A modern voice for today’s woman

Background

Impact of Inappropriate Imprisonment

As institutions, prisons are often bleak and overcrowded, and can actually serve to exacerbate mental illness. The report of the Joint Committee on Human Rights on deaths in custody 2004 stated: “The evidence we have gathered suggest that prison actually leads to an acute worsening of mental health problems.  By sending people with a history of attempted suicide and mental health problems to prison for minor offences the state is placing them in an environment that is proven to be dangerous to their health and wellbeing.”  This viewpoint is supported by growing amounts of self-harm; almost half of all the women in prison now injure themselves repeatedly. Overall there were 22,324 incidents of self-harm recorded in 2005-6. In addition to this the suicide rate for young men in prison is eighteen times that for young men in the community. On release from prison men are eight times, and women thirty six times, more likely to commit suicide than their counterparts outside. 

There are very many vulnerable groups within the prison population. Age Concern is troubled about increasing numbers of elderly prisoners suffering from dementia. Black and minority ethnic groups are grossly overrepresented in custody. One in ten young people in prison suffer from a severe psychotic illness compared to 0.2% of teenagers outside in the community. 

Women in prison are five times more likely to be suffering from a mental illness than women in the community. The Corston Review into the situation for vulnerable women in the criminal justice system found that ‘Significant and substantial mental health morbidity is unlikely to be addressed during a prison sentence and is likely to have been a factor in the pattern of offending behaviour prior to sentence.’

Many within the field believe that using prison to punish those with severe mental health problems is unjust and counter-productive, as imprisonment does little or nothing to address their needs, improve wellbeing or reduce re-offending.

Diversion from Police Stations and Courts

It is a common complaint of magistrates and judges that they feel obliged to remand in custody, or to hand down a prison sentence, to people who are mentally ill because they can find no alternative way of obtaining a psychiatric assessment of, or gaining treatment for, their condition.

In its 2005 ‘Troubled Inside’ report on the mental health needs of men in prison, the Prison Reform Trust found the lack of an integrated national system of court diversion and liaison schemes means that many people with serious mental health problems are not being identified at an early stage in the criminal justice process. These schemes, covering police stations and courts are intended to identify mental health concerns early and ensure that people get appropriate help and treatment.  Speaking at the report launch Juliet Lyon, director of the Prison Reform Trust said: “The use of prison to warehouse people for their mental illness is a criminal use of our justice system, it is cruel, makes ill people worse and disrupts the rehabilitative work of prisons.”

Research by the Home Office (RDS Occasional Paper no 79, Home Office 2002) finds that court diversion schemes can significantly improve re-offending rates and treatment outcomes. Those admitted to treatment through the courts were half as likely to re-offend (28%) compared to those of a similar age and offence profile who had been given a custodial sentence (56%). The report concluded: ‘from these results, there is no justification for the view that diversion to a hospital is a ‘soft option’ or that it fails to offer public protection. On the contrary, these results indicate that it may constitute an effective means of crime reduction in those suffering from mental illness.’

Provision of Mental Healthcare

In her report on the mental health needs of prisoners (October 2007) HM Chief Inspector of Prisons concluded that “For, even if there were more and improved diversion schemes, there simply are not enough secure places for those who could appropriately be diverted there; nor is there sufficient community provision for those with complex needs, including mental health needs. Indeed, the failure to identify need, and provide support, at an early stage is the reason why some people offend in the first place.”

A study of court liaison and diversion schemes by Nacro (a charity dedicated to the care and resettlement of offenders), found provision to be patchy across the country, with a few schemes working well and providing people with a real alternative to prison but most failing to meet good standards of access or quality. Most are poorly staffed, do not cover both police stations and courts, and many do not have immediate access to NHS beds when they need them.

Transfers from Prison

For those in prison, delays experienced in transferring those sectioned to a secure health setting remain a problem as does the time sometimes taken before an assessment is carried out. Far too often seriously ill, heavily medicated people are held in isolated segregation units awaiting a hospital bed.  Delays in transfers out of prison can diminish the prospects of an eventual recovery.

Good Practice


In her recent mental health review, HM Chief Inspector of Prisons cited two examples of areas where good work was being done to avoid the inappropriate imprisonment of the severely mentally ill:

Liverpool: ‘A generic mental health team was based in Liverpool Magistrates’ Court and provided a comprehensive care service for clients with serious mental health problems in the criminal justice system. It was able to divert clients away from the criminal justice system when appropriate and liaised with community services and prisons to ensure good aftercare. It was the link for many parts of the criminal justice and health services and provided training to the police.’

Chelmsford: ‘If a client was sent to prison, which might in itself increase the level of risk, the Chelmsford Criminal Justice Mental Health Team contacted healthcare staff in the prison to advise whether an inpatient bed was required, and to fax reports and other information to the prison directly. Because it was an established forensic clinical team with a consultant psychiatrist, the team could keep the client on its caseload and open the care programme approach if they were bailed, or refer to the relevant community mental health team. Because of the team’s links with forensic services and good relationships with local commissioners it could also refer directly to low or medium secure beds, even out of area.’