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. Find out more about what CSTRs are in our report here.

In the recent Sentencing White Paper, the CSTR programme is used as an example of best practice in supporting people in contact with the criminal justice system who would benefit from receiving treatment. To support the scale up of the CSTR programme, the Ministry of Justice committed new justice funding to the CSTR Programme for 2020/21, in addition to the significant funding already committed by NHS England and NHS Improvement in their 2019 NHS Long Term Plan.

For this blog series, Clinks and Nacro are meeting with different sites to discuss their journey to becoming a CSTR site, learn how the site functions, appreciate the benefits CSTRs offer to service users, and understand how the sites have been faring during Covid-19.

What’s new

Whilst community sentence treatment requirements in the form of drug rehabilitation requirements (DRRs), alcohol treatment requirements (ATRs), and mental health treatment requirements (MHTRs) have existed for many years, the CSTR programme was created to develop and further increase the use of MHTRs – which were historically underused – alongside the other treatment requirements. The programme also introduced CSTR sites across England which offer ATRs, DRRs and MHTRs, and where necessary, in combination. Since 2017, sites have been launching all over England, and there are now 15 sites in operation – a number that has been increasing even during Covid-19.

In December 2020, we met with Neale Thomas, Wellbeing and Public Health Manager at the Essex CSTR site. Here’s what we found out:

How do you set up as a CSTR site?

Before becoming a CSTR site, Essex already had a good partnership with the ATR and DRR providers (Phoenix Futures and Open Road) and the Criminal Justice Commissioning Group, meaning they were able to build the site on the back of these relationships. The Criminal Justice Commissioning Group is part of Essex County Council and is made up of representatives from Probation, the Community Rehabilitation Company (CRC), Police, Office of the Police Fire and Crime Commissioner, the local Clinical Commissioning Groups/Integrated Care Systems and NHS England and NHS Improvement. The group looks at issues related to people in contact with the criminal justice system facing multiple disadvantage and plans services around identified need. The Essex CSTR site is funded through a local health and justice partnership.

To complete their offer to service users, the Essex site had to add on MHTR services delivered by St. Andrew's Hospital on top of their existing referral and care pathways available for alcohol and substance misuse services. When Essex became a CSTR site, a multidisciplinary CSTR steering group was formed which included representatives from justice, health and local authority. They developed a CSTR model which allowed them to add in new clinical staff to deliver MHTRs, working alongside the substance misuse provider and court teams.

Prior to the site going live, they looked at other sites and their delivery models, learning from their experiences and knowledge. This groundwork helped Essex prepare for going live and is something Neale recommends to others who are preparing to set up as a CSTR site.

How have services changed?

Neale reflected that in many ways, MHTRs were the missing link to the services they did provide, that completed the range of services they could offer service users, meaning there is now a better range of non-custodial options.

Delivering combined requirements to service users

Neale reflected that it was rare that someone would come to the attention of services with just one issue, and therefore it is sensible to look at them holistically.

The CSTR programme demonstrates that you can use the treatment requirements together to address the needs of service users. For people who experience multiple disadvantage with complex and entrenched needs, they need support to address their interlinking issues, which the CSTR programme offers.

Adapting to Covid-19

The Essex CSTR site went live during the first Covid-19 lockdown in March 2020, so Clinks and Nacro were keen to hear how the Essex site delivered treatment requirements under these circumstances. Neale confirmed that the site didn’t need to make adaptations that were too demanding on the site, although they did stop drug testing during lockdown due to social distancing requirements.

For ATRs and DRRs, group work programmes were switched to one-to-one, and online group programmes were introduced. Neale stated the online programmes were not as good as face-to-face services, but at least they enabled services to continue. MHTRs were one-to-one anyway, so these were able to continue as normal, with a mix of face-to face and remote. Face- to-face contact was conducted in a safe way with proper protection for both service users and staff.

In terms of service user engagement, for some people engagement was better than ever. Essex is a large county and is difficult to navigate via public transport, so online and telephone services made it easier for some to engage. Fortunately, there was no sudden drop off in engagement, and the site was a little more lenient regarding breaches. The leniency came from an understanding locally that there would be times during the pandemic when – for valid reasons that might not be applicable before Covid-19 – people might genuinely struggle to make their sessions. The site wanted their services to be efficient and for people to get the most out of them and did not want to penalise people for situations caused by a national pandemic.

Multi-agency working and the voluntary sector

Neale stated that multi-agency working is key to functioning as a CSTR site. For the site to be successful, you need a range of commissioners and a partnership approach to funding, meaning everyone is invested. The voluntary sector is key to the delivery of services, including providing assessments at court and delivering ATR and DRRs. Both delivery and strategic partners are paramount, with neither taking precedence.

Are there any downsides?

Our conversation with Neale demonstrated there were no downsides to becoming a CSTR site. On the contrary, Neale reflected that he would encourage everyone to do it, if possible. The only challenges he cited was that the MHTR programme became oversubscribed very quickly, and that partners at NHSE often had a better understanding of MHTRs then they did DRRs and ATRs.

Words of advice

Finally, we asked Neale what he would advise those involved in the process of becoming a CSTR site or considering it. His response was as follows:

1. Do the groundwork and learn from other sites. Ask what worked, and replicate that. Ask what didn’t work and avoid that.
2. Partnership working is essential, as is a good board for the site that meet regularly and maintain good communication.

We learnt a lot from Neale about how CSTR sites function operationally, and the benefits that they offer to service users who have multiple and complex needs that, when addressed, can successfully divert them away from custody. In our next blog, we’ll be hearing from the Plymouth CSTR site, which went live in the beginning stages of the CSTR programme, in December 2017.