Memorandum submitted by Partnerships in
Care
I am writing to you in your capacity as Chair
of the Justice Select Committee. You may be interested in the
following information, which outlines the issues surrounding the
appropriate treatment of offenders with serious mental illnesses.
We also recommend alternative solutions for the management of
seriously mentally ill prisoners to the benefit of the whole criminal
justice system.
It is estimated that up to 8% of the prison population—or
up to 6,500 offenders—suffer from serious mental illnesses
and require intensive psychiatric treatment. This specialist treatment
is not available in prisons. These offenders should be diverted
from prisons to secure psychiatric hospitals where they can receive
the treatment they require. Of those 6,500, only 1,855 offenders
were diverted into such settings in 2006-07.
According to a number of campaign groups, including
the Prison Reform Trust and the Sainsbury Centre for Mental Health,
prisons are ill-equipped to cope with the demands of severe mental
disorders. It is not the role of prisons to care for the seriously
mentally ill, yet they are often expected to do so. The diversion
of severely mentally disordered offenders out of prison and into
secure hospitals reduces pressure on the prison system. It also
ensures that fewer individuals are in unsuitable accommodation,
to the detriment of their health and opportunities for rehabilitation.
I represent Partnerships in Care (PiC), which
is the largest independent provider of medium-secure psychiatric
care across the UK, consisting of 23 hospitals nationwide and
employing more than 3,000 people. Working in partnership with
the NHS and HM Prisons Service, PiC provides specialist treatment
and rehabilitation services to help prepare patients for their
return to the community, alternative accommodation or indeed a
return to prison. The independent sector as a whole accounts for
approximately 35% of total capacity for patients diverted to medium-secure
psychiatric settings.
We have a concern that many offenders, who should
be in hospital receiving treatment for their mental illnesses,
are not getting it. The effective transfer of seriously mentally
ill offenders to hospital will impact positively on prison overcrowding
and discipline problems, and will increase possibilities for rehabilitation.
Under current arrangements, the Department of Health via Primary
Care Trusts (PCTs) fund a secure hospital placement, and the Ministry
of Justice fund a stay in prison for those not diverted to hospital.
This means that there is little incentive for a PCT to fund a
hospital placement in a secure psychiatric hospital. This is hindering
the transfer and diversion of those who require treatment.
Obviously the cost of diverting offenders into
psychiatric hospital settings cannot be ignored, but, there is
a mistaken belief that it is always more costly to place an offender
in a secure hospital than it is to place that offender in prison.
The cited costs of keeping one offender in prison for one year,
usually in the region of £40,000, do not take into account
the extra cost required for the care of a seriously mentally disordered
offender in a prison setting. These costs can include single cell
suicide watch, extended stays in the hospital wing or drug and
alcohol treatment. Where seriously mentally ill prisoners are
forced to remain misplaced in prison rather than hospital their
mental state tends to deteriorate, making eventual treatment even
more costly and complex than before.
Furthermore, an offender released from prison
is more likely to re-offend than an offender treated in a hospital.
In 2005, the likelihood of a prisoner re-offending during the
two years following their release was 65%. For those treated in
hospital it was only 7%. Some have argued that there are not enough
beds available for mentally ill offenders, but the current occupancy
rate in the independent sector is 84% with around 1,300 beds empty.
To encourage appropriate treatment of prisoners
and reduce re-offending, we propose the following:
1. The diversion of severely mentally disordered
offenders away from prisons and into secure psychiatric settings
is prioritised, with the Department of Health provided with better
incentives.
2. Greater awareness among the judiciary of the
availability and benefits of diversion schemes. This will ensure
that the rate of re-offending and the associated costs are taken
into account when assessing the cost-effectiveness of various
sentencing options.
3. A shared budget between the Ministry of Justice
and the Department of Health for the provision of care and treatment
for mentally disordered offenders.
We would be grateful for any support you may
be able to offer. Given the extensive debate around the future
of Titan Prisons and the forthcoming Bradley Review on Offender
Mental Health, we would be keen to meet with you to discuss our
concerns.
Mihir Magudia
Consultant
November 2008
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