The CSTR scheme aims to reduce reoffending by improving access to mental health and substance misuse treatment in the community through greater use of treatment requirements in community or suspended sentence orders.

We spoke with, Gregory Yard, Senior Probation Officer and Mignon French, CSTR Programme Manager about their work with the Milton Keynes Community Sentence Treatment Requirement (CSTR) testbed.

This initiative seeks to reduce reoffending by supporting offenders’ access to mental health and substance misuse treatment in the community through enhanced use of treatment requirements in community or suspended sentence orders. The CSTR testbed launched in October 2017 and is part of a cohort of five pilots jointly overseen by the Ministry of Justice, Department of Health and Social Care, NHS England and Public Health England.

Expanding the use treatment requirements

Gregory and Mignon explained that before the Milton Keynes testbed site went live, research was carried out to inform their work. They found that at the point of sentencing, the use of the three treatment requirements which can be included within community and suspended sentence orders: drug rehabilitation requirements (DRRs), alcohol treatment requirements (ATRs) and mental health treatment requirements (MHTRs) for adult offenders, were rarely used. This is despite the fact that substance misuse and mental health issues are widespread within the offending population. They also found that prior to 2014, many people were not fully aware of what their requirements were, including what they meant, what their purpose was and what they intended to achieve.

This research was also undertaken to understand how to help those who were not considered eligible for referral to secondary services for mental health support. Lack of eligibility could be for multiple reasons: those who were continually reoffending had low level mental health issues and problems surrounding social and economic conditions including issues with housing, family and stability.

The Pilot

The CSTR pilot seeks to address these issues by introducing a new screening and assessment approach in courts and enhancing the provision of treatment within the community. At the local level, the approach is a collaboration between National Probation Service (NPS), Thames Valley Community Rehabilitation Company MTC Novo, P3, Her Majesty's Courts and Tribunals Service (HMCTS), Compass drugs and alcohol service, IAPT health care (Improving Access to Psychological Therapies), Clinical Commissioning Group, Health and Justice Commissioners.

In court, the new framework seeks to ensure that all assessments and consent required for a treatment requirement can be obtained on the day. Drug and alcohol assessments are undertaken by NPS duty officers as part of Pre-Sentence Report (PSR) preparation, with the support of community-based treatment providers. For mental health needs, an initial screen is undertaken by a support worker from the charity P3, and if a need is identified then an assistant psychologist will complete the required assessments with the support of an off-site supervisor.

Once sentences are passed, offenders receive treatment in the community. Substance misuse treatment is being delivered through pre-existing treatment provision, while additional provision for mental health treatment has been established as part of the pilot. Alongside treatment, clients also receive wrap-around support from a P3 link worker who will help them address issues such as housing, financial difficulties or relationship problems. Offenders with a ‘dual diagnosis’ can also receive both an MHTR and DRR or ATR simultaneously.

Improving outcomes for service users

The current project has its roots in a pilot which operated in Milton Keynes from 2014-2017 and sought to improve the use of MHTRs with the goal of reducing reoffending by addressing the core factors driving offending, in terms of both mental health and social care needs. An initial outcomes study found that offenders who completed the treatment showed a significant improvement in mental health symptoms, coping skills and criminogenic needs. The Milton Keynes project won awards from both the Howard League and HMCTS and was asked to present at the international conference for correctional reform in Los Angeles in 2015.

To date, the current project has produced significant increase in the use of treatment requirements, and improved engagement amongst people on those requirements, leading to improved compliance. Staff estimate that it has averted 142 weeks of custody and are now seeking to extend the length of the pilot in Milton Keynes and to expand the use of this model to other areas.

The Institute for Public Safety Crime and Justice is currently conducting a multi-site evaluation of CSTRs which it is contracted to do until 2023, though this may be extended. Seven sites form part of a continuous evaluation which comprises short bespoke reports such as: exploring health outcomes for MHTRs and exploring re-offending outcomes for individuals who receive mental health intervention as part of an MHTR; with reports like these forming part of a yearly overarching site report. 

In the 2020 Sentencing White Paper, the government committed to an expansion of the CSTR programme, aiming for 50% coverage of mental health provision by 2023/24 and aiming to go further with drug and alcohol treatment too. 

You can view the 2019 CSTR Protocol Process Evaluation Report here and also view our 2021 CSTR Briefing here.


This case study was compiled by Jaskirat Mann in 2018 and updated by Jason Watt in 2021

Click here to return to the Map

This project is part of our map of innovation, which charts innovative projects happening across the UK’s justice systems. You can search and filter the projects to find things that are most interesting to you.