Strong Local Voice, Strong Local Champion

Mental Health of Prisonners

Mrs. Annette L. Brooke (Mid Dorset and North Poole) (LD): Today the prison population stands at more than 75,000. Of the men and women locked up in our jails the vast majority of them will have mental health problems. Recent research by the Office for National Statistics found that seven out of ten prisoners suffer from two or more mental health disorders; in many cases this includes substance misuse problems. This means that as I speak there will be more than fifty thousand people locked up in our jails who are mentally ill, being supported by dedicated staff, who are not trained psychiatric nurses, but are trying to do their best in difficult circumstances. As one prison officer recently told a national newspaper:

'We are no longer prison officers, we are mental health workers. We are enthusiastic, but we are only amateurs.'

These amateurs have to deal with the full range of mental health problems. Firstly there are the seriously mentally ill, those who are acutely mentally ill. The head of the recently formed National Offender Management Service, Martin Narey, has said that at any one time there are some 5,000 prisoners who should be immediately transferred to secure psychiatric settings. It is difficult, verging on the impossible to provide the right kind of environment for those people in prison.

Prisons are not by their nature therapeutic environments. They are not places where prisoners can compulsorily be treated, and they cannot compulsorily be treated for the reason that they are not therapeutic environments. They are places that will be dealing with very, very disturbed people, and prison staff struggle to do a terrific job in many of those circumstances in simply trying to contain the degree of illness and dangerousness.

Compared to ten or even five years ago the transfer of prisoners who are sectioned under the Mental Health Act to secure NHS facilities is improving. It is usually possible to do it within three months of diagnosis, but even in those three months a prisoner can deteriorate quite dramatically in the circumstances in which they may necessarily find themselves in a prison. So, it is not as good as it should be. And in parts of the country where the mental health trusts are unable to find room, deeply troubled prisoners can remain festering in prison for many, many months, remaining a danger to not only themselves but also to other prisoners and staff.

Secondly, there will be the many very seriously mentally ill prisoners who will not be sectioned because they are not considered to be treatable, because they suffer from various kinds of personality disorder. A staggering 64 per cent of male and 50 per cent of female sentenced prisoners have a personality disorder. They will not be accepted into mental health institutions. Indeed, those who have been would sometimes be returned to prisons because they are too dangerous, too difficult to deal with in special hospitals. Governors will be reluctant to take these prisoners. As highlighted by HM Chief Inspector of Prisons there is a policy within the Prison Service which is, shockingly, called "sale or return", whereby prisoners are sent by one governor to another on the understanding that if they misbehave they will be returned. It is not a way in which we should be dealing with people who are, of course, difficult but are also people who have great needs and are usually very damaged. It means you have a whole category of prisoners who are basically on a merry-go-round. They are going from one prison to another for weeks at a time, usually to give respite to prison staff. This does little to help them, but instead exacerbates their mental condition.

Within a prison these disturbed men and women are often held away from the main wing either in the health care unit or in special segregation units. As the Independent Monitoring Board, the Home office appointed prison watchdogs, of a local prison in Surrey, HMP High Down, recently reported to the Home Secretary:

'It is distressing to watch mentally ill men being shuttled between the Segregation and Health Care units. Their condition is adversely affected by Segregation but their condition cannot be adequately managed in our standard prison healthcare unit'

You also have levels of other kinds of mental disorder, often associated with substance abuse. I would not discount the advances that have been made in recent years for prisoners who have drug problems. But there is still a long way to go. The Government proudly tells us that more than 40,000 detoxifications take place across the Prison Service each year. But there are question marks over the quality of these detoxifications. How many of them took place in health care centres rather than on prison landings? How many detoxified prisoners received follow up and what kind? The Home Office also says that more than 40,000 initial assessments will have been made last year, under the CARAT programme for prisoners with drug problems. But how many of those in CARAT's initial assessments went on to provide the full process of counseling, assessment, referral, advice and throughcare? How many prisoners who are in treatment and rehabilitation programmes complete those programmes? How many prisoners are gaining access to treatment and support services on release and with what delay? And is there any information about the numbers of prisoners with dual diagnosis and what co-ordinated Prison Service provisions is addressing their needs? These are all questions that have been asked by prison reform groups, such as the Prison Reform Trust, but the Home Office is unable to give any answers. Perhaps the minister might be able to help today.

The situation is compounded by the severe overcrowding in jails across the country. According to the Prison Reform Trust, 85 of the 138 jails in England and Wales are overcrowded with more than 16,500 prisoners having to double up in cells designed for one. The large local jails up and down the country have in effect become vast transit camps where tens of thousands of prisoners are processed each year. There is a real danger with the system being so overstretched that staff will fail to identify and then monitor the vulnerable, mentally unstable prisoners.

We are already seeing the consequences of cramming mentally ill people into overcrowded jails. Incidents of self-harm among prisoners have increased five fold since 1998. Last year there were 17,300 incidents recorded. Among female prisoners the level of self-harm is particularly alarming. A far higher proportion of women injure themselves repeatedly. Many of them will have suffered domestic violence and sexual abuse. For them, and for the many desperate men in our prisons, self-harm is a way to release their mental pain. As one former prisoner wrote in a recent report by the Prison Reform Trust:

"During the two and half years of my incarceration I was to discover the depths of despair one can fall into, believing I was losing my mind, believing I was dead, believing I was buried alive, believing I would never be free. I learnt about self- harm, physically and emotionally, I learnt how to survive, yet at the same time how it feels to want to die every day….. Prison is not a place for the mentally ill, and too many are there already that should not be."

So why have our prisons become dumping grounds for the mentally ill? The answer is simple. According to the mental health charity Mind, we have lost 50,000 psychiatric beds over 20 years. There is literally nowhere for people to go when they have mental breakdowns and quite often that leads to prison, often for minor offences. The courts are also remanding increasing numbers of mentally ill offenders into custody to await pre sentence psychiatric reports because there are not sufficient places available in bail hostels. On top of that there are is a shortage of court diversion schemes across the country so that offenders who are acutely ill or at risk of suicide can be given hospital places or the treatment they need.

The solution is not to turn our prisons into treatment centres on the cheap. The solution lies outside the criminal justice system. So much offending by mentally ill people is a public health, rather than a criminal justice, concern. The problem will not be solved by cramming yet more people into our jails or by investing in yet another prison building programme, it currently costs £36,500 per year to keep a person behind bars, but by providing more resources for mental health care, drug treatment, court diversion and mental health support and supervision centres across the country. This could easily be paid for from the millions of pounds that would be saved from taking the mentally ill out of our prisons. Does the minister not accept this?