Mental Health in Prisons

Kate Green Excerpts

Wednesday 10th January 2018 Westminster Hall

[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.

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[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.

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[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?

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[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.