The Rotherham Pathways service, run by national mental health charity Together for Mental Wellbeing, supports young people to lead a life away from crime. It offers mental health support to vulnerable young adults aged 17 -24 years who come into contact with police and emergency services in Rotherham.
Evidence shows young people aged 17 to 24 years are the most likely to commit a criminal offence, but also the most likely to desist with the right support. Yet too many vulnerable young adults are entering the justice system because they are not able to access the support they need in their local community. Much attention is now being given to the overlap and interaction between mental health, policing and the criminal justice system and it is now accepted that a solution must involve all three.
Winners of 2016 Positive Practice Children & Young People’s MH Award
Sadly young people who come into contact with the police often have a range of complex underlying needs including substance misuse, learning difficulties, homelessness, extreme poverty, trauma or abuse. These can often go unnoticed and remain unmet for any number of reasons and their behaviour may lead to a number of arrests rather than tackling the root cause.
The Rotherham Pathways service, run by national mental health charity Together for Mental Wellbeing, supports young people to lead a life away from crime. It offers mental health support to vulnerable young adults aged 17 -24 years who come into contact with police and emergency services in Rotherham.
The service supports individuals to manage their mental wellbeing and access community resources, from employment and training, to housing, mental health and substance misuse services. The staff team also supports young adults to identify, understand and alter any behaviours that are perpetuating their mental distress.
Individuals who are at risk of offending or at a pre-conviction stage are identified at the earliest possible opportunity. A mental health practitioner is available in police custody and individuals can also be referred by police, the Vulnerable Person’s Unit, the Youth Offending Service (YOS), mental health services including Child and Adolescent Mental Health Services (CAMHS) and other local agencies.
Young adults are then supported for approximately twelve months, for up to six hours per week. The aim is that each individual will leave the service having developed a personal set of resources that will reduce their mental distress, risk of offending and dependency on emergency services.
By working closely with young people and the South Yorkshire Police, Pathways has successfully managed to divert young people away from the police by 44% (comparing police contacts pre and during intervention). This demonstrates how the service has made a real difference by reducing police time and costs.
The service has also made a real difference to the lives of the people it supports and they have been positive about what it has enabled them to achieve. People have told us that before Pathways they didn’t know where to go for help and were struggling with managing their mental wellbeing and other practical things such as finding suitable housing.
Since using Pathways individuals have been supported to identify the three hardest things that are currently making their lives difficult and then take steps to overcome these things. This could include support to help manage their mental wellbeing, find a job, a local activity to take part in or a place to live.
For example, Ryan who uses our Pathways service in Rotherham, told us what he has been able to achieve since receiving support: “I was referred to Pathways by the local area housing officer. Pathways came to see me at home and asked me lots of questions about how they could help me. I told them about how down I felt and about the voices that I was hearing. They really listened to me and I felt like they understood me. I was drinking, taking drugs and hurting myself to make the feelings I was experiencing go away.
Pathways accompanied me to lots of appointments including my GP, benefits interviews and drug and alcohol appointments. Pathways also referred me to secondary mental health services but after assessing me they said I didn’t fit their criteria. A few months later I wasn’t getting any better so Pathways referred me again. After another assessment they allocated me a Care Coordinator and a Support Worker and I am just waiting to hear from them. Pathways also referred me to a local housing support project so I now have a tenancy support worker who helps me keep on track with my bills and keeping my tenancy in order.
With support from all the people I have around me I was awarded priority to move to a one bedroom flat, I am currently bidding on properties and looking forward to moving.
Things feel like they are looking up and I’m positive about the future. I am very grateful for all the support I have had from Pathways, thank you for being there for me.”
The Rotherham Pathways project is one of six that form part of the T2A Alliance’s three- year national Transition to Adulthood Pathway programme to deliver interventions to young adults involved with the criminal justice system. On a day-to-day level Together runs the project in partnership with South Yorkshire Police, Rotherham Metropolitan Borough Council and Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust (RDaSH).
The Pathways service works strategically with these partners to develop ways in which they can work together more effectively and, as a result, help prevent individuals from reaching crisis point.
The service is also support the work happening as part of the Crisis Care Concordat. Crisis responses only go so far, what Pathways provides is support before and after a crisis to prevent it from reoccurring. In addition, the service encourages strategic leads for emergency services to take account of the precipitating, longer-term factors behind emergency service use and ensure individuals have access to support to addresses these.
