Secondary Mental Health Treatment Requirements: Evaluation of the Pilot Programme

Background
Mental health problems are common in people in contact with the criminal justice system who can find it difficult to access and engage with treatment. Mental Health Treatment Requirements (MHTRs) can be added to community sentences in England and Wales as an alternative to short prison sentences. They require the person to attend for mental health treatment. These orders have been successfully used by people with primary-care level treatment needs. They are rarely used for those with severe mental health problems who require specialist (secondary) care, despite high levels of unmet health need. Policy makers would like to increase use of these secondary MHTRs. However, there is little evidence about how to do this, how they currently work, their costs, or effects on health.

Aims/objectives
We aim to evaluate secondary MHTRs at three sites in England which have received funding to develop ways to increase their use (‘proof of concept’ sites), and one site in Wales by:
1. Developing an MHTR programme theory of how MHTRs work (or do not) that would facilitate understanding of need, barriers to take-up and delivery, and solutions
2. Identifying a method for the large-scale evaluation of effectiveness and cost-effectiveness of secondary MHTRs

Method
1. We will conduct primary research to develop an Initial Programme Theory (IPT); a generalisable model of how secondary MHTRs work and for whom. This will include development of a cost and consequences model of secondary MHTR use. The IPT will be developed, tested and refined within each site through consultation with policymakers and multi-agency practitioners, patients and carers, and examination of routine NHS data and documents. Qualitative data will be analysed using a realist approach to thematic analysis. We will use the IPT to develop flexible guidance for practitioners and services.
2. A PPI panel will provide consultation throughout the study. We will consult with them and policy makers to conduct an evaluability assessment. We will explore data availability and draw upon the IPT to develop a study design, including a feasibility phase, that can be built in to a future secondary MHTR rollout. We will establish which routine data are required to monitor and evaluate service quality.