimhood range from individual, relationship and
                                                                                                                      situational factors – such as race, gender, relationship/
                                                                                                                      parenting styles, exposure to substance misuse, being
                                                                                                                      a refugee or asylum seeker – to wider social norms,
        Increase identification of people           Improve the health, wellbeing and resilience of people seen in
                                                                                                                      inequalities and determinants, including access to
        affected by interpersonal violence          the health and justice context, including their sense of safety
                                                                                                                      education, secure housing and work.
        or abuse                                    and security
                                                                                                                      However, the evidence suggests that some risk factors
                                                                                                                      may have a more pronounced effect by inherently
                                                                                                                      increasing vulnerability to violent crime, offending and
                                                                                                                      being a victim of abuse.
                                                                                                                      These risk factors include                                                                 CASE STUDY:
                                                                                                                      • a
                                                                                                                         dverse childhood experiences                                                           Adverse Childhood Experiences
                                                                                                                      • m
                                                                                                                         ental health issues and psychological trauma                                           A vulnerable 8-year-old child, who was living in a
                                                                                                                      • h
                                                                                                                         aving a learning disability, autism or a                                               household where there was frequent domestic
        Create an awareness that offending and victimhood
                                                                                  Reduce health inequalities in                                                                                                  abuse, arrived at a new school. It wasn’t long
        can be markers of poor psychological and physical health                                                        communication disorder.5
                                                                                  a locality                                                                                                                     before he began displaying some extremely
        and wellbeing                                                                                                 Whilst multiple factors combined may increase the                                          violent and disturbing behaviour towards
                                                                                                                      risk of entering the criminal justice system, including                                    other pupils and staff. The school is a trauma
                                                                                                                      factors commonly associated with socio-economic                                            informed school. Trauma informed practice
                                                                                                                      disadvantage and social exclusion e.g. homelessness,                                       is a cornerstone of the approach set out in
                                                                                                                      unemployment, some factors may also create a context                                       this strategy. Instead of approaching the child
                                                                                                                      in which the risk of violence or harm is normalised e.g.                                   with traditional sanctions for disruptive and
                                                                                                                      trans-generational family violence or abuse.                                               threatening behaviour, the child was supported
                                                                                                                      These risk factors apply to children and young people                                      with interventions that recognise the effects of
        Reduce the risks associated with offending or becoming a                  Reduce offending and                as well as adults, but in the case of children and young                                   adverse childhood experiences (ACEs). The child
        victim of violence or harm                                                reoffending rates                   people, exposure to multiple adverse childhood events                                      was allocated a 1-1 worker and also given access
                                                                                                                      can significantly impact upon child development –                                          to a ‘calm room’.
                                                                                                                      neurologically, psychologically and in terms of health-                                    Accompanied by some 1-1 therapeutic support
                                                                                                                      related behaviours – and increases vulnerability to both                                   this meant that the child’s disruptive and often
                                                                                                                      victimhood and offending.6                                                                 violent episodes at school reduced from around
     The associated opportunity is to
     use this strategy to reinforce and                                                                                                                                                                          6 per month to nil, over the course of 6 months.
                                                                                                                      Responding to the risks                                                                    This didn’t just support the child, but also
     enhance a shared understanding of
     the interaction of complex risk factors                                                                          Many of the strategic interventions recommended by                                         prevented the disruption of other pupils at the
     that can lead to acts of crime and                                                                               the World Health Organisation (WHO) (see page 22)                                          school, allowing the focus to remain on learning
     exploitation or becoming a victim of                                                                             focus on protective factors or provision which evidence                                    and education. Without these intensive trauma-
     it, and, develop a more attuned and                                                                              suggests may mitigate some of these risk factors.                                          informed interventions, it is likely that the child
     integrated public service and VCSE                                                                                                                                                                          would have been permanently excluded, at
                                                                                                                      Public Health England7 (see page 14) also emphasises
     response to addressing and mitigating                                                                                                                                                                       significant cost to both the child and the school.
                                                                                                                      the value of individual, family and social protective
     the effects of those risk factors.                                                                               factors for vulnerable children and young people.
                                                                                                                      The following case studies from existing services in
                                                                                                                      Greater Manchester, and further examples throughout
                                                                                                                      the strategy, exemplify effective responses to various
                                                                                                                      presenting risk factors.

