Jail ‘default’ option for people with mental illness – HM Prison Inspector

A new report from the UK’s Chief Inspector of Prisons says the country’s jails have become the “default” option for mentally ill people – even for those who pose little or no risk to public safety.

Anne Owers, head of Her Majesty’s Prison Inspectorate since 2001, said: “Prisons can provide better and more focused care for those who need to be there; but they will only do so effectively if there is sufficient alternative provision for those who should not be there, and effective community support for those who leave prison.

“Unless those gaps are filled, mentally ill people will continue to fall through them and into our overcrowded, increasingly pressurised prisons.

“Prison has become, to far too large an extent, the default setting for those with a wide range of mental and emotional disorders.”

‘The mental health of prisoners – A thematic review of the care and support of prisoners with mental health needs’ is published this week. In the report, Ms Owers and her team have identified key areas where the needs of mentally disordered offenders (MDOs) are not being adequately met.

Ms Owers said: “Two findings stand out starkly from this report. The first is that there are still too many gaps in provision and too much unmet and sometimes unrecognised need in prisons.

“The second, equally important, is that the need will always remain greater than the capacity, unless mental health and community services outside prison are improved and people are appropriately directed to them: before, instead of, and after custody.

“Our research showed serious weaknesses in the essential links with residential staff providing day-to-day care, those supporting suicidal and self-harming or segregated prisoners, forensic psychologists offering cognitive behaviour programmes, and
resettlement teams.

“It was of particular concern, given the well-established connection between substance misuse and mental illness, that joint work between mental health and
substance misuse teams was in general weak; nor did the initial clinical management of drug and alcohol dependent prisoners provide enough psycho-social support at this critical time.

“One of the key messages of this report is the need to develop a clear blueprint for the delivery of mental health services in prison, including appropriate external support and governance, and internal integration with other prison staff and services.”

The report also found that reception screening is failing to pick up the extent or diversity of need, partly because it is not always properly followed up by appropriately skilled staff, but also because the screening itself is not sensitive enough to pick up real, and particularly unacknowledged, need.

“Our research also found significant weaknesses and inconsistencies in court diversion and liaison schemes, established to identify and divert those who should properly be cared for in mental health settings,” said Ms Owers.

“Only two out of the 23 primary care trusts in our sample knew of the existence of such a scheme. The best diversion schemes had good links with health, social care, and access to forensic skills; the worst operated only occasionally and without any clear accountability or clinical governance.

“All were short of funds. We recommend that there should be a clear service specification for the delivery and focus of diversion schemes, and resources allocated to them.

“However, this essentially brings the argument back full circle. For, even if there were more and improved diversion schemes, there simply are not enough secure places for those who could appropriately be diverted there; nor is there sufficient community provision for those with complex needs, including mental health needs. Indeed, the failure to identify need, and provide support, at an early stage is the reason why some people offend in the first place.

“Our final, and perhaps most important, key message is therefore to those commissioning and providing services outside prisons. This requires the same holistic, multi-agency approach within the community as we have recommended in prisons.”

Rebecca Remigio, Head of Consultancy with Welsh mental health charity Hafal, said: “The crisis in the prison system means that for many vulnerable inmates prison is a frightening and dangerous environment.”

“The Ministry of Justice must address problems in sentencing guidelines to ensure that people with significant mental illness do not end up in prison and that courts stop sending women and young people, many of whom have mental health problems, to prison for offences which do not pose a risk of harm to the public.”

* To read ‘The mental health of prisoners – A thematic review of the care and support of prisoners with mental health needs’, click here