Missed 'psychiatric' cases? The effectiveness of a court diversion scheme

Court Diversion Schemes have been evaluated in terms of clinical outcome or case disposal in studies focusing on individuals who are referred to the scheme. Little is known about the 'psychiatric caseness' of court defendants not referred. The present study was undertaken with the aims of identifying levels of 'missed caseness' in an 'in-custody' population at a busy London Magistrates court and to consider how such populations might be more effectively screened. A random sample of individuals in custody was selected and semi-structured interviews conducted (n = 100). Very high levels of alcohol abuse, illicit drug misuse and histories of deliberate self-harm were found. Such individuals were very unlikely to be referred to the duty psychiatrist scheme. These findings highlight the difficulties in screening for alcohol abuse, illicit drug misuse and histories of deliberate self-harm in an in-custody court population. The context in which screening takes place is discussed. Realistic and inexpensive improvements are suggested for identifying those at greatest risk.