Dr Saal Seneviratne Expert Witness in Psychiatry

Review of journal article:
Severe mental illness, common mental disorders, and neurodevelopmental conditions amongst 9088 lower court attendees in London, UK

Chaplin et al. BMC Psychiatry (2022) 22:551

For 25 years, Court Mental Health Liaison and Diversion services (CMHLDS) have supported vulnerable individuals within England and Wales’ criminal justice system. They don’t provide treatment but assess and guide decision-making for charges, sentences, and disposal of defendants. Despite their importance, CMHLDS face issues like varied local interpretations of policies and problematic sharing of information across justice pathways. While major mental illnesses are their focus, they also support other vulnerable groups. Deficiencies in the CMHLDS have been highlighted, especially regarding intellectual disability, autism, and ADHD. Despite a high prevalence of mental health needs and substance misuse among referred defendants, there’s a need to extend CMHLDS to individuals with multiple vulnerabilities. Comparisons of mental illness prevalence across different settings within the criminal justice system are required to enhance service provision.


They collected data from the National Health Service Minimum Data Set (MDS) in the UK. Providers sent monthly data forms to the National Health Service England (NHSE), which were then compiled into aggregated data. The data reflected information from clinical and custody records and was obtained directly from frontline court and liaison staff. The data complied with ICD-10 criteria. Various disciplines, including Forensic Mental Health Practitioners, Registered Nurses, Forensic Psychiatrists, and psychologists, contributed to the data. Assessing clinicians reviewed historical records and conducted assessments to assign diagnoses. The data was analyzed using SPSS 25, employing descriptive statistics, chi-square tests, and measures of association. The data collection process followed ethical guidelines, with permissions obtained from NHSE and Together, the organization responsible for managing activity data in criminal justice services. All data were anonymized before being provided to the research team.


In the study, 9,088 defendants were referred to the CMHLDS. The majority were male (79.1%) and the average age was 37.5 years. The most common age group was 30-39 years. The defendants’ ethnicities were primarily White (50.2%), followed by Black (20.2%), Asian (12%), Mixed ethnicity (6.1%), and Chinese (0.2%). Psychiatric disorders were identified in 72.8% of defendants, with schizophrenia, personality disorder, and depression being the most common. Males had higher rates of schizophrenia and neurodevelopmental disorders (NDDs), while females had higher rates of personality disorder, anxiety, depression, and bipolar affective disorder. Substance use disorders were more prevalent than alcohol misuse, with higher rates among males. People of mixed ethnicity had the highest rates of substance use disorder, while those of White ethnicity had the highest rates of alcohol use disorder. NDDs were present in 5.5% of defendants, with intellectual disability being the most common. Males were more likely to have NDDs, and White and mixed ethnicity individuals had higher NDD rates.

Discussion and conclusion

The evaluations of the CMHLDS (Criminal Justice Liaison and Diversion Services) indicate their effectiveness in identifying offenders with psychiatric disorders. However, more research is needed to determine the number of defendants with mental health needs who go unidentified and would benefit from referral. There is a need for understanding which services work best for vulnerable or marginalized groups. This study examines the characteristics of 9,088 defendants in CMHLDS in London, revealing high rates of psychiatric morbidity, with schizophrenia, depression, and personality disorders being common. Substance and alcohol misuse rates were also high. Neurodevelopmental disorders were present in a small percentage of defendants, and further research is required to address their specific needs within CMHLDS.