Increasing the Use of Treatment Requirements (MHTR and ATR) in Criminal Justice: A Path to Rehabilitation

Jessica Kimbell, GovNet
Oct 18, 2023

G20MJIT - Interview with Mignon French-1

Ahead of the Modernising Criminal Justice conference on 12th November 2020, the GovNet team caught up with Mignon French to talk about treatment requirements as part of a community sentence, as an alternative to custody; as well as the recent pilot study in this area.

It is well documented there are high numbers of individuals within the Criminal Justice System who experience significant mental health and substance misuse problems, but the use of treatment requirements as part of a community sentence remains low and has been declining over recent years.

There are many reasons for this and includes the need to improve partnerships between health and justice along with reducing siloed working. Also improved engagement with individuals that may have a number of vulnerabilities and/or disengaged from services, and the availability of effective and appropriate treatment provision.

Improved partnerships can increase the use of treatment requirements, particularly as an alternative to custody. There are three types of treatment requirement: Mental Health Treatment Requirement (MHTR), Drug Rehabilitation Requirement (DRR) and Alcohol Treatment Requirement (ATR)

Treatment requirements are not new; they were introduced as a sentencing option in the Criminal Justice Act in 2003. By 2018, however, out of all community requirements commenced only 0.4% were for MHTRs, 4% DRRs and 3% ATRs. This is in the context of a 39% decrease in the number of people starting community orders between 2009 and 2018.

Some of the reasons thought to contribute to the low uptake of the treatment requirements, are highlighted in the CSTR Evaluation[1]. One example is a lack of clarity regarding suitability to receive a treatment requirement, especially MHTR, for those with lower-level mental health and complex social issues. Other barriers include commissioning responsibility, appropriately accessible services for all adults, along with awareness of sentencers about the effectiveness of mental health/substance misuse treatment requirements for individuals with associated vulnerabilities.

All members of the general population have access to treatment, and this should be no different for an individual involved in the Criminal Justice System. However, the reality is that the availability of holistic care to support those with complex health needs is difficult, especially when the individual presents with multiple issues such as mental health, substance misuse, social, trauma and abuse.

To address this a national partnership has formed to tackle this issue. The Community Sentence Treatment Requirement (CSTR) Programme which developed in 2017, includes Ministry of Justice, NHS England and NHS Improvement, Department of Health and Social Care, Public Health England and Her Majesty’s Prison and Probation Service. This is the first programme to focus on defining effective assessment and treatment processes through integrated partnerships for individuals whose offence falls into the category of a community or suspended custodial sentence order.

The CSTR programme focuses on increasing the use of all three treatment requirements, reducing reoffending, and to offer an alternative to custodial sentences, by addressing the health and social issues.

Individuals may be assessed to determine whether they are suitable to receive a CSTR and have consented to receive a drug, alcohol or mental health treatment requirement along with identifying additional social support they may require. The CSTR delivery partners will then work together to ensure that processes, services and pathways are in place to enable information, assessment and consent on the day of the court hearing wherever possible. The recommendation is then provided to the court as an option within the community order, ensuring that information about the recommendations includes the treatment plan, confirmation of informed consent, and details of the organisation or clinician who will oversee the treatment requirement.

Lessons learned from five sites have now been published [2] and indicate that by strengthening partnerships, processes and governance pathways it is possible to increase the use of treatment requirements, in particular MHTR. The process evaluation also provides feedback from the site workforce and individuals who collectively agreed that increased use of CSTRs is beneficial in addressing some of the underlying causes of offending behaviors, offering an alternative to custodial sentences and enabling rehabilitation within the community.

We are pleased that this programme is now increasing to cover additional courts across England. The CSTR programme is actively working with a number of new areas, supported by funding from NHS England & NHS Improvement along with local partnership funding from health and justice services. This is providing clinical expertise both within courts and to provide treatment/interventions post-sentence. In addition, CSTR programme leads to work with areas to develop integrated health and substance misuse partnerships thereby increasing the use of all treatment requirements





Mignon French is a jointly qualified general and psychiatric nurse who has worked across the mental health sector for over 30 years. Her professional interest in Criminal Justice, mental health and associated vulnerabilities has further developed over the past 15 years. In 2014 she was central to developing the first  Mental Health Treatment Requirement (MHTR) pilot in Milton Keynes which provided some of the thinking and learning for the current Community Sentence Treatment Requirement (CSTR) Programme. Mignon was appointed as the CSTR Programme Manager in the summer of 2017, where she is responsible for working directly with the original five CSTR testbed sites, as well as supporting new and developing sites. Along with partners, Mignon also takes a lead role in the development, implementation and strategic direction of the CSTR Programme which reports into the CSTR Programme Board, a partnership between Ministry of Justice, NHS England, Department of Health and Social Care, Public Health England and  Her Majesty’s Prison and Probation Service. Mignon is also a Magistrate Chair in Northamptonshire and takes an active lead in highlighting the vulnerability issues by providing specialist knowledge about mental health and associated vulnerabilities.