Mental Health in Prisons

Wednesday 10th January 2018 Westminster Hall

09:30

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

I beg to move,

That this House has considered mental health in prisons.

It is a pleasure to serve under your chairmanship, Mr Howarth. I am pleased to have the opportunity to discuss this intolerable crisis. Suicide and self-harm in prison have reached record highs. In 2016, 119 prison suicides were recorded—the highest number since records began—and there were 41,103 incidents of self-harm in the year to June 2017. Again, that is the highest figure on record. With staff numbers dropping off and some parts of the prison estate unfit for human habitation, it is clear that the Government need to take decisive action to fulfil their statutory duty of care. Some prisoners may have had a mental health problem on entering the criminal justice system, but most prisoners’ mental health deteriorates in prison, because of the conditions imposed on them.

[Kate Green (Stretford and Urmston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. Before getting into the detail of what happens in prison, my hon. Friend is right to draw attention to the fact that many people have mental health problems before entering prison. Does she agree that when the police identify at interview, as they are required to do, that someone is under the care of mental health services, they should be required then to make contact with that individual’s mental health practitioner to get full information on their suitability for custody?

[Ms Rimmer]

I do, and I thank my hon. Friend for that intervention. What she describes is one major component that is missing and would help to resolve the situation. People are locked up in a small cell for the vast majority of the day, subject to a poor diet and living in inhuman and dirty conditions. Those who were previously healthy often develop depression, anxiety and violent tendencies because they are in effect caged, with little food and no stimulation.

Since March 2017, Her Majesty’s Prison and Probation Service, formerly NOMS—the National Offender Management Service—has been responsible for the management and operation of prisons in England and Wales and for ensuring that the prison environment is safe and decent. The Ministry of Justice is now responsible for prison policy and commissioning of services in prisons. NHS England is responsible for healthcare in prisons, in terms of both physical and mental health. In 2016-17, NHS England spent an estimated £400 million providing healthcare in adult prisons in England. It is estimated that £150 million of that was spent on mental health and substance misuse services, although the exact figure is unknown. All those bodies have a fundamental duty of care, yet as the Public Accounts Committee damningly concluded, they do not even know where they are starting from, how well they are doing or whether their current plans will be enough to succeed in caring for prisoners with mental health needs.

[Dr David Drew (Stroud) (Lab/Co-op)]

Does my hon. Friend accept that another problem is that those bodies do not know where people are going post-prison? I have in my constituency the excellent and nationally reputed Nelson Trust; it has a women’s centre in Gloucester. Its big bone of contention is that it gets very little access to the women before release. With all the mental health problems, drug abuse and victim support issues, it needs access in prison before release. Does my hon. Friend agree that that is crucial?

[Ms Rimmer]

I absolutely agree and will come to that point later in relation to communication.

The Government’s efforts to improve the mental health of people in prison have been poorly co-ordinated. Information is not shared across the organisations involved and not even between community and prison GPs. For example, NOMS advised NHS England to commission mental health services for a male prison at HMP Downview and then decided to open it as a female prison. Six months later, healthcare was still catching up with those changes. What a shocking failure of government! Clearly, quality systems of working and communication are urgently required between prison management, HMPPS, policy makers and commissioners at the Ministry of Justice and the commissioned contractors for health services and NHS England.

It is clear that not enough has been done to prevent increases in deaths in custody. That was the subject of last year’s Joint Committee on Human Rights interim report entitled “Mental Health and Deaths in Prison”. The report homed in on why progress has not been made on preventing deaths in prison, despite the numerous insightful and comprehensive analyses produced on the issue following the Woolf report in 1991. Those include reports by Lord Harris of Haringey, the Joint Committee on Human Rights, the Public Accounts Committee, the National Audit Office, the Howard League and the Select Committee on Justice. Those are just some of them. I hope the Minister would agree that there is no lack of knowledge of or information on the problem, as it has been well reported.

While the Joint Committee on Human Rights inquiry was in progress in March 2017, the Government introduced the Prisons and Courts Bill. Following its Second Reading, the Joint Committee wrote to the Government, proposing key amendments, but unfortunately the Dissolution of Parliament got in the way. The Committee instead published an interim report in May 2017. In November, the Chair of the Joint Committee, my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), wrote to the Secretary of State for Justice, expressing her disappointment at the non-inclusion in the Queen’s Speech of the prisons Bill promised before the general election and noting that he had said he would take some administrative steps. The Chair stated in her letter to the Government that the Committee’s findings showed that concrete legislation was needed, and outlined clear steps forward, to ensure that prisoners’ humanity is protected and their welfare safeguarded. The Joint Committee’s proposals included a statutory minimum ratio of prison officers to prisoners, a prescribed legal maximum amount of time for prisoners to be kept in a cell and the provision of a key worker for each mentally ill prisoner.

[Andrew Selous (South West Bedfordshire) (Con)]

The hon. Lady has a long-standing and serious interest in these issues. Does she agree that one thing that would help in this area would be training prisoners in work in which they could get jobs on release, to fill shortages out in the community, and that that is part of giving people hope and a purpose, which can help to improve mental health?

[Ms Rimmer]

I absolutely agree. Undoubtedly, having work would keep people safer outside. It would give them a purpose and be a way of keeping them sane outside, so that they did not go through the revolving door back to prison.

The Chair of the Joint Committee requested, in her letter of 30 November 2017, a response to both the interim report and the letter by 8 January. That has not happened. The Government are refusing to act and therefore showing contempt for the lives of their detained citizens. The Justice Committee’s report of May 2016 stated that the Government had been reluctant to acknowledge the serious nature of the operational and safety challenges facing prisons and the role of their own policy decisions in creating them. Little appears to have changed.

We know that just 10% of the prison population in England are in treatment for mental illness, but recent inspections show that 37% report having emotional wellbeing and mental health problems.

[Kate Green]

Those figures are shocking. I am sure that my hon. Friend agrees that it is even more distressing that 70% of women in custody have mental health problems.

[Ms Rimmer]

I absolutely do. The institute of psychiatry, psychology and neuroscience at King’s College London estimates that more than half of prisoners may have common mental disorders, including depression, post-traumatic stress disorder and anxiety, and believes that 15% of prisoners have more specialist needs. Those are significant figures, but guesstimates are not good enough. The most commonly used estimate, which is that 90% of prisoners have mental health issues, dates from 1998— 20 years ago. The Government have no idea of the scale of the problem. The Ministry of Justice must address that to plan services and meet needs.

The National Audit Office has recently stated:

“Government does not collect enough, or good enough, data about mental health in prisons, which makes it hard to plan services and monitor outcomes.”

It particularly criticised NHS England for the data collected, which

“do not measure outcomes for prisoners, continuity of care or service quality.”

How damning! This failure to monitor poor mental health levels and the mental health services provided in prison simply would not happen in the outside world. It is costing our citizens their wellbeing and sometimes their lives. Let us remember, it is also costing the taxpayer.

The lack of knowledge about prisoners’ mental health exists at all stages of the cycle: on entry to prison, a point raised by my hon. Friend the Member for Stretford and Urmston (Kate Green); during their stay in prison; and after they leave. This means that future prison needs, present prison needs and community needs, and consequently budget requirements, cannot possibly be accurately planned for. For instance, what consideration was given, and finance afforded, to the detained historical sexual abusers? These are elderly people with age-related health needs, such as heart conditions, dementia, diabetes and cancer. The money came from the prison health budget and the issue occurred at the same time as spice arrived. Consequently, there was less money for mental health drug treatment at the most crucial time.

