five years make–no change-prison

Prison doorIn 2002, 300 psychiatric nurses from the NHS were sent into prison hospitals to help prison staff handle the crisis of mental health in our jails. Likened by the then director general of the prison service, Martin Narey, to the “cavalry coming over the hill”, what these in-reach teams found on reaching the summit was something akin to the battleground of Mordor at the beginning of the Lord of the Rings films. It was a battle that prison staff were – and still are – losing.

More than 70% of prisoners suffer from two or more mental health disorders. Around a fifth have four of the five major mental health disorders. Self-harming, particularly among women and young people, is rife. The suicide rate in custody for 2007 is already well over last year’s, and more women have killed themselves in jail this year – seven so far – than during all of 2005 and 2006.

Yet prison service instructions in recent years have seen mandatory training abolished for staff in areas such as post-incident care and suicide and self-harm prevention. A report last week by the chief inspector of prisons, Anne Owers, found that mental health treatment in custody had in fact declined since psychiatric nurses had been introduced.

Importing NHS services into prisons at a minimum service level has only highlighted the immense scale of need, and has done nothing to deal with the problem. The picture Owers paints is one of a prison service with no idea of what it is dealing with or how to deal with it. There is no “national blueprint” for delivering mental healthcare in custody – an astonishing failure.

The Howard League legal team encounters widespread issues affecting many of the children and young adults in custody. Indeed, in one case, we have secured a public inquiry that goes to the heart of what is wrong with the existing approach to those whose poor mental health leads them to commit crime.

Susan (not her real name) has just had her 21st birthday and is in Rampton high security hospital after spending three years in prisons. In jail, her despair was so great she cut herself repeatedly – and so severely that she had to be rushed to hospital for blood transfusions. On one day while in custody, aged 17, Susan made deep lacerations to her arms and her wrist. That evening, she was found with a ligature around her neck.

The response of prison staff was to isolate her in the segregation unit, on one occasion for 20 days, as if her behaviour could be controlled by punishment. Instead, predictably, it only got worse.

It took two years and a high court injunction for the Howard League’s lawyers to get Susan moved from prison to a secure psychiatric environment. Susan has since responded well to care and treatment and a public inquiry is due to begin shortly. Susan’s is not our only case that revolves around the suitability of prison for those with mental health needs.

With prison overcrowding at record levels, it is surely time for the government to address the fact that too many people in our jails should not be there in the first place. As Owers recommends, a multiagency approach is required that ensures sufficient provision of care to divert the mentally ill from custody – and with effective community support for those who are leaving prison.

When custody is required, we need to consider what kind of secure environment would best serve an individual’s needs. One thing is clear: our prisons cannot continue to be awash with the blood and misery of their inmates


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