                                                                                                                      5
                                                                                                                         Mental health and learning disabilities are both highlighted in the 2009 Bradley Report: Lord Bradley’s review of people with mental health problems or learning
                                                                                                                         disabilities in the criminal justice system
                                                                                                                      6
                                                                                                                        As 4 – Public Health England (PHE) Collaborative approaches to preventing offending and re-offending in children (CAPRICORN): A resource for local health &
                                                                                                                         justice system leaders to support collaborative working for children and young people with complex needs, published July 2019
                                                                                                                      7
                                                                                                                          As 6
18   Integrated Health and Justice Strategy                                                                                  19

     National and international policy and evidence
     The national context for health and justice
     In the UK over the period 2013-14, a series of structural   and mental health, who commonly engage in
     and policy changes took effect in the delivery of local     high-risk behaviours and whose needs are often
     and national public health provision, the rehabilitation    multiple and complex.
     of offenders and the National Probation Service.
                                                                 In the intervening period since the publication of
     Public Health England (PHE), The Probation Chiefs           Balancing Act, the Revolving Doors Agency has
     Association (PCA) and the Revolving Doors Agency (a         published Rebalancing Act in January 2017. The
     specialist national charity) responded to these changes     primary message of Rebalancing Act is that a whole-
     by collaborating to produce a briefing paper called         system, integrated response is the only solution to
     Balancing Act: addressing health inequalities among         supporting people with multiple, complex health and
     people in contact with the criminal justice system.         social needs and circumstances, and that addressing
                                                                 people’s needs in this way will give rise to wider social
     The briefing highlighted that male and female
                                                                 and community benefit – what they refer to as a
     offenders and ex-offenders are an often-overlooked
                                                                 ‘community dividend’.8
     group who disproportionately experience poor physical

     Benefits of the Community Dividend

                                   Improved health                                Reduced offending
                                    = reduced costs                                = reduced cost to
                                         to NHS                                    law enforcement

                                                          Community
                                                           Dividend
                                                                                      Supporting
                                   Lower crime rates                                rehabilitation =
                                      = improved                                   increasing levels
                                   community safety                              of productive activity
                                                                                 and social cohesion

     One example of this is breaking the pattern of              often include coercive and/or physically abusive
     offending, abuse or psychological trauma that can           relationships.
     sometimes be ‘passed’ between generations of
                                                                 However, Rebalancing Act acknowledges that working
     the same family e.g. domestic abuse reducing the
                                                                 in the arena of health inequalities with people who
     likelihood of poor mental health amongst wider family
                                                                 often have complex and multiple health, care and
     members, supporting effective parenting and caring,
                                                                 social needs is challenging. Whilst our understanding
     meaning that children are less likely to become ‘looked
                                                                 of the characteristics and needs of this population
     after’ by the state due to concerns about safeguarding.
                                                                 group is improving, our understanding of what works
     An example of this in Greater Manchester is the
                                                                 to reduce the health and social inequalities they
     success of the Women’s Support Alliance in reducing
                                                                 experience is less well-developed.
     offending rates amongst women offenders, by tackling
     the issues that have contributed to offending which

     8
         Diagram courtesy of PHE
20                                                                                                                         Integrated Health and Justice Strategy                                                                                         21

