Together with Nacro, Clinks is writing a blog series on the Community Sentence Treatment Requirements (CSTR) programme as part of our health and justice work funded by the Department for Health and Social Care’s Voluntary, Community and Social Enterprise (VCSE) Health and Wellbeing Alliance. The CSTR programme is jointly overseen by NHS England and NHS Improvement, Public Health England, the Department for Health and Social Care, Her Majesty’s Prison and Probation Service, and the Ministry of Justice. The programme aims to reduce reoffending and divert people from short-term custodial sentences by addressing the mental health, substance and alcohol misuse issues of the person in contact with the criminal justice system through treatment requirements that are undertaken in the community. In addition to funding from the NHS Long Term Plan, the CSTR programme has been given an additional £2.5million from the recently announced Mental Health Recovery Programme, with investment coming from the Department for Health and Social Care. Find out more about what CSTRs are in our report here.

For this blog series, Clinks and Nacro met with different CSTR sites to discuss their journey to becoming a CSTR site, how the site functions, how the site works with the voluntary sector, the benefits it offers to service users, and how they have been functioning during Covid-19. We have visited three CSTR sites: Essex, Plymouth, and Northamptonshire. This is the final blog in our series.

As all sites have voluntary sector partners who deliver treatment requirements, we have been keen to understand the experiences of organisations delivering these requirements, how they engage with statutory agencies, and what advice they would give to other organisations who may deliver treatment requirements as the programme rolls out in the future. We previously published our findings from the Plymouth CSTR site, which we conducted in February 2021.

For our third and final site visit in March 2021, we met with Angie Kennedy, CEO of C2C Social Action, an organisation that supports people through the criminal justice system, and her team at the Northamptonshire CTSR site. This site provides a women’s specific CSTR programme with C2C Social Action running a women’s centre where they deliver the CSTRs. Here’s what we found out:

What treatment requirements do you deliver?

The delivery of mental health treatment requirements (MHTRs) in Northamptonshire starts with assessments carried out at court, and staff also work with assistant psychologists to deliver mental health interventions. All treatment requirements are delivered in a holistic manner and are individually tailored to the needs of each woman. This could take the form of group work or one-to-one sessions for example – whatever is most beneficial for the woman involved. The approach to delivering CSTRs here is service user led, acknowledging that each woman is different and will have different preferences.

At the end of the support offered, the team will signpost service users to other agencies, which they see as a crucial element to the work as it ensures women have the option to continue to engage with services and continue to move forward with their progress.

How have services changed?

Prior to becoming a CSTR site, MHTRs were available but there were low take up rates from magistrates. Having someone in the courts promoting the value of MHTRs means they have a higher profile. They can also be used in combination with alcohol treatment requirements (ATRs) or drug rehabilitation requirements (DRRs), and building those links has meant service users are better supported with joined-up communication between different agencies delivering services.

How does delivering combined requirements benefit service users?

When women have a combined order in Northamptonshire, all agencies involved will come together to look at the needs of the service user and put together an action plan. The quality of the initial appointment is really important for identifying need, who will be delivering what and ensuring this is communicated to the service user.

CSTRs in Northamptonshire are delivered out of the C2C Women’s Centre, which serves as a one-stop shop, meaning women can receive all CSTR site-related services in one place as well as C2C’s additional services. These include but are not restricted to: wellbeing courses, family contact sessions and food provision. Having everything under one roof makes it easier for women to engage in their treatment requirements and reduces the possibility that women will fail to attend appointments as they can access several different services in one location.

How engaged are service users with CSTRs?

The support offered within the CSTR programme with mental health needs, substance and alcohol misuse, combined with the additional specialist support that C2C offers, means women are addressing these issues with the support of both statutory agencies and the voluntary sector.

The uptake of CSTRs in Northamptonshire is very high and the team reflected that the impact of the site not being active would be devastating. Without the CSTRs and subsequent engagement with the women’s centre, women would not have the same opportunities to address their needs which could lead to increasing levels of homelessness, substance and alcohol misuse issues and women serving  custodial sentences due to the increased likelihood that women would breach their licence conditions.

Adapting to Covid-19

Adapting, unsurprisingly, was the key theme of this discussion. The team continued the work of the CSTR site by delivering sessions out walking, and having video and phone calls set for each individual during the pandemic. They conducted group work online, as the women’s centre was closed with the exception of emergencies. As part of C2C’s additional support, they also delivered frequent food parcels to women in need.

Some women experienced digital exclusion, especially those who were homeless. In these instances, the team put people in contact with an organisation who can provide them with data or a phone, and this has enabled them to keep in touch.

Service user experience during Covid-19

The experience of service users during Covid-19 has varied. Some have much preferred face to face contact and have struggled with remote services. Others are thrilled to be able to see one another via Microsoft Teams through group work sessions, and have learnt practical ways to cope during lockdown. In terms of engagement during lockdown, there have been very few missed appointments, though the team has been more flexible with this particularly for women with children at home. At the time of the interview there had only been two missed appointments since the start of January 2021, despite Northamptonshire supporting 350 women within the probation service, 50% of who undertake MHTRs.

Benefits of the CSTR programme 

The main benefit of the programme is the link with the community mental health team. The assistant psychologist now works out of the women’s centre and the relationship with the community mental health team is a lot stronger than it was prior to becoming a CSTR site.

Room for improvement

The team reflected that despite the success of the site, there is always room for improvement. They also felt the training for magistrates has been good, and continuing with this will enable an increased number of orders given.  

Multi-agency working and the voluntary sector

Everyone that we spoke to from the team felt that multi-agency working was key to delivering support to service users, and that the site itself works because of partnerships. The holistic hub approach within the women’s centre, serving as a one-stop shop, means that all agencies involved can talk to each other as well as the service user to design and improve treatment requirements for each individual woman. This collaborative way of working underpins the ethos of delivering CSTRs to women in Northamptonshire.

Zahra Wynne was Clinks' Health and Justice Policy and Development Officer until June 2021.