The partners we work with are positive about the support Pathways offers. For example, a member of the police force in South Yorkshire, told us that:
“There is an overwhelming acceptance that the vast majority of incidents that we attend involve some form of mental ill health. As a service we are neither trained or are adequately prepared to deal with the complex demands of the individuals involved. To have the Pathways team working alongside the police is hugely important. The Pathways team are able to target a particular group and as such provide a much more focussed service to those individuals. This has allowed me to signpost people to Pathways in the knowledge that they will receive the support they require. This has, in turn, led to a reduction in demand on police services.”
The charity has a dedicated Service User Involvement Directorate which ensures that people with lived experience of mental distress are not just involved in shaping the way its services run but that they lead the way.
The Pathways service has worked closely with the Service User Involvement Directorate to ensure that it has its own specific service user leadership strategy. By taking on board feedback from people that use the service and ensuring this is used to make changes and improvements to the service, it is able to build on what works and what doesn’t. This ensures that the service is truly led by those that use it.
The Pathways service user leadership strategy involves three specific types of feedback: Using verbal feedback and implicit feedback; Giving feedback at the senior project board meeting; Providing feedback on the ‘3 Hardest Things’ tool Using verbal feedback and implicit feedback Meetings, questionnaires and board meetings are a great way to get feedback. This is a tactic used at Rotherham Pathways to gain both positive and negative feedback to drive forward service improvements. However, when speaking to a group of young people who can be difficult to engage it is important not to solely rely on these methods. The staff team is specifically trained to look for implicit feedback from people who find it difficult to communicate. This means focusing on what people don’t say, as much as what they do say. The team looks for behaviours such as: individuals not turning up for appointments, concealing information and displaying aggressive behaviours. This feedback is then used to develop ways to better communicate with individuals and ensure they want to use the service and that they feel comfortable sharing information.
Collectively the team also reflects on how things have gone, including what’s gone well and what could have been done differently. This fosters a culture of feedback, mutual learning and continual improvement. This staff feedback is used to directly shape and develop the service. For example, as a result of feedback the following changes have been made:
We increased the length of time that we offer support for from three months to 12 months, • We changed the way we use assessment forms, ensuring we build a rapport with the individual, rather than asking lots of questions at the initial meeting.
Feedback at the senior project board meeting
Service users are invited to attend a senior project board meeting. This meeting is attended by senior staff and key stakeholders of the project. It has a key role in directing the project. Service users are supported to bring feedback in whichever medium they feel comfortable. They might choose to tell their own story of how they came to use our service. They might share their experiences of mental health, police and criminal justice services. Or, they might discuss a particular aspect of health or justice engagement. At this meeting the people that use the service tell us:
How Together has worked for them and what could be improved
How services have served them in the past and any problems
Advice to all agencies about how they could improve Feedback on the ‘3 Hardest Things’ tool The ‘3 Hardest Things’ is a support planning tool that allows the service user to take the lead in identifying the three areas of need that are most important to them currently. Staff then plan the support they receive from the service to address these needs. The service user takes the lead in deciding on what outcomes are important to them, thinking about what they would like their life to be like. The staff then work backwards to decide what the first step will be in addressing the problem, in order to begin their journey towards resolving it. Working in this way ensures that the individual stays in control throughout the process and is motivated to engage with the service, rather than feeling support has been decided by the professionals. By involving staff, service users and carers in the way the service, Pathways ensures that it continuously improves the support it offers.
When Pathways first started providing support, people aged 18-24 years who were at risk of entering the Criminal Justice System, or had their first contact, were able to use the service. After the service started it became apparent that there was the need to provide support to people aged 17 year olds, which it now does. As part of the ongoing service development, it has been raised through feedback, and at the strategic board, that the service could also support 16 year olds to better bridge the transition from Children’s and Adolescent Mental Health Services. This is something the project is now looking into doing, but had it had known this at the start it may have increased the age range sooner.
The service has also dealt with individuals with a high level of need, due to cutbacks to statutory services nationally. The service also didn’t anticipate receiving a high number of referrals for people with learning difficulties, autism and those displaying sexually inappropriate behaviour. Pathways is one of the only services to not exclude this group. The model was initially equipped to deal with individuals with a high level of need. However, it needed to build partnerships with other services to gain referrals. If the service was to start again, it would develop these relationships from the start in order to support the individuals with complex needs from the outset.