     Health care in the criminal justice system

     NHS England also published its Strategic direction        Following on from this, NHS England then published
     for health services in the justice system: 2016-2020,     its Strategic direction for sexual assault and abuse
     covering the provision of care for men and women in all   services – Lifelong care for victims and survivors:
     custodial settings (pre-, during and post-custody). The   2018-2023, which highlights:
     strategic priorities include:
                                                               • S
                                                                  trengthening the approach to prevention
     • A radical upgrade in early intervention                 • P
                                                                  romoting safeguarding and the safety, protection
     • A
        decisive shift towards person-centred care that         and welfare of victims and survivors
       provides the right treatment and support                • I nvolving victims and survivors in the development
     • S
        trengthening the voice and involvement of those         and improvement of services
       with lived experience                                   • I ntroducing consistent quality standards
     • S
        upporting rehabilitation and the move to a pathway    • D
                                                                  riving collaboration and reducing fragmentation
       of recovery
                                                               • E
                                                                  nsuring an appropriately trained workforce
     • E
        nsuring continuity of care, on reception and post
       release, by bridging the divide between healthcare      Most recently, the NHS Long Term Plan published in
       services provided in justice, detained and community    January 2019 reinforces the importance of access
       settings                                                to health and social care for the vulnerable young
     • G
        reater integration of services driven by better       people and adults seen in the criminal justice system.
       partnerships, collaboration and delivery                It also makes specific references to national pilot
                                                               schemes including the Community Service Treatment           Violence reduction as a public service and population health goal
                                                               Requirement (CSTR) programme and RECONNECT. The
                                                               CSTR enables courts to require people to participate        The World Health Organisation has been advocating                It has developed an ‘ecological framework’ as a way
                                                               in community treatment, instead of a custodial              for better awareness about violence as a public health           of understanding the factors that influence violence,
                                                               sentence, whilst RECONNECT is a care after custody          issue, and the multiple effects of violence on health            showing the interaction of multiple factors that can
                                                               service which works with people before they leave           and wellbeing, since the publication of its first World          lead to violent behaviour and it is regarded to be a
                                                               prison to assist the transition to health and social care   report on violence and health in 2002.                           sound basis for understanding the issue.
                                                               community-based services.
                                                               These national strategies set out expectations for the
                                                                                                                           Factors that Influence Violence – World Health Organisation
                                                               way healthcare needs to evolve for offenders in custody
                                                               and victims and survivors. Similarly, this Greater
                                                                                                                            Societal                            Community                    Relationship                  Individual
                                                               Manchester Health and Justice Strategy creates a set
                                                               of priorities for improving access to health and care        Rapid social change                 Poverty                      Poor parenting practices      Victim of child
                                                                                                                                                                                                                           maltreatment
                                                               provision for offenders, ex-offenders and the victims        Gender, social and economic         High crime levels            Marital discord
                                                               of abuse and sexual violence living in our Greater           inequalities                                                                                   Psychological/personality
                                                                                                                                                                High residential mobility    Violent parental conflict     disorder
                                                               Manchester communities. As the work to develop the           Poverty
                                                               strategy has progressed, it is clear that many of the                                            High unemployment            Low socioeconomic             Alcohol/substance abuse
                                                                                                                            Weak economic safety nets                                        household status
                                                               principles expressed in the national strategies are                                              Local illicit drug trade                                   History of violent behaviour
                                                               equally relevant to offenders, and victims of violence       Poor rule of law                                                 Friends that engage in
                                                               and abuse, living in the city region.                                                            Situational factors          violence
                                                                                                                            Cultural norms that support
                                                                                                                            violence
22                                                                                                                                                                    Integrated Health and Justice Strategy                                                                                                                23

     In 2010, WHO published a series of evidence briefings                            Strategy) that is characterised by a multi-agency                               The evidence-base for what works to support                                      evidence and insight indicates that the style, aims and
     on violence prevention, in which it advocated 7 main                             system response that is place-based, and which                                  vulnerable and marginalised people whose needs                                   responsiveness of support may be as important as the
     strategic interventions, based on a review of the                                draws on public health thinking. It recommends five                             cut across health, care and the criminal justice                                 focus of the intervention.
     available international evidence. They are listed below                          components to successful serious violence prevention:                           system is still an emerging field in the UK, but current
     with some examples.
                                                                                      • c
                                                                                         ollaboration
                                                                                                                                                                      Some characteristics of positive support include10:
     Public Health England has also developed a resource                              • c
                                                                                         o-production
     to support the local system response to violent crime,
                                                                                      • c
                                                                                         o-operation in data and intelligence sharing,                                                                                               Non-judgemental and
     which advocates a balance between prevention and
                                                                                      • c
                                                                                         ounter-narrative development                                                                                                                  person-centred
     enforcement, and aligns with the evidence above.9
     The resource outlines an approach to serious violence                            • c
                                                                                         ommunity consensus.
     prevention (defined by the national Serious Violence

