37. Memorandum submitted by
The Sainsbury Centre for Mental Health
INTRODUCTION
The Sainsbury Centre for Mental Health (SCMH)
is a national charity working to improve quality of life for people
with mental health problems. One of our two core work programmes
focuses on the mental health of prisoners in the UK. Our response
to the Committee considers the mental health aspects of sentencing
policy within the terms of reference of the inquiry.
It is now well-established that prisoners have
disproportionate levels of mental ill health. Levels of mental
illness in prison are three times those in the wider population.
Mental health problems among prisoners are also likely to be more
complex.
Tackling the high levels of imprisonment of
people with mental health problems and of mental illness within
prisons will require a strategic approach that includes sentencing
policy. This paper examines some of the key issues that should
be included in this approach.
NEW INVESTMENT
IN AN
EXPANSION OF
CUSTODY AND
COURT LIAISON
SERVICES
Custody and court liaison services exist to
divert people with severe mental health problems from the criminal
justice system to the health service. Research by Nacro shows
that where such services are working well they can be effective.
But too often they are unable to have a major impact on the system
for reasons including:
— they do not work at both police stations
and courts;
— they do not function on all days
of the week;
— they do not have the power to admit
patients to beds (eg for lack of a doctor in the team); and
— there are no suitable facilities
in hospital or the community to which to divert people.
A CLEAR ROLE
FOR COMMUNITY
MENTAL HEALTH
SERVICES
Community mental health services have undergone
a major expansion since the National Service Framework for Mental
Health (for adults in England) was published in 1999. Alongside
generic community mental health teams there are now crisis teams,
assertive outreach teams and early intervention teams.
It is not clear how far such services are supporting
offenders, for example those on community orders. We do know,
however, that mental health requirements are rarely used for those
on community orders and that many of those given such requirements
opt to go to prison instead. Identifying how much care community
teams offer to offenders outside prison (and how this can be improved)
should be a major priority for research.
Research by SCMH has also shown that many prison
inreach teams struggle to find community services for prisoners
when they are released and that prisoners who were previously
supported by community services are abandoned by them as soon
as they enter the criminal justice system.
A NEW APPROACH
TO HOSPITAL
TRANSFERS
A major problem in many prisons is the long
time it takes for prisoners who need compulsory treatment under
the Mental Health Act to be transferred to hospital. Government
guidance on hospital transfers has begun to make improvements
in this regard. However, progress may be limited if it is always
assumed that patients should be transferred to medium secure units.
A review of what facilities prisoners can be moved to may help
to broaden the scope for timely transfers.
INCREASED INVESTMENT
IN PRISON
MENTAL HEALTH
SERVICES
Even with the most effective diversion and transfer
arrangements, prisons will never be mental illness-free zones.
Better mental health care in prisons must continue to be a priority
for both the criminal justice system and the NHS.
Responsibility for prison health care is now
fully in the hands of NHS commissioners (predominantly primary
care trusts). Following the guidance in Changing the Outlook (DH
and Home Office 2001) most prisons now have access to a "prison
inreach" team to coordinate the care and support of prisoners
with severe mental health problems: those who would be on the
caseloads of community mental health teams if they were not in
prison.
The presence of inreach teams is beginning to
offer some help to prisoners with severe mental health problems.
However, it is clear that prisons lack the spectrum of services
that would be expected of an effective mental health service.
Primary care for people with less severe mental health problems
is inadequate in most establishments we have visited (through
research studies in London and the West Midlands). Inreach teams
are overwhelmed by demand, leaving many unable to offer much more
than an assessment service. And the challenges of the prison environment,
such as chaotic reception screening processes and the frequent
movement of prisoners between establishments, have not been properly
considered.
We need to see a "whole system" approach
to mental health care for prisoners that encompasses all the levels
of care they need; that responds to "complex" needs
such as a dual diagnosis of mental ill health and substance use
and/or personality disorders; and that responds to the particular
demands of this very difficult (but not impossible) working environment.
BETTER RESETTLEMENT
AND RELEASE
PLANNING
Good resettlement starts from the earliest point
a person enters the criminal justice system. For those with mental
health problems, resettlement needs to include early engagement
with the full range of community services that they need. Currently
release planning starts a few weeks before at best. This hampers
efforts to resettle the individual into society and can lead to
gaps and discontinuities in their health and social care.
COMMISSIONING BETTER
SERVICES
The key to achieving all of these changes is
effective and committed commissioning. People with mental health
problems who are in the criminal justice system at any point need
timely access to effective treatment, care and support. This should
mean that a range of alternatives to custody are available for
those identified by well-resourced liaison teams; that people
on community orders have access to care appropriate to their needs;
that prisons offer the full range of mental health care services;
and that people released from prison get access to the support
they need to rebuild their lives.
8 March 2007
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