Towards a health-informed approach to penal reform? Evidence from ten countries • The recent growth in the length of prison sentences (including the greater use of life and other indeterminate sentences) should be reversed, so that custodial terms are of fixed duration and proportionate length, with a focus on rehabilitation and preparation for release. 4.2.2 Reducing numbers of people with mental health conditions in custody The prison setting will rarely be a positive one for mental health treatment. A range of measures and options can be pursued to divert from prison (and perhaps from prosecution) people who, on account of their mental health conditions, should not be in custody at all. These include measures to divert people away from the criminal justice system at the point of their first contact with police following an arrest or a report of unusual or disturbing conduct. If a person with mental health problems is prosecuted and convicted, treatment orders and similar measures can be used by courts at the sentencing stage, with input from social workers, psychologists, probation officers and other experts. It should also be possible to transfer from custody into more suitable accommodation people whose mental health has significantly deteriorated in prison, for example, prisoners with severe dementia or a terminal illness. We outline below some specific interventions capable of reducing numbers of people with mental health problems in custody, which could be adapted for use in other similar jurisdictions. These approaches require a reasonable level of community-based provision and decent, humane alternatives to custodial settings. In much of the world, community mental health services, psychiatric hospitals and residential units suited to the needs of mentally ill or otherwise vulnerable people are scarce or non-existent. Where this is the case, the first stage of any reform process must be an assessment of existing alternatives and of the available resources to build alternative capacity and health provision in the community. The measures outlined below also require effective systems for information-sharing and collaboration between the police, probation and court services, on the one hand and health and social services, on the other. Putting these systems in place will be a necessary first step to reform in some countries. Diversion schemes Lord Bradley’s review of people with mental health problems in the criminal justice system of England and Wales reported in April 2009 (Bradley, 2009). Many of its recommendations have been instrumental in changing policy and practice. The review highlighted the importance of diverting people with mental health needs away from prosecution and prison into treatment and care. One intervention flowing from this has been the system of ‘liaison and diversion’. The essential elements are: • identifying people coming into contact with the justice system with mental health problems, intellectual or learning disabilities, substance misuse or other vulnerabilities • assessing the identified individuals and referring them to an appropriate treatment or support service • sharing information (with the individual’s consent) with criminal justice agencies and the judiciary, so that informed and timely decisions can be made about case management and sentencing. Clearly the success of such schemes depends on the availability of community support and treatment options. A chronic shortfall in funding for mental health services has been identified as a potential limitation on its future effectiveness in England and Wales. ‘Street triage’ systems In recognition of the high degree of involvement between police and individuals who may have mental health problems, the street triage system was introduced in parts of England in 2013. It involves dedicated mental health professionals working in teams with police officers, listening to calls for assistance, attending scenes that 22