Centre for Mental Health

Prisoners need urgent help for trauma and abuse, says Sainsbury Centre report

25 June 2008

Prisoners need access to psychological therapy to help them to overcome the trauma and abuse many of them have experienced, according to a report published today by the Sainsbury Centre for Mental Health.

From the Inside, by Graham Durcan, is based on interviews with 98 prisoners in five West Midlands prisons. It finds that most prisoners had chaotic and difficult lives prior to being incarcerated. Many had seen mental health services but they had not stayed in touch.

From the Inside finds that the 'average' prisoner has a combination of mental health, substance use and other problems. Mental ill health is not the exception but the rule. Women prisoners suffer especially high levels of distress when they are separated from their children.

But few prisoners feel able to admit that they have problems for fear of bullying and harassment. Many said they desperately needed someone to talk to that they could trust. Few found that prison health services provided the safe space they needed to deal with emotional problems.

From the Inside does find that specialist prison mental health teams were beginning to make a difference. Prisoners seeing 'inreach' teams said they felt more confident about their chances of getting their lives back on track outside prison.

But most prisoners with less severe mental illnesses are not seen by inreach teams they and get little or no help from prison health care. And different services in the same prisons are often unable to work together despite being needed by the same people.

From the Inside sets out what prisoners themselves say they need to improve their mental health. They need 'someone to talk to', they need 'something to do' during the day and they need practical help to plan for what they will do after they are released.

From the Inside calls for a major rethink of prison mental health services. It says all prison staff should have mental health awareness training. Prison hospital beds should not be used for prisoners in a mental health crisis. And prisoners with complex problems should not be passed from one service to another but offered personal support for all of their needs. This should include access to psychological therapy for those who need it.

Graham Durcan, Sainsbury Centre research and development manager, said: "Prisoners' views about their mental health have for too long been ignored. We found that prisoners have a very clear and reasonable understanding of what they need. As well as better health care they need to know that when they are released they will have somewhere to live, a job, contact with their family and a chance to keep off drugs. Too often these basic needs are not met.

"Prisons will never be mental illness-free zones. Prisoners should be offered mental health services that match the severity of their needs. This not only needs new investment in improved services but efforts to tackle the customs and practices that are wasteful of resources and that make good quality care hard to achieve."

Lord Ramsbotham, formerly the Chief Inspector of Prisons in England and Wales, said: "I could not commend From the Inside more highly. Sadly prisons are, all too often, used as repositories for those who are neglected and rejected by other services in the community.

"This is not a fit and proper task for prisons and the needs of these neglected people have, until now, been too often ignored. Therefore, because they form such a significant part of current prison populations, their particular needs must be catered for."

Additional information

The prison population of England and Wales now exceeds 80,000 and is set to rise to beyond 100,000 within a decade.

Nine out of ten prisoners have one or more mental health problem. Many also have a complex mix of other issues including substance misuse, poverty and a history of abuse.

All English prisons now have inreach teams to help prisoners with severe and enduring mental health problems. Funding for inreach is £300 per head of the prison population. This is one-third of what is needed to offer the same standards of care as community mental health services provide.