Court Mental Health Liaison and Diversion services (CMHLDS) have been operating to support vulnerable people through the criminal justice (correctional) system (CJS) in England and Wales for at least 25 years (1). These services operate principally within police stations and lower (Magistrates’) courts, and they assist people at whatever stage in the process they present, including before or after an arrest has taken place or charges have been laid, while attending court as an accused person, or following conviction (Disley, 2016). However, important operational differences can exist between them, arising from different local interpretations of policy and legislation (2). To date, little research is available regarding the characteristics of court defendants with psychiatric or neurodevelopmental disorders (NDDs) referred to CMHLDS, or those most at risk of self-harming and suicidal behaviour (1, 3). Although the main focus of CMHLDS is on people who present with major mental illness, people in other potentially vulnerable groups are also eligible including people with NDDs, substance and alcohol misuse. In England and Wales, key national reports have highlighted deficiencies in existing CMHLDS, and described the inequalities experienced by people from groups that have not traditionally been prioritised within these services, including those with intellectual disability (ID) (4, 5), autism spectrum disorders (ASD) and attention deficit and hyperactivity disorder (ADHD) (6).
To date there has been a lack of research emphasis within CMHLDS, when compared to other areas of the CJS such as prisons and police custody. Therefore it is important to consider each of these settings interdependence given that screened rates of psychiatric and neurodevelopmental disorders can vary according to the setting, and that people in the criminal justice system move between criminal justice and healthcare services. As healthcare services develop they are increasingly being provided within the CJS as a pathway (7). Comparing rates of mental illness (MI), community prevalence rates has been estimated at 3.4%, for depression, 3.8%, for anxiety disorders, 0.3% for schizophrenia, 1.4% for alcohol use disorder and 0.9% for drug use disorder (8, 9), with rates for a specific NDD estimated at between 0.8-1% for ASD, 0.5-2% for ADHD and 0.4-3% for ID (10). In comparison, a London based study of 600 police detainees, found rates of psychiatric disorders at 39%, with 8% screening positive for psychotic disorders and 5–8% with major depression (11). In an 18-month review of 1092 cases at two London police stations, 66.8% were reported to have psychiatric disorders. These included 20.1% with psychotic illnesses, 16.6% with depression, 21.2% with primary drugs or alcohol issues, and 6% with intellectual disability (12). More recent work found that 40% met the threshold for a lifetime prevalence of major mental illness, with a screened prevalence of 14% for ADHD and 4% for ID (13).
It is clear that people attending court are at higher risk of psychiatric disorder. A study of those appearing in court from overnight police custody found that they had a higher rate of psychiatric disorder compared to community court attendees (6·6% vs 1.3%) (3). Of 99 defendants with psychiatric disorders, 66 (66.6%) had ‘serious’ conditions. Meanwhile, high levels of suicidality are reported amongst these samples (13, 14).
The aim of the current study was to analyse a database of over 9000 defendants to provide a comprehensive description of people with psychiatric and neurodevelopmental disorders who are processed through the lower courts. We aimed to examine rates of these disorders, and to determine whether differences arise regarding protected characteristics (e.g., age, gender and ethnicity) to determine whether they should be taken into greater consideration in future service developments (5, 15, 16).