Over 35% of prisoners in England suffered from a mental health disorder in 2016 and over 25% of them were treated.
Eighty suicides were reported between 2019 and 2020.
Persons with mental illness who have committed an offence are usually held under the ordinary prison regime. Some prisons may have an in-patient healthcare unit that provides treatment to people with severe mental health disorders who are awaiting transfer to a general psychiatric hospital. Prisons without these units can transfer prisoners to other facilities, but this rarely happens in practice. The unit in Pentonville prison has 22 beds.
Some facilities have units reserved for people with severe personality disorders called Psychologically Informed Planned Environments (PIPEs). These units were designed “to offer a safe and facilitating environment to help prisoners develop socially” but they don’t provide any treatment.
Prisoners with mental illness are sometimes placed in “units for vulnerable prisoners”. The main goal is to protect them from other prisoners. As they are normally deemed unfit to work and are left out of activities, they usually remain in their cells.
Prisoners with severe mental illness may be placed on suicide watch, and monitored according to the Assessment, Care in Custody, and Teamwork (ACCT) process. The Committee for the Prevention of Torture (CPT) observed that they are regularly transferred to segregation units in Doncaster, Liverpool and Wormwood Scrubs prisons. Some of them are sent there while waiting to be transferred to a general psychiatric hospital. Time spent in segregation may last up to 23 hours a day, and there are no planned activities. However, visits, phone calls and walks are allowed. In many prisons, the segregation units are dilapidated and unsanitary. Following a visit to the Liverpool prison, the CPT reported that a mentally ill person placed in a segregation unit had inflicted serious self-harm. It deemed this placement inappropriate and recommended an emergency transfer to a psychiatric hospital.
Access to mental healthcare¶
Health screening must be carried out within 24 hours of admission. The nurse in charge of the screening process obtains the defendant’s medical history (health issues, treatments, addictions, and mental health status) through a questionnaire comprised of 120 questions, of which 35% are optional ─mostly those related to suicide and self-harm. Following the screening, the nurse refers the defendant to a doctor for a second visit if necessary.
There are many requests for mental health appointments. A prisoner who makes this request is first seen by a nurse. The lack of healthcare staff is causing long wait times. Patients must be escorted to their appointment by a prison officer. In some prisons, between 30% and 50% of the prisoners cannot attend their appointments because of staff shortage.
Prison boards sounded the alarm about the overcrowded health units and lack of resources. Prisoners in Deerbolt wait up to 27 weeks to access one-on-one psychotherapy. Every month, over 120 people are referred to High Down’s prison health services.
Provision of mental health treatment¶
Any prisoner with mental health problems can receive an individual treatment plan. Those with severe mental illness are given medication. Access to therapy varies from one facility to another. The majority of prisons do not have sufficient resources to provide psychological assessments. Therapy is especially lacking in women’s prisons.
PIPEs offer psychotherapy and group therapy to individuals with personality disorders. In-patient healthcare units provide limited mental health treatment.
Those suffering from substance abuse are carefully monitored and assessed within five days of entering prison. Most prisons offer therapy and substitutes for nicotine and opioids. Half of them have “drug-free” units for these individuals.
Ambulatory care is provided by a mental health team consisting of a psychiatrist (sometimes full-time), psychiatric nurses and psychologists. Social workers and occupational therapists are also available. In some prisons, mental health staff are not available during evenings and on weekends.
Requests for psychological consultations are made in writing or orally. In some prisons, these can be made directly through cell phones. Doncaster’s prisoners must complete a form online.
The CPT observed that in the healthcare unit of Liverpool prison, assessments are carried out in the presence of prison officers. It noted that healthcare professionals of psychiatric hospitals inform the escorting prison officers about decisions related to patients. The officers then return the prisoner and inform the prison healthcare team. The CPT believes that this practice infringes upon patient confidentiality.
Medications for prisoners with mental health problems are prescribed by a psychiatrist or a general practitioner. Nurses at the Doncaster and Wormwood Scrubs facilities distribute these medications in particularly busy areas. The CPT considers this practice contrary to patient confidentiality as it exposes vulnerable prisoners to potential violence from other prisoners.
In theory, prisoners undergoing a mental health crisis must be transferred to a general psychiatric hospital. Nevertheless, they may be placed in segregation cells while awaiting their transfer. In 2017, about 8% of prisoners waiting for transfer to a mental health facility were kept on suicide watch and moved to a “segregation cell”. The CPT recommended that pending transfer, patients “should be accommodated in the prison health care inpatient unit and not held in segregation.”
Prison officer training¶
A four-hour introductory training programme on mental illness was made available to prison officers in 2016. They are trained to identify a prisoner’s deteriorating mental health and refer to the relevant healthcare personnel. The programme is only for new recruits, and there is no further training for the existing staff. The implementation of these programmes is left up to the discretion of facility directors. Additional mental health awareness training for prison staff is available, but usually cancelled due to low participation rates.
Continuity of treatment¶
From the very beginning of a sentence, special attention must be given to community reintegration. There is no guarantee of continuing care for foreigners, nor those serving short sentences.
“Clinical Commissioning Groups” (CCGs) are in charge of local health services, and are responsible for the healthcare of released prisoners. Prison facilities use “SystmOne” to ensure the continuity of care. This is an electronic system containing the medical records of prisoners.
Released prisoners in Wales have the right to a psychiatric assessment called the “Mental Health Measure” after which they can access mental health care. Persons incarcerated in England may sometimes have their care interrupted when returning home to Wales.