Howard League blog · 23 Feb 2017
Our evidence to Parliament’s inquiry into mental health and deaths in prisons
I gave evidence to Parliament’s Joint Committee on Human Rights on 22 February as part of its inquiry into mental health and deaths in prisons. We had already submitted written evidence setting out our concern, but I raised an additional issue in my oral evidence.
In 2016, 196 men and women died in prison due to natural causes, up 33% from the previous year. This is the highest since records began in 1978.
Age at time of death
|60 and over
Over a third of the people who died by natural causes in prison in 2016 were under the age of 60 and 72 of the 196 prisoners were aged 59 and under.
According to NICE, many prisoners have significant health needs caused by a combination of accumulated social and economic disadvantage, undiagnosed chronic health conditions and previous poor access and uptake of mainstream community health services.
The World Health Organisation has concluded that prisons are not healthy places and overcrowding, violence, a lack of light and fresh air and poor diet are common.
In prisons in England and Wales, overcrowding, understaffing, high levels of violence and the restricted prison regime are causing and exacerbating physical and mental ill health. Prisoners are spending hours locked in their cells with little to occupy them and limited access to fresh air and exercise.
The healthcare that prisoners receive in prison should be equivalent to that in the community, but it is not. Staffing shortages are impacting on the provision of prison healthcare. A report by the Howard League and Centre for Mental Health (2017) stated ‘health care staff described how patients frequently missed their healthcare appointments because there was nobody to escort them’. The Department of Health is unable to provide data on the number of missed healthcare or hospital appointments for prisoners (Hansard HC debate, 12 Sept 2016).
A PPO investigation into the death of a 41 year old prisoner at Dovegate prison in 2015 found that ‘there was a significant delay in diagnosing the man’s cancer, as two GPs did not follow national clinical guidelines for referring patients to specialists and the man missed a number of investigative blood tests, which healthcare staff did not follow up.’
There is a well-documented link between mental and physical health (eg Royal College of Psychiatrists). Physical health problems significantly increase the risk of poor mental health and vice versa. People with chronic or terminal illness are also at greater risk of suicide.
Given the significant health needs of prisoners, the impoverished prison regime is exacerbating ill-health. It is highly likely that prisoners with chronic physical health conditions will also have poor mental health.
A report by the Prisons and Probation Ombudsman in 2012, before the dramatic decline in prison conditions, on Natural cause deaths in prison custody 2007–2010 found that the leading causes of natural deaths in prison were diseases of the circulatory system and cancers, reflecting the leading causes of death in the community (PPO). However the report stated:
‘Investigations of deaths of prisoners under the age of 45 years found that a proper and timely investigation of symptoms did not happen in 40% of cases. Particular concerns were expressed around the following three themes:
- Delays in referrals to healthcare staff, prison doctors and outside specialists
- Delays in responding to rapid deterioration in health and summoning emergency services
- Poor monitoring of chronic conditions (including asthma, diabetes & epilepsy)’
The delays in responding to physical health needs and the stress of living with chronic health conditions in prison undoubtedly impact on a prisoners’ mental health, particularly if they feel their health concerns are not being prioritised or taken seriously by staff.
The PPO has been critical of the unnecessary use of restraints such as chains on prisoners attending hospital near the end of their lives. The impact that a restraint will have on the mental wellbeing of a patient who is subject to medical procedures or dying should not be underestimated.
Whilst it is absolutely right that the people dying by suicide is a national scandal and should attract concern and action, there are also far too many people dying of other causes, many of whom might have lived longer and better.