         WHO strategic interventions                                 Examples of practical support / services that show emerging                                                Services need
                                                                                                                                                                                                                                                                                                 Approaches that build
                                                                     evidence of effectiveness                                                                                to be dynamic and
                                                                                                                                                                                                                                                                                                  self-confidence and
                                                                                                                                                                           responsive to mirror the
                                                                                                                                                                                                                                                                                                         agency
                                                                                                                                                                              nature of recovery
         Increasing safe, stable and nurturing                       Programmes that provide parental support and family
         relationships between children and                          approaches / therapies which focus on attachment, family bonds
         their parents and caregivers                                and healthy relationships often in the Early Years e.g. Family
                                                                     Nurse Partnership, Triple P, Incredible Years Pre-school.
                                                                     Multi-component approaches e.g. Multi-systemic therapy
                                                                     (an intensive family therapy which addresses multiple issues)
                                                                                                                                                                          Build in and expert
                                                                     and Sure Start programmes are also thought to have a
                                                                                                                                                                        ‘relapse’ as part of the                                                                                                 Eliminating stigma and
                                                                     positive effect.
                                                                                                                                                                       service delivery model as                                                                                                 focusing on inclusion in
                                                                                                                                                                       this is an integral part of                                                                                                       society
         Developing life skills in children                          Programmes that address life, social and emotional skills and                                       the recovery process
         and adolescents                                             competencies e.g. Incredible Years Child / teacher programmes,
                                                                     Training Promoting Alternative Thinking Strategies (PATHS).

         Reducing availability and harmful                           Programmes that offer brief interventions and longer-term
                                                                                                                                                                                                                   Valuing the positive input of friends and also family,
         use of alcohol                                              treatment for problem drinking, including psychotherapeutic
                                                                                                                                                                                                                  supporting people to reconnect with social networks
                                                                     interventions such as CBT. Reducing alcohol sales has also been
                                                                                                                                                                                                                             and form healthy relationships
                                                                     linked to reducing violence.

         Reducing access to guns, knives                             Programmes that directly target young people in gangs e.g. as in
                                                                                                                                                                      Reducing serious violence                                                        (SVRU), which has been operating since 2006. Other
         and pesticides                                              USA and Glasgow.
                                                                                                                                                                                                                                                       UK regions, including the West Midlands Violence
                                                                                                                                                                      Greater Manchester is one of several regions to have
                                                                                                                                                                                                                                                       Prevention Alliance and the Cardiff Model for Violence
         Promoting gender equality                                   School-based programmes that address gender norms and                                            adopted a public health informed approach to violence
                                                                                                                                                                                                                                                       Prevention, have adopted approaches designed to
                                                                     attitudes and issues of gender-based power and control.                                          reduction and has recently established a Violence
                                                                                                                                                                                                                                                       understand and predict the prevalence, types and
                                                                                                                                                                      Reduction Unit (VRU). This VRU is a dedicated, co-
                                                                                                                                                                                                                                                       causes of violence within a community and take steps
                                                                                                                                                                      located, multi-agency team including representation
         Changing cultural norms that                                Programmes that address dating violence and sexual violence                                                                                                                       to address those issues through co-ordinated multi-
                                                                                                                                                                      from across policing, health, local authorities, schools
         support violence                                            amongst young people by challenging social and cultural norms.                                                                                                                    agency action.
                                                                                                                                                                      and the voluntary sector. These partners will work
                                                                                                                                                                      together to tackle violent crime and its underlying                              In developing its approach to violence reduction, the
         Victim identification, care and                             Programmes that aim to identify victims e.g. through screening                                   causes, by identifying the drivers of serious violence                           new Greater Manchester Serious Violence Action
         support                                                     and referral, alongside interventions such as advocacy for                                       locally and developing a coordinated response to                                 Plan will be informed by the most up to date evidence
                                                                     victims of violence e.g. IRIS domestic violence intervention, and                                tackle them.                                                                     in the field and expertise in criminology, through a
                                                                     psychosocial interventions which address psychological trauma.                                                                                                                    collaboration with Manchester Metropolitan University
                                                                                                                                                                      Greater Manchester has modelled elements of its
                                                                                                                                                                                                                                                       (MMU) academics.
                                                                                                                                                                      approach on the Scottish Violence Reduction Unit

     9
      Public Health England. A whole-system multi-agency approach to serious violence prevention: A resource for local system leaders in England, published October
     2019                                                                                                                                                             10
                                                                                                                                                                           Based on Greater Manchester analysis of common themes drawn from multiple evidence sources used to develop the strategy
24                                                                                                                        Integrated Health and Justice Strategy                                                                                   25

