That mental health problems are widespread among the prison population in England and Wales has been known for some time. Mental ill health, combined with a range of related disadvantages in life, is the norm rather than the exception among people of all ages in custody.

What has been less well-known is that the same difficulties apply to those under the supervision of probation services. Yet new evidence produced by the University of Lincoln (Brooker et al 2011) has shown that rates of mental ill health among the probation caseload are very similar to those of the prison population, and as in prison much of this poor health is unrecognised, untreated and makes their rehabilitation all the more difficult.

The report’s findings are stark. More than a quarter of offenders in contact with probation said they currently had a mental illness. One in seven had a mood disorder and one in five had an anxiety disorder. Some eight per cent had a psychotic illness: about eight times the national average. About half had the symptoms of a personality disorder; more than half had the signs of hazardous or harmful alcohol consumption; and 12 per cent had the signs of serious drug misuse.

As worrying as the findings on the prevalence of mental ill health, the researchers found that 60 per cent of those with a mood or anxiety disorder were not receiving any treatment. Only half of those with a current psychosis were receiving any support from mental health services. And while 88 per cent of those with a drug problem were receiving treatment for this, the proportion getting help fell to only 40 per cent of those with serious alcohol problems. This latter finding reflects the very clear inequality reported last month in HSJ within prisons: that people who misuse alcohol get much less support from a range of services than those who use street drugs (Lewis, 2011).

These extremely high rates of poor health and untreated illness reinforce the need for urgent action to implement the government’s pledge to extend effective diversion arrangements to all police stations and courts in England and Wales over the next four years. Liaison and diversion services at their best are able to identify people at the earliest opportunity when they come into contact with the justice system. They are able to screen for a range of difficulties including not just mental ill health but drug or alcohol problems, learning disabilities and speech and communication difficulties: all of which may not just have affected their offending but which will have a big impact on their ability to cope with the justice system and their chances of successful rehabilitation.

Diversion services are then able to inform decision-making by the police and the courts, potentially avoiding lengthy delays for psychiatric reports later in the judicial process. And, importantly, good diversion services will ensure that the right forms of support are offered and that individuals whose lives can be complex and chaotic are properly linked with services before ‘letting go’ of them (Centre for Mental Health, 2009).

Some diversion teams are making a big difference and showing what can be achieved for relatively little investment. Services like MO:DEL in Manchester and the Youth Justice Liaison and Diversion pilots in six localities across England (and soon to be extended to 30 more) are leading the way in offering a proactive, robust and effective form of diversion.

The NHS now has the opportunity to invest in diversion services across England. These will deliver most value if they link to a wide range of community-based services so that the difference they make in a person’s life is most effective. If they achieve their potential, one of the most stark inequalities in health care can begin to be redressed even in these toughest of times for all public services.


Brooker, C. et al, 2011. An investigation into the prevalence of mental health disorder and patterns of health service access in a probation population.

Centre for Mental Health, 2009, Diversion. Available at

Lewis, S., 2011 ‘PCTs urged to fill alcohol treatment gap in prisons’ HSJ Online, 30 August 2011