Mental illness, trauma, and crime: A global infection spreads 

Gavin Wilkinson
Monday, 10 December 2018

Whilst working for the probation service in an approved premises, I remember that Monday afternoon was the weekly scheduled spot to review the progress being made by our foreign national offenders. As a senior member of staff in the service foreign national offenders was my area of responsibility. After sifting through the ten files we had, nothing of note was brought up in the meeting until we came to the last file. Concern was starting to emerge amongst staff about Ahmed (not his real name). Staff were pointing to an increasing number of incidents in which Ahmed seemed to be more visibly distressed.

Ahmed was coming to the office to speak to staff more frequently, informing them that he was feeling unwell and stressed. He was also starting to isolate himself, spending more time in his room. Ahmed had fled to Britain from a country in which war and famine were part of its recent history. After being in the UK for a year he obtained employment (illegally) in a warehouse. After working there for a year he returned to his workplace with two other foreign nationals and committed a robbery in which cash, and various products were stolen. A security guard was also seriously injured in the struggle. Ahmed and his associates received prison sentences. Upon release they were subject to intensive probation supervision. 

The blockade begins
Because of Ahmed’s immigration status (declared illegal at the time) he had the threat of being sent back to his country of origin. At this point in time it was a denial from the embassy, representing Ahmed’s country of origin, that he belonged to them, which was delaying the inevitable deportation. In addition to this confusion, Ahmed also had the label of ‘no recourse to public funds’ hanging over him which meant housing, welfare benefits, and even some NHS services would not engage with him. The immediate uncertainty over Ahmed’s future was not helping him or us. Not being able to work, claim benefits, apply for housing and the extended decision (and the lack of transparency), about whether he was to be deported, or not was starting to make Ahmed feel more depressed.  He was also having trouble sleeping, becoming hypervigilant, and becoming increasingly irritable with those around him. 

Thinking of creative ways ahead for Ahmed 
We couldn’t help Ahmed with many important things. After a frantic search for services that could potentially offer assistance we found a service that specialised in helping displaced foreign nationals when they arrived in the United Kingdom. A conversation with a psychiatrist in this service led to the shared belief that Ahmed may well be suffering from the symptoms of post-traumatic stress disorder (PTSD). If Ahmed consented a psychiatric assessment should happen as soon as possible. PTSD is a psychiatric condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock. Symptoms can include disturbance of sleep and constant vivid recall of the experience, with dulled responses to others and to the outside world. Periods of depression, anxiety and hypervigilance are also common. 

The assessment process 
Ahmed agreed to be assessed for PTSD. In conjunction with the psychiatrist I began issuing the various psychometric tests to Ahmed to build a picture about the extent of his symptoms. After several clinical interviews, the psychiatrist concluded that Ahmed was suffering from PTSD, and would require treatment. Though our concern was that Ahmed could be deported without warning and his treatment could come to an abrupt end, and this could be potentially damaging for him. The psychiatrist decided to take the risk and began treating him. 

Ahmed’s life post assessment
Fifteen months after his psychiatric assessment, Ahmed was still in the UK and under the supervision of the probation service, and still receiving treatment. His symptoms were now becoming more manageable. Of equal importance was that he had not re-offended or violated the terms of his probation order. But he still did not have a clear decision from the authorities about his future. 

A clearer more definite way forward required for the UK 
Immigration enforcement within the Home Office in 2016 cited that 5,810 foreign national offenders (FNOs) were removed from the UK in 2015-2016. The highest number ever, and that 32,000 were removed since 2010. Up to 2,071 FNOs were removed during the Early Removal Scheme (ERS) period in 2015-2016, saving the tax payer approximately £25m. It is of note that 60 per cent of overall FNO removals in 2015-2016 were European Economic Area (EEA) nationals. In 2016 foreign nationals serving custodial sentences accounted for 7.7 per cent of the total prison population. Whilst these figures shine some light on the scale of the problem, the practicalities of working with some foreign national offenders receive little attention.

Access to already oversubscribed services can be difficult. The British Medical Association (BMA) in 2018 reported that waiting lists for mental health services for the severely mentally ill can range from six months to two years. The result of these problems is often a supervisory experience for an offender which is unhelpful, and potentially expensive for the tax payer home and abroad. Lack of access to services and transparency about the end game for this group means that the root causes of offending are difficult to address. 

Gavin Wilkinson works with internet sex offenders, and has 16 years of experience working in mental health and criminal justice services