NHS England does not even know what it spends on mental health in prisons. Perhaps the Minister could enlighten us—although I know he is a new Minister.

[The Parliamentary Under-Secretary of State for Justice (Dr Phillip Lee)]

No, I am not. I am the last man standing.

[Ms Rimmer]

I apologise.

The Government’s own prisons and probation information states:

“Prisoners get the same healthcare and treatment as anyone outside of prison.”

That is demonstrably not the case in our prisons at present. In reality it is clear that our prisoners are struggling with ever-increasing levels of poor mental health and are actively let down by the system. It is impossible to reach any conclusion other than that the Government’s failure to act adequately is exacerbating what is approaching a mental health emergency in our prisons.

The Joint Committee on Human Rights inquiry last year noted that the body of research in the last three decades has overwhelmingly found that the common feature of deaths in custody is a prisoner’s mental health. Figures published by the Ministry of Justice in November of last year confirm that it will have received a “real-terms cumulative decrease”—in other words, a savage cut—of 40% in funding. That is £3.7 billion in a decade by the end of 2019-20. Who is suffering most as budgets are cut to the bare bones? It is prison staff on the ground, working in unsafe conditions and at increased risk of attack; the prisoners in their care; and society as a whole. The cuts have led to dangerous situations in our prisons and have cost lives.

The Howard League report of 2016, “Preventing prison suicide,” damningly concluded that

“Staff shortages have increased the risk of suicide”

in our prisons. There was a cut of almost 7,000 frontline officers—austerity measures. Was there a risk assessment prior to the prison officer reduction of 7,000? I very much doubt it. I would like to see it, if there was one.

I welcome the Government’s pledge to recruit an additional 2,500 staff by the end of 2018. Unfortunately, only half of these have been recruited so far. I believe this promise will not be sufficient to tackle the issue at hand—the facts speak for themselves. There is a serious retention problem: loss of prison staff is outstripping recruitment at a quarter of prisons, often the most dangerous ones. It has been found that prisoners now miss an average of 15% of medical appointments, due to a lack of staff to escort them. The sheer lack of prison staff at present means that prisoners’ physical activity is greatly restricted as their safety outside cells cannot be guaranteed. Some 31% of prisoners at local prisons report spending at least 22 hours a day cooped up in their cells as a result of inadequate staffing and this surely must affect their mental health.

The Howard League reported last year that two children and young people a week call its advice line stating that they have problems accessing prison healthcare. I am advised of two shocking cases. One example was a child who was kept in isolation at a children’s prison for months awaiting transfer, despite prolific self-harm. He was kept in a bare cell with a transparent door for observation. He was judged by a psychiatrist as not medically fit to be segregated, but was kept in almost total isolation for several months before finally being transferred to hospital. Another child, a 15-year-old with attention deficit hyperactivity disorder, was not consistently given his medication. He was isolated and self-harming, even attempting suicide. It was only after the Howard League raised concerns on multiple occasions about his self-harm and severe needs that his pills were consistently given to him, and it was only when he made a suicide attempt that any action was taken to move him to a more suitable placement. I consider that an inhuman and barbaric way to treat two of our children. Suffer not little children: surely the fifth richest country in the developed world could and must care for such children better and work to rehabilitate them.

Prison psychiatrists overwhelmingly feel that service cuts have adversely affected their ability to provide care for prisoners, which is particularly concerning when there are such inadequacies in transferring acutely unwell prisoners out of these establishments. There are cases where the contractors employed by NHS England failed to carry out the services they were obliged to. In two cases, their costs were not recouped—how damning. These are people denied their care, and public funds gifted. The Government target of 14 days for eligible prisoners to be admitted to a secure hospital from prison was met only 34% of the time in 2016-17, 7% waited for more than 140 days, and one person waited for more than a year in misery. This is cruelty.

The staff are inadequately trained and only 40% receive refresher training. The importance of the screening process has not been sufficiently emphasised to staff. Staff do not always enter data on the “risk of suicide” and “risk of self-harm” of prisoners in their records of these screenings. How can needs be spotted if they are not identified and recorded? As my hon. Friend the Member for Stretford and Urmston mentioned earlier, this should take place at the police station. Even when the details are recorded, there simply are not enough prison officers to monitor this adequately.

Evidence received by the Public Accounts Committee bears testimony to the fact that the increase in suicide and self-harm in our prisons is in part due to the use of drugs. I acknowledge the work of Her Majesty’s Prisons and Probation Service—the number of drug seizures has increased rapidly with nearly 3,500 services in our prisons in 2016, following the legislation making spice illegal, and a new test has been introduced to detect psychoactive drugs with trained dogs to sniff out these substances.

The prison estate itself is also in a deplorable condition. Over a quarter of it was built before 1900 and the majority was not built with healthcare in mind. We have all seen the case of HMP Liverpool in recent weeks. Some of the estate there was in such bad condition—dirty, rat-infested and hazardous—that it could not be cleaned at all. The state of that prison was described as one of squalor, in 21st-century Britain. It is not right that we house prisoners in such horrendous conditions. Surely the mental health of anyone living in such unsanitary circumstances would suffer.

With the Government’s brutal cuts showing no sign of slowing down, and the need for staff still outstripping supply in many places, what will this mean for prisoners with mental ill health in the future? I fear there will be no substantial improvement for prisoners facing this plight any time soon. It is in everyone’s interest to improve this situation, not least because effectively treating prisoners with poor mental health is essential to reducing reoffending and ensuring that those who live with mental health problems can do so more cohesively in our society and communities.

We have a fine example of where decency works, and works well: HMP Askham Grange operates on this principle. It refers to prisoners as residents, and has built an atmosphere of respectful relationships. Its reoffending rate is 6%, while latest Ministry of Justice figures show a national average of a 29.6% reoffending rate within a year. There are six prisons with executive governors. Is there any improvement in mental health outcomes in these prisons? But a bigger question remains: should people with mental health conditions be in our prisons at all? Is it as simple as a psychiatrist making a judgment that someone is, as it is sometimes said, “bad, not mad,” and should therefore be incarcerated?

[Mrs Madeleine Moon (Bridgend) (Lab)]

Is it not also true that prisons have sometimes become dumping grounds for NHS failure, that sometimes in the NHS it is cheaper to let the person go to prison than to take responsibility for their treatment and that that is part of the problem we face?

[Ms Rimmer]

Sadly, I accept my hon. Friend’s point.

It is clear that when people who are already prisoners are acutely mentally unwell, they are being kept in situations that are doubtless of further detriment to them and brutalise them. Evidence obtained by the Joint Committee on Human Rights made clear that acutely mentally unwell people are too often

“inappropriately being sent to prison as a ‘place of safety’”,

and stated that there is an

“urgent need to resource and make better use of community alternatives to prison for offenders with mental health conditions, particularly those who are currently given short sentences”.

I hope that the Minister heeds the points I have made and I am sure that hon. Members will add to them, as the interventions have done. I ask him to commit to looking into the recommendations made by the Joint Committee on Human Rights and the Public Accounts Committee. We are at a crisis point in our prisoners’ mental health, and Government should not neglect their duty of care for those who are incarcerated in our prisons.

I welcome the steps taken by the Government to address the issue of spice in prisons, but that is just one component of the mental health emergency and does not tackle the root problems. The Ministry of Justice needs to review policy and commissioning, HMPPS to review the management and operation and NHS England to review the whole system of collating data on health, including mental health needs, and the provision of support. These citizens are owed parity of esteem, quality healthcare and the opportunity for the greatest possible mental health wellbeing both in and out of prison. I call on the Minister to address this as a matter of urgency. The Government have a legal obligation, a moral responsibility and a financial duty to treat these mentally ill people with respect, dignity and humanity.

