Mental Health in Prisons

Phillip Lee Excerpts

Wednesday 10th January 2018 Westminster Hall

[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?

--- Later in debate ---

[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.