Making sense of interactions between mental health and criminal justice services: the utility of cultural historical activity systems theory

• Date: 11 June 2018
• DOI: https://doi.org/10.1108/IJPH-01-2017-0006
• Published date: 11 June 2018
• Pages: 124-141
• Author: Sarah Hean,Elisabeth Willumsen,Atle Ødegård
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Making sense of interactions between

mental health and criminal justice

services: the utility of cultural historical

activity systems theory

Sarah Hean, Elisabeth Willumsen and Atle Ødegård

Abstract

Purpose –Effective collaboration between mental health services (MHS) and criminal justice services (CJS)

impacts on mental illness and reduces reoffending rates. This paper proposes the change laboratory model

(CLM) of workplace transformation as a potential tool to support interagency collaborative practice that has

potential to complement current integration tools used in this context. The purpose of this paper is to focus

specifically on the theoretical dimension of the model: the cultural historical activity systems theory (CHAT)

as a theoretical perspective that offers a framework with which interactions between the MHS and CJS can

be better understood.

Design/methodology/approach –The structure and rationale behind future piloting of the change

laboratory in this context is made. Then CHAT theory is briefly introduced and then its utility illustrated in the

presentation of the findings of a qualitative study of leaders from MHS and CJS that explored their

perspectives of the characteristics of collaborative working between MHS and prison/probation services in a

Norwegian context and using CHAT as an analytical framework.

Findings –Leaders suggested that interactions between the two services, within the Norwegian system at

least,are most salient whenprofessionalsengage in the reintegrationand rehabilitationof the offender.Achieving

effective communication within the boundary space between the two systems is a focus for professionals

engagingin interagency workingand this is mediatedby a range of integrationtools such as coordination plans

and interagency meetings. Formalised interagency agreements and informal, unspoken norms of interaction

governed this activity. Key challenges limiting the collaboration between the two systems included resource

limitations, logisticalissues and differences in professional judgments on referral andconfidentiality.

Originality/value –Current tools with which MHS/CJS interactions are understood and managed, fail to

make explicit the dimensions and nature of these complex interactions. The CLM, and CHAT as its theoretical

underpinning, has been highly successful internationally and in other clinicalcontexts, as a means of exploring

and developing interagency working. It is a new idea in prison development, none as yet being applied to the

challenges facing the MHS and CJS. This paper addresses this by illustrating the use of CHAT as an

analytical framework with which to articulate MHS/CJS collaborations and the potential of the CLM more

widely to address current challenges in a context specific, bottom-up and fluid approach to interagency

working in this environment.

Keywords Collaboration, Prison staff, Norway, Mental health, Integration,

Cultural historical activity systems theory

Paper type Conceptual paper

Background

Offender rehabilitation is a key strategy employed by criminal justice services (CJS) internationally to

reintegrate offenders back into society and reduce reoffending rates (Ministry of Justice, 2013;

Armstrong, 2012; Skardhamar and Telle, 2012). Offenders are encouraged to engage in education,

employment, drug treatment and other interventions as part of this rehabilitation process.

Received 31 January 2017

Revised 16 May 2017

12 June 2017

Accepted 13 July 2017

Sarah Hean is a Professor of

Social Work and Social

Sciences at the Department of

Social Work, Universitetet i

Stavanger, Stavanger, Norway;

and is at the Faculty of Health

and Social Sciences,

Bournemouth University,

Poole, UK.

Elisabeth Willumsen is a

Professor of Social Work at the

Department of Health,

Universitetet i Stavanger,

Stavanger, Norway; and is at

the Department of Health

Sciences, Hogskolen i Molde,

Molde, Norway.

Atle Ødegård is a Professor at

the Department of Health

Sciences, Hogskolen i Molde,

Molde, Norway; and is at the

Department of Social Work,

Universitetet i Stavanger,

Stavanger, Norway.