09:51

[John Howell (Henley) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Howarth.

This is such a crucial issue that it has been of great interest to the Select Committee on Justice throughout our sittings. I remember well that when the hon. Member for St Helens South and Whiston (Ms Rimmer) was a member of that Committee, she and I attended a number of prisons and examined this issue together while looking around them.

There is a high likelihood that prisoners will have some form of mental illness. The 1998 study to which the hon. Lady referred, which showed that 90% of prisoners had some sort of mental health issue, had so many people in it because alcohol misuse and drugs misuse were included within that definition, and that is quite broad.

I want to mention the drugs scene in prisons. We have to accept that two groups of people suffer from drug problems in prison: those who had drug problems before they went into prison, which should have been picked up in the assessment process—I will say something about that in a minute—and those who are switched on to drugs while in prison. The hon. Lady and I both know that a lot of effort is being put in to try to prevent the smuggling of drugs into prisons, particularly as people use more and more sophisticated means, such as drones, to do so. We have to stop these things coming into prisons.

The point made about the need for information sharing and about the assessment process when prisoners arrive is absolutely crucial. From the experience that the hon. Lady and I have had looking around prisons, it is absolutely the case that the assessment process is de minimis: it does not go into the depth that one would expect. That is partly for the historical reason that mental health has been a second service, and I hope that it is now changing.

[Kate Green]

I absolutely agree with the hon. Gentleman about that initial assessment. Does he agree that it is important that, when someone is already under the care of mental health services in the community, evidence is gathered from their own practitioner, and that it is not enough just to gather the evidence, but that conclusions need to be drawn and appropriate routes taken and that may mean not remanding or incarcerating someone as a result of a conviction?

[John Howell]

I agree with the hon. Lady. This problem goes back to the whole way in which the justice system is set up in anticipating the mental health issues suffered by many of the people who are brought before the courts. If a problem can be identified there, a better treatment can perhaps be undertaken to solve it. A greater emphasis needs to be put on the assessment process, which needs to include a very good assessment of patients’ mental health conditions.

There are two aspects that I want to mention in connection with that. One is the power that we are giving prison governors. I am all in favour of giving prison governors back powers over their own prisons, but as a component of that we have to ensure that prison governors and their staff are fully aware of the mental health issues that they will face. From my visits to the prison in my constituency, I would not want to put a huge amount of greater stress on the prison governor, who is doing a very good job in difficult circumstances, but I would like to ensure a minimum level of mental health awareness at that level so that it can be taken into account. After all, as we are trying to put mental health care workers, or somebody with responsibility for mental health, into schools, it seems only appropriate that we should do the same in our prison estate, where larger numbers of people suffer from those issues.

My second point is the importance of purposeful imprisonment. It is absolutely crucial that we do not allow prisoners to stay in their cells for up to 22 hours a day. We need to find things for them to do. I will mention an example, because I think it predates the time when the hon. Member for St Helens South and Whiston was a member of the Select Committee. We went on a trip to Denmark, where we visited a prison. There is nothing unusual in that, but there was a great deal of unusualness in the way in which the prisoners were allowed to operate. Instead of the “Porridge”-style large prison benches for food, the prisoners were allowed to cook their own food. There was an issue over knives, which had to be chained to the wall, and things like that, but the prisoners could earn their own money, buy food from the shops and cook their own food.

[Rebecca Pow (Taunton Deane) (Con)]

I cannot resist asking a question now, although I will be talking about this in my speech. Does my hon. Friend agree that gardening projects—for example, prisoners growing their produce at the prison and then cooking it—can also be highly beneficial?

[John Howell]

I agree with my hon. Friend. It is important to recognise the extent of purposeful intent in the prison system; if gardening can fulfil that purpose, it is a very good one. I would like to see more done on prisoners’ ability to cook for themselves. I asked this of a former Lord Chancellor, who assured me that it was being developed within the prison system, so I hope that it is.

That is all I want to add to the debate. It is important and the issues that the hon. Member for St Helens South and Whiston raised are very germane to the topic.

09:59

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

It is a pleasure to serve under your chairmanship, Mr Howarth.

I thank the hon. Member for St Helens South and Whiston (Ms Rimmer) for calling this important debate, and I concur with what the hon. Member for Henley (John Howell) just said about purposeful imprisonment. Before I begin, I must declare my interest as a co-chair of the justice unions and family courts parliamentary group, and I apologise that I have an unavoidable commitment that means I will have to leave before the close of the debate.

A civilised society with a functioning criminal justice system cannot tolerate the present level of self-harm and suicide among inmates. That, and the doubling of the prison population over the past 30 years, is symptomatic: the prison regime of England and Wales is fundamentally unfit for purpose. There is no doubt that our penal system needs reform. The outdated principles of reprimand and revenge must now be tempered by the 21st-century ethics of rehabilitation and repair. I will focus on that second principle of repair in terms of mental health, and I will also touch on the importance of Welsh- language provision in that process of repair.

The prison environment provides an opportunity to control most aspects of inmates’ day-to-day lives. The state should grasp the chance to reduce long-term social costs and improve public safety by addressing such issues as skills deficits and physical and mental health, yet we see unprecedented levels of self-harm and suicide in prisons. It recently emerged that in the past four years four inmates took their own lives within a week of arriving at HMP Swansea.

Extreme overcrowding, harsh budget cuts and severe staff shortages mean that it is increasingly common for inmates to be locked in their cells for up to 23 hours a day. I have seen the cells myself at HMP Liverpool. They were described by the chief inspector of prisons as “squalid, dirty and disgraceful”, with water running down the walls, broken Victorian windows and electricity wires pulled out. I understand that they were pulled out so that people could then use them for attempts at suicide. We can all agree that subjecting anyone, regardless of their offence, to inhumane conditions clearly obstructs any attempt at rehabilitation and can only exacerbate the mental health problems from which so many prisoners suffer.

The Public and Commercial Services Union has considerable experience in this area, representing 2,500 staff working in the HM Prison and Probation Service. In its alternative vision for prisons, it calls for them to be

“a place of genuine reform where people are treated in a way as to generate mutual respect and genuine rehabilitation”.

The PCS, with its substantial expertise, proposes a number of important recommendations; most notably, it suggests that the Prison Service’s policy statement should be revised so that its main aim is that

“rehabilitation and the avoidance of recidivism is the focus of…the prison service”.

To improve the system, the Government must first recognise that they cannot do this alone. They must engage with those who work tirelessly in the sector, and seriously consider their recommendations for improvements. I approached the previous Minister about this matter and I ask the Minister present in the Chamber whether he will agree to meet the PCS and representatives of the justice unions parliamentary group to discuss that new initiative. I am sure we agree that there is real value in working together.

In addition to providing adequate mental healthcare, it is important to create environments in which inmates feel comfortable in which to facilitate repair. One important example is the provision of services in Welsh for Welsh speakers. The Welsh Language Commissioner found the provision of Welsh language services in prisons to be “very, very patchy”. I am aware of that problem from HMP Berwyn, which is the nearest prison to my constituency. When it was set up, we were promised that there would be specific Welsh-language services, but it is very difficult to get information about exactly what those services are. I have constituents who are first- language Welsh speakers who are still being sent to prisons in England when there is space in HMP Berwyn. I ask for that to be addressed as soon as possible. The Welsh Language Commissioner also describes efforts to meet Welsh-language demands as “not very effective” and “not consistent”. I remind the Minister that the Welsh Language Act 1993 is applicable to offender management.