                                                                                                                          Additional insight from health and justice focused workshops
                                                                                                                          Several workshops were hosted as part of the                Other service user feedback highlighted the following
                                                                                                                          stakeholder engagement for the development of the           themes and issues:
                                                                                                                          strategy. Some of these were general, whilst others
                                                                                                                                                                                      • t he long lasting and devastating impact of domestic
                                                                                                                          focused on specific issues and groups, including
                                                                                                                                                                                        violence and abuse within families and a reluctance
                                                                                                                          children and young people, vulnerable and
                                                                                                                                                                                        to disclose it because of fear both of the perpetrator
                                                                                                                          marginalised women, and people with learning
                                                                                                                                                                                        and of children being taken into care
                                                                                                                          disabilities and autism.
                                                                                                                                                                                      • t he impact of domestic violence and abuse on
                                                                                                                          The feedback at the workshops reinforced many of the          children and the need for services supporting
                                                                                                                          messages from the evidence above. Discussions at              children to be trauma-informed
                                                                                                                          the children and young people’s engagement event in
                                                                                                                                                                                      • s
                                                                                                                                                                                         ervices in the right place, at the right time, for as
                                                                                                                          particular drew attention to the additional vulnerability
                                                                                                                                                                                        long as people need support
                                                                                                                          associated with having a learning disability, having
                                                                                                                          autism, and/or having difficulties communicating, and       • t ransition points and their impact on individuals are
                                                                                                                          their presentation among young people in contact with          often particularly difficult and require additional and
                                                                                                                          youth justice services.                                        consistent support – including from primary to high
                                                                                                                                                                                         school, from children’s to adult social care, from
                                                                                                                                                                                         prison to community, from a home environment to
                                                                                                                                                                                         being looked after

     Greater Manchester evidence and insight                                                                                                                                          Acting on what we know
                                                                                                                                                                                      Based on this Greater Manchester-specific evidence,
     Local research                                                                                                                                                                   and reinforced by wider national and international
     Understanding the health and social care needs of the       They are:                                                                                                            sources, this first integrated health and justice strategy
     offender population and the victims of violence and                                                                                                                              for Greater Manchester has a strong focus on the
                                                                 • A
                                                                    Health Needs Assessment of the population served                                                                 groups of people in our communities who appear to be
     abuse in depth is a relatively new arena of public policy
                                                                   by the St Mary’s Sexual Advice and Referral Centre                                                                 at an increased risk of violent crime and abuse.
     and service delivery for public health and criminal
                                                                   (SARC), which summarises the characteristics and
     justice teams, but the same principles apply as for                                                                                                                              This might be because of characteristics or
                                                                   needs of the people who have used the service, in
     other population health work:                                                                                                                                                    circumstances which seem to increase vulnerability to
                                                                   particular multiple attendances
     • understand the needs of the population of interest;                                                                                                                            criminality or victimhood, such as race, gender, having
                                                                 • T
                                                                    he Voice of Survivors Research: Hearing Women for
                                                                                                                                                                                      a learning disability/autism/communication issue, and
     • identify health-related risk factors and their causes;     Change – conducted by MMU, MASH and Manchester
                                                                                                                                                                                      rough-sleeping.
       and                                                         Rape Crisis
     • intervene in ways that reduce the exposure to or                                                                                                                              Alternately, it could be because evidence and insight
                                                                 All four documents are available separately and a
       offer protection from the detrimental effects of                                                                                                                               suggests that intervening earlier to reduce the risks
                                                                 collated summary of their main insights has fed into
       those risk factors.                                                                                                                                                            associated with offending behaviour is the most
                                                                 the development of this strategy.
                                                                                                                                                                                      effective approach e.g. focusing on identifying and
     Work has already been completed that will support           Overall, local insight and research is consistent                                                                    supporting potentially vulnerable children and young
     the development of this strategy and advance our            with national and international findings. These                                                                      people and addressing underlying problems as early
     understanding of the needs and characteristics of           point towards a range of complex often interrelated                                                                  as possible, such as trauma or hidden mental health
     people in contact with the criminal justice system in       factors that increase an individual’s vulnerability to                                                               issues.
     Greater Manchester. These include:                          contact with the criminal justice system, including
     • A
        Greater Manchester Criminal Justice System              poor physical and mental health, and lifestyle factors
       Health Needs Assessment (CJS HNA) (2018)                  including smoking, drug and alcohol use, alongside
                                                                 previous life experiences which may have been
     • A
        n independent Health and Criminal Justice
                                                                 traumatic or challenging.
       Strategic Commissioning Review (2018)
     There are also a number of pieces of victim-focused
     research and insight which have been undertaken
     by Greater Manchester partners working to support
     victims of domestic and sexual violence which inform
     this strategy.
26                                                                                                                                               Integrated Health and Justice Strategy                                                                               27

