Select Committee on Home Affairs First Report


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.[292] 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.[293]

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."[294]

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.[295]

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.[296] 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 accommodation.[297]

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.[298] 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.[299] 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

293   Prison Reform Trust Factfile, July 2004 Back

294   Ev 144 (para 3.6.5) Back

295   Q 209 Back

296   Ev 144 (para 3.6.4) Back

297   HM Inspectorate of Prisons, Annual Report of Chief Inspector of Prisons for England and Wales, 2002-03 (2003) Back

298   Office for National Statistics, Psychiatric Morbidity among young offenders in England and Wales (2000)  Back

299   Prison Reform Trust Factfile, July 2004 Back

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