I’m a nurse who has spent the past 15 years determined to bring hope, care, and empathy into the criminal justice system, by focusing on addressing the underlying reasons people enter the system.
My goal was simple: to enable the delivery of appropriate mental health support for those who need it as part of a community order, rather than resorting to prison or community orders that fail to address the root causes of criminal behaviour.
What is a Mental Health Treatment Requirement (MHTR)?
A Mental Health Treatment Requirement (MHTR) may be sentenced by the court and included into a community or suspended sentence order. The MHTR provides tailored mental health support for people with a range of underlying mental health difficulties, such as depression and anxiety. In total there are 13 requirements which may be included in a community order, the purpose being to prevent further offending by directly addressing the underlying reasons for offending behaviours. Three of these requirements are for treatment; in addition to the MHTR, there is the Drug Rehabilitation Requirement (DRR) and Alcohol Treatment Requirement (ATR). Treatment requirements are only included within a sentence if the person consents to the treatment pre-sentence.
Untreated mental health difficulties are all too often overlooked within the criminal justice system. But by focusing on mental health care and providing the right support at the right time, we have been able to help people break free from cycles of crime and begin healing from past traumas and life circumstances.
From 2008, I worked in the Department of Health supporting a national women’s programme. During this time, I was shocked to discover how underused MHTRs were, especially considering the benefits they could offer people, their families, and the justice system. I was baffled as to why these options weren’t being widely used, particularly when they had the potential to offer a robust alternative to prison sentences.
I became a Magistrate in 2010, which confirmed the high prevalence of untreated mental health difficulties among defendants, as described within Lord Bradley’s report (2009) into mental health and the criminal justice system. It became clear there were fundamental issues around how MHTRs were being applied, and which agency was responsible for delivering them.
Overcoming the barriers to offering Mental Health Treatment Requirements
I couldn’t stop thinking about how we could ensure that people in need of mental health support had access to treatment instead of being sentenced to prison. I was determined to find a solution.
By chance, I met Andy Bell from Centre for Mental Health. Together, we discussed the barriers preventing the effective use of MHTRs and brainstormed potential solutions. We decided to bring together key partners, supported by Centre for Mental Health, including representatives from the Department of Health, Ministry of Justice, NHS Commissioning, and national psychology leads to tackle the problem head-on.
Looking back, this meeting was the starting point of the MHTR journey. It sparked a collaborative effort to address the issue, and we soon realised there was a clear problem: up until that point, there had been no direct commissioning responsibility, no clinical model, and no evidence to support the delivery of MHTRs in a way that could improve health outcomes and reduce reoffending.
Providing effective mental health support to people given community order
With initial seed funding from NHS England, the MHTR pilot launched in Milton Keynes Magistrates and Aylesbury Crown Court during April 2014. After extensive planning led by probation, we conducted mental health awareness-raising for court staff, probation officers, judicial members, health care providers, and substance misuse staff.
We employed a clinical psychologist and two assistant psychologists to screen, assess, and gain consent from the people who had been referred by probation pre-sentence. If they were sentenced by the judiciary, the MHTR team then provided bespoke psychological interventions post-sentence which formed part of the community or suspended sentence order.
For the first time, people were sentenced to a community order from a dedicated MHTR provider who could provide the MHTR, or an MHTR in combination with a drug or alcohol treatment requirement.
The impact of this pilot was groundbreaking: in the year prior, only three people had been sentenced to an MHTR at Milton Keynes Magistrates and Aylesbury Crown Court. By the end of the first pilot year, this number had increased to over 60. This meant more people receiving effective mental health support, and fewer going to prison for short-term sentences which didn’t address the underlying offending issues.
Importantly, the feedback we received from the people who experienced the service was better than we could have hoped for. Many people described how their lives had been saved, families kept together, and, for the first time, they had felt heard and valued. Particularly for women (many of whom had been victims of abuse and trauma), these interventions gave them the confidence to move forward and build a better future.
A national initiative for Mental Health Treatment Requirements
From that point, the journey has been one of continuous learning, development, and collaboration. The success of the Milton Keynes pilot led to the creation of a national partnership programme. In 2017, I became the Programme Manager of a partnership replicating the Milton Keynes pilot in five areas, along with increasing the use of drug and alcohol treatment requirements.
Moving forward, by the end of 2025, MHTR services will be available across all criminal courts in England, commissioned by NHS England. The ongoing national evaluation of the MHTR programme is set to conclude by the end of 2025, but the latest published data continues to show statistical significance in improved health outcomes, and a statistical reduction in reoffending. To date, from the evaluation sites alone, there have been over 7,000 people sentenced to a community order which includes mental health treatment, instead of other community orders or prison sentences.
2025 brought my MHTR leadership within NHS England to an end, but the journey continues, with the need for further funding and greater support for people who require swift access to MHTRs through secondary care services. Last week, the Independent Sentencing Review advocated the increased use of Community Sentence Treatment Requirements (like MHTRs) for people with mental health needs.
What keeps me motivated is the belief that MHTRs have the ability to change lives. By working together, we can build a system that heals rather than punishes.