     Benefits of violence reduction in human and system costs                                                                                    2. Whole-system leadership for health and justice
     The World Health Organisation reports that although                              In Rebalancing Act, The Revolving Doors Agency             Our one system approach                                  Our strategy aims
     the economic case for a focus on interpersonal                                   also put forward the concept of a ‘community
                                                                                                                                                 This strategy will be delivered by a wide variety of     In considering what is needed to create an environment
     violence prevention isn’t currently well-developed11,                            dividend’ which points to the wider societal benefits
                                                                                                                                                 public service partners in the statutory and VCSE        in which colleagues are informed, equipped and
     “the provision of treatment, mental health services,                             of addressing the health inequalities associated with
                                                                                                                                                 sectors and the implementation of the strategy           supported to improve practice, the aims of the strategy
     emergency care and criminal justice responses are                                crime, violence and offending, because of the extended
                                                                                                                                                 will reinforce and complement a series of existing       are to:
     some of the direct costs associated with violence.”                              impact on the families and communities who surround
                                                                                                                                                 Greater Manchester-wide programmes, including
                                                                                      and support offenders and victims.                                                                                  • H
                                                                                                                                                                                                             ighlight the risk factors, health vulnerabilities and
     The need for additional and sometimes intensive                                                                                             programmes in support of:
                                                                                                                                                                                                            health inequalities experienced by offenders,
     support from public and voluntary services including                             “The community dividend model suggests that by
                                                                                                                                                 • Gender based abuse and domestic violence                 ex-offenders and the victims of personal violence
     health, social care and criminal justice services, for                           addressing the health needs of those in contact with
     both victims of violence and offenders, is self-evident                          the criminal justice system there can be positive          • Serious Violence Action Plan                           • P
                                                                                                                                                                                                             rovide clarity on the existing evidence base (and its
     but largely unquantifiable.                                                      effects on the wider population. People in prison or       • Learning disability                                      limitations)
                                                                                      those in their friendship, family and social networks      • Autism                                                 • A
                                                                                                                                                                                                             dvocate for the introduction of trauma-informed
     Individuals, and their families, bear the most serious
                                                                                      also disproportionately experience wider societal health                                                              practices proportionately across the workforce which
     consequences of interpersonal violence including                                                                                            • Mental health, including suicide prevention
                                                                                      and social inequalities – they often come from under-                                                                 emphasise the strong association between adverse
     sometimes life-long effects on behaviour and health,                                                                                        • Substance misuse
                                                                                      served populations and return to those communities                                                                    childhood and life experiences and victimhood/
     including:12                                                                                                                                • Homelessness
                                                                                      when their immediate involvement in the criminal                                                                      offending – and collaboratively identify the resources
     • A
        cute physical injury or disability: Lacerations,                             justice system has ended. Therefore, meeting the                                                                      to deliver high-quality workforce development
                                                                                                                                                 Alignment and integration with other Greater
       fractures, brain or major organ injury, burn and scalds.                       health needs of people in contact with the criminal                                                                 • I nform integrated, whole system public health
                                                                                                                                                 Manchester-wide strategies will be essential to
     • M
        ental health and behavioural effects Alcohol and                             justice system can help to achieve reductions in crime,                                                               approaches to violence reduction with an emphasis
                                                                                                                                                 achieving improvements in the field of health and
       drug abuse, depression and anxiety, post-traumatic                             reduce offending and improve the individual’s health.”13                                                              on early help, early in life and stimulate Greater
                                                                                                                                                 justice. These programmes of work include:
       stress disorder, suicidal thoughts or behaviour, eating                                                                                                                                              Manchester partners to work towards delivering
                                                                                                                                                 • The Greater Manchester Children’s Plan
       and sleep disorders, smoking, unsafe sex                                                                                                                                                             this collaboratively
                                                                                                                                                 • T
                                                                                                                                                    he Children and Young People’s Health and
                                                                                                                                                                                                          • C
                                                                                                                                                                                                             reate a clear account of ‘health and justice’ for
     • S
        exual and reproductive effects: Unintended                                                                                                Wellbeing Framework
                                                                                                                                                                                                            mainstream health, care and criminal justice
       pregnancy, pregnancy complications, gynaecological                                                                                        • T
                                                                                                                                                    he Greater Manchester Mental Health in Education       services, using and sharing data and intelligence, so
       disorders, chronic pelvic pain, HIV and other sexually                                                                                      (MHiE) programme                                         that vulnerable and marginalised people are better
       transmitted infections
                                                                                                                                                 • T
                                                                                                                                                    he ‘A Bed Every Night’ scheme and the Housing          identified and appropriately supported
     • C
        hronic disease: Arthritis and asthma, cancer,                                                                                             First Greater Manchester regional pilot                • A
                                                                                                                                                                                                             cknowledge the complexity of working where
       cardiovascular diseases, diabetes, kidney problems,                                                                                       • T
                                                                                                                                                    he Justice and Rehabilitation Devolution               health and justice issues intersect and explore with
       liver disease                                                                                                                               memorandum of understanding                              localities and partners how to develop and share best
                                                                                                                                                 • T
                                                                                                                                                    he White Paper on Unified Public Services for the      practice across Greater Manchester and learn from
                                                                                                                                                   People of Greater Manchester                             each other, in the short and medium term
                                                                                                                                                 • S
                                                                                                                                                    tanding Together – The Police and Crime Plan         • U
                                                                                                                                                                                                             nderstand how current organisational practices
                                                                                                                                                                                                            and processes may need to change to facilitate
                                                                                                                                                 • O
                                                                                                                                                    ur People, Our Place – the Greater Manchester
                                                                                                                                                                                                            more effective early identification and intervention of
                                                                                                                                                   Strategy
                                                                                                                                                                                                            vulnerable children, young people and adults, within
                                                                                                                                                 Along with identifying what we plan to do differently      organisations and between them e.g. assessment
                                                                                                                                                 in Greater Manchester to reduce health inequalities        and referral practices
                                                                                                                                                 and improve life chances for victims and offenders,      • E
                                                                                                                                                                                                             mphasise collaboration amongst commissioners
                                                                                                                                                 the strategy also sets out how the conditions will be      and providers in order to improve the accessibility
                                                                                                                                                 created for professionals and practitioners to improve     and quality of support for this population group.
                                                                                                                                                 what they currently do and the way they do it.