[Kate Green]

I am interested in what the hon. Lady is saying about Welsh-language provision in prisons for Welsh speakers. Does she agree that there is a need for British Sign Language provision for deaf prisoners who are BSL users?

[Liz Saville Roberts]

I do. It is evident to me that means of communication and respect are fundamental to how we address mental health and issues of self-esteem. All methods of communication that are more effective for prisoners should be addressed.

I hope the Minister agrees that denying an offender language rights only heightens feelings of isolation and segregation. I ask him to commit to ensuring that Welsh-language provision is strengthened in the prison sector across England and Wales.

Many other Members wish to speak in this important debate, so I will conclude. To truly make prisons a place of rehabilitation and repair, the Minister faces a challenge. I beg of him to approach this challenge innovatively and in the spirit of co-operation. The reality is that by failing to act on the horrifying number of cases of self-harm and suicide in prisons, we are to all effects and purposes condoning haphazard and extrajudicial capital punishment.

[Several hon. Members rose—]

[Mr George Howarth (in the Chair)]

Order. We have approximately 25 minutes before I call the Front Benchers and four people wish to speak. If people exercise restraint in their use of time, we should get everybody in.

10:05

[Rebecca Pow (Taunton Deane) (Con)]

I am delighted to serve under your chairmanship, Mr Howarth. I pay credit to the hon. Member for St Helens South and Whiston (Ms Rimmer) for securing this important debate. If we can make progress, it will make such a difference to people’s lives.

I make no apology for devoting my short speech to the benefits of the environment and gardening in the justice system and how that can have a positive effect on people’s mental health. We know that imprisoning somebody does not in itself reduce reoffending rates. To do that we must try, where possible, to give prisoners skills to increase their employability chances once they leave and help them to reintegrate in the community. Environmental and gardening schemes can help to do that and to improve mental health outcomes at the same time.

As I have said in a previous debate, many prisons feel very industrialised. They are covered with tarmac and concrete and have little green space. Evidence shows that when people are not in contact with green space and nature, there is a negative impact on their mental health. I recently contributed to an article in Gardeners’ World magazine—lots of people were surprised that I could get an article into that magazine as a Conservative MP. In that article, I mentioned the benefits of gardening schemes in prisons. It seemed to strike a chord and I got some responses, one of which was an interesting email from Paul Evans, the DART—drugs and alcohol recovery team—strategy manager at HMP Rye Hill.

Paul explained that a gardening scheme had been developed at Rye Hill through a partnership between Garden Organic and the Natural Beekeeping Trust. It is funded by the NHS via the local authority. He was keen to stress that he has seen extremely positive outcomes in his experience of using gardening as a therapeutic intervention. He explained that within a few weeks of working on the garden project, men who had been in the depths of despair, using illegal substances and confining themselves to their cells—we have heard about that from other hon. Members—with no motivation to seek employment were the first to line up at their wing gate in the morning. They were happy to attend and get outside to work.

Gardening caused a positive change in behaviour. The most common feedback that Paul hears from individuals is: “I slept the whole night through last night, and that is the first time I have done that in years”.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

One of my first visits as a new MP was to HMP Shotts. Like HMP Rye Hill, it has a garden centre that the prisoners thoroughly enjoyed. It also has woodwork and other activities. The biggest problem was that there were no staff available for supervision, so the time for those activities, which would go a long way to help their mental health, was very limited.

The hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) mentioned the PCS. Let us listen to the staff, who are there full time. I am interested to hear more about the PCS report, and for there to be a lot more official staff.

[Rebecca Pow]

When I was a news reporter, I went to HMP Leyhill, near Bristol, which had a fantastic gardening project that gave much benefit to the prisoners. They used to do a Royal Horticultural Society garden at Chelsea flower show for which they regularly won gold medals. It is about funding. The project I have mentioned is a well-funded combination of partnerships. We should learn from that.

Coventry University’s independent evaluation of the project showed that the garden often acted as a safe haven for many offenders with mental health issues, helping to relieve symptoms of depression and self-harm, and suicidal thoughts. Even more interestingly, it discovered that the long-term effects often go beyond that. The project has a long-term impact: one prisoner said in a diary entry that it saved his life, having offered him a sense of normality. Gardening projects are quite simple—this is not complicated stuff.

I will give one other example. HMP and YOI Parc, a category B men’s prison and young offenders institution in Bridgend, south Wales, has an extensive garden in which up to 15 prisoners work at a time. It recently won the Windlesham trophy for the best-kept prison garden, judged by the Royal Horticultural Society. I do not know whether you receive the RHS magazine The Garden, Mr Howarth, but it is a really good read. The November issue quotes Parc’s director, Janet Wallsgrove:

“The role of any prison is to keep secure individuals who have been given a custodial sentence, yet also to provide opportunity to bring about change. The importance of the environment within prisons is greatly underestimated—prison gardens reduce violence, improve mental health and teach horticultural skills.”

The article further notes:

“The gardens enable prisoners to work towards NVQ horticultural qualifications, giving the option of a career in horticulture on their release.”

I have met many members of the horticultural industry, and there is a need for skilled workers and employees in the sector. As my hon. Friend the Member for Henley (John Howell) said, we need to find gainful employment and skills for prisoners. This is another opportunity that could be built on.

I recently met the head of sustainability at the Royal College of Psychiatrists. He stressed the mental health benefits of contact with nature and gardening. I hope to work with him on increasing the opportunities for that, which can make such a difference. In my constituency, Taunton Deane, remand clients often go and work outdoors in the grounds of an equestrian centre. Those I have spoken to have said how beneficial it has been. There are also wildlife trust mental health projects—a lot more that can be done in this area.

We know that there is a lot to tackle if we are to deal with sustainability in prisons. Gardening is not a panacea, but it can definitely help. After a debate on prisons, to which many hon. Members present contributed, I received a letter from a prisoner at Littlehey Prison in Cambridge asking for my help to set up a conservation and wildlife unit in the prison. He was inspired by listening to the speeches in the debate and asked me to give him some advice, which I will absolutely endeavour to do. He has been tasked with setting up the unit, which he believes could have a particular benefit for OAP prisoners, of whom there is a rising number in our prisons. Anything I can do to help, I will. I know gardening is only a small area, but I think it should be part of the model for tackling mental health issues in our prisons.

10:13

[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate the hon. Member for St Helens South and Whiston (Ms Rimmer) on securing this important debate. A lot has been said about the prevalence of mental health issues within our prisons, which is even higher among women than among men. Shockingly, we imprison a large number of people essentially because of their mental ill health—people whose offending is linked in some way to mental ill health or distress. It seems to me an enormous failure of public policy over many years, for which no single Government are responsible, that so many people with significant mental ill health, learning disabilities or autism end up in our prisons inappropriately. I want to address what we should be doing instead.

First, we incarcerate far too many people in our country. We put far more people in prison than most other civilised European countries. Compare this country with Finland or Germany: Finland incarcerates people at about half the rate we do, but no one suggests that it is an uncivilised country in which lawlessness prevails. It manages its issues in a different way from us—I would suggest a much more civilised way.

[Gavin Robinson (Belfast East) (DUP)]

The right hon. Gentleman mentions incarceration rate. I visited Pentonville jail at the weekend, where the cells are 13 feet by 7 feet. Victorians were not known for their generosity, but their cells were built for one prisoner each. Cells of exactly the same size now regularly hold two or four prisoners.

