An outcome evaluation of the National Model for Liaison and Diversion scheme in England, which identifies and supports people in the criminal justice system with health issues and vulnerabilities, using a novel, large-scale linked data set. This evaluation looks at the impact on health service utilisation, reconviction, diversion from the criminal justice system, and timeliness of court processes, as well their economic effects.

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Outcome Evaluation of the National Model for Liaison and Diversion

by Emma Disley, Evangelos Gkousis, Shann Hulme, Katherine I. Morley, Jack Pollard, Catherine L. Saunders, Jon Sussex, Alex Sutherland

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Research Questions

  1. What impact, if any, did the implementation of the National Model of Liaison and Diversion have on health service utilisation; reconviction; diversion from the criminal justice system; or timeliness of court processes?
  2. What were the economic effects of any identified impacts?

Liaison and Diversion (L&D) services identify and support people in the criminal justice system who have vulnerabilities such as mental and physical health issues and learning disabilities.

RAND's evaluation of the National Model for L&D was conducted at 27 sites in England using a novel, linked data set combining national level administrative data from both the healthcare and criminal justice sectors.

This evaluation examined the impact of the National Model for L&D on health service utilisation, reconviction, diversion from the criminal justice system and timeliness of court processes, as well as the economic effects of identified impacts.

Analyses conducted across the data sources consistently showed that L&D services are successfully engaging with a group of service users with a broad range of vulnerabilities, often at a time of acute crisis when they are most in need of support. The strongest effect appeared to be an increase in diversion from custodial sentences, although L&D services may also increase referrals to mental health and drug and alcohol treatment services.

There was no evidence of an impact on offending, but also no evidence that outcomes became worse due to L&D referral.

Key Findings

  • L&D services succeeded in engaging people with a broad range of vulnerabilities.
  • L&D services appear to intervene at a point of crisis.
  • L&D services appear to increase diversion from custodial sentences.
  • The interventions offered, and their uptake, varies by individual and by L&D site, and range from advice and brief interventions, to primary care referral, to detention for psychiatric assessment.
  • Following L&D referral, there is a short-term increase in referral to mental health services.
  • Drug and alcohol treatment referral and attendance may increase following L&D referral.
  • Referral to L&D services does not appear to reduce offending.
  • Court processes are not significantly affected by L&D services.
  • The L&D programme contributes to savings in the criminal justice system between £13.1 million and £41.5 million through diversion from custody and consequent increases in productivity.

Recommendations

  • L&D services could be improved through increased capacity for onward referrals.
  • Approaches could be added to support people who have multiple vulnerabilities but who are not currently eligible for onwards referral because no single vulnerability meets the required therapeutic threshold.

Table of Contents

  • Chapter One

    Evaluation context

  • Chapter Two

    The methodological approach for the evaluation of the National Model for L&D

  • Chapter Three

    Characteristics of people referred to L&D and of the evaluation cohort

  • Chapter Four

    Accident & Emergency care utilisation

  • Chapter Five

    Use of specialist mental health services

  • Chapter Six

    Use of Improving Access to Psychological Therapies

  • Chapter Seven

    Use of drug and alcohol treatment services

  • Chapter Eight

    Offending

  • Chapter Nine

    Diversion from the CJS

  • Chapter Ten

    Court timeliness

  • Chapter Eleven

    Summary of economic evaluation of the National Model for L&D

  • Chapter Twelve

    References

  • Annex A

    Implementation of the evaluation

  • Annex B

    Data linkage and matching

  • Annex C

    Development of the counterfactual

  • Annex D

    L&D Programme minimum data set analyses

  • Annex E

    Variation in evaluation outcomes between L&D sites

  • Annex F

    Additional secondary analyses

  • Annex G

    Team leader interview interviews

  • Annex H

    Complete economic analysis

  • Annex I

    Approvals and consent

Research conducted by

This report has been prepared for the Department of Health and Social Care and NHS England and conducted by RAND Europe.

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