     11
        WHO Global Status Report on Violence Prevention (2014)
     12
        Based on findings of WHO Global Status Report on Violence Prevention (2014)
     13
        Rebalancing Act 2017, p. 12
28                                                                                                                                         Integrated Health and Justice Strategy                                                                                                          29

                                                            A whole-system approach                                                        In Greater Manchester, the principles of Family Justice                     – and in some instances this is already the case.
                                                                                                                                           are well-aligned with the broader ambitions set out in                      Colleagues from the Centre for Mental Health were
                                                            to Family Justice                                                              our approach to unify public services within a single,                      asked to review emergent place-based initiatives
                                                                                                                                           coherent and effective model.15 More specifically,                          already being delivered in Greater Manchester and
                                                            Family Justice is a branch of the Health and Justice                           integrated, place-based teams working within some                           found that they demonstrated “the ready capacity to
                                                            agenda which pursues the provision of integrated                               of Greater Manchester’s neighbourhoods present an                           deliver” on the principles of Family Justice.
                                                            support for vulnerable families engaged in the criminal                        opportunity to deliver a Family Justice approach
                                                            justice system. Its purpose is to ensure that services
                                                            make decisions together which promote the holistic
                                                                                                                                           Unified Public Services in GM
                                                            wellbeing of the whole family.
                                                            The internationally recognised principles of Family
                                                            Justice are:                                                                                                                                                             Information is shared between agencies safely
                                                                                                                                                                  Directed by one public service leadership team.                    to support effective delivery and identifying those
                                                            • S
                                                               afety focused: Increase safety, promote healing,                                                                                                                     most at risk.