[Norman Lamb]

I totally agree with the hon. Gentleman’s point. The hon. Member for St Helens South and Whiston mentioned that prisoners are often put in cells for 22 hours a day. Just imagine what that does to their mental distress, particularly if they are sharing a cell. It is intolerable and uncivilised.

Some good things have happened. The liaison and diversion service that is being rolled out nationally, which began under the coalition Government and was based on Lord Bradley’s recommendations, is a very good thing. The idea is that, as soon as someone with mental ill health appears in the criminal justice system, either in court or in a police station, they can be identified and referred for diagnosis and treatment. The problem is that if we do not have sufficient mental health services to deal with those referrals, we will not achieve nearly as much as we could with a properly functioning mental health system.

Mental health treatment requirements can be used as an alternative to prison. Addressing the underlying cause of offending behaviour seems to me so much more sensible, yet the Royal College of Psychiatrists notes a 48% reduction over the past 10 years in the use of such mental health treatment requirements—only 1.2% of offenders with mental health issues receive them. Much more use could be made of that option. I met the Minister a few months ago to discuss it in relation to the west midlands, where I chaired a commission on mental health. A couple of local magistrates courts are seeking to make much greater use of mental health treatment requirements—a really interesting initiative that is worth watching.

Our commission also focused on what happens when people leave prison. Too often, there is no link between the support or lack of it that people receive in prison, and what happens when they leave. They are abandoned in the community, often at enormous risk to themselves and sometimes to others. Professor Richard Byng leads the Engager project to enhance the through-the-gate approach and ensure that it is informed by mental health, so that people who work in the through-the-gate system and help the transition from prison back into the community are supported in their mental health needs and linked up to the services they need.

I will end by mentioning a case that is enormously shocking and that I do not think has yet been properly addressed. In March 2013, Phillip Simelane brutally murdered a young girl on a bus in Birmingham. He had not long been released from prison. He was known to have psychosis and a long history of serious mental health problems. His mother, a nurse, had been trying for years to get the authorities to engage with her and provide proper support for her son. She was massively let down by the system, as were Phillip Simelane and the victim who lost her life. Four years on, an independent review considered the lessons to be learned from the case. Its findings, and particularly the comments of its chair Kiran Bhogal, are really shocking:

“it is disheartening and worrying that our review, as with many reviews and investigations before ours, has found that many of the underlying challenges and problems remain despite the commendable effort made by all organisations involved to change practice and procedure…The fact that there remains a risk that these vulnerable prisoners continue to be released from prison without adequate support and supervision leaving them and the general public at risk is of extreme concern.”

I raised this issue in Prime Minister’s questions last year and I raise it again now with the Minister. I would very much like the Minister to meet me and key people from the west midlands to discuss it, because it is vital that we learn lessons to stop similar tragedies from happening in future.

[Several hon. Members rose—]

[Mr George Howarth (in the Chair)]

Order. Before I call the next speaker, I remind them that there are two other people left to speak, and 10 minutes left for them all to speak in, before the Front Benchers. It would be good if the remaining speakers could share that time.

10:19

[Mrs Madeleine Moon (Bridgend) (Lab)]

Thank you, Mr Howarth. It is a pleasure to serve under your chairmanship and to take part in this excellent debate, secured by my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer).

We know what the problem is—people are coming into prison with mental health problems or, because of the circumstances they encounter in prison, they develop mental health problems, but we are still not being honest in how we tackle those problems. We put society at risk, including the prison officers within the prison system who have to deal with those people. They are behaving in an aggressive, difficult or dysfunctional way not because they are difficult individuals, but because their mental health problems are driving them to express their frustration, anger and psychosis in ways that are difficult to manage. Those same individuals then return to society posing a greater risk than they did when they entered prison. We know the problem—we have known it for a long time and yet we are still not dealing with it.

Recent Ministry of Justice statistics on self-harm among prisoners showed a record high of 41,103 incidents in the 12 months leading up to June 2017, which was a 12% increase on the previous year. This year, self-harm incidents have risen by 10,850, which is up a further 10%. We know that self-harm, which is often a manifestation of fear and frustration, is a major problem. It is also often a precursor to suicide.

We know what the problems are and we know who the experts are in this field. Professor Keith Hawton, the director of the Centre for Suicide Research at Oxford, has done a lot of work in this field. He has shown that both males and females often enter prison with psychiatric disorders, sometimes with multiple disorders, especially depression, anxiety, personality disorders and post-traumatic stress disorder. We know the problems but are not looking at the answers.

May I again draw the Minister’s attention to the excellent work being carried out at Parc Prison under the directorship of Janet Wallsgrove and by Corin Morgan-Armstrong in the Parc Supporting Families scheme? The scheme works very closely with prisoners to maintain their family links, which is such an important thing to do. It also deals with dysfunctionality within the family and relationships with children, so that we do not have the multigenerational problems of people carrying on almost as if there is a family history of prison.

We all know that there is a problem for people in accessing mental health support in prison, and accessing it when they leave. A young girl in my constituency has been in prison almost 30 times and she is not yet 30 years old. Her problems are mental health problems, but each time she has accessed mental health services, the people involved have given up and thought, “Let the prison establishment deal with her problems”. That is an absolutely criminal indictment of the support we give to vulnerable young people.

I will conclude, Mr Howarth, because I am very aware of the time constraints, by commending the work of the Samaritans and its listening scheme, which is such an important source of support for prisoners, allowing them to talk to someone in total confidentiality and to express their frustrations and distress, knowing that someone is listening. It is an important point of access for the person who is suffering from a mental health problem, but learning to listen is also an important skill for the prisoners who take part in the scheme.

We know we have a problem and we know how to deal with it. I appreciate that there are problems in wider society, such that we do not have enough people with the skills to deal with mental health issues, but if we do not tackle this problem in our prison system, it will get worse.

Finally, it is important to train prison officers, to have the right numbers of prison officers who have the right skills, and to recognise that prison officers are no longer just the containers of prisoners. Instead, they are part of the therapeutic environment that prisons must become if we are to tackle these problems.

10:25

[Chris Evans (Islwyn) (Lab/Co-op)]

Thank you, Mr Howarth, for calling me to speak in this very important debate, and I congratulate my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) on her succinct but very informative speech.

I also congratulate the Minister—the Under-Secretary of State for Justice, the hon. Member for Bracknell (Dr Lee)—on surviving the reshuffle. He is the sole survivor. However, the reshuffle raises a very important issue. For me, the situation is unacceptable. This is the second time in living memory that the Ministry of Justice has been cleaned out in a reshuffle. It is unacceptable that we have had six Justice Secretaries in seven years. Only one of them has lasted for even two years. That has led to inconsistent policy and inconsistent reform, and a lot of things have been kicked into the long grass.

While all that has gone on and while the Government have reshuffled the Ministry of Justice, a National Audit Office report to the Public Accounts Committee, of which I am a member, said that £400 million was spent on healthcare in prisons in England in 2016-17, treating 7,917 mental health patients. However, the inspector of prisons found that 31,328 prisoners, who make up 37% of the prison population, reported having mental health or wellbeing issues. Incidents of self-harm and suicides increased—there were 120 suicides in prisons in 2016, the highest number on record.

Prisons and the probation service estimate that 70% of the prisoners who ended their own life between 2012 and 2014 had mental health needs. Identification of those who need mental health services is not consistent. It is all very well our standing here and saying, “Well, they’re in prison. They’re locked away.” For those of us who have stood in our constituencies and somehow had to find some sort of comfort for grieving families who have been victims of those with mental health problems, that is simply not good enough.