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VOL. 14 NO. 2 2018, pp. 124-141, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-01-2017-0006

Offenders’mental health mediates the success with which they engage in these interventions

and desist from future criminal behaviour (Skeem and Peterson, 2011). The disproportionate

levels of mental illness in prison populations reported in international syntheses of prevalence

statistics (e.g. 3.7 per cent of prisoners suffer from psychosis and 47 per cent from

personality disorder) are therefore a concern (Fazel and Danesh, 2002) and requires professionals

from mental health services (MHS) and the criminal justice system (CJS) to cross organisational

boundaries to work together (Fazel and Baillargeon, 2011; Andrews and Bonta, 2010; World Health

Organisation, 2005; Fazel and Danesh, 2002).

A sequentialintercept model outlines the pointswhere mental health and CJS work togetherduring

an offender’s trajectory through the criminal justice system. These are points where the MHS and

CJS are most likely to overlap in their objectives and where structures need to be in place to

facilitate MS/CJS interactions and easy access of the offender to MHS. The first of these points

(intercept 1) is at the pointof arrest, when interactions fall between the police/emergency services,

the MHS and theindividual. Post arrest, offendersmay also be diverted fromthe courts and criminal

justice system where possible and into MHS (intercept 2). However, if the individual enters the

prison system, then they need to have easy access to MHS so they can receive appropriate

treatment either during their court proceedings or subsequent custodial sentence (intercept 3).

When nearing release, offenders need to be prepared for their transition back into society and be

preparedto access community MHS when on the outside (intercept4). Finally ex-offendersneed to

receive support to maintain their mental illness and remain crime free when on the outside during

their probation, parole periods and beyond (intercept 5) (Munetz and Griffin, 2006).

Efforts to improve i nteragency collaboration a nd integration at these differe nt points of intercept

is in keeping with int ernational general health and welfa re service integration policy (e.g . Equity

and Excellence White Paper, UK –Department of Health, 2010; Norway’s Coordination

Reform –Department of Health and Care, 2013; WHO Global Strategy on People –Centred

and Integrated Health Services –World Health Organisat ion, 2015) but these d irectives have

tended to bypass forensic mental health and offender rehabilitation environments,

concentrating on less-complex inter-organisational collaborations. Where it is acknowledged

(e.g. in the US Congress of the Justice and Mental Health Collaboration Programme aiming

explicitly to fac ilitate collabora tion among criminal justice, mental he alth treatment and

substance abuse se rvices –CSR Incorporated, 2012), little is still known about what

characterises a ctual collaborati ve practice between the MHS and CJS profe ssionals. This is

despite integrati on and collaboratio n between these orga nisations being kno wn to impact on

reoffending rate s, the financial and emoti onal costs incurred by the of fender, the victims, th eir

families and the tax payer (Roman, 2013; Bond and Gittell, 2010). Researchers and

practitioners ne ed to understand thes e collaborative pro cesses by making thes e explicit if the

delivery of MHS to the offender population is to be improved.

Steadman (1992) and Burney Nissen (2010) have called for closer scrutiny of these MHS/CJS

interactionssupporting specificallythe systematic analysis of interorganisationalworkings using the

concept of the boundary spanner. Boundary spanners are individuals who facilitate cross system

cooperation between organisations. Their role is complex, requiring knowledge of both systems,

high levelsof initiative and the endorsementof all cooperating organisations(Burney Nissen, 2010).

Boundary spanners require a frameworks that will help them make sense of the work that takes

place in each of the collaborating institutionto help them articulate the challenges that exist at the

interface of the two systems and to structure innovative solutions to these.

Working with offenders and across MHS and CJS borders is a particularly complex adaptive

environment where many elements interact with each other in often non-linear and unpredictable

ways. It may be defined as a “wicked problem”in service planning (Rittel and Webber, 1973),

something difficult to define and that exists within open systems, influenced by a multitude of

interacting influences. Multiple solutions may be available but these are each difficult to predict,

test or disprove and will vary in effectiveness depending on the context and stakeholder involved.

As such, any solution aimed at improving reoffending rates, rehabilitation and interagency

working will resist attempts to develop standardised care pathways, structured interagency

meetings or service level agreements between organisations that promote uniform, one size fits

all coordination of care across agencies.

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