Mental health in prison Contents

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Introduction

1.This inquiry looks at mental illness in prisons in England and Wales. Her Majesty’s Prisons and Probation Service (HMPPS) runs prisons and probation services across England and Wales as an agency of the Ministry of Justice. Responsibility for providing prison healthcare (including for those with mental illnesses) moved from the prison service to the NHS in 2005 following concerns raised by HM Inspector of Prisons about the general level of qualifications and experience of staff in prison medical services compared to the NHS (with which they had to compete for staff).1

2.Healthcare is a devolved matter; in Wales, the Welsh Government and NHS Wales are responsible for healthcare provision in prisons.2 HMPPS works in partnership with NHS England and NHS Wales to commission prison healthcare from a variety of public bodies (including the NHS) and private and voluntary sector organisations. NHS England also commissions liaison and diversion services aimed at channelling vulnerable people away from the criminal justice system. National agreements set out the combined responsibilities of the various parties including the Department for Health and Social Care, Public Health England and Public Health Wales.3

3.The purpose of prison is not just to rehabilitate but to punish and deter offenders through incarceration, including separation from family and community. There are, nevertheless, legal and humanitarian reasons for ensuring that prisoners’ healthcare needs (physical and mental) are met while they are in the custody of the state.4 We are conscious that some sections of the public may fear that prisoners whose mental health needs require treatment get a ‘soft option’ and that some people may believe some prisoners will manipulate professionals into believing their mental health needs are greater than is the case. We are, however, aware of no qualitative or quantitative evidence that misdiagnosis of prisoners is widespread. The evidence received from our public call for evidence suggests, by contrast, that many prisoners keep their mental health problems to themselves owing to the stigma and shame attached and that those who do need help often have trouble getting it.

4.Mental illness is on a spectrum and prisoners’ conditions (as with the general public) may range from less severe and undiagnosed issues such as mild depression to those who are severely unwell. Prisoners are more likely than the general public to have further conditions alongside mental illness (for example learning disabilities, autism, speech and language difficulties, ADHD, acquired brain injury and substance abuse) that may make treatment of their mental illness more challenging.5

5.The identification of mental illness in a prisoner can happen at different stages for different individuals before or during time in custody, including where:

• the police are called if a person in a mental health crisis behaves in a way that worries or affects others;
• an acutely mentally ill person in the process of being prosecuted is held on remand because no mental health bed is available in the community;
• a person is suitable for a community order that includes a requirement for mental health treatment but that treatment is not available and the sentencer decides on prison instead;
• a person arrives in prison with a mental illness recognised in the community but of which the prison service is unaware;
• a person was unaware of having a mental illness, or was aware of it but concealed it from others; or
• someone becomes mentally ill in prison.

Probation staff, community mental healthcare services, prison service staff and prison healthcare staff are all involved in identifying, managing, and treating prisoners’ mental illness through these stages.