MPs call prison mental health system “disjointed and incoherent”

Work with offenders on a Justice Committee report which is calling for root and branch reform

The Justice Select Committee has published its report on mental health in prisons. The report calls the current situation in prisons a crisis and says it will not improve unless root and branch reform takes place. The report says that a “disjointed and incoherent” approach to care has left many prisoners suffering from mental health issues undiagnosed and unable to access care. It calls on the NHS, Ministry of Justice and the Prison and Probation Service to implement a system of integrated care, that improves identification of mental health issues, provides seamless care while in prison and supports transition to care in community settings on release. The main issues highlighted by the Committee are outlined below.

The scale of the problem

Roughly 10% of the prison population are receiving treatment for mental illness, however as many as 70% may be suffering from mental health issues. The true scale of the mental health crisis is not well understood because data collection, on the extent of mental health issues and spending on treatment, is poor. Without this benchmark data it is not possible to develop strategies to improve support or assess the current quality of intervention programmes. 

MPs say that the NHS should assess what shortfalls exist in mental health services in prisons and develop plans to ensure the level of support is equivalent to those outside, also taking into account the specific needs of those in a prison environment. 

Staffing shortage

The Committee highlights problems recruiting and retaining experienced, well trained staff as a key problem. Given the shortages of staff in the community, it is no surprise that it is difficult to recruit mental health professionals to work in prison.

The need for integrated care

The Committee says that much more work is needed to implement integrated healthcare across the prison estate. MPs said they are aware of some programmes which deliver healthcare seamlessly in a patient centred way, removing barriers between primary, secondary, mental and physical care, but that these are the exception rather than the rule. 

Prison as a mental health safety net

A central theme of the report is that too many people are in prison primarily because of their unmet mental health needs. The Committee says that too many offenders are sent back in prison because community orders with mental health requirements are unavailable in many areas. MPs urge the Government to be much more ambitious and ensure that these orders are available in all parts of England and Wales by 2023, not its current target of 50%. 

Screening

The Committee heard evidence that 1 in 12 prisoners do not receive a health screening appointment within 24 hours of arrival in prison, and that BAME prisoners are less likely to have a mental health condition identified than white prisoners. There were also concerns about the standards for carrying out health screenings and whether they are routinely overseen by competent mental health professionals with experience of the criminal justice system. 

Prison officers and other operational staff play a crucial role in identifying prisoners in need of mental health support and directing them towards appropriate treatment. The Committee said that HMPPS must ensure that staff receive proper and ongoing mental health training.

Continuity of care

Unsurprisingly, MPs found that  the transfer of information between community and prison support services needs to be improved with released prisoners and their doctors able to access prison medical records immediately. 

The impact of the pandemic

As readers will be well aware from the number of reports already published into the impact of coronavirus on the mental health of people in prison, prolonged lockdowns combined with anxiety about getting ill in prison has had a serious impact on prisoners’ mental health. The Committee recommended that the capacity of prison mental health services be increased to meet increased demand.

Conclusion

The Committee did acknowledge that mental healthcare in prison had improved since it became the responsibility of the NHS in 2005 but said that it was not good enough. Sir Bob Neill, the Chair of the Justice Committee, summarised MPs’ main concerns:

“Mental health in prisons is not treated with the focus it needs. When there isn’t sufficient data to even give an indication of the scale of the problem it is clear that there needs to be concerted and systemic reform. We do not know how many people are missing out on the help they so desperately need or how effective current mental health support systems are and this needs to change fast. 

"We are calling on the Prison and Probation Service, NHS and Ministry of Justice to work together to develop an integrated approach to mental health in prisons. It must ensure that all prisoners with mental health needs are identified and guided to support services. Care must be seamless, both in accessing different physical and mental health support, and in ensuring a smooth transition to community care when leaving prison. 

"We have a duty of care to those who are in prison and we must do more to live up to it."