Mental Health Awareness Week: Mental Health in Prison

As we enter Mental Health Awareness Week, we are reminded of the growing recognition of mental illness in our society. Unfortunately, this awareness has not translated into meaningful action for those behind bars, with nine out of ten people in prison suffering from at least one mental health problem.  

Years ago, before I joined the Howard League, I met the then Prisons Minister at a social function. I had been observing the Parole Board hearing of a man serving an IPP sentence earlier that day and expressed my concern about mental health in prison. The Minister responded with ‘look, these people are in prison Andrea, they aren’t meant to be happy’. When I asked how many of them had mental health problems before they went into prison, he shrugged.  

Last year, 85 people took their own lives in our prisons.

The point is that our prisons are full of people who have long suffered with poor mental health – it’s often led them into the criminal justice system – in addition to those people who develop problems when inside. It’s not just a question of not being ‘happy’. Anyone who spends any time in prisons knows that they are teeming with people struggling with serious mental health problems. After years of total lockdown under COVID, and not much more regime in many prisons now, we have a crisis of impoverished mental health in our prisons, with grave impacts on the people who live and work in them. 

Last month, the government released data showing an increase of nearly 30% of self-harm incidents in custody, and no progress in reducing the number of self-inflicted deaths. Last year, 85 people took their own lives in our prisons. There is undoubtedly systemic failure in providing adequate mental health support in the system. But how did we get to this position and why is progress towards securing good mental health in prison so glacial? 

The theme of this year’s Mental Health Awareness Week is ‘moving more for our mental health’. Movement plays an important role in protecting and improving mental health. But people in prison are at a stark disadvantage, with basic entitlement allowing just one hour a week of exercise and people locked in their cells – and overcrowded cells, at that – for as much as 23 hours a day. With prison populations rapidly outpacing the rate of staff recruitment and retention, disruptions to regime are becoming commonplace. Many people spend most of the day ‘banged up’, which means movement out of cells to exercise, socialise, or attend work and education – all critical factors in sustaining a healthy mind – is all too often compromised. 

Despite the clear need, the resources allocated to mental health services in prisons are woefully inadequate and constantly thrown into disarray by dwindling numbers of prison officers. For the staff that do remain, training is a huge problem, with officers telling us that they feel ill-equipped to deal with people with such complex needs and those in mental health crisis. One of our members in a Category B prison tells us: “The system needs to provide better training for understanding and supporting those with [poor] mental health.”  

There have been nearly 80,000 incidents of self-harm in the prison estate in the past year, with those who have been remanded or recalled more at risk.

Prison officers supporting people with poor mental health are overstretched, often forcing a reliance on agency staff – a costly and transient alternative. Staffing chaperones to mental health units has become a challenge, and lengthy caseloads are now the norm – the Independent Monitoring Board (IMB) at HMP Cardiff recently reported an average monthly caseload of 160 for the mental health team, with people at Durham prison waiting up to 128 days to see a psychiatrist. Similarly, the IMB at Feltham prison is concerned that around half of psychology appointments don’t go ahead due to low staffing levels – last August there was a two-week period where all appointments were cancelled. 

Under these pressures, prison officers have less time to observe, interact and build positive relationships with people in prison – crucial in picking up on mood, and a noted key protective factor against suicide.

Eastwood Park (2022)

In the context of overcrowded and understaffed prisons, the tragic upshot of deteriorating mental health among people in custody comes as no surprise. This is in part reflected in increasing rates of self-harm and suicide. There have been nearly 80,000 incidents of self-harm in the prison estate in the past year, with those who have been remanded or recalled more at risk. The rate of self-harm is nearly nine times higher in the female estate than in the male. Earlier this year, the IMB at HMP Eastwood Park reported a 128% increase of incidents of self-harm in the past 12 months.  

One of our members in a high security prison tells us they have seen three suicides over the course of their sentence.