Alongside offering practical support to individuals to help them manage their mental wellbeing, a key aspect of the service is supporting individuals to access community resources, from employment and training, to housing, mental health and substance misuse services.
One of the key challenges faced when setting up the service was that some of the services that people were referred onto were already full, or people did not meet the eligibility criteria. Furthermore, some services that might be needed do not currently exist in Rotherham.
As a result, the service increased the length of time that individuals were able to access support from three to 12 months. This ensured that individuals were able to access support for long enough to tackle all of the things that are making their lives difficult.
The Pathways service in Rotherham is run by a national mental health charity, Together for Mental Wellbeing. The organisational support that Pathways receives ensures that there is a high level oversight of the project and that effective methods of recruitment and retention of staff are in place, so that the service can continue running effectively at all times.
More locally, Pathways was designed from the ground up, in line with the local need in Rotherham. The project acts as a focal point for multi-agency collaboration, by pooling relevant information to understand and address issues, and as an integrator between services. We have helped develop alternative, yet sustainable, pathways to help divert this cohort from becoming entrenched in the criminal justice system as a result of their vulnerabilities going unmet. Pathways is a viable and effective model, that benefits partners and public alike and there is agreement and commitment from the partners we work with to continue and grow this service. Together’s Criminal Justice Directorate also works to ensure that the lessons learnt can be shared to support developmental opportunities and also that the model can be replicated in other areas.
Initial data collected from the individuals we have supported has shown that there has been a decrease in arrests for the people Pathways has supported.
The service is also being evaluated independently as part of the T2A Pathway Programme. The multi-faceted evaluation of the T2A Pathway Programme will evaluate the impact and effectiveness of the six T2A Pathway projects and is being carried out by Hallam Centre for Community Justice at Sheffield Hallam University and its partner Social Justice Solutions, completing in 2017.
The over-arching aims of the evaluation are to:
Establish an evidence base for the T2A projects; Demonstrate effective interventions; Measure the impact of delivering young adult-specific interventions at the T2A pathways points; Provide robust evidence that will be taken seriously by policy-makers and commissioners at a central and local level.
An interim report, published in May 2016, identified areas that are particularly relevant to our Rotherham model – for example, evidence to suggest the benefits of a welfare-driven approach to young adults and a holistic approach to the complex and numerous needs of clients. The report also referenced how projects were able to align their service to meet a locally-identified unmet need that had been identified by key statutory agencies, and this has certainly been the case for the Pathways project in Rotherham.
The Pathways service uses what it learns to develop ways in which emergency services and other key organisations can work together more effectively and as a result help prevent individuals from reaching crisis point.
The service also regularly attends events and gives presentations to share lessons learnt. For example, in March this year the Project Manger attended the Oxford University Department of Criminology’s 50th anniversary event on Criminal Justice and Mental Health. The Manager gave a presentation to students and professionals about the project and how it is delivered. The feedback was very positive and gave the chance for those assembled to hear about how a frontline service can tackle some of the problems around poor outcomes and reduced funding for this client group. The Manager also presented at the Kings Fund conference for CAMHS professionals. On that occasion a former service user gave his own account of how the service had been helpful to him, and how we differed to statutory services in terms of engaging him positively and him feeling listened to.
As part of the T2A evaluation, Together will be supporting the dissemination of the evidence base that highlights how services that take into account maturity and transitions for young adults at key points throughout the criminal justice process can be more effective. We will use our external communication strategy, which includes using social media as a tool to reach a wide range of audiences.
Here are a few comments from people we have supported, as well as family members of people we have supported, about the service:
“I can’t go bored or fed up anymore, I keep my mind on things and keep motivated, I know I hear voices in my head but I have just got to live with it and ignore it. I am really grateful for your support, it really means a lot to me, thank for being there for me” (young adult).
“Thank goodness for your service Alison because you’re a lifeline…I’m visiting my son in his lovely flat with hope for the future when I’m sure I could have been one of the visitors visiting him in prison. Thank you.” (Mother)
“Thank you once again for all your support. The one true fact is that without you I’m sure the outcome for Joe would have been very different I’m sure of it. You listened to concerns and beyond that you took action. Action is the big word here because services such as mental health said the words but took no action and if it weren’t for you Joe could have ended up in a circle of going into prison. Not because he is a bad person but because I feel it would have been easier to send him down that road” (Mother)