I will cite an example from my own constituency. In November 2014, Matthew Williams went out one night and met Cerys Yemm. They went back together to the Sirhowy Arms hotel in Argoed, where he violently killed her. The Argoed hotel murder case was launched by the Ministry of Justice and found a series of failures. In 2004, Mr Williams had been diagnosed with schizophrenia after spending five weeks in a mental health in-patient unit. However, Mr Williams had been a highly frequent user of drugs since adolescence. Schizophrenia should not be diagnosed during states of drug intoxication or withdrawal. Drug-induced psychotic episodes have very similar symptoms to schizophrenia. After Mr Williams left the in-patient unit, his diagnosis was never re-evaluated.

The Argoed homicide report found that, during his diagnosis, Mr Williams was experiencing a drug-induced psychotic episode, and that there was insufficient evidence to support a true diagnosis of schizophrenia. Mr Williams was on and off medication throughout his life, and not enough support was given to him when he was leaving prison. In fact, he had 26 convictions for 78 offences.

It could be argued that the key affliction affecting Mr Williams was drug addiction. He had been using drugs on the night that Cerys was murdered. Those people who had been in contact with him described him as being

“low in mood and pessimistic, but not psychotic”.

The report’s authors believe that his drug use on the night of the murder could have triggered a psychotic episode. Drug addiction was overlooked in favour of a schizophrenia diagnosis—the substance abuse was never truly addressed.

There were inconsistent mental health records: there was a schizophrenia diagnosis, an unofficial undiagnosis and an unofficial personality disorder diagnosis. Medication was prescribed and then unprescribed. Most damningly, Mr Williams was released from prison without medication and continued with consistent drug use in the two weeks after his release. The lack of consistency in the mental health diagnoses, both inside prison and outside, led to a terrible, terrible incident, the effects of which are still being felt in Argoed and the local community at the moment.

Even though Mr Williams was ultimately responsible for murdering Cerys in a terrible way—I pay tribute to the quiet dignity of Cerys’s family—the escalation of mental health issues such as drug addiction could have been prevented throughout the different diagnoses and follow-up. Consistent care and consistent support could have been provided to Mr Williams, but both in prison and outside he received neither.

We need more structured interventions for people with mental health issues, including personality disorders and substance misuse. There also needs to be better sharing of healthcare information prior to someone’s discharge from prison, between community mental health teams and mental health in-reach teams. That would provide consistency and would be a protective measure against possible relapse in any mental health condition. There should also be follow-up appointments with individuals. The PAC reported on these issues and we call on the Government to act on that report now.

10:29

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is an absolute pleasure to serve under your chairmanship today, Mr Howarth. I pay tribute to and congratulate the hon. Member for St Helens South and Whiston (Ms Rimmer) on securing this timely and necessary debate. I commend the effort she has put into such an important debate.

I declare an interest, having worked in a forensic community mental health team for many years prior to entering Parliament, and also at the local state hospital in Carstairs in Scotland. The debate has been excellent and has raised many of the issues that I hoped to cover. I will speak shortly about the issues that have not been raised. I commend everyone who has spoken. The hon. Member for Henley (John Howell), who sits on the Justice Committee, spoke with great expertise and has undertaken extremely valuable work in this area. The hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), who has left her seat—I hope I pronounced her constituency correctly—spoke about the importance of learning in prison and language and culture. Learning and having access to education is extremely important in reducing recidivism, in giving people purpose and improving mental health.

The hon. Member for Taunton Deane (Rebecca Pow) is an absolute advocate for Taunton Deane and now also for gardening projects. The importance of recreation in prisons cannot be underestimated. It gives people a holistic approach to their mental health, which is so important alongside other activities such as health and exercise and the other types of industry that we have heard about from the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney). That is so important because we must see the prisoner as an individual and build upon their skills and resilience.

I thank the right hon. Member for North Norfolk (Norman Lamb), who has absolute expertise in this area. He spoke eloquently about the importance of diversion services and alternatives to prison. The hon. Member for Bridgend (Mrs Moon) made an extremely valuable point regarding supporting and maintaining family lives. The hon. Member for Islwyn (Chris Evans) spoke about failures between liaison links among community services and how picking up mental health problems at an early stage in those who present the greatest risk can prevent crime, which is a valuable and important point. We must learn lessons from the past.

Suicide and self-harm are obviously significant issues in prison because prisoners are adjusting to a situation that they may never have been placed in before. There is a potential feeling of loss of hope. There is also a culture in prison that people have to acclimatise to, which can be extremely difficult. Also, there are significant issues of bullying in prisons that should be addressed. Will the Minister think about how we can address those issues going forward? All of those issues make it difficult for people going into prison. Aside from people who develop mental health problems when they are incarcerated, there are also people who have had mental health issues prior to going into prison.

On pre-morbid conditions, it is crucial that assessment is done at the earliest possible stage, because someone who is already unwell may require transfer to a secure hospital. It might not be appropriate for them to be in a prison. If assessment can be done earlier in the criminal justice system there might be diversion services that would be more appropriate, depending on the offence.

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

With the average cost of a new prisoner being £119,000 a year and the ongoing cost in excess of £40,000 a year, does the hon. Lady agree that it is exceptionally important to invest in mental health provision before people end up in prison? Making sure we assess the numbers who are in prison and having accurate records means we are able to do that beforehand.

[Dr Cameron]

That is a well-made point. Prevention and looking at early diversion and picking up mental health issues where they are the significant issue at play in someone’s offending is crucial. Assessment is more difficult for prison staff and mental health staff in a short-stay prison. I hope the Minister will look at that. There is a high volume of prisoners in short-stay prisons. They come and go in a very short time and it is difficult to get all of the services properly in place, so that will need resourcing. It would help to address those issues.

Co-morbidity has been raised, which is extremely important. We have already heard that many people develop drug problems in prison. That is in fact true and much more must be done to prevent drugs coming into prison, but we also need substance misuse programmes in prison and we need to be mindful of liaison with drug and alcohol services on release, because one of the greatest risks of overdose is when someone has come off drugs in prison and then starts again as soon as they leave. So that is another area of vulnerability.

We must look at particularly vulnerable offenders and services for women and young offenders. We also need an increased awareness of autism in prison. There is a high risk of suicide within that community, particularly if they are incarcerated.

In my experience, far too many of our veterans go into prison. We are failing them, frankly. They have experienced conflict and high levels of trauma, so we really need services and programmes that support them when they come back from active duty. We must prevent them from feeling they are no longer able to cope and committing offences.

Will the Minister also address the availability of programmes in prison for mental health coping skills, cognitive behaviour therapy and managing mental illness programmes? What progress has there been on that? Staff in secure hospitals who work with evidence-based programmes already have substantial experience and their expertise could be utilised in training.

In conclusion, I want to ask about co-ordination of response. In working in this area, I find that access to psychiatry is likely to be access to a liaison psychiatrist who comes in and out of the prison and does not know the prisoners very well. To what extent can we address having full-time psychiatric staff in prisons who are able to assess people repeatedly, know their case history and can prevent people relapsing or pick up issues extremely early?

I want to reiterate the importance of family connections and ensure we build a system whereby we rehabilitate as well as punish people, because that is crucial to protection of the public and to reducing recidivism. Building family connections and giving people hope, aspirations, skills and education, and seeing them holistically as an individual will go some way towards helping their mental health. It is crucial that mental health services are available in prison and as a follow-up.

10:38

[Imran Hussain (Bradford East) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I thank my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) for securing this important debate on behalf of my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman). I thank hon. Members from all parties for their informative and well-thought-out contributions.