Twenty-seven per cent of all incidents of self-harm in the prison estate took place among children and young people, and recent government statistics reveal a particularly shocking rate among girls in custody. Although they represent only two per cent of the population of children in custody, they accounted for 63% of all self-harm incidents recorded in the 12 months to December 2023. Girls who self-harmed did so on average 67 times per year, compared to four times for boys. This was brought into sharp focus last March, when inspectors found that children at Wetherby prison had been forcibly stripped and subjected to pain-inducing restraint by all-male teams of officers, on one occasion to remove a girl’s clothing to prevent her self-harming. The Howard League has started a petition, calling on the government to move girls out of Wetherby and into suitable accommodation where they can be cared for and supported. You can sign the petition here. 

It is especially troubling to see no reduction in the high rates of self-inflicted deaths in prisons. One of our members in a high security prison tells us they have seen three suicides over the course of their sentence. And I have written before about the devastating impacts of the IPP and other indeterminate sentences on mental health of people in prison, with particularly high rates of suicide for these groups. 

“The prison system is full of people with severe mental health problems who would be better suited to a hospital environment.”

Prisons – and increasingly, Segregation Units within prisons – are wrongly used as places of safety for people with poor mental health. Under the Bail Act 1976, courts can remand people to prison for their ‘own protection’, without that person being convicted or sentenced – even in cases where the charge they face could not result in a prison sentence. It is wrong in principle to use the most punitive sanction available to the state to make up for failings in care and protection in the community, and the scrutiny and safeguards applied to this process are minimal. Prisons are not suitable environments for people in mental health crisis and there are other more appropriate alternatives to offer the right support without the need for incarceration. For the past five years, the Howard League has campaigned to abolish the power to remand people to prison for their own protection and will continue to do so till we see the end of this cruel legislation and practice. 

As the HMIP themed report earlier this year highlighted, transfers to hospital under the Mental Health Act are particularly problematic, with around a quarter of those in custody in need of specialist treatment waiting over 28 days for an assessment or transfer to hospital. Prison is a particularly inappropriate place for people at high risk of suicide. Life inside does not effectively address vulnerability and risk and can in fact exacerbate it. Another one of our members who has recently been released from jail tells us “the prison system is full of people with severe mental health problems who would be better suited to a hospital environment.” 

Prison is a singularly inappropriate setting for people in mental health crisis; it puts lives in danger. People in prison are in the care of the state, which has a duty to hold them decently and safely. Rather than receiving the treatment they desperately need, in moments of crisis these people are all too often met with isolation, perpetuating cycles of incarceration and deteriorating mental health. This does not keep them safe, nor does it ultimately keep the community safe. 

This Mental Health Awareness week, we must continue to demand change. The government, our prison service, and society as a whole must prioritise mental health support for people caught up in the criminal justice system. This means ending the use of prison as a place of safety, empowering staff to provide the right levels of care, and investing in comprehensive mental health services and diversion programs to stop people in need of mental health care from being swept into the criminal justice system.  

The Howard League will continue to campaign for better understanding and prevention of poor mental health, including self-harm and suicide, in the penal system. We invite others to join us in breaking the silence and demanding a brighter future for those battle poor mental health and losing hope in our prisons. 

Andrea Coomber KC (Hon.) 

Comments

• Alex Mackenzie says:

  6 Aug 2024 at 7:38 am

  At the moment, even the bare minimum level of Mental Health Care is not being provided in Prison. It seems that only those who overtly behave in a way which demonstrates the need for hospital treatment receive any meaningful assistance. As you say, however, this is usually in the Segregation Unit.

  Even basic medications are not bring provided consistently meaning that, before Prisoners can even think about addressing their offending or behaving appropriately, they are having to deal with the impacts of this. In turn, this leaves to Prisoners giving up because they feel everyone else has given up on them first.

  Self-harm seems to be the norm when it should be the exception. With stretched staff, without medical expertise, having to decide how to prioritise the needs of Prisoners.

  This, in turn, leads to a lack of trust in staff from prisoners and a feeling of being unsafe. Which then spreads to those working with and supporting those in Prison, whether professionally or personally. These support networks are vital as ancillary assostance.

  Mental Health Care in the community is far from ideal but if our prisons could meet that it would appear to be a huge improvement. This should be concerning in and of itself given the complex needs of so many people inside our prisons.

  Something has to give and soon.

  Reply