                                                              and foster empowerment through services for
                                                              victims and their children
                                                            • V
                                                               ictim-centred: Provide victim-centred services that                                                                                                                  Working as one public service workforce, with
                                                              promote victim autonomy                                                                             A single commissioning function for the locality.                  redesigned roles and shared Job Descriptions
                                                                                                                                                                                                                                     across organisations.
                                                            • S
                                                               urvivor-driven: Shape services to clients by asking
                                                              them what they need
     CASE STUDY:                                            • R
                                                               elationship-based: Maintain close working                                                         Universal services, like schools and GPs,
     A Place-Based Approach to                                relationships among all collaborators/agencies
                                                                                                                                                                  are cornerstones of public services in their                       The VCSE sector are part of the fabric of public
                                                                                                                                                                  communities and are connected with other                           services. Public services are delivered with local
     Supporting Families                                                                                                                                          public services through integrated                                 citizens, communities businesses.
                                                            • O
                                                               ffender-accountability: Increase offender
                                                                                                                                                                  neighbourhood functions.
     A place-based team in Holts and Lees draw on             accountability through evidence-based prosecution
     support from probation services. This provides an        strategies and/or evidence-based treatment                                                                                                                             One integrated neighbourhood function for
     enhanced way of working with ex-offenders and            programs                                                                                                                                                               each geographic footprint (30-50k). Frontline
     their families in a local setting. In one particular   • T
                                                               ransformative: Evaluate and adjust services by
                                                                                                                                                                                                                                     practitioners, pulling on specialist support.
     example, the probation worker was aware that it          including survivor input and evidence based best                                                                                                                       • Care coordinators/navigators
     was highly likely one of her clients would receive       practices                                                                                                                                                              • Community safety advisors
     a custodial sentence of up to 6 months.                                                                                                                                                                                         • CRC workers
                                                            • C
                                                               ulturally competent: Commitment to the utilisation                                                                                                                   • District nurses
     This offender expressed concern about the                of culturally competent services                                                                                                                                       • Early years workers
     impact his time in prison would have on his            • E
                                                               mpowered: Offer survivors a place to belong even                                                                                A single function
                                                                                                                                                                                                                                     • Environmental health officers
                                                                                                                                                     Integrated specialist                                                           • Family support workers
     family and home, as he was the sole tenant for           after crisis intervention services are no longer                                          /acute services
                                                                                                                                                                                             for triage, assessment,
                                                                                                                                                                                                    tasking and                      • Focused care workers
     his two-bedroom property, as well as the main            necessary                                                                                   for the most
                                                                                                                                                                                               coordination across
                                                                                                                                                      complex and costly                                                             • Health visitors
     claimant for all their benefits. The probation                                                                                                                                                  all cohorts                     • Housing officers
                                                            • K
                                                               ind-hearted: Develop an approach that values,
     worker brokered a relationship with the place-                                                                                                                                                                                  • Key workers/early help workers
                                                              affirms, recognises and supports staff, volunteers,
     based team who supported the offender to                                                                                                                                                                                        • Mental health practitioners
                                                              and clients.14                                                                                                                                                         • Neighbourhood beat officers
     complete a deed of assignment to put the
                                                                                                                                                                                                                                     • Neighbourhood/community safety officers
     tenancy in joint names and, once sentenced, a
                                                                                                                                                                                                                                     • Pharmacists
     local support worker was immediately available                                                                                                                                                                                  • Police community support officers
     to support his girlfriend to apply for welfare                                                                                                                                                                                  • Social workers
     benefits in her own right. The team also offered                                                                                                                                                                                • Substance misuse workers
     ongoing support to the family whilst the offender                                                                                                                                                                               • VCSE sector workers and volunteers
     completed his five-month sentence.
     When released from prison, the offender stated
     to the probation worker that for the first time he
     felt he was being released into a more stable
     environment where historically his life would
     have been much more chaotic. He wanted to
     stop offending, and he stated that a more stable
     home life would help him to do this.
                                                            14
                                                                 EFJCA, ‘About the Family Justice Centers’, https://www.efjca.eu/centers   15
                                                                                                                                                The Greater Manchester Model: Further, Faster 2019
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