15 MENTAL HEALTHCARE IN PRISONS
357. The Prison Reform Trust estimates that around
90% of prisoners can be diagnosed as suffering from at least one
of the five main categories of mental disorder: psychosis; neurosis;
personality disorder; alcohol misuse; and drug dependency.
Seventy-two per cent of male and 70% of female sentenced prisoners
suffer from two or more of these mental health disorders. Around
20% of those on remand and 12% to15% of those serving sentences
suffer from four of these five mental disorders. A high proportion
of prisoners have been treated in psychiatric hospitals : 20%
of male and 15% of female sentenced prisoners have previously
been admitted for in-patient psychiatric care.
358. Concern about the quality of health services
available to prisoners increased in the mid-1990s. In 1997, the
Report of the Independent Standing Health Advisory Committee for
the Prison Service stressed the importance of "equivalence"
in mental health care provision; that is, that the mental health
services available to prisoners should be of the same type and
range, and of the same quality, as those available to NHS patients
in the community.
359. In the late 1990s, the then Home Secretary and
Health Secretary jointly established a Working Group from the
Prison Service and the NHS Executive to consider the future organisation
of, and ways of improving, prisoners' health care. The Group accepted
the principle of equivalence, both in terms of mental health services
and of prison health care generally. The strategy now being implemented
by the Prison Service stems from the findings and recommendations
of that Working Group, as set out in its Report, The Future
Organisation of Prison Health Care (1999).
360. We welcome the Government's adoption of the
principle of equivalence in relation to the provision of mental
health care for prisoners, and the dedicated NHS funding to support
the introduction of multi-disciplinary teams in prisons designed
to provide mental health services for prisoners along the lines
of community mental health teams. However, there is a long way
to go before prison health care provision matches the NHS standards
of care in the community.
361. In April 2003, responsibility for funding for
prison health services was transferred from the Home Office to
the Department of Health. It is planned that within five years
NHS Primary Health Care Trusts will be responsible for health
care provision in prisons in their area. Dedicated funding has
now been made available from the NHS budget to support the introduction
into prisons of multi-disciplinary teams which are designed to
provide mental health services for prisoners along the lines of
community mental health teams which provide services to the population
at large. By the end of 2004, there are due to be mental health
in-reach teams in 88 prisons in England and Wales. The Department
of Health's NHS Plan (July 2000) included the commitment that
"by 2004, 5,000 prisoners at any time should
be receiving more comprehensive mental health services in prison.
All people with severe mental illness will be in receipt of treatment,
and no prisoner with serious mental illness will leave prison
without a care plan and a care co-ordinator."
362. By April 2006, funding responsibility for healthcare
within the Prison Service will transfer to the NHS, with Primary
Care trusts taking on full responsibility for commissioning prison
health services. One of the results of the closer links between
prisons and their local health providers has been that prisons
are finding it easier to get people into secure NHS provision.
This is now largely accomplished within three months of someone
being sectioned. A further benefit is the increasing number of
mental health in-reach services across the prison estate which
are both supporting prisoners and, in some prisons, training staff.
363. The Prison Service states that on any one day
in prisons in England and Wales, there will be around 5,000 prisoners
with a severe and enduring mental disorder requiring specialist
treatment in a secure mental health unit.
In oral evidence, the Chief Inspector of Prisons estimated (from
the Inspectorate's visits to local prisons) that 41% of prisoners
held in prison health care centres should be held in secure NHS
364. We consider that the current system of prison
mental health care provision is failing in two fundamental respects.
First, some individuals suffering mental illness are committing
crimes, being convicted and being sent to prison because of the
failures of mental health care provision in the community. Second,
prisoners who become severely mentally ill in prison are not being
diverted out of the prison system to appropriate specialist secure
units in the community.
365. The Office for National Statistics states that
prisoners are twice as likely to be refused treatment for mental
health problems inside prison as outside.
The Prison Reform Trust estimates that at any one time there
are likely to be at least 40 prisoners having been assessed who
have to wait three months or more before being transferred to
hospital. The Trust argues that the long periods prisoners routinely
have to wait before being assessed or transferred demonstrates
the overstretched position of the prison mental health care system.
We were told about prisoners with acute mental illness being moved
to prison segregation units in an attempt to minimise disruption
to the daily prison regime. This is an unacceptable practice and
it is improper to expect untrained prison staff to try to provide
the interim care these prisoners require whilst they await transfer.
366. We deplore the delays in assessing the mental
health care needs of prisoners on admission to prison and throughout
their sentences. The Government's National Action Plan fails to
include specific action points aimed at improving access to and
provision of high quality mental healthcare to prisoners. We recommend
that this gap in strategic policy planning be addressed as a matter
of urgency. In particular, we recommend that more places be made
available in specialist secure units in the community to provide
the expert mental health care prisoners need within proper facilities.
367. We recommend that the Healthcare Commission
be given statutory authority to monitor, inspect and evaluate
the adequacy of mental health care provision across the prison
estate, both on a thematic and prison-by-prison basis, indicating
models of best practice and providing recommendations for action.
292 7% of male and 14% of female sentenced prisoners
have a psychotic disorder, 14 and 23 times the level in the general
population: Prison Reform Trust Factfile (July 2004). Back
Prison Reform Trust Factfile, July 2004 Back
Ev 144 (para 3.6.5) Back
Q 209 Back
Ev 144 (para 3.6.4) Back
HM Inspectorate of Prisons, Annual Report of Chief Inspector of
Prisons for England and Wales, 2002-03 (2003) Back
Office for National Statistics, Psychiatric Morbidity among young
offenders in England and Wales (2000) Back
Prison Reform Trust Factfile, July 2004 Back