Mental Health in Prisons

Debate between Phillip Lee and Marie Rimmer

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?

Oral Answers to Questions

Debate between Phillip Lee and Marie Rimmer

Tuesday 5th September 2017 Commons Chamber

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

3. How Government investment in (a) cyber-security and (b) the National Cyber Security Centre will support victims of cyber-crime; and if he will make a statement.

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

The Government are investing £1.9 billion to transform our ability to respond to the cyber-threats we face. This includes continuing to develop our support to victims of cyber-crime. I am committed to making sure that victims get the support they need to cope with and, as far as possible, recover from the effects of crime. The National Cyber Security Centre is part of GCHQ, which the Foreign and Commonwealth Office has ministerial responsibility for.

[Ms Rimmer]

Given that it is Government policy that victim support is commissioned locally by individual police and crime commissioners, is the Minister content that there is sufficient resource for victim support? Given the year-on-year increase in cyber-crime, and considering the national and international nature and background of cyber-criminals, does he not agree that a single, national approach to victim support would act as a better deterrent and a better support structure for victims, rather than allowing criminals to cherry-pick among the 43 police forces?

[Dr Lee]

As I made clear in my initial response, cyber-security policy does not sit with this Department—in fact, it sits with the Cabinet Office. Victim support funding has gone up from £51 million in 2010-11, and I was pleased to announce that it is going up to £96 million in 2017-18. Most of that is spent via PCCs. Importantly, I have put in place an audit of the performance of PCCs with regard to funding for victims’ services.