‘ There was initially some scepticism [ but ] what ’ s now evident is that our steering group of police , probation , the bench , and the NHS can all see the benefit of this approach .’
in the UK , but also in Europe . A lack of employment and housing , and adverse childhoods put the county on a par with Bristol and Manchester rather than neighbouring Devon , for example .’
Cornwall ’ s long history of deprivation goes hand-in-hand with higher rates of drug and alcohol use and other complexities .
‘ So , when the opportunity arose to implement combined MHTRs and drug and alcohol orders in Cornwall alongside With You , which already has extensive experience in supporting drug and alcohol issues , we were always clear that we didn ’ t want this to work is silos . It would certainly benefit those affected , the system and those who operate within it by reducing pressure on them and overarching costs . The approach has also had a positive impact on the individual in the system who may otherwise have experienced a very different outcome in the first instance or be at risk of reoffence . There was initially some scepticism from other agencies around combining the orders and how effective this would be . However , what ’ s now evident is that our steering group of police , probation , the bench , and the NHS can all see the benefit of this approach .’
ONWARD REFERRALS As part of a combined order , With You can support people with moderate anxiety , depression , and personality disorders , but not with serious mental illness ( which is eligible for a secondary MHTR ). In these situations , there would be an onward referral to an appropriate mental health service . During the assessment , the team will review individual circumstances and the ‘ why ’ behind every case , which often sees them take a trauma-informed approach and acknowledge the role that this might play in their daily life .
Taking a trauma-informed approach can help break down the stigma and fear around mental health and identify any link between this and people who struggle with drug or alcohol misuse . We have provided additional training to upskill our team to enable them to deal with lower-level mental health issues , working holistically with a personalised approach to see what motivates the individual .
We haven ’ t thrown the rule book out , but we don ’ t sit behind a desk in a meeting room if we are supporting someone who struggles with formality and authority . We get out and meet people where they are in their lives .
We ’ re in a strong position of offering combined community sentence treatment requirements ( CSTRs ) which includes MHTRs , so we have a unique perspective of knowing the right time to start the drug treatment or mental health treatment . For some people we support , it ’ s about teaching them to recognise when they ’ re struggling with daily life and teaching simple breathing techniques , mindfulness , or CBT . For others , it ’ s about harnessing the power of the outdoors and nature with activities such as sea swimming or coarse fishing . Our approach is holistic and adaptive to the individual ’ s needs .
HEARING FROM A SERVICE USER
Jason ( name changed ), was referred to With You during lockdown and had struggled with his mental health for many years . However , it wasn ’ t until he was given an MHTR that he got the support he needed .
‘ I ’ ve been told had I not been arrested during lockdown , I ’ d probably have been given a community order . Getting arrested turned out to be a blessing in disguise . I completed the MHTR order over a year ago , but I ’ m still doing everything my support worker recommended . It ’ s made me feel so much more in control of my life .
‘ I ’ ve lived with my mental health issues for so long I never thought I ’ d be able to manage them . I feel much more resilient now to deal with things . It lifted my mood and I ’ ve learnt to share my emotions and not keep them locked inside .’
HUGE POTENTIAL It ’ s apparent – and concerning – that those engaging with us have never received support for mental health issues before . One of the stand-out learnings for us is the use of functional analysis tools which are an integral part of MHTRs , helping to identify the root of the problem before developing a personalised solution for the individual . The potential for this kind of solution is stratospheric , and at a basic level is something that ’ s been right under our noses for too long .
‘ If we don ’ t deal with trauma and mental health , we are inevitably going to see future generations facing similar issues , finding drugs and alcohol as solutions ,’ adds Kim . ‘ Our data shows us how important it is to look at the individual - what they need and when – because everyone ’ s needs will differ . ‘ Many service providers don ’ t realise the link between neurodivergent conditions such as Aspergers , ADHD , depression , and low-level offending , or recognise that these individuals are increasingly finding it more difficult to access pathways to basic support , such as health , housing , and benefits .’
CULTURE CHANGE Mental health is everyone ’ s responsibility , and the biggest mistake support providers can make is to treat everyone who offends the same . With You has introduced training for all frontline workers - not just those working directly on MHTRs - to help them better understand the link between mental health and drug and alcohol misuse .
There is an urgent need to address neurodiversity and recognise the role it plays in why people offend . The experience of the last two years has shown us that if you create a 12-week person-focused plan for someone with anxiety and no neurodivergent issues , this same plan would likely fail someone who has anxiety and untreated ADHD who is selfmedicating with alcohol .
All our workers are able to adapt their practice and delivery to individuals with neurodivergent conditions , so that they can engage effectively in their CSTRs . The combined MHTR and drug and alcohol orders are working because the individual is at the centre of their own journey .
Eve Potts is operations manager at With You
For more information about With You Cornwall and the MHTR service visit : https :// www . wearewithyou . org . uk / services / cornwall-truro /
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