Mental health in prisons: let's stop and think

The recent BBC Panorama documentary on children behind bars showed the horrible circumstances and bullying children and young people were exposed to by members of staff who were supposed to keep children safe and support their rehabilitation. 

Yesterday, the Prison Ombudsman published a report on mental health services in prisons and it seems that the circumstances are not much better in adult prisons. Over the course of two years, nearly 200 people with identified mental health needs took their own lives in prison. This is almost one third of the total number of suicides reported in prisons in the UK. The rates of suicide and self-harm have increased over the years, with 2014 having the highest-ever number of suicides in English and Welsh prisons.

Mental health problems are all too common in prisons. The 2009 Bradley report showed that more than 90% of young offenders had a common mental health problem and figures seem equally high for adult prisoners. A more recent study showed that nearly half of prisoners could be at risk of anxiety and depression. This report also showed a link between mental health problems like anxiety and depression and recent drug use, with nearly a third of prisoners who recently used drugs reporting feeling anxious and depressed.

The figures are telling. Another study from 2003 found that nearly three quarters of drug users experienced mental health problems.

Silo working

The report by the Prison Ombudsman found that mental health services need improvement and there are clear issues in information sharing and referrals: it seems that there still is a level of 'silo working' going on, with a lack of collaboration between prison and healthcare staff. Even between healthcare staff there is a lack of joined-up working between mental health and substance misuse services, despite the evidence showing that these need integrated approaches in order to deliver the best results.

Further, there were reports of a lack of appropriate training of staff and high-quality mental health assessments. It’s clearly a system under pressure, which is currently failing to deliver high-quality, evidence-based care and support.
Hence, it may not be too much of a surprise that re-offending rates remain high. 2014 figures show that nearly 60% of prisoners on short-term sentences re-offend within a year of release.

These issues together are all indicative of a need for further investment in integrated care and quality regulation of mental health services in prison. We need to think about alternative pathways of care and early intervention for people with mental health problems who offend.

Tailored interventions needed

The high levels of people with learning disabilities who end up in the criminal justice systems highlights the importance of adequate support and tailored interventions. Finally the over-representation of people from some black, Asian and minority ethnic communities in prisons and the inadequate provision of timely, appropriate mental health care is a chronic problem that we need to address.

Prisons should not only offer a place of safety but also a place of rehabilitative support. We need to ask ourselves whether the current state of care is really the best way to support people to live mentally healthy lives and whether our current offering of services in prison gives people the best start to a crime and drug-free life when they are allowed back into society.

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