My hon. Friend the Member for St Helens South and Whiston articulated the real crisis of mental health in our prisons. Other hon. Members also made some very important points about assessment and recording issues, information-sharing issues, pressures on prison officers, isolation and overcrowding issues, and individual tragic cases that perhaps could have been prevented had the system worked better. Government Members also spoke about some of the much-needed recreational activities that are very important to wellbeing, including cooking and gardening, although they will agree with me that some of the underlying and more pressing issues have to be addressed before we move on to those areas.

[Dr Drew]

One of the most stressful and important issues regarding mental health is women who give birth in prison or have young children. I found, to my shock, that Eastwood Park prison, which has a mother and baby unit, was shut for over a year because of an argument about a flood and who was going to pay for the damage. That meant that all women in the whole of the south west and south Wales had nowhere to go to in the vicinity. That is not acceptable, is it?

[Imran Hussain]

That is a shocking account. Again, that highlights some of the underlying issues in our prison services that could perhaps be dealt with a lot better.

Hon. Members will forgive me if I am unable to cover all the contributions that have been made today, but I know that the Minister, to be fair to him, does listen and will respond. My hon. Friend the Member for Islwyn (Chris Evans) rightly pointed out that the Minister is the last man standing, and perhaps the oldest hand now in the Ministry of Justice. I am sure that he will use his skills to persuade the new Secretary of State that we do have a crisis in our prison service, but I will leave that to him.

[Dan Carden (Liverpool, Walton) (Lab)]

I will be quick. Liverpool prison is perhaps in some of the most dire straits of all prisons in this country, as has been mentioned by my colleagues. The Secretary of State for Justice said on 18 December that an action plan would be forthcoming in January. Can I plead with the Minister that that is not forgotten in the midst of the reshuffle, and ask him perhaps to write to me or let me know in today’s debate when that action plan will be forthcoming?

[Imran Hussain]

My hon. Friend makes a very important point. Obviously, it is an issue that is very close to him, as it relates to his constituency, but it is also of concern to us all, and I hope that the Minister will listen and respond.

As recognition of mental illness in society increases, with a greater understanding of just how damaging it can be, so it does in prison. However, prisoners have a much greater likelihood of suffering from mental illness than the general populace, with one in three prisoners estimated to be suffering from mental illness.

[Afzal Khan (Manchester, Gorton) (Lab)]

I will also be very brief. One of the causes of concern is the impact on black and Muslim prisoners. Reports from Her Majesty’s Inspectorate of Prisons and from Dame Anne Owers say that negative outcomes, stereotyping and discriminatory treatment are consistently experienced by Muslim and black prisoners. Does my hon. Friend agree that the Minister could take a number of steps to help address that? First, religion and ethnicity should be recorded on all clinical records. Secondly, the uptake and outcomes of mental health services in prison should be examined by religion and ethnicity. Thirdly, mental health literacy and religious literacy training should be provided to all prison officers.

[Imran Hussain]

My hon. Friend is right to point out some of the particular issues regarding black, minority ethnic and Muslim prisoners. I will come on to the broader recording issues, but he makes some very important and sensible suggestions.

Unfortunately, most evidence suggests that the estimate that one in three prisoners suffers from mental illness is wildly conservative, demonstrating that it is a real problem, which manifests itself in the self-harm that has risen dramatically in recent years. Many of those self-harming and taking their own life are suffering from a mental illness, representing yet another crisis in our prison system that is spiralling out of control. The Government cannot get to grips with the crisis and are not doing enough to address it. I mentioned one of the reasons for that earlier, when I stated that the number of prisoners suffering from mental illness is just an estimate. There is no accurate record, clear marker, or identifiable way to determine who is suffering from a mental illness in prison; there is just an estimation of the scale of the problem—close to sheer guesswork on the part of the MOJ.

Even when prisoners are screened for mental illness, it is done poorly. Rather than a thorough assessment from a qualified mental health professional, most prisoners are briefly assessed, and given 120 questions to complete in often as little as 10 to 20 minutes. When thrown in with the increasingly toxic nature of prisons, the answers that come back are less than truthful. When the MOJ does not even centrally collect the basic number of prisoners in the prison estate who are suffering from mental illness, and when prisoners are not properly assessed, prisons simply do not know who is vulnerable and who is not, so how can they possibly be expected to provide care for them? The MOJ is failing at the first hurdle—being able to treat mental illness—even before we get on to the treatment itself. That is simply not good enough.

Unfortunately, the conditions after a prisoner has entered are little better, which means that even if they are identified as having a mental illness, they are not always properly treated. The commissioning of healthcare means that mental health provision is disjointed and varied across prison estates, with HM Inspectorate of Prisons finding gaps in primary care, professional counselling and therapies across estates, as well as failings in access to services, gaps in those services, and a failure to follow up on mental health concerns. That is bad, and is certainly not improved by the fact that the partnership agreement between the Prison Service and NHS England, setting out the objectives in providing healthcare to prisoners actually expired in April. There has been a transfer of responsibilities from the National Offender Management Service to the new Prison Service during that time, but I do not buy that as an excuse.

Prisoners with serious mental illnesses are treated even worse as they face extended waits for transfer to secure hospitals. NHS England set a target of 14 days from identification to transfer, but the reality is that prisoners awaiting transfer were reviewed in October 2016, with findings showing that prisoners waited an average of 47 days for their first assessment, a further 36 days for their second assessment, and a further 13 days for the Secretary of State to sign a warrant. That is clearly unacceptable.

All of that demonstrates that the Government are just not getting to grips with the crisis and are not moving to address it. To add to that, Government policy is making it worse. Substantial budget cuts to the Ministry of Justice have been passed on to the Prison Service, with the funding that NOMS received significantly falling. That translates to a reduction of around 30% in operational staff, meaning fewer staff on the wings and on the balconies, and crucially fewer staff who are able to understand individual prisoners and recognise when they are vulnerable. Furthermore, staff shortages and safety concerns have resulted in prisoners being forced to spend longer periods of time locked up in cells. Isolation and confinement are bad enough for those without mental health issues, but they can be devastating for those with mental health issues.

Fewer staff also leads to a rise in the number of drugs getting into prisons, as fewer prison officers results in fewer searches and reduced intelligence gathering and awareness. Drugs, both those of which we have an understanding, such as cannabis and cocaine, and those classed as new psychoactive substances, such as spice, are having a major impact on our prison estates and on the mental health of prisoners. Although the Government are introducing powers to stop the use of mobile phones and are training more dogs to combat smuggling, that is simply not enough without more prison officers.

I will conclude there, as I know the Minister has a number of points to come back on. In summing up, I would say that we have seen mental health care in prisons degrade on the Government’s watch. They must prove that they are serious about addressing it, because right now we see no such evidence. They need to record just how big a problem mental health in prisons is, screen prisoners properly and conduct an immediate review, for without that knowledge, they cannot begin to get to grips with the issue. They need to properly invest in getting prison officers back on the wings and the balconies—but not at the expense of support staff.

10:50

[The Parliamentary Under-Secretary of State for Justice (Dr Phillip Lee)]

It is a pleasure to serve under your chairmanship, Mr Howarth. Although I am the most experienced Justice Minister standing, it is going to be a bit of a challenge for me to answer all the questions in nine minutes, but I will do my very best.

