Mental Health in Prisons

Madeleine Moon Excerpts

Wednesday 10th January 2018 Westminster Hall

[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.

--- Later in debate ---

[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.