Mental Health in Prisons

Marie Rimmer 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.

[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.

--- Later in debate ---

[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.