I congratulate the hon. Member for St Helens South and Whiston (Ms Rimmer) on securing this debate on such an important issue. I also thank right hon. and hon. Members for their passionate and knowledgeable contributions to the debate. As well as the hon. Member for St Helens South and Whiston, we heard from my hon. Friend the Member for Henley (John Howell), the hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) and my hon. Friend the Member for Taunton Deane (Rebecca Pow). I recognise the value of gardening —in all the prison visits I have made, the pride taken in the prison gardens and the therapeutic benefits garnered as a result are striking.

I will of course meet the right hon. Member for North Norfolk (Norman Lamb) to discuss the distressing case he mentioned. The hon. Member for Bridgend (Mrs Moon) mentioned Parc. I recently visited the young offenders institution at Parc and was impressed with the environment for young people. The hon. Member for Islwyn (Chris Evans) was very generous in his comments, as ever. I thank him. Yes, I am the continuity man—I am on my third Secretary of State. I also thank the shadow Front-Bench spokespeople for their contributions—the hon. Members for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and for Bradford East (Imran Hussain).

The Government committed to reforming our prisons and prison culture in the “Prison Safety and Reform” White Paper of November 2016. Since then, we have delivered changes that will help prisoners to receive the mental health support they need to engage positively with society, but I am clear that more can be done to improve access to services and support for prisoners, who are some of the most vulnerable people in our society.

First, I am clear that appropriate interventions and treatments at the right time and in the right place are vital to improving outcomes for those with mental health issues and other vulnerabilities. We are working across Government to help people access the services they need from their first contact with the criminal justice system. In England, liaison and diversion services have been rolled out in police stations and courts, covering more than 70% of the country. Those services, commissioned by NHS England, will be rolled out to cover 90% of England by the end of April 2019 and will be nationwide by April 2021. In Wales, where health is devolved, there is a separate but similar criminal justice liaison service.

We are building on services that divert those with mental health problems away from custody by increasing access to treatment for offenders in the community. Courts are already able to include mental health and substance misuse treatment as part of a community sentence, but often do not do so because of the barriers that offenders can face in getting the help that they need.

In 2016, only 669 mental health treatment requirements were given, which is approximately 0.5% of all community sentences. To tackle that, along with the Department of Health and Social Care, NHS England and Public Health England, we have been working to develop a protocol for community sentence treatment requirements. It will set out what action is required by health and justice staff to ensure that pathways into timely and appropriate treatment are in place, and that greater use is made of mental health and substance misuse treatment requirements as part of community sentences. The protocol, which includes a new maximum waiting time from date of sentence, will provide quicker access to mental health treatment, giving offenders the right support to keep them out of prison where appropriate, and breaking the cycle of reoffending.

In Wales, a project team is working on mental health treatment requirements, and the goal to improve MHTR is captured in the Welsh Government’s “Together for Mental Health” delivery plan. A similar protocol is being considered to cover devolved health services in Wales.

We have made good progress in diverting those with mental health needs away from prison, but many offenders with poor mental health are still being placed in a custodial setting, which brings me to my second point: we need to do more to make sure that these men and women receive the help they need. We know that we need the right staffing levels to provide a safe and secure regime that engages with prisoners with poor mental health in a supportive and rehabilitative way. That is why we committed to an increase of 2,500 prison officers by the end of 2018. Since we published the White Paper, we have recruited a net extra 1,255 prison officers over the last year, which puts us on track to meet the target, and means that officer numbers are now at their highest since August 2013.

We also know that the relationship between staff and prisoners is fundamental in supporting their wellbeing and reducing their risk of self-harm. Our offender management in custody model will see every person in closed conditions being assigned a key worker to motivate support and signpost them to the most appropriate services to help them to reform. Prisoners will be supported to attend scheduled health and mental health appointments. Their dedicated officer will be in a better position to respond to changes in their behaviour or mental wellbeing. The offender management in custody model has been rolled out in eight pathfinder prisons, and our aim is to introduce it into all other establishments by March 2019.

Last but not least, we need to ensure that our staff have the right skills to identify prisoners’ needs and risks, and provide them with the appropriate support. All staff in prisons, whether they are prison officers or staff in any other organisation working in a prison, receive mental health awareness training as part of the introduction to suicide and self-harm prevention course. It is also included in entry-level training for our new prison officers. Since April, 11,000 members of staff have started that training. The mental health awareness module informs staff of the most prevalent mental health issues in prison, including how poor mental health might affect behaviour and how officers can interact positively with prisoners presenting with mental health needs.

I acknowledge the concerns raised about how the age and condition of some parts of the estate might impact on the mental health and wellbeing of prisoners. I assure hon. Members that the Government are committed to transforming the prison estate in England and Wales and will be investing in the estate to deliver up to 10,000 new places. That includes pushing ahead with plans to close older prisons and open new accommodation during this Parliament.

I am aware of concerns about the amount of time that prisoners spend in cell rather than in activities that would support their mental health and reduce reoffending. We are committed to providing a supportive and rehabilitative regime with which prisoners can engage positively. In 2016-17, offenders completed 16 million hours of work and there were on average 11,200 offenders working in prison workshops.

For those prisoners who are seriously ill and require transfer to secure hospital to meet their care needs, we are considering ways in which we can best support them while they are awaiting transfer—we are working closely with NHS colleagues on how we can improve the transfer process. Her Majesty’s Prison and Probation Service has issued a learning bulletin aimed at senior management and staff that provides guidance on the transfer process, managing risk and supporting individuals prior to and following transfer.

To support those in crisis we have worked with the Samaritans to produce a new digital suicide prevention learning tool, which is designed to give staff more confidence to engage with prisoners who may be at risk of suicide. We continue to support the Samaritans’ Listener scheme and are funding a new initiative designed to build emotional resilience in prisoners in their early days in custody.

We are exploring with probation colleagues how to ensure better continuity of the work being done to improve mental health in prisons through to the community to provide ongoing support and help reduce reoffending on release. Since 1 July 2017, prisoners can now register with a GP prior to their release. That will facilitate a quicker transfer of patient and treatment information from prison to GP, supporting prisoners to access community healthcare services on release.

Hon. Members raised a number of questions, including on the level of self-inflicted deaths. I am responsible for women’s prisons. When I took over in July 2016, I inherited a situation in which there was a suicide every month on the women’s estate. We have had only one suicide since January 2017. Every self-inflicted death is a tragedy and I want to be cautious in publicising those figures, but I am hoping that there is a trend in place and we are improving the situation in the women’s estate. There has also been a similar decline in the number of self-inflicted deaths in male prisons, although there were still 77 up to September 2017, which is obviously too many.

Spice is a particular problem, and increasingly so in broader society. We have introduced dogs to detect spice coming into prisons. I am under no illusions about how difficult this is, nor about the challenges of spice and the impact it might have on people’s psychiatric health. This is a work in progress and it will remain challenging, but we are determined to do better.

We recognise the value of employment on release. I recall going to HMP Drake Hall, where I met a young lady who was working for Halfords and was already placed into the job on release. I want to see more of that.

Transfer times for secure hospital placement is a particular concern to me. I get regular updates and have done ever since I started in the post. We have made some progress but we need to make more.

The report for the Joint Committee is currently with the new Secretary of State. Once he has read it, signed off and gone through the process, it will be published as promised.

I apologise for not being able to answer all the other questions. Finally, I thank all colleagues. This is an important issue and we need to continue to work hard to make things better for prisoners.

10:59

[Ms Rimmer]

I thank all Members from right across the House and all parties, and the Minister for his obvious commitment and desire to do things. We wish him well and look forward to the vast improvements in our prisons and in safeguarding for our prisoners, and to the fruitful lives they live in society when they leave prison healthy.

Question put and agreed to.

Resolved,

That this House has considered